TY 2018 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) K CARLTON BUCHANAN MD...................................................................... BOARD MEMBER	2.00 ................. 3.00	X			50,139	0
(2) A KEITH CARNES MD...................................................................... BOARD MEMBER	2.00 ................. 4.00	X			3,805	0
(3) J MICHAEL LEVENGOOD JD...................................................................... CHAIRMAN	2.00 ................. 5.00	X			3,395	0
(4) L C JOHNSON...................................................................... BOARD MEMBER	2.00 ................. 5.00	X			2,945	0
(5) TERRI JONDAHL...................................................................... BOARD MEMBER	2.00 ................. 3.00	X			2,750	0
(6) PHILIP WOLFE...................................................................... PRESIDENT &	38.00 ................. 23.00		X		1,319,212	39,731
(7) ALAN BIER...................................................................... EXECUTIVE VP	60.00 .................		X		696,949	33,254
(8) JESSIE T SHEPHERD...................................................................... EXECUTIVE VP	40.00 ................. 20.00		X		693,269	103,936
(9) THOMAS Y MCBRIDE III...................................................................... EXECUTIVE VP	40.00 ................. 20.00		X		622,417	33,999
(10) STEPHEN NADEAU...................................................................... SR. VP OF HU	60.00 .................		X		441,659	43,920
(11) PATRICIA A LAVELY...................................................................... SR. VP & CIO	60.00 .................		X		439,426	50,397
(12) PETER WHEELER...................................................................... GENERAL COUN	40.00 ................. 20.00		X		410,979	74,375
(13) PAMELA GARLAND...................................................................... VP & CNO	60.00 .................		X		216,480	53,250
(14) SEE SCHEDULE O...................................................................... SEE SCHEDULE	.................		X		0	0
(15) SEE SCHEDULE O...................................................................... SEE SCHEDULE	.................		X		0	0
(16) MARK D DARROW...................................................................... DIRECTOR GME	60.00 .................			X	392,936	36,537
(17) NISHITH PATEL...................................................................... VP & COO (GM	60.00 .................			X	375,842	33,253

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(F) Estimated amount of other compensation from the organization and related organizations
(18) JAMES DENNARD JR........................................................................ VP & COO (GM	60.00 .......................	X		368,088	0	73,523
(19) MICHAEL C BOBLITZ........................................................................ VP PLANNING	60.00 .......................	X		301,641	0	59,285
(20) SCOTT OREM........................................................................ VP FINANCE	60.00 .......................	X		299,058	0	66,828
(21) JANET SCHWALBE........................................................................ VP PHYSICIAN	60.00 .......................	X		298,718	0	49,168
(22) THOMAS LYNCH........................................................................ VP MANAGED C	60.00 .......................	X		292,333	0	64,136
(23) CATHIE L BRAZELL........................................................................ DIRECTOR WOM	60.00 .......................	X		289,019	0	38,787
(24) CATHY DOUGHERTY........................................................................ ASST. VP REV	60.00 .......................	X		277,678	0	39,653
(25) TODD E VERMEER MD........................................................................ CMIO	60.00 .......................	X		258,982	0	44,427
(26) DIANA POTTS........................................................................ CHIEF NURSIN	60.00 .......................	X		258,322	0	28,175
(27) BONNY RICHARDSON........................................................................ ASSOCIATE GE	40.00 .......................20.00	X		207,744	0	32,287
(28) MIKE HEMPHILL........................................................................ DIRECTOR OF	60.00 .......................	X		151,552	0	23,750
(29) PETER JKAPLAN MD........................................................................ TEACHING FAC	40.00 .......................		X	323,845	3,738	34,894
(30) JOHN S HARVEY MD........................................................................ PRG. DIRECTO	60.00 .......................		X	320,233	3,986	37,407
(31) KEVIN E JOHNSON MD........................................................................ PROGRAM DIRE	60.00 .......................		X	252,878	0	44,588
(32) KIMBERLY C BATES MD........................................................................ PROGRAM DIRE	60.00 .......................		X	252,180	0	43,689
(33) TANNA LIM MD........................................................................ TEACHING FAC	40.00 .......................		X	249,491	0	36,506

(A) Name and business address	(B) Description of services	(C) Compensation
ALLIANCE LAUNDRY & TEXTILE SERVICES 60 GRINDER STREET BUFFALO,NY14215	LAUNDRY	3,190,606
ADCAP NETWORK SYSTEMS INC PO BOX 5365 NEW YORK,NY10087	IT SERVICES	2,312,195
CUMBERLAND GROUP LLC PO BOX 932555 ATLANTA,GA31193	NETWORK SERVICE	1,565,271
STRATEGIC PRODUCTS & SERVICES LLC PO BOX 780987 PHILADELPHIA,PA19178	IT	1,436,412
BOTTOM LINE SYSTEMS LLC 541 BUTTERMILK PIKE BUTTERMILK SPRINGS,KY41017	BILLING	1,213,579
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 31

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

GWINNETT HOSPITAL SYSTEMINC

Employer identification number

58-2002413

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2017. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2017. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2017. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2018

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2018

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2018

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2018 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

GWINNETT HOSPITAL SYSTEMINC

Employer identification number

58-2002413

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization GWINNETT HOSPITAL SYSTEMINC

Part I	Contributors (See instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization GWINNETT HOSPITAL SYSTEMINC		Employer identification number 58-2002413

Part II	Noncash Property (See instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization GWINNETT HOSPITAL SYSTEMINC			Employer identification number 58-2002413
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

GWINNETT HOSPITAL SYSTEMINC

Employer identification number

58-2002413

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2018

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...............................
c	Total lobbying expenditures (add lines 1a and 1b) ...................................................................
d	Other exempt purpose expenditures ........................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2018

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

89,633

Total. Add lines 1c through 1i ....................................................................................................

89,633

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1	DUES PAID TO THE GEORGIA HOSPITAL ASSOCIATION WERE 315,061 OF THIS AMOUNT, APPROXIMATELY 25%, OR 78,795 WERE FOR LOBBYING. GHA ALSO COLLECTS DUES FOR THE AMERICAN HOSPITAL ASSOCIATION. GWNINNET HOSPITAL PAID AHA DUES IN THE AMOUNT OF 47,162; 22.98% OF WHICH WAS FOR LOBBYING (10,838).

Schedule C (Form 990 or 990EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

GWINNETT HOSPITAL SYSTEMINC

Employer identification number

58-2002413

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2018

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	17,677,348	16,418,968	13,725,769	11,718,864	10,214,402
b	Contributions ...		-4,005	674,126	1,178,882	1,970,731
c	Net investment earnings, gains, and losses	1,362,255	1,262,385	2,019,073	828,023	-466,269
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	19,039,603	17,677,348	16,418,968	13,725,769	11,718,864

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

25.200 %

Temporarily restricted endowment SchDMd Bullet

74.800 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	18,734,214		18,734,214
b	Buildings ....	303,411,292	178,895,635	124,515,657
c	Leasehold improvements	22,116,817	19,068,502	3,048,315
d	Equipment ....	380,265,864	314,487,353	65,778,511
e	Other .....	7,503,021	2,370,565	5,132,456
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				217,209,153

Schedule D (Form 990) 2018

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
INTEREST RATE SWAPS	35,026,866
SELF-INSURANCE RESERVES	13,992,687
DUE TO AFFILIATES	13,962,741
THIRD PARTY SETTLEMENTS	9,213,620
ACCRUED INTEREST PAYABLE	3,481,493
EXECUTIVE BENEFITS LIABILITY	1,851,728
ACCRUED AUDIT LIABILITY	1,500,000
CANCER COLLECTIONS PAYABLE	654,956
ASSET RETIREMENT OBLIGATION	300,865
SALES & REALTY TAX	72,144
BOND EXPENSE PAYABLE	-2,499,276
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	77,557,824
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2018

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	749,467,192
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	5,188,274
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-7,381,005
e	Add lines 2a through 2d .....................			2e	-2,192,731
3	Subtract line 2e from line 1..................			3	751,659,923
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	353,485
b	Other (Describe in Part XIII.) ...........	4b	-101,403
c	Add lines 4a and 4b....................			4c	252,082
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	751,912,005

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	757,921,568
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................			2e
3	Subtract line 2e from line 1...................			3	757,921,568
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	353,485
b	Other (Describe in Part XIII.) ............	4b	38,289,601
c	Add lines 4a and 4b.....................			4c	38,643,086
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	796,564,654

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PAGE 2, PART V, LINE 4	TO SUPPORT GWINNETT HOSPITAL SYSTEM, INC.
SCHEDULE D, PAGE 3, PART X	THE HOSPITAL HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3). THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAX ON UNRELATED BUSINESS INCOME. THE HOSPITAL APPLIES FASB ASC TOPIC 740, INCOME TAXES (ASC 740), WHICH ADDRESSES THE ACCOUNTING FOR UNCERTAINTY IN TAX POSITIONS. IT ALSO PROVIDES GUIDANCE ON THE TIMING OF RECOGNITION OF TAX POSITIONS IN AN ENTITY'S FINANCIAL STATEMENTS AND THE DETERMINATION OF THE VALUES OF THESE POSITIONS. THE HOSPITAL DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX POSITIONS THAT SHOULD BE RECOGNIZED IN THE FINANCIAL STATEMENTS FOR 2019.
SCHEDULE D, PAGE 4, PART XI, LINE 2D	INTEREST RATE SWAP CHANGE -7,381,005
SCHEDULE D, PAGE 4, PART XI, LINE 4B	UBI FROM PARTNERSHIP K-1 -101,403
SCHEDULE D, PAGE 4, PART XII, LINE 4B	TRANSFERS TO AFFILIATES 38,289,601

Schedule D (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

GWINNETT HOSPITAL SYSTEMINC

Employer identification number

58-2002413

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 125.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			70,356,624	11,472,015	58,884,609	7.390 %
b	Medicaid (from Worksheet 3, column a) . . . . .			107,761,608	71,446,417	36,315,191	4.560 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .			178,118,232	82,918,432	95,199,800	11.950 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	98	207,030	5,716,389	99,614	5,616,775	0.710 %
f	Health professions education (from Worksheet 5) . . .	42	7,924	15,755,600	6,253,766	9,501,834	1.190 %
g	Subsidized health services (from Worksheet 6) . . . .	6	11,028	50,757,049	42,533,667	8,223,382	1.030 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	1		7,940		7,940
j	Total. Other Benefits . .	147	225,982	72,236,978	48,887,047	23,349,931	2.930 %
k	Total. Add lines 7d and 7j .	147	225,982	250,355,210	131,805,479	118,549,731	14.880 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members	1	716
6	Coalition building	2	372	24,914	24,914
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	3	1,088	24,914	24,914

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

128,232,247

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

26,439,266

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

126,598,671

Enter Medicare allowable costs of care relating to payments on line 5.....

141,731,006

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-15,132,335

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1GWINNETT PHY CENTER	RENTAL REAL ESTATE	7.000 %	90.000 %
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2018

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?2Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)						Facility reporting group
1	GWINNETT MEDICAL CENTER (GMC) LAWRENCEVILLE 1000 MEDICAL CENTER BLVD LAWRENCEVILLE,GA30046 WWW.GWINNETTMEDICALCENTER.ORG 067-460	X	X	X	X	A
2	GWINNETT MEDICAL CENTER DULUTH 3620 HOWELL FERRY ROAD DULUTH,GA30096 WWW.GWINNETTMEDICALCENTER.ORG 067-628	X	X	X	X	A

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	A
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.GWINNETTMEDICALCENTER.ORG

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SUPPLEMENTAL INFORMATION

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 125.000000000000% and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.GWINNETTMEDICALCENTER.ORG/MEDIA/FI

The FAP application form was widely available on a website (list url):

WWW.GWINNETTMEDICALCENTER.ORG/MEDIA/FI

A plain language summary of the FAP was widely available on a website (list url):
WWW.GWINNETTMEDICALCENTER.ORG/PATIENTS

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	A
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
GROUP A, FACILITY 1, GWINNETT MEDICAL CENTER (GMC) - PART V, LINE 3E	THE TOP PRIORITY AREAS WERE IDENTIFIED TO MEET COMMUNITY NEEDS: MANAGE HEALTH CONDITIONS AND CHRONIC DISEASE TREATMENTS - PROVIDE EMERGENCY SERVICES FOR ACUTE CONDITIONS AND INJURIES - PROVIDE SERVICES TO TREAT AND MANAGE CHRONIC DISEASES AND ACUTE CONDITIONS - PROVIDE SERVICES TO PROMOTE INDEPENDENCE FOR PERSONS WITH DISABLING CONDITION - PROVIDE COMPREHENSIVE SERVICES TO THOSE SUFFERING FROM THE DISEASE OF OBESITY - PROVIDE SERVICES TO THE INTERNATIONAL POPULATION IMPROVE ACCESS TO CARE - COLLABORATE WITH COMMUNITY HEALTHCARE PROVIDERS TO IMPROVE ACCESS TO CARE - ASSIST THE INTERNATIONAL COMMUNITY IN ACCESSIBILITY OF HEALTHCARE SERVICES - COLLABORATE WITH COMMUNITY ORGANIZATIONS FOR ACCESS TO TREATMENT OF BEHAVIORAL HEALTH AND MENTAL DISORDERS - COLLABORATE WITH COMMUNITY ORGANIZATIONS FOR ACCESS TO SERVICES FOR PERSONS WITH DISABILITIES PREVENT CHRONIC DISEASES AND INCREASE WELLNESS - COLLABORATE WITH COMMUNITY ORGANIZATIONS TO INCREASE PHYSICAL ACTIVITIES AND HEALTHY EATING - COLLABORATE WITH COMMUNITY ORGANIZATIONS TO RAISE HEALTHY KIDS - COLLABORATE WITH COMMUNITY ORGANIZATIONS TO PROMOTE HEALTHY AGING - COLLABORATE WITH COMMUNITY ORGANIZATIONS TO PREVENT AND DETECT CHRONIC DISEASE
GROUP A, FACILITY 1, GWINNETT MEDICAL CENTER (GMC) - PART V, LINE 5	COMMUNITY INVOLVEMENT AND INPUT IS AN IMPORTANT COMPONENT OF OUR NEEDS ASSESSMENT PROCESS. THE GWINNETT COALITION FOR HEALTH AND HUMAN SERVICES IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO ADDRESSING THE HEALTH AND HUMAN SERVICE NEEDS OF EVERYONE IN GWINNETT COUNTY. IT DOES SO THROUGH COLLABORATIVE COMMUNITY PLANNING, APPLIED RESEARCH, COMMUNITY EDUCATION, MEMBERSHIP DIVERSITY, CONSENSUS BUILD, ADVOCACY AND INNOVATION. OUR ORGANIZATION HAS BEEN AN ACTIVE PARTNER OF THE GWINNETT COALITION FOR HEALTH AND HUMAN SERVICES (GWINNETT COALITION) FOR MORE THAN 30 YEARS. IN AUGUST 2018, THE PLAN TO CONDUCT THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS APPROVED BY GWINNETT HOSPITAL SYSTEM SENIOR LEADERSHIP COMMITTEE AND THE COMMUNITY HEALTH AND WELLNESS COUNCIL. IN AUGUST 2018, THE BOARD OF DIRECTORS COMMUNITY BENEFIT COMMITTEE APPROVED THE PLAN AND THE PLAN WAS SHARED WITH THE LEADERSHIP COMMITTEES AT THE LAWRENCEVILLE AND DULUTH HOSPITALS. THE GWINNETT COALITION FOR HEALTH AND HUMAN SERVICES ALSO AGREED TO COLLABORATE WITH GWINNETT MEDICAL CENTER AND THE GWINNETT COUNTY HEALTH DEPARTMENT TO GATHER COMMUNITY DATA TO BE SHARED BY ALL THREE ORGANIZATIONS FOR COMMUNITY ASSESSMENT PROCESSES. THESE THREE ENTITIES COMMITTED TO PROVIDING FINANCIAL AND IN-KIND SUPPORT FOR THE ASSESSMENT PROCESS. THE ASSESSMENT ALSO INCLUDED PARTICIPATION OF COUNTY DEPARTMENTS, SCHOOL DISTRICTS AND COMMUNITY SERVICE AGENCIES PROVIDING HEALTH AND RELATED SERVICES. TO ENSURE INPUT FROM PERSONS WITH BROAD KNOWLEDGE OF THE COMMUNITY, THE PARTNERSHIP CONDUCTED FOCUS GROUPS, COMMUNITY SERVICE AGENCY COMMITTEE MEETINGS AND COMMUNITY KEY LEADER INTERVIEWS. THE GWINNETT COUNTY 2014 YOUTH SURVEY RESULTS WITH MORE THAN 48,000 PARTICIPANTS WERE INCLUDED IN THE COMMUNITY INPUT DATA SET AS WELL AS THE SUMMARY COMMUNITY REFERRAL TREND DATA FROM THE GWINNETT COALITION'S HELPLINE WERE INCLUDED IN THE ANALYSIS FROM 2015 THROUGH 2017. GWINNETT COUNTY COALITION FOR HEALTH AND HUMAN SERVICES LEADERSHIP INCLUDES ELLEN GERSTEIN, EXECUTIVE DIRECTOR, KEITH FENTON, CHIEF OPERATING OFFICER, SUZY BUS, HELPLINE DIRECTOR, KIM THOMAS, PLANNING AND EVALUATION MANAGER, SARAH JANE BASKIN, PROGRAM SPECIALIST, AND RACHAEL HOLDER, SPECIAL PROJECTS COORDINATOR. GWINNETT COUNTY PUBLIC HEALTH DEPARTMENT STAFF MEMBERS WHO PARTICIPATED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDE THE FOLLOWING: LLOYD M. HOFER, M.D., M.P.H. RECEIVED HIS MEDICAL DEGREE IN 1973, FROM THE UNIVERSITY OF ALABAMA. DR. HOFER IS BOARD CERTIFIED IN PEDIATRICS AND CERTIFIED IN MEDICAL MANAGEMENT. DR. HOFER PRACTICED PEDIATRICS AND ADOLESCENT HEALTH IN HATTIESBURG, MISSISSIPPI AND MONTGOMERY, ALABAMA. IN 1987 DR. HOFER BEGAN HIS PROFESSIONAL CAREER IN PUBLIC HEALTH WITH THE ALABAMA DEPARTMENT OF PUBLIC HEALTH WHERE HE SERVED AS THE DIRECTOR OF THE DIVISION OF CHILD HEALTH UNTIL 1992. IN 1992, DR. HOFER ACCEPTED THE POSITION OF DISTRICT 4 HEALTH DIRECTOR IN LAGRANGE, GEORGIA, DIVISION OF PUBLIC HEALTH, DEPARTMENT OF HUMAN RESOURCES SERVING 12 COUNTIES. DR. HOFER DIRECTED MANAGEMENT OF FISCAL, CLINICAL, ADMINISTRATION, AND DAY TO DAY OPERATION OF THE COUNTY HEALTH DEPARTMENTS. HE SERVED IN THIS CAPACITY UNTIL 1997. FROM 1997 TO 2001 DR. HOFER WAS AN ASSOCIATE MEDICAL DIRECTOR FOR BLUE CROSS BLUE SHIELD IN TENNESSEE AND ALABAMA. DR. HOFER RETURNED TO GEORGIA PUBLIC HEALTH IN JANUARY 2002 AND IS THE DISTRICT HEALTH DIRECTOR FOR GWINNETT, NEWTON & ROCKDALE COUNTIES. CONNIE RUSSELL IS THE DISTRICT PROGRAM DIRECTOR FOR GWINNETT, NEWTON, AND ROCKDALE COUNTY HEALTH DEPARTMENTS, WHERE SHE HAS WORKED SINCE 2001 TO SUPPORT THE HEALTH AND WELLBEING OF THE COMMUNITY. IN ADDITION TO HER ADMINISTRATIVE RESPONSIBILITIES FOR MULTIPLE PUBLIC HEALTH PROGRAMS, SHE IS A COMMUNITY LIAISON FOR THE HEALTH DEPARTMENT. SHE SERVES ON THE BOARDS OF GWINNETT COALITION FOR HEALTH AND HUMAN SERVICES, GWINNETT ADVISORY BOARD OF UNITED WAY OF GREATER ATLANTA AND THE GEORGIA EAST METRO MEDICAL RESERVE CORPS. CONNIE IS A NATIVE OF GEORGIA WHO HOLDS A B.A IN PSYCHOLOGY, M.A. IN PSYCHOLOGICAL SCIENCES (GSU), AND M.P.H IN HEALTH PROMOTION AND BEHAVIOR (GSU). SHE IS A MASTER CERTIFIED HEALTH EDUCATION SPECIALIST (MCHES). TARA ECHOLS RECEIVED HER BACHELOR OF SCIENCE DEGREE IN BIOLOGY FROM BOWLING GREEN STATE UNIVERSITY IN BOWLING GREEN, OHIO; A MASTER OF BUSINESS ADMINISTRATION DEGREE FROM THE UNIVERSITY OF PHOENIX-CLEVELAND CAMPUS; AND A MASTER OF PUBLIC HEALTH DEGREE FROM EMORY UNIVERSITY. SHE HAS SIXTEEN YEARS OF EXPERIENCE IN PUBLIC HEALTH INCLUDING WORK IN LEAD POISONING PREVENTION, FOOD SAFETY, EMERGENCY PREPAREDNESS, BEHAVIORAL HEALTH, HEALTH PROMOTION AND EDUCATION. TARA HAS SERVED IN VARIOUS LEADERSHIP CAPACITIES WITHIN THE GWINNETT, NEWTON AND ROCKDALE (GNR) COUNTY HEALTH DEPARTMENTS SINCE JANUARY 2013 AND IS CURRENTLY THE PERFORMANCE MANAGEMENT & COMMUNITY HEALTH DIRECTOR. SHE SUCCESSFULLY LED GNR TO BECOME THE THIRD HEALTH DISTRICT IN THE STATE OF GEORGIA TO BECOME ACCREDITED BY THE PUBLIC HEALTH ACCREDITATION BOARD IN 2016, AND AS PART OF THAT PROCESS MANAGED THE COMMUNITY HEALTH ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLANNING EFFORTS. AS A CERTIFIED SIX SIGMA GREEN BELT, TARA MANAGES ALL QUALITY IMPROVEMENT EFFORTS, AS WELL AS DEVELOPING AND IMPLEMENTING THE DEPARTMENT'S STRATEGIC PLAN. VERONICA MAHATHRE HAS BEEN THE HEALTH COMMUNICATIONS COORDINATOR AT THE GWINNETT, NEWTON AND ROCKDALE COUNTY HEALTH DEPARTMENTS SINCE 2017. SHE IS PASSIONATE ABOUT SPREADING AWARENESS OF PUBLIC HEALTH, MENTAL HEALTH, AND WELLNESS INITIATIVES TO THE GENERAL PUBLIC AND STAFF MEMBERS. PART OF HER WORK INCLUDES DEVELOPMENT AND IMPLEMENTATION OF COMMUNICATION AND MARKETING STRATEGIES TO TARGETED POPULATIONS FOR DISEASE PREVENTION. SHE COORDINATES COMMUNICATIONS FOR PROGRAMS AND STAFF ACROSS THE ORGANIZATION AS WELL AS WORKS WITH LOCAL MEDIA NEWS OUTLETS. SHE ALSO ACTS AS DEPUTY PUBLIC INFORMATION OFFICER FOR THE EMERGENCY PREPAREDNESS DEPARTMENT. VERONICA RECEIVED HER MASTER'S IN PUBLIC HEALTH WITH A FOCUS ON HEALTH PROMOTION & BEHAVIOR FROM GEORGIA STATE UNIVERSITY IN 2016. SHE HAS PREVIOUS WORK EXPERIENCE WITH ASSESSING HIV/AIDS PREVENTION MESSAGES AT THE CENTERS FOR DISEASE CONTROL AND PREVENTION, EARLY BEHAVIORAL INTERVENTIONS AT GEORGIA STATE UNIVERSITY'S CENTER FOR LEADERSHIP IN DISABILITY, AND EVALUATING WORKPLACE MEDITATION INTERVENTIONS AT EMORY UNIVERSITY. THE FOCUS GROUP MEETINGS FOR THE GWINNETT COUNTY COMMUNITY NEEDS ASSESSMENT TOOK PLACE IN FEBRUARY 2018 WITH A TOTAL OF 90 PARTICIPANTS. THE FOCUS GROUPS WERE A COLLABORATION OF NINE DIFFERENT POPULATIONS, INCLUDING: ENGAGED CITIZENS, VETERANS, SENIORS, HOMELESS, HISPANIC/LATINO, BEHAVIORAL HEALTH/SUBSTANCE ABUSE, FAMILIES OF ADULTS WITH DEVELOPMENTAL DISABILITIES, AFRICAN AMERICAN AND ASIAN. TOPICS DISCUSSED DURING THE FOCUS GROUP MEETINGS INCLUDE COMMUNITY RELATIONS AND ENGAGEMENT, ECONOMIC AND FINANCIAL STABILITY, EDUCATION, SAFETY, AGE FOCUS, AND HEALTH AND WELLNESS. MANY OF THE CONCERNS RAISED IN THESE FOCUS GROUPS ECHOED THE FINDINGS FROM OUR PREVIOUS ASSESSMENT. MOST OF THEM WERE INVOLVED IN THEIR COMMUNITIES, FELT SAFE AT HOME, WERE SATISFIED WITH EMS AND FIRE SERVICES, AS WELL AS PUBLIC SCHOOLS, LIBRARIES AND PARKS. MOST OF THE CHALLENGING ISSUES DEALT WITH TRANSPORTATION AND COMMUNICATION IN VARIOUS PARTS OF THEIR LIVES. THEY FELT THERE WAS NOT ENOUGH PUBLIC TRANSPORTATION TO SUPPORT JOBS AND HOUSING NEEDS IN THE COUNTY, IN ADDITION TO TRANSPORTATION NEEDS FOR YOUTH, SENIORS AND DISABLED. THE GROUPS WERE CONCERNED ABOUT COMMUNICATION, WITH A MAJOR EMPHASIS ON RESOURCES AND HOW TO ACCESS THOSE RESOURCES. THEY WERE NOT AWARE OF HEALTH DEPARTMENT RESOURCES AND FELT EMERGENCY PREPAREDNESS NEEDED TO BE ADDRESSED. IN COMMUNITY RELATIONS AND ENGAGEMENT, THE FOCUS GROUPS SPOKE OPENLY ABOUT THE POLITICAL SYSTEM NOT REPRESENTING ALL PEOPLE IN GWINNETT. THEY FELT THERE WERE MANY TRANSPLANTS FROM OTHER PLACES, AND THEY LACK FAMILY AND COMMUNITY SUPPORT TO BE SUCCESSFUL HERE. ECONOMIC AND FINANCIAL STABILITY WERE WIDESPREAD ISSUES AND COVERED JOBS, HOUSING AND HOMELESSNESS. OVERALL, THE GROUPS FELT THAT AVAILABLE JOBS DO NOT COVER THE COST OF LIVING IN GWINNETT. MANY STRUGGLE WITH LOW-PAYING ENTRY-LEVEL JOBS OR NOT ENOUGH HOURS. AFFORDABLE HOUSING IS A MAJOR NEED FOR MANY OF THE GROUPS. INCREASING RENT AND COST OF LIVING WITHOUT JOB STABILITY IS A STRAIN FOR MANY GWINNETT HOUSEHOLDS. THEY WERE CONCERNED ABOUT HOMELESSNESS IN THE COUNTY, ESPECIALLY PEOPLE STAYING IN EXTENDED-STAY HOTELS, PEOPLE TEMPORARILY LIVING WITH OTHER PEOPLE, AND NO RESOURCES AVAILABLE FOR HOMELESS MEN. SEVERAL GROUPS WERE WORRIED ABOUT FUTURE FINANCIAL STABILITY, PARTICULARLY FOR DISABLED ADULTS AND SENIORS. EDUCATION WAS A KEY ISSUE FOR THE FOCUS GROUPS. THEY FELT THE SCHOOL LEADERSHIP WAS NOT REPRESENTATIVE OF THE DIVERSITY OF THE COMMUNITY. THEY NOTICED A DISPARITY BETWEEN SCHOOL DISTRICTS IN THE COUNTY, AND MANY TIMES, THIS CORRELATED BACK TO FINANCIAL STABILITY IN FINDING GOOD SCHOOLS WHERE THEY COULD AFFORD TO LIVE. THE GROUPS
GROUP A, FACILITY 1, GWINNETT MEDICAL CENTER (GMC) - PART V, LINE 6A	GWINNETT MEDICAL CENTER IN LAWRENCEVILLE AND GWINNETT MEDICAL CENTER - DULUTH ARE LOCATED 10 MILES APART IN GWINNETT COUNTY AND SERVE THE SAME COMMUNITY. THE MAJORITY OF PATIENTS WHO USE EACH FACILITY ARE GWINNETT COUNTY RESIDENTS; THEREFORE, BOTH FACILITIES PARTICIPATED IN GATHERING DATA.
GROUP A, FACILITY 1, GWINNETT MEDICAL CENTER (GMC) - PART V, LINE 6B	THE CHNA WAS CONDUCTED THROUGH COLLABORATION WITH THE GWINNETT COALITION FOR HEALTH AND HUMAN SERVICES AND THE GWINNETT COUNTY HEALTH DEPARTMENT.
GROUP A, FACILITY 1, GWINNETT MEDICAL CENTER (GMC) - PART V, LINE 11	BASED ON THE RESULTS OF THE 2019 CHNA THE TOP OPPORTUNITIES LIE IN THE FOLLOWING AREAS: - MANAGING HEALTH CONDITIONS AND CHRONIC DISEASE TREATMENTS - IMPROVING ACCESS TO CARE - PREVENTING CHRONIC DISEASES AND INCREASING WELLNESS OUR FACILITIES UPDATE THEIR IMPLEMENTATION STRATEGIES IN 2019 TO ADDRESS HEART DISEASE, STROKE, CANCER, EMERGENCY AND TRAUMA SERVICES, CHRONIC LOWER RESPIRATORY DISEASE, DIABETES, MATERNAL/INFANT HEALTH, INJURY PREVENTION AND WELLNESS PROGRAMS. THESE IMPLEMENTATION STRATEGIES INCLUDE DEPARTMENT DESCRIPTIONS AND AN IN-DEPTH TABLE OF PROGRAMS AND COMMUNITY COLLABORATIONS WITH SPECIFIC STRATEGIES LINKED TO THE IDENTIFIED NEEDS. PLEASE SEE THE 2019 LAWRENCEVILLE AND DULUTH IMPLEMENTATION STRATEGIES FOR COMPLETE DESCRIPTIONS. WHEN GATHERING INPUT FROM COMMUNITY MEMBERS THROUGH FOCUS GROUPS, COALITION SUBCOMMITTEES AND KEY INFORMANT INTERVIEWS, OUR COMMUNITY IDENTIFIED NEEDS IN AREAS AFFECTING QUALITY OF LIFE, COMMUNITY RELATIONS AND ENGAGEMENT, ECONOMIC AND FINANCIAL STABILITY, EDUCATION, SAFETY, YOUTH, AS WELL AS HEALTH AND WELLNESS. THE LEADING CONCERNS CONTINUE TO BE TRANSPORTATION AND ROAD CONGESTION, COMMUNITY COMMUNICATION AND ENGAGEMENT, INCREASING HOMELESSNESS AND JOB LOSSES, CRIME, LACK OF DIVERSITY IN COMMUNITY LEADERSHIP AND RESIDENTS WITHOUT ADEQUATE HEALTH INSURANCE. THESE COMMUNITY NEEDS ARE NOT BEING ADDRESSED DIRECTLY BY THE HOSPITAL BECAUSE THESE NEEDS ARE OUTSIDE THE HOSPITAL'S SCOPE OF PRACTICE AND THE HOSPITAL DOES NOT HAVE RESOURCES TO ADDRESS THEM. HOWEVER, AS A MEMBER ORGANIZATION OF THE GWINNETT COALITION FOR HEALTH AND HUMAN SERVICES, WE PARTICIPATE IN COALITION INITIATIVES TO STRIVE TO IMPROVE THESE ISSUES IN COLLABORATION WITH OTHERS IN OUR COMMUNITY. FROM A HEALTH PERSPECTIVE, LACK OF ADEQUATE DENTAL CARE FOR RESIDENTS WITHOUT INSURANCE AND LACK OF MENTAL HEALTH SERVICES WERE IDENTIFIED NEEDS BY COMMUNITY REPRESENTATIVES. WHILE HOSPITAL LEADERSHIP AGREES THAT ADEQUATE DENTAL CARE FOR RESIDENTS WITHOUT INSURANCE IS AN ISSUE, ADDRESSING THIS ISSUE IS OUTSIDE THE HOSPITAL'S SCOPE OF PRACTICE. THE COALITION'S HEALTH AND WELLNESS COMMITTEE IS AWARE DENTAL CARE IS BEING PROVIDED ON A SLIDING-SCALE AT GOOD SAMARIAN COMMUNITY CLINIC. AT THIS TIME LIMITED RESOURCES FOR THIS INITIATIVE HAS BEEN IDENTIFIED. THE AMERICAN DENTAL ASSOCIATION'S GWINNETT CHAPTER IS ALSO ADDRESSING THIS ISSUE. THERE ARE IDENTIFIED COMMUNITY HEALTH NEEDS IN WHICH OUR HOSPITALS ONLY PROVIDE MINIMAL SUPPORT BECAUSE WE DO NOT HAVE DESIGNATED TREATMENT UNITS OR OUTREACH PROGRAMS FOR THESE CONDITIONS. ALTHOUGH WE TRIAGE PATIENTS WITH BEHAVIORAL AND MENTAL HEALTH CONDITIONS AND SUBSTANCE ABUSE PROBLEMS IN OUR EMERGENCY DEPARTMENTS, OUR ORGANIZATION DOES NOT HAVE TREATMENT UNITS FOR THESE CONDITIONS. HOWEVER, GWINNETT HOSPITAL SYSTEM, INC. COVERS UP TO FIVE DAYS OF THE COST FOR TREATMENT AT RIVERWOODS FOR MEDICALLY INDIGENT EMERGENCY DEPARTMENT OR INPATIENT PATIENTS WHO MEET THE CRITERIA AND ARE IN NEED OF INPATIENT PSYCHIATRIC TREATMENT. SUMMITRIDGE HOSPITAL IN LAWRENCEVILLE AND LAKEVIEW BEHAVIORAL HEALTH IN NORCROSS ARE PRIVATE FOR-PROFIT PSYCHIATRY AND ADDICTION MEDICINE FACILITY. ADDITIONALLY, THE STATE OF GEORGIA PROVIDES MENTAL HEALTH SERVICES THROUGH VIEW POINT HEALTH (FORMERLY KNOWN AS GWINNETT ROCKDALE NEWTON COMMUNITY SERVICE BOARD). GMC-LAWRENCEVILLE HAS A LEVEL III NEONATAL INTENSIVE CARE UNIT AND A 12-BED PEDIATRIC EMERGENCY DEPARTMENT; HOWEVER, THE HOSPITAL DOES NOT HAVE A PRIMARY FOCUS ON INPATIENT PEDIATRICS. GWINNETT COUNTY HAS A WIDE RANGE OF PEDIATRIC HEALTHCARE SERVICES AVAILABLE THROUGH CHILDREN'S HEALTHCARE OF ATLANTA. THE SPORT'S MEDICINE PROGRAM IS A COMMUNITY OUTREACH PROGRAM THAT PROVIDES SPORTS MEDICINE TRAINERS FOR YOUTH IN LOCAL HIGH SCHOOLS AND COMMUNITY SPORTS ORGANIZATIONS.
GROUP A, FACILITY 1, GWINNETT MEDICAL CENTER (GMC) - PART V, LINE 13H	THE FOLLOWING TYPES OF ACCOUNTS MAY BE CONSIDERED CHARITY CARE ELIGIBLE WITHOUT ADDITIONAL DOCUMENTATION: (1) ACCOUNTS REFERRED TO COLLECTION AGENCIES THAT ARE RETURNED AS UNCOLLECTIBLE; (2) BANKRUPTCIES; (3) REFERRALS FROM APPROVED COMMUNITY AGENCIES; (4) NO ESTATE (DECEASED); (5) ELIGIBILITY FOR MEDICAID IN STATES OTHER THAN GEORGIA; ELIGIBILITY FOR STATE/FEDERAL PROGRAMS WHERE PROGRAM FUNDING HAS BEEN EXHAUSTED; (6) PRESUMPTIVE CHARITY QUALIFICATION. PRESUMPTIVE FINANCIAL ASSISTANCE IS A FAP DETERMINATION METHOD USED BY GHS. UPON INITIATION OF EMERGENCY, OUTPATIENT, AND INPATIENT SERVICES, GHS WILL UTILIZE A THIRD-PARTY TO CONDUCT AN ELECTRONIC REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THIS PREDICTIVE MODEL INCORPORATES PUBLIC RECORD DATA TO CALCULATE A SOCIO- ECONOMIC AND FINANCIAL CAPACITY INDICATOR THAT INCLUDES ESTIMATES FOR INCOME, ASSETS AND LIQUIDITY. THE ELECTRONIC TECHNOLOGY IS DESIGNED TO ASSESS EACH PATIENT BY THE SAME STANDARDS AND IS CALIBRATED AGAINST HISTORICAL APPROVALS FOR GHS' FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS OUTLINED BELOW. THE INFORMATION RETURNED BY THIS MODELING APPLICATION WILL BE CONSIDERED ADEQUATE DOCUMENTATION FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FAP. OTHER FINANCIAL DOCUMENTS WILL NOT BE REQUIRED IF THE PATIENT QUALIFIES FOR FREE CARE UNDER THE PRESUMPTIVE FINANCIAL ASSISTANCE METHODOLOGY.
GROUP A, FACILITY 1, GWINNETT MEDICAL CENTER (GMC) - PART V, LINE 16J	GMC COLLABORATES WITH COMMUNITY BASED CLINICS TO PROVIDE CHARITY CARE FOR CERTAIN SERVICES WITHOUT GOING THROUGH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. IF CARE IS NEEDED BEYOND THE SERVICES EXCLUDED FROM THE PROCESS, THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE PROVIDED TO THE COMMUNITY MEMBER. THE THREE CLINICS ARE: 1.GOOD SAMARITAN CLINIC, 2.TRUTH'S COMMUNITY CLINIC, 3.HOPE CLINIC. IN ADDITION TO THE COMMUNITY BASED CLINICS, GMC HAS DEVELOPED THE FAITH COMMUNITY NETWORK WHICH CONNECTS THE HOSPITAL AND FAITH COMMUNITIES IN OUR AREA. THROUGH THIS OUTREACH, THE FINANCIAL ASSISTANCE IS SHARED WITH THE NETWORK TO ENSURE THE MEMBERS WITHIN THIS NETWORK ARE GIVEN OUR FINANCIAL ASSISTANCE INFORMATION. REGARDLESS IF A COMMUNITY MEMBER IS REFERRED BY AN OUTREACH PROGRAM, SHOULD HE PRESENT FOR CARE, OUR REGISTRATION TEAM PROVIDES DOCUMENTS THAT INCLUDE INFORMATION ABOUT OUR FINANCIAL ASSISTANCE POLICY AND APPLICATION. DURING THIS REGISTRATION, PAYMENT OPTIONS ARE DISCUSSED AND PROVIDED WHICH INCLUDES FINANCIAL ASSISTANCE AS AN OPTION. AS A REMINDER AFTER CARE, INFORMATION ABOUT FINANCIAL ASSISTANCE IS PROVIDED ON ALL BALANCE DUE STATEMENTS.

Schedule H (Form 990) 2018

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Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2018

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Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION	THE WOUND TREATMENT CENTER IS A PHYSICIAN PRACTICE THAT WAS INCLUDED IN THE SUBSIDIZED SERVICES CATEGORY. THE FACILITIES PROVIDE SERVICES THAT MEET IDENTIFIED COMMUNITY NEEDS. THE CENTER OFFERS SERVICES THAT THE COMMUNITY DOES NOT CURRENTLY HAVE THE CAPACITY TO PROVIDE. THE MEDICAL PRACTICE PROVIDES A SIGNIFICANT BENEFIT TO THE COMMUNITY AND DOES NOT OPERATE PRIMARILY TO INCREASE REFERRALS OF PATIENTS WITH THIRD PARTY COVERAGE AS A MAJORITY OF THE PATIENTS ARE UNDERINSURED, UNINSURED OR COVERED BY FEDERAL OR STATE INSURANCE PLANS FOR AT-RISK POPULATIONS. IN ADDITION, THE MEDICAL PRACTICE IS OPERATED EFFICIENTLY AND PAYMENTS TO PHYSICIANS ARE REASONABLE AND IN-LINE WITH THE GUIDELINES FROM THE MEDICAL GROUP MANAGEMENT ASSOCIATION AS WELL AS PREVAILING COMMUNITY RATES FOR PHYSICIAN REIMBURSEMENT. EXPENSES AT COST FOR SUBSIDIZED SERVICES FOR THE PHYSICIAN PRACTICE HAS BEEN CALCULATED FROM TOTAL DEPARTMENT EXPENSES AT COST MINUS BAD DEBT, MEDICAID AND CHARITY CARE. - WOUND CARE CLINIC COSTS 648,401 WITH A NET COMMUNITY BENEFIT EXPENSE OF 173,827 - RENAL SERVICES COSTS 20,978,404 WITH A NET COMMUNITY BENEFIT EXPENSE OF 3,023,877 - DIABETES & NUTRITION COSTS 809,633 WITH A NET COMMUNITY BENEFIT EXPENSE OF 651,498 - TRAUMA SERVICES COSTS 25,874,150 WITH A NET COMMUNITY BENEFIT EXPENSE OF 3,703,400 - CONCUSSION INSTITUTE COSTS 1,204,936 WITH A NET COMMUNITY BENEFIT EXPENSE OF 613,560 - REHAB SERVICES COSTS 1,241,525 WITH A NET COMMUNITY BENEFIT EXPENSE OF 57,221
PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE	BAD DEBT EXPENSE OF 128,232,247 WAS OFFSET AGAINST REVENUES IN THE FINANCIAL STATEMENTS. THERE IS NO NEED TO ADJUST THE TOTAL EXPENSES USED TO CALCULATE THE PERCENTAGES IN PART 1, LINE 7, COLUMN (F).
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION	LINE 7A - CHARITY CARE COSTS WERE CALCULATED USING A MEDICAID SPECIFIC COST-TO-CHARGE RATIO (CCR) FROM THE MEDICARE COST REPORT. A MEDICAID CCR WAS USED BECAUSE THE MEDICAID POPULATION BETTER REPRESENTS THE UTILIZATION AND ACUITY OF THE CHARITY POPULATION THAN THE USE OF AN OVERALL CCR AS CALCULATED IN WORKSHEET 2. A CCR WAS USED INSTEAD OF A COST ACCOUNTING SYSTEM BECAUSE CHARITY, AS WELL AS BAD DEBTS, REPRESENT ONLY A PORTION OF A PATIENT ACCOUNT THAT IS BEING WRITTEN OFF. LINE 7C - MEDICAID SHORTFALL WAS CALCULATED USING A MEDICAID SPECIFIC COST-TO-CHARGE RATIO FROM THE MEDICAID COST REPORT.
PART II - COMMUNITY BUILDING ACTIVITIES	COMMUNITY BUILDING ACTIVITIES INCLUDE PROGRAMS THAT ADDRESS ROOT CAUSES OF HEALTH PROBLEMS AND ARE CAPTURED IN THE CATEGORIES OF LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS, COALITION BUILDING AND WORKFORCE DEVELOPMENT IN AN EFFORT TO ENHANCE PUBLIC HEALTH. OUR ORGANIZATION DID NOT PARTICIPATE IN THESE ACTIVITIES TO INCREASE REFERRALS OR TO FULFILL REGULATORY REQUIREMENTS OR CURRENT STANDARDS-OF-CARE. COALITION BUILDING INCLUDES PARTICIPATION OF THE FAITH COMMUNITY NURSING, WOMEN'S SERVICES, DIABETES AND NUTRITION SERVICES, LEARNING RESOURCES, TRAUMA SERVICES AND PHYSICIAN SERVICES DEPARTMENTS. THESE DEPARTMENTS PARTICIPATE IN COMMUNITY COALITIONS AND OTHER COLLABORATIVE EFFORTS WITH THE COMMUNITY TO ADDRESS SAFETY AND HEALTH ISSUES TO PROMOTE THE HEALTH OF THE COMMUNITY; FOR EXAMPLES, CHILD PROTECTION TASK FORCE, GWINNETT PUBLIC SCHOOL SYSTEM, AND THE YMCA BOARD OF DIRECTORS. OUR COMMUNITY COLLABORATIONS CONTINUE TO SUPPORT OUR VISION AND MISSION AND FURTHER TIE US TO THE COMMUNITY WE SERVE. GWINNETT HOSPITAL SYSTEM PARTICIPATED ON THE GWINNETT COALITION FOR HEALTH AND HUMAN SERVICES BOARD THAT SERVES THE COMMUNITY THROUGH INITIATIVES DRIVEN BY ITS SUBCOMMITTEES (E.G., EXECUTIVE COMMITTEE, BOARD OF DIRECTORS, GREAT DAYS OF SERVICE, RESEARCH AND ACCOUNTABILITY COMMITTEE, HEALTH AND WELLNESS COMMITTEE AND SCREENING BRIEF INTERVENTION AND REFERRAL TO TREATMENT COMMITTEE). WE COLLABORATE WITH J. M. TULL - GWINNETT YMCA, GWINNETT UNITED IN DRUG EDUCATION, INC. (GUIDE), SAFE KIDS GWINNETT, AND BOY SCOUTS' MEDICAL EXPLORERS PROGRAM. OUR ORGANIZATION WORKS CLOSELY WITH THE GWINNETT CHAMBER OF COMMERCE AND ACTIVELY PARTICIPATES IN PARTNERSHIP GWINNETT, WHICH IS A COMPREHENSIVE PLAN THAT PARTNERS GOVERNMENT, EDUCATION, HEALTHCARE AND BUSINESS IN AN ECONOMIC DEVELOPMENT PLAN. IN ADDITION TO THE CHAMBER, GWINNETT HOSPITAL SYSTEM IS INVOLVED WITH INDIVIDUAL CITIES IN THE COUNTY. GWINNETT HOSPITAL SYSTEM IS INVOLVED WITH STATE AND COUNTY GOVERNMENT AGENCIES INCLUDING GEORGIA DEPARTMENT OF HEALTH AND HUMAN SERVICES, GWINNETT PUBLIC HEALTH DEPARTMENT, VIEW POINT HEALTH, GEORGIA TRAUMA CARE NETWORK COMMISSION, GEORGIA STATE OFFICE OF EMERGENCY MEDICAL SERVICES AND TRAUMA, PARTNERSHIP AGAINST DOMESTIC VIOLENCE (PADV), GWINNETT SEXUAL ASSAULT CENTER & CHILDREN'S ADVOCACY CENTER, GWINNETT COUNTY JUSTICE SYSTEM, GWINNETT COUNTY POLICE DEPARTMENT, GWINNETT COUNTY PUBLIC LIBRARY, GWINNETT COUNTY PUBLIC SCHOOL SYSTEM, DEPARTMENT OF FAMILY CHILDREN SERVICES (DFCS), DEPARTMENT OF AGING SERVICES (DAS), GWINNETT COUNTY SENIOR SERVICES AND THE GEORGIA MEDICARE FOUNDATION. GWINNETT HOSPITAL SYSTEM WORKS WITH NATIONAL AGENCIES WHICH HAVE LOCAL CHAPTERS INCLUDING THE AMERICAN HEART ASSOCIATION, AMERICAN RED CROSS, MARCH OF DIMES, AMERICAN STROKE ASSOCIATION, AMERICAN CANCER SOCIETY, AMERICAN DIABETES ASSOCIATION AND THE UNITED WAY. OUR EFFORTS IN WORKFORCE DEVELOPMENT INCLUDE RECRUITING PHYSICIANS IN MULTIPLE SPECIALTIES FOR COMMUNITY PRACTICES ACCORDING TO COMMUNITY NEEDS ESTABLISHED IN THE 2018 PHYSICIAN NEEDS ASSESSMENT. THE ORGANIZATION'S PRIMARY PURPOSE IN THESE EFFORTS IS TO ASSIST IN COMMUNITY PHYSICIAN RECRUITMENT TO IMPROVE ACCESS TO CARE IN OUR COMMUNITY.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY	IN THE CURRENT YEAR, BAD DEBTS ARE REPORTED AT CHARGES WRITTEN OFF IN THE PERIOD PLUS AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS. SEE THE LINE 4 NOTE BELOW FOR A MORE DETAILED DESCRIPTION OF THE METHODOLOGY USED IN DETERMINING THE AMOUNT REPORTED ON LINE 2 PER THE FINANCIAL STATEMENT FOOTNOTE RELATED TO "PROVISION FOR UNCOLLECTIBLE ACCOUNTS". DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE REFLECTED IN THE PATIENT BALANCE PRIOR TO ACCOUNTS BEING WRITTEN OFF TO BAD DEBT.
PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE	THE HOSPITAL USES A NOTE ON THE PATIENT ACCOUNT TO IDENTIFY PATIENTS UNCOOPERATIVE WITH THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY THAT WOULD HAVE LIKELY QUALIFIED FOR CHARITY IF INFORMATION HAD BEEN AVAILABLE TO DETERMINE ELIGIBILITY. DUE TO THESE ACCOUNTS LIKELY BEING ELIGIBLE FOR FINANCIAL ASSISTANCE, THEY SHOULD BE INCLUDED AS PART OF THE HOSPITAL'S COMMUNITY BENEFIT. THE TOTAL BAD DEBT EXPENSE ESTIMATED TO QUALIFY AS FAP- ELIGIBLE IS 26,439,266. THE ESTIMATED COSTS (CALCULATED USING THE RATIO OF COST TO CHARGES) ARE 8,699,981.
BAD DEBT EXPENSE FOOTNOTE TO 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 WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF- PAY PATIENTS, WHICH INCLUDE PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, MANAGEMENT RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD SERVICES ARE RENDERED 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 HOSPITAL'S 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 HOSPITAL'S PROVISION FOR UNCOLLECTIBLE ACCOUNTS INCREASED 29,824,287 FROM 98,408,000 IN FISCAL YEAR 2018 TO 128,232,247 IN FISCAL YEAR 2019.
PART III, LINE 8 - MEDICARE EXPLANATION	THE COSTS REPORTED ON LINE 6 ARE PER THE MEDICARE COST REPORT AND WERE CALCULATED BASED ON COST-TO-CHARGE RATIOS. SINCE THE AMOUNTS REPORTED ON LINES 5 & 6 ONLY INCLUDE MEDICARE PART A COSTS AND PAYMENTS, THE OTHER MEDICARE (I.E. - MEDICARE PT C, PHYSICIAN SERVICES, FEE SCHEDULE, NON- ALLOWABLE) COSTS AND PAYMENTS ARE INCLUDED IN THE ATTACHED MEDICARE RECONCILIATION. 15,132,335 OF THE MEDICARE SHORTFALL REPORTED ON LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT SINCE THAT PORTION OF THE SHORTFALL WAS RELATED TO THOSE PATIENTS THAT HAD MEDICAID AS A SECONDARY PAYOR AND THEREFORE DEEMED INDIGENT FOR MEDICARE BAD DEBT PURPOSES. MEDICARE FFS SHORTFALL (MEDICARE COST REPORT) MEDICARE FFS SHORTFALL (LESS SUBSIDIZED SVCS - PT I, LN 7G) 15,132,335 OTHER MEDICARE SHORTFALLS (NON MEDICARE COST REPORT) MEDICARE REPLACEMENT (OVERAGE)(PER HPM) 29,230,487 MEDICARE PRO FEE SHORTFALL (PER HPM) (148,233) MEDICARE FEE SCHEDULE SHORTFALL (PER CCR) 785,488 MEDICARE NON-ALLOWABLE COSTS 6,785,476 PY SETTLEMENT RECEIVED - SHORTFALL (IMPACT TO I/S) TOTAL MEDICARE SHORTFALL 51,785,553
PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION	THE FINANCIAL ASSISTANCE POLICY STATES THAT THOSE PATIENTS APPROVED FOR FINANCIAL ASSISTANCE WILL BE BILLED AT MEDICARE RATES. IN ADDITION, THE CREDIT AND COLLECTION POLICY DESCRIBES HOW UNINSURED PATIENTS CAN RECEIVE A PROMPT PAY DISCOUNT. THIS POLICY ALSO DESCRIBES THE AVAILABILITY OF THE FINANCIAL ASSISTANCE PROGRAM. CONTACT INFORMATION IS PROVIDED FOR ANYONE NEEDING ASSISTANCE OR HAVING QUESTIONS. UNINSURED PATIENTS ARE GIVEN AN AUTOMATIC DISCOUNT FROM GROSS CHARGES NOT RELATED TO THE FINANCIAL ASSISTANCE PROGRAM. PATIENTS RECEIVE HOSPITAL STATEMENTS THROUGH THE BILLING CYCLE. UNPAID ACCOUNTS ARE REFERRED TO AN EXTERNAL COLLECTION AGENCY AFTER ALL EFFORTS BY THE HOSPITAL HAVE BEEN MADE. COLLECTION AGENCIES NOTIFY THE HOSPITAL OF ANY ACCOUNTS THEY IDENTIFY THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE.
PART VI, LINE 2 - NEEDS ASSESSMENT	THE 2019 GWINNETT MEDICAL CENTER-LAWRENCEVILLE AND GWINNETT MEDICAL CENTER-DULUTH COMMUNITY HEALTH NEEDS ASSESSMENT ARE OUR MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENTS. AS PREVIOUSLY STATED, THE TWO FACILITIES ARE 10 MILES APART AND BOTH ARE IN GWINNETT COUNTY. DATA FOR EACH ASSESSMENT WAS GATHERED AT THE COUNTY LEVEL BECAUSE THE MAJORITY OF THE PATIENTS WHO UTILIZE OUR HOSPITALS ARE RESIDENTS OF GWINNETT COUNTY; ON AVERAGE, ABOUT 20 PERCENT OF OUR PATIENTS ARE FROM SURROUNDING COUNTIES. RESIDENTS OF THE COUNTY USE BOTH FACILITIES DEPENDING ON THEIR PERSONAL PREFERENCES OR AVAILABILITY OF SERVICES. SECONDARY DATA FOR OUR CHNAS WAS GATHERED THROUGH MULTIPLE DATA SOURCES. THE HOSPITALS HAVE A LICENSE FOR CONDUENT HEALTHY COMMUNITIES INSTITUTES THAT PROVIDES A CONSTANTLY UPDATED WEB-BASED PLATFORM WITH DEMOGRAPHIC INFORMATION AND HEALTHY PEOPLE 2020 TRACKER FOR GWINNETT COUNTY RESIDENTS. THIS INFORMATION PLATFORM INCLUDES BOTH A DISPARITIES DASHBOARD AND A COMMUNITY DASHBOARD OF ABOUT 145 INDICATORS INCLUDING THE FOLLOWING CATEGORIES: HEALTH, ECONOMY, EDUCATION, ENVIRONMENT, GOVERNMENT AND POLITICS, PUBLIC SAFETY AND SOCIAL ENVIRONMENT. ADDITIONAL SECONDARY VITAL STATISTICS DATA ARE PROVIDED BY THE ONLINE ANALYTICAL STATISTICAL INFORMATION SYSTEM (OASIS), WHICH IS A TOOLSET THAT ALLOWS ACCESS TO THE GEORGIA DIVISION OF PUBLIC HEALTH'S STANDARDIZED HEALTH DATA REPOSITORY. OUR PLANNING DEPARTMENT IDENTIFIES HOSPITAL-BASED NEEDS USING ADMISSION/DISCHARGE AND OTHER UTILIZATION DATA. THE SYSTEM-LEVEL ANNUAL COMMUNITY BENEFIT PLAN DESCRIBES HOW THE HOSPITALS AND SUPPORT FACILITIES ADDRESS IDENTIFIED COMMUNITY HEALTH NEEDS. EACH YEAR PROGRAMS ARE EVALUATED FOR EFFICIENCY, EFFECTIVENESS, OUTCOMES AND COMMUNITY COLLABORATION; THEN, ADMINISTRATION PRIORITIZES HOW THE ORGANIZATION MEETS COMMUNITY NEEDS THROUGH DEPARTMENT BUDGETING FOR EACH COMMUNITY BENEFIT PROGRAM. THE ORGANIZATION'S COMMUNITY HEALTH & WELLNESS COUNCIL IS AN INTERNAL COMMUNITY BENEFIT COMMITTEE WITH REPRESENTATIVES FROM MORE THAN 25 DEPARTMENTS FROM BOTH HOSPITALS. THIS COUNCIL IS TASKED WITH THE ANNUAL PLAN AND IMPLEMENTATION STRATEGIES UPDATES AND SUBMISSION FOR APPROVAL BY HOSPITAL ADMINISTRATION AND THE GWINNETT HOSPITAL SYSTEM BOARD OF DIRECTORS. IN ADDITION TO THE GMC'S CHNA, HOSPITAL STAFF HAS BEEN ACTIVE PARTICIPANTS IN THE GWINNETT COALITION FOR HEALTH AND HUMAN SERVICES DEVELOPMENT AND MONITORING OF THE 2014-2018 GWINNETT COMMUNITY STRATEGIC PLAN. THE SUBCOMMITTEES ARE INVOLVED WITH MANY COMMUNITY-LEVEL ACTIVITIES TO MEET COMMUNITY NEEDS. THE COALITION'S FIVE-YEAR STRATEGIC PLAN IS ALSO INCLUDED ON OUR HOSPITAL WEBSITE IN THE COMMUNITY HEALTH NEEDS ASSESSMENT SECTION UNDER COMMUNITY HEALTH COLLABORATIONS. THIS IS A LINK TO THE DOCUMENT HTTP://WWW.GWINNETTCOALITION.ORG/PRIORITY-AREAS/ THE GWINNETT PUBLIC HEALTH DEPARTMENT USED THE DATA SETS OBTAIN THROUGH THE HOSPITAL AND THE COALITION COLLABORATIONS TO DEVELOP THE 2019 COMMUNITY HEALTH ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN. THIS IS A LINK TO THE DOCUMENT HTTP://WWW.GNRHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH- ASSESSMENTCOMMUNITY-IMPROVEMENT-PLAN/.THIS REPORT DESCRIBES A COMBINED COMMUNITY HEALTH ASSESSMENT (CHA) AND COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) FOR GWINNETT COUNTY USING THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) FRAMEWORK. THE HOSPITALS WORK VERY CLOSELY WITH THE HEALTH DEPARTMENT TO IMPROVE THE HEALTH OF OUR COMMUNITY.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	EVERY PATIENT REGISTERED AT A GMC FACILITY IS PROVIDED A DOCUMENT ALERTING HIM OR HER TO THE AVAILABILITY OF THE SYSTEM'S FINANCIAL ASSISTANCE PROGRAM. ADDITIONALLY, PATIENTS ARE PROVIDED A "BILLING AND COLLECTION INFORMATION" DOCUMENT THAT AGAIN ADVISES THE PATIENT HOW TO APPLY FOR FINANCIAL ASSISTANCE. FOR THOSE PATIENTS ADMITTED TO THE HOSPITAL, THE INPATIENT HANDBOOK ALSO INSTRUCTS THEM HOW TO SEEK FINANCIAL ASSISTANCE FROM OUR TEAM OF FINANCIAL COUNSELORS. IN ADDITION, PATIENT BILLS INCLUDE CONTACT INFORMATION FOR SEEKING FINANCIAL ASSISTANCE VIA TELEPHONE OR BY EMAIL AT FINANCIALCOUNSELOR@GWINNETTMEDICALCENTER.ORG. THE HOSPITAL SYSTEM'S WEBSITE ALSO INCLUDES THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND APPLICATIONS IN ENGLISH, SPANISH, KOREAN AND VIETNAMESE.
PART VI, LINE 4 - COMMUNITY INFORMATION	GWINNETT COUNTY IS LOCATED IN THE NORTHEAST SUBURBS OF THE METROPOLITAN ATLANTA AREA AND IS 98 PERCENT URBAN. THIS IS THE 46TH LARGEST COUNTY IN THE STATE OF GEORGIA BY LAND MASS (430.38 SQUARE MILES) AND THE SECOND LEADING BY POPULATION (920,260 ESTIMATED RESIDENTS IN 2017). THE POPULATION OF GWINNETT COUNTY HAS INCREASED BY 36.9 PERCENT SINCE 2000 AS SHOWN IN FIGURE 1. ACCORDING TO THE 2010 U.S. CENSUS, GWINNETT COUNTY IS THE 59TH MOST POPULATED COUNTY IN THE NATION. FIGURE 1. HISTORICAL POPULATION, GWINNETT COUNTY 1960-2010 CENSUS POPULATION PERCENTAGE CHANGE 1960 43,541 34.7% 1970 72,349 66.2% 1980 116,903 130.7% 1990 352,910 111.4% 2000 588,448 66.7% 2010 805,321 36.9% SOURCE: U.S. CENSUS BUREAU, 2015 OVERALL, GWINNETT COUNTY HAS A YOUNG POPULATION WITH THE MEDIAN AGE AT 34.9 YEARS OF AGE ACCORDING TO THE 2013-2017 AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES. FIGURE 2. POPULATION BY GENDER, GWINNETT COUNTY 2017 AGE IN YEARS MALES FEMALES TOTAL 0-4 31,070 30,174 61,244 5-9 34,899 34,899 68,869 10-14 37,946 36,707 74,653 15-19 35,551 33,628 69,179 20-24 30,197 29,408 59,605 25-29 30,515 30,690 61,205 30-34 29,910 31,114 61,024 35-39 32,490 34,715 67,205 40-44 32,012 35,531 67,543 45-49 34,172 36,719 70,891 50-54 31,890 33,935 65,825 55-59 28,552 30,061 58,613 60-64 21,943 24,036 45,979 65-69 15,781 18,706 34,487 70-74 10,749 12,903 23,652 75-79 6,236 7,952 14,188 80-84 3,469 5,026 8,495 85+ 2,585 5,018 7,063 SOURCE: GEORGIA DIVISION OF PUBLIC HEALTH, OASIS, 2018 THE POPULATION HAS BECOME MORE RACIALLY AND ETHNICALLY DIVERSE WITH REPRESENTATION FROM ACROSS THE NATION AND AROUND THE WORLD. IN 2013-2017, THE AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATED THE GWINNETT COUNTY POPULATION TO BE 349,434 (39.3 PERCENT) WHITES ALONE, 230,815 (25.9 PERCENT) BLACKS ALONE, 99,659 (11.2 PERCENT) ASIANS ALONE AND 1,688 (0.2 PERCENT) WAS AMERICAN INDIAN OR ALASKA NATIVE, NATIVE HAWAIIAN OR PACIFIC ISLANDER, AND 19,491, TWO OR MORE RACES. IT WAS ALSO NOTED 184,621 (20.7 PERCENT) OF THE POPULATION WAS HISPANICS OR LATINO. IN 2013-2017 THE AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATED, 34.4 PERCENT THE GWINNETT COUNTY POPULATION OVER THE AGE OF FIVE SPEAK A LANGUAGE OTHER THAN ENGLISH (18.5 PERCENT SPANISH, 6.1 PERCENT OTHER INDO-EUROPEAN, 7.4 PERCENT ASIAN AND PACIFIC ISLAND, 2.4 PERCENT OTHER LANGUAGES). OF THE POPULATION 18 YEARS AND OVER, 22.5 PERCENT SPEAK A LANGUAGE OTHER THAN ENGLISH (8.6 PERCENT SPANISH AND 13.9 PERCENT OTHER LANGUAGES) FOR THE SAME TIME PERIOD. IN 2018-2019 THE GWINNETT COUNTY PUBLIC SCHOOL SYSTEM INCLUDES 140 SCHOOLS (80 ELEMENTARY SCHOOLS, 29 MIDDLE SCHOOLS, 22 HIGH SCHOOLS AND 9 OTHER EDUCATIONAL FACILITIES/SCHOOLS) AND SERVES NEARLY 180,320 STUDENTS. THE SCHOOL HAS APPROXIMATELY 22,000 EMPLOYEES. IT HOLDS THE POSITION OF THE LARGEST EMPLOYER IN THE COUNTY AND IS ONE OF THE LARGEST EMPLOYERS IN GEORGIA. THE SCHOOL BUS SYSTEM IS THE THIRD LARGEST TRANSPORTER OF STUDENTS IN THE COUNTRY WITH 1,980 BUSES. PRIMARY CARE PROVIDER RATE: 61 PROVIDERS PER 100,000 POPULATION IN 2015 (U.S. COUNTIES AVERAGE: 75 PROVIDERS). THIS TREND IS A SLIGHT IMPROVEMENT SINCE THE 2014 RATE OF 60 PROVIDERS. (CONDUENT HEALTHY COMMUNITIES INSTITUTE) IN 2017, ADULTS 19-64 WITH HEALTH INSURANCE: 76.4 PERCENT IN 2017 (U.S. COUNTIES AVERAGE: 87.7 PERCENT). THIS IS A SLIGHT IMPROVEMENT WHEN COMPARED WITH 75.1 PERCENT REPORTED IN 2014. THE NUMBER OF RESIDENTS WITH INSURANCE IS WELL BELOW THE HEALTHY PEOPLE 2020 TARGET OF 100 PERCENT. (CONDUENT HEALTHY COMMUNITIES INSTITUTE) CERTAIN RACE/ETHNICITY AND AGE GROUPS WERE MUCH LESS LIKELY TO HAVE INSURANCE THAN OTHERS. WHILE WHITE ALONE (88.7 PERCENT), AFRICAN AMERICAN ALONE (82.2 PERCENT) AND ASIAN ALONE (80.4 PERCENT) WERE MORE LIKELY TO HAVE INSURANCE, HISPANIC (41.1 PERCENT) AND OTHER RACES (28.3 PERCENT) WERE THE LESS LIKELY TO HAVE INSURANCE. WHEN COMPARED BY ADULT AGE GROUPS, AGES 55-64 (83.8 PERCENT) AND AGES 45-54 (81.6 PERCENT) WERE MORE LIKELY TO HAVE INSURANCE WHILE AGES 19-25 (70.7 PERCENT) WERE LEAST LIKELY TO HAVE INSURANCE. (CONDUENT HEALTHY COMMUNITIES INSTITUTE) IN 2016, CHILDREN UNDER THE AGE OF 18 WITH HEALTH INSURANCE: 91.6 PERCENT (U.S. COUNTIES AVERAGE: 95.5 PERCENT). THIS IS A SLIGHT IMPROVEMENT WHEN COMPARED WITH 90.2 PERCENT REPORTED IN 2014. HOWEVER, THE HEALTHY PEOPLE 2020 TARGET IS 100 PERCENT. (HEALTH COMMUNITIES INSTITUTE) AS REPORTED WITH ADULTS, CERTAIN RACE/ETHNICITY GROUPS WERE MUCH LESS LIKELY TO HAVE INSURANCE THAN OTHERS. WHILE WHITE, NON-HISPANIC (93.0 PERCENT), AFRICAN AMERICAN (95.7 PERCENT) AND ASIAN (90.3 PERCENT) WERE MORE LIKELY TO HAVE INSURANCE, HISPANIC (85.3 PERCENT) AND OTHER RACES (84.8 PERCENT) WERE THE LESS LIKELY TO HAVE INSURANCE. (CONDUENT HEALTHY COMMUNITIES INSTITUTE) ACCORDING TO COUNTY HEALTH RANKINGS IN 2015, GWINNETT HAD 61 PROVIDERS PER 100,000 POPULATION, AND IN 2016 GWINNETT HAD 60 NON-PHYSICIAN PRIMARY CARE PROVIDERS PER 100,000 POPULATION. COUNTY HEALTH RANKINGS ALSO REPORT IN 2016, 59 DENTISTS PER 100,000 POPULATION. WHILE THESE RATES DEMONSTRATE THE PRESENCE OF HEALTH CARE PROFESSIONAL IN THE COUNTY, THE COST OF CARE FOR THOSE WITHOUT ADEQUATE INCOME OR INSURANCE ARE PREVENTING THESE RESIDENCE FROM RECEIVING CARE. THE U.S. CENSUS BUREAU'S AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES FOR 2013-2017 PROVIDES A REPRESENTATION OF AVERAGE CHARACTERISTICS OF THE POPULATION AND IS NOT REPRESENTATIVE OF A SINGLE POINT IN TIME. FROM THESE SURVEYS, THE FOLLOWING INFORMATION HAS BEEN MADE AVAILABLE ABOUT GWINNETT COUNTY RESIDENTS. - THERE WERE 268,519 HOUSEHOLDS IN GWINNETT. THE AVERAGE HOUSEHOLD SIZE WAS THREE. FAMILIES MAKE UP 75.7 PERCENT OF THE HOUSEHOLDS. NONFAMILY HOUSEHOLDS MADE UP 24.3 PERCENT OF ALL HOUSEHOLDS; 10.7 PERCENT WERE PEOPLE LIVING ALONE. - EIGHTY-SEVEN PERCENT OF RESIDENTS 25 YEARS OF AGE AND OVER HAD AT LEAST GRADUATED FROM HIGH SCHOOL AND 32.4 PERCENT HAD A BACHELOR'S DEGREE OR HIGHER. - TWENTY-FIVE PERCENT OF THE POPULATION WAS FOREIGN BORN. - IT IS ESTIMATED 467,633 OF THE POPULATION 16 YEARS OF AGE AND OLDER ARE IN THE LABOR FORCE. - SEVENTY-NINE PERCENT OF WORKERS DROVE TO WORK ALONE, 11.6 PERCENT CARPOOLED, ONE PERCENT TOOK PUBLIC TRANSPORTATION AND TWO PERCENT USED OTHER MEANS. THE REMAINING FIVE PERCENT WORKED FROM HOME. FOR THOSE WHO COMMUTED, THE AVERAGE TRAVEL TIME TO WORK WAS 31.6 MINUTES. - THE MEDIAN HOUSEHOLD INCOME WAS 64,496. EIGHTY-NINE PERCENT OF THE HOUSEHOLDS RECEIVED EARNINGS AND 12.2 PERCENT RECEIVED RETIREMENT INCOME OTHER THAN SOCIAL SECURITY. MORE THAN 19.5 PERCENT OF THE HOUSEHOLDS RECEIVED SOCIAL SECURITY. THE AVERAGE INCOME FROM SOCIAL SECURITY WAS 19,392. THESE INCOME SOURCES ARE NOT MUTUALLY EXCLUSIVE; THAT IS, SOME HOUSEHOLDS RECEIVE INCOME FROM MORE THAN ONE SOURCE. - TWELVE PERCENT OF RESIDENTS WERE BELOW THE POVERTY LEVEL. 17.7 PERCENT UNDER 18 WERE LIVING BELOW THE POVERTY LEVEL, COMPARED WITH 7.5 PERCENT OF THE PEOPLE 65 YEARS OF AGE OLD AND OVER. - THE MEDIAN MONTHLY HOUSING COSTS FOR MORTGAGED OWNERS WAS 1,500, NON- MORTGAGED OWNERS 482 AND RENTERS 1,142. SEVENTY-SEVEN PERCENT OF OWNERS WITH MORTGAGES, 23.0 PERCENT OF OWNERS WITHOUT MORTGAGES AND 50.6 PERCENT OF RENTERS SPENT 30 PERCENT OR MORE OF HOUSEHOLD INCOME ON HOUSING. - THERE WERE 283,256 HOUSING UNITS IN GWINNETT COUNTY, 6.3 PERCENT OF WHICH WERE VACANT. OF THE TOTAL NUMBER OF HOUSING UNITS, 73.3 PERCENT WERE IN SINGLE UNIT DETACHED STRUCTURES, AND 1.5 PERCENT WERE IN MOBILE HOMES. - LESS THAN TWO PERCENT OF THE HOUSEHOLDS DID NOT HAVE TELEPHONES. - LESS THAN ONE PERCENT OF THE HOUSEHOLDS DID NOT HAVE ACCESS TO A CAR, TRUCK OR VAN FOR PRIVATE USE. IN ADDITION TO OUR FACILITIES, GWINNETT COUNTY HAS ONE FOR-PROFIT HOSPITAL, EASTSIDE MEDICAL CENTER IN SNELLVILLE. THERE ARE MANY HOSPITALS IN SURROUNDING COUNTIES OF THE METROPOLITAN ATLANTA AREA. SUMMITRIDGE HOSPITAL IN LAWRENCEVILLE AND LAKEVIEW BEHAVIORAL HEALTH IN NORCROSS ARE FOR-PROFIT HOSPITALS TO SERVE MENTAL HEALTH AND SUBSTANCE ABUSE. ACCORDING TO THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, HEALTH RESOURCES AND SERVICE ADMINISTRATION, FOUR CENSUS TRACTS ARE DESIGNATED MEDICALLY UNDERSERVED AREAS (CT 0503.19, CT 0503.20, CT 054.19 AND CT 0504.21) IN GWINNETT COUNTY. THERE ARE TWO FEDERALLY QUALIFIED HEALTH CENTERS IN GWINNETT COUNTY (NORCROSS) SERVING RESIDENTS FROM THESE CENSUS TRACTS AS WELL AS OTHER GWINNETT COUNTY RESIDENTS.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH	GWINNETT HOSPITAL SYSTEM'S VISION IS TO BE THE HEALTH SYSTEM OF CHOICE IN OUR COMMUNITY BY ENHANCING THE HEALTH OF OUR PATIENTS AND OTHER CUSTOMERS. GHS IMPLEMENTS ITS VISION AND PROMOTES THE HEALTH OF THE COMMUNITY BY JOINING WITH PHYSICIANS, COMMUNITY MEMBERS AND ORGANIZATION, AND OTHER HEALTHCARE ORGANIZATIONS TO TREAT INJURY AND DISEASE AS WELL AS PROVIDING PREVENTIVE AND EARLY INTERVENTION CARE TO OUR CUSTOMERS. THE BOARD OF DIRECTORS OF GWINNETT HOSPITAL SYSTEM IS COMPRISED OF A MAJORITY OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE BOARD MEMBERS ARE DEDICATED TO PROVING QUALITY HEALTHCARE TO OUR COMMUNITY. GHS EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN OUR COMMUNITY FOR A MAJORITY OF OUR DEPARTMENTS. GWINNETT HOSPITAL SYSTEM HAS OVER 800 AFFILIATED PHYSICIANS PROVIDING HEALTHCARE SERVICES AT BOTH GWINNETT MEDICAL CENTER-LAWRENCEVILLE AND GWINNETT MEDICAL CENTER-DULUTH CAMPUSES. GHS CONTINUALLY SEEKS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY APPLYING ITS SURPLUS FUNDS TO PATIENT CARE, MEDICAL EDUCATION AND RESEARCH. FULL-TIME EMERGENCY DEPARTMENTS ARE OPERATED AT BOTH THE GWINNETT MEDICAL CENTER-LAWRENCEVILLE AND GWINNETT MEDICAL CENTER-DULUTH CAMPUSES. NO ONE REQUIRING EMERGENCY CARE IS DENIED TREATMENT. THE 60-BED EMERGENCY DEPARTMENT AT GWINNETT MEDICAL CENTER-LAWRENCEVILLE IS ONE OF THE BUSIEST IN GEORGIA. THIS LOCATION HAS A 12-BED CHILDREN'S EMERGENCY CENTER, AN ACCREDITED CHEST PAIN CENTER AND IS DESIGNATED AS A LEVEL II TRAUMA CENTER PROVIDING 24 HOURS A DAY, SEVEN DAYS A WEEK TRAUMA TEAM COVERAGE SERVING RESIDENTS OF GWINNETT COUNTY AND THE SURROUNDING AREA. ONLY 25 OF THE STATE'S 152 ACUTE-CARE HOSPITALS ARE DESIGNATED TRAUMA CENTERS. BOTH GWINNETT MEDICAL CENTER IN LAWRENCEVILLE AND GWINNETT MEDICAL CENTER - DULUTH AND ASSOCIATED FACILITIES PARTICIPATE IN MEDICARE, MEDICAID, CHAMPUS AND PEACHCARE AS APPROPRIATE FOR SERVICES PROVIDED.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM	GWINNETT HOSPITAL SYSTEM IS A LICENSED 464 BED HEALTHCARE ORGANIZATION WITH TWO ACUTE-CARE HOSPITALS: GWINNETT MEDICAL CENTER IN LAWRENCEVILLE AND GWINNETT MEDICAL CENTER-DULUTH. THESE TWO FACILITIES SERVE AREAS OF BOTH GWINNETT COUNTY AND TO A LESSER EXTENT SEVERAL SURROUNDING COUNTIES. IN ADDITION TO THE MEDICAL-SURGICAL HOSPITALS, THE ORGANIZATION ALSO INCLUDES THE GWINNETT WOMEN'S PAVILION ON THE GWINNETT MEDICAL CENTER-LAWRENCEVILLE CAMPUS AS WELL AS THE GLANCY REHABILITATION CENTER IN DULUTH. OTHER AFFILIATED ORGANIZATIONS INCLUDE: - GWINNETT HEALTH SYSTEM, INC. - THE NONPROFIT PARENT ORGANIZATION OF GWINNETT HOSPITAL SYSTEM AND ITS AFFILIATES. - GWINNETT MEDICAL CENTER FOUNDATION - A NONPROFIT PHILANTHROPIC ORGANIZATION THAT SUPPORTS THE GWINNETT HOSPITAL SYSTEM BY RAISING MONEY FOR CAPITAL EQUIPMENT PURCHASES FOR GWINNETT MEDICAL CENTER-DULUTH AND GWINNETT MEDICAL CENTER-LAWRENCEVILLE, NEUROSCIENCE, ORTHOPEDICS AND A VARIETY OF OTHER PROGRAMS. - GWINNETT MEDICAL PROPERTIES - A NONPROFIT ORGANIZATION THAT OWNS MEDICAL PROPERTIES IN AND AROUND GWINNETT COUNTY FOR THE PURPOSE OF AIDING GWINNETT HOSPITAL SYSTEM IN FULFILLING ITS MISSION. - GWINNETT MEDICAL GROUP - A NONPROFIT ORGANIZATION WHOSE MISSION IS TO OPERATE PHYSICIAN CLINICS IN AND AROUND GWINNETT COUNTY.
PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT	GEORGIA
ADDITIONAL INFORMATION	THE URL TO THE COMMUNITY HEALTH NEEDS ASSESSMENTS FOR 2018 - 2019 CAN BE FOUND - HTTP://CHNADASHBOARD.GWINNETTMEDICALCENTER.ORG/CONTENT/SITES/GWINNETTHOSPIT AL/FY2019_COMMUNITY_HEALTH_NEEDS_ASSESSMENT.PDF THE URL FOR THE RELATED IMPLEMENTATION STRATEGIES CAN BE FOUND - FOR GWINNETT MEDICAL CENTER IN LAWRENCEVILLE HTTP://CHNADASHBOARD.GWINNETTMEDICALCENTER.ORG/CONTENT/SITES/GWINNETTHOSPIT AL/FY2019_IMPLEMENTATIONSTRATEGIES_GMCL_HR.PDF. FOR GWINNETT MEDICAL CENTER IN DULUTH - HTTP://CHNADASHBOARD.GWINNETTMEDICALCENTER.ORG/CONTENT/SITES/GWINNETTHOSPIT AL/FY2019_IMPLEMENTATIONSTRATEGIES_GMCD_HR.PDF. THE URL TO THE FINANCIAL ASSISTANCE POLICY CAN BE FOUND - HTTP://WWW.GWINNETTMEDICALCENTER.ORG/MEDIA/FILE/100-18%20FINANCIAL %20ASSISTANCE%20PROGRAM_2011%20FINAL.PDF. FOR THE FINANCIAL ASSISTANCE APPLICATION - HTTP://WWW.GWINNETTMEDICALCENTER.ORG/MEDIA/FILE/27987-FIN%20ASSESSMENT %20APPLICATION(1).PDF. FOR THE PLAIN LANGUAGE SUMMARY - HTTP://WWW.GWINNETTMEDICALCENTER.ORG/PATIENTS-VISITORS/PATIENTS/PATIENT- FINANCIAL-ASSISTANCE-POLICY

Schedule H (Form 990) 2018

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
GWINNETT HOSPITAL SYSTEMINC

Employer identification number
58-2002413

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) GWINNETT MEDICAL GROUP 1000 JOHNSON FERRY ROAD ATLANTA,GA30342	58-2143107	501C3	32,665,587	SUPPORT RELATED ORG.
(2) GWINNETT HEALTH SYSTEM 1000 JOHNSON FERRY ROAD ATLANTA,GA30342	58-2135755	501C3	5,624,014	SUPPORT RELATED ORG.
(3) GWINNETT HOSPITAL SYSTEM FOUNDATION 1755 NORTH BROWN ROAD SUITE 100 LAWRENCEVILLE,GA30043	58-1828486	501C3	30,000	SUPPORT RELATED ORG.
(4) GEORGIA GWINNETT COLLEGE FOUNDATION 1000 UNIVERSTIY CENTER LANE LAWRENCEVILLE,GA30043	20-5107997	501C3	180,000	SUPPORT NURSING PROG
(5) GWINNETT TECH FOUNDATION INC 5150 SUGARLOAF PARKWAY LAWRENCEVILLE,GA30043	58-2106879	501C3	180,000	SUPPORT NURSING PROG
(6) LEADERSHIP GWINNETT FOUNDATION 6500 SUGARLOAF PARKWAY DULUTH,GA30097	26-1522249	501C3	10,000	COMMUNITY SUPPORT
(7) NE GEORGIA COUNCIL BOY SCOUTS OF AM PO BOX 399 JEFFERSON,GA30549	03-0229256	501C3	7,500	COMMUNITY SUPPORT
(8) CINK CHARITIES 6555 SUGARLOAF PARKWAY DULUTH,GA30097	45-5277628	501C3	19,750	COMMUNITY SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2018

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) EDUCATIONAL SCHOLARSHIPS	22	64,766	FMV CASH
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

SCHEDULE I, PAGE 1, PART I, LINE 2

SCHEDULE I, PART I, LINE 2: GRANTS TO ORGANIZATIONS WERE MADE ONLY TO SECTION 501(C)(3)ORGANIZATIONS OR GOVERNMENTAL AGENCIES. SCHOLARSHIPS ARE GIVEN ANNUALLY THROUGH AN OPEN APPLICATION PROCESS. APPLICATIONS ARE ACCEPTED FOR 6 WEEKS EACH YEAR. APPLICATIONS ARE REVIEWED BY A COMMITTEE COMPRISED OF HUMAN RESOURCE AND LEARNING RESOURCE EMPLOYEES. THOSE SELECTED ARE ENROLLED IN A HEALTHCARE PROFESSIONAL DEGREE PROGRAM IN AN ACCREDITED COLLEGE OR UNIVERSITY. THE COMMITTEE EVALUATES APPLICANTS USING A 13 POINT PROCESS WITH EXTRA WEIGHTING GIVEN TO (1) THOSE APPLICANTS WITH HIGH GPAS; (2) STUDYING IN AREAS OF COMMUNITY NEED; (3) PROVIDING REFERENCE LETTERS FROM CREDENTIALED PROFESSIONALS; AND (4) INDICATING AN INTEREST IN WORKING WITH THE HOSPITAL UPON COMPLETION.

Schedule I (Form 990) 2018

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

GWINNETT HOSPITAL SYSTEMINC

Employer identification number

58-2002413

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2018

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1PHILIP WOLFE PRESIDENT & CEO	(i) (ii)	752,882 -------------	335,205 -------------	231,125 -------------	17,875 -------------	21,856 -------------	1,358,943 -------------	101,847 -------------
2ALAN BIER EXECUTIVE VP & CMO	(i) (ii)	431,701 -------------	150,979 -------------	114,269 -------------	15,125 -------------	18,129 -------------	730,203 -------------	48,614 -------------
3JESSIE T SHEPHERD EXECUTIVE VP AND COO	(i) (ii)	495,280 -------------	123,446 -------------	74,543 -------------	70,926 -------------	33,010 -------------	797,205 -------------	41,427 -------------
4THOMAS Y MCBRIDE III EXECUTIVE VP & CFO	(i) (ii)	447,185 -------------	109,455 -------------	65,777 -------------	20,625 -------------	13,374 -------------	656,416 -------------	-------------
5STEPHEN NADEAU SR. VP OF HUMAN RES.	(i) (ii)	301,521 -------------	90,601 -------------	49,537 -------------	20,625 -------------	23,295 -------------	485,579 -------------	27,997 -------------
6PATRICIA A LAVELY SR. VP & CIO	(i) (ii)	318,950 -------------	61,072 -------------	59,404 -------------	44,856 -------------	5,541 -------------	489,823 -------------	35,380 -------------
7PETER WHEELER GENERAL COUNSEL	(i) (ii)	299,295 -------------	60,112 -------------	51,572 -------------	51,243 -------------	23,132 -------------	485,354 -------------	28,879 -------------
8PAMELA GARLAND VP & CNO	(i) (ii)	179,177 -------------	24,366 -------------	12,937 -------------	23,879 -------------	29,371 -------------	269,730 -------------	-------------
9MARK D DARROW DIRECTOR GME	(i) (ii)	341,778 -------------	47,013 -------------	4,145 -------------	13,750 -------------	22,787 -------------	429,473 -------------	-------------
10NISHITH PATEL VP & COO (GMC, INC.)	(i) (ii)	235,842 -------------	82,520 -------------	57,480 -------------	13,750 -------------	19,503 -------------	409,095 -------------	4,209 -------------
11JAMES DENNARD JR VP & COO (GMC, INC.)	(i) (ii)	260,354 -------------	72,336 -------------	35,398 -------------	42,026 -------------	31,497 -------------	441,611 -------------	16,370 -------------
12MICHAEL C BOBLITZ VP PLANNING & DEVEL.	(i) (ii)	234,780 -------------	50,468 -------------	16,393 -------------	30,150 -------------	29,135 -------------	360,926 -------------	14,458 -------------
13SCOTT OREM VP FINANCE	(i) (ii)	224,513 -------------	46,138 -------------	28,407 -------------	36,253 -------------	30,575 -------------	365,886 -------------	18,515 -------------
14JANET SCHWALBE VP PHYSICIAN SVC.	(i) (ii)	230,794 -------------	46,006 -------------	21,918 -------------	36,044 -------------	13,124 -------------	347,886 -------------	11,534 -------------
15THOMAS LYNCH VP MANAGED CARE	(i) (ii)	220,241 -------------	42,143 -------------	29,949 -------------	32,943 -------------	31,193 -------------	356,469 -------------	19,182 -------------
16CATHIE L BRAZELL DIRECTOR WOMEN'S SVC	(i) (ii)	225,626 -------------	44,081 -------------	19,312 -------------	29,476 -------------	9,311 -------------	327,806 -------------	-------------
17CATHY DOUGHERTY ASST. VP REVENUE	(i) (ii)	213,162 -------------	60,423 -------------	4,093 -------------	19,350 -------------	20,303 -------------	317,331 -------------	-------------
18TODD E VERMEER MD CMIO	(i) (ii)	238,286 -------------	-------------	20,696 -------------	13,750 -------------	30,677 -------------	303,409 -------------	-------------
19DIANA POTTS CHIEF NURSING OFF.	(i) (ii)	191,946 -------------	45,797 -------------	20,579 -------------	17,301 -------------	10,874 -------------	286,497 -------------	8,978 -------------
20BONNY RICHARDSON ASSOCIATE GEN. LEGAL	(i) (ii)	180,924 -------------	24,976 -------------	1,844 -------------	15,405 -------------	16,882 -------------	240,031 -------------	-------------
21MIKE HEMPHILL DIRECTOR OF MATERIAL	(i) (ii)	135,131 -------------	13,901 -------------	2,520 -------------	11,599 -------------	12,151 -------------	175,302 -------------	-------------
22PETER JKAPLAN MD TEACHING FACULTY GME	(i) (ii)	285,367 ------------- 3,738	18,984 -------------	19,494 -------------	17,823 -------------	17,071 -------------	358,739 ------------- 3,738	-------------
23JOHN S HARVEY MD PRG. DIRECTOR GME	(i) (ii)	311,227 ------------- 3,986	8,775 -------------	231 -------------	15,045 -------------	22,362 -------------	357,640 ------------- 3,986	-------------
24KEVIN E JOHNSON MD PROGRAM DIRECTOR GME	(i) (ii)	232,498 -------------	8,800 -------------	11,580 -------------	13,243 -------------	31,345 -------------	297,466 -------------	-------------
25KIMBERLY C BATES MD PROGRAM DIRECTOR GME	(i) (ii)	231,155 -------------	11,025 -------------	10,000 -------------	12,825 -------------	30,864 -------------	295,869 -------------	-------------
26TANNA LIM MD TEACHING FACULTY GME	(i) (ii)	244,218 -------------	5,000 -------------	273 -------------	11,770 -------------	24,736 -------------	285,997 -------------	-------------

Schedule J (Form 990) 2018

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE J, PAGE 1, PART I, LINE 3	GWINNETT HOSPTIAL SYSTEM RELIES UPON GWINNETT HEALTH SYSTEM (THE PARENT ORGANIZATION OF A MULTI-ENTITY HEALTH SYSTEM THAT INCLUDES GWINNETT HOSPITAL SYSTEM) TO ESTABLISH AND MONITOR EXECUTIVE COMPENSATION. GWINNETT HEALTH SYSTEM, INC. (THE SYSTEM) BOARD OF DIRECTORS HAS ESTABLISHED A COMPENSATION COMMITTEE (THE COMMITTEE) MADE UP OF VARIOUS INDEPENDENT BOARD MEMBERS WHO REVIEW THE COMPENSATION OF THE CEO, TOP MANAGEMENT AND OTHER KEY-EMPLOYEES THROUGHOUT THE MULTI-ENTITY SYSTEM. THE COMMITTEE IS RESPONSIBLE FOR DETERMINING THE COMPENSATION OF THE CEO. THE CEO IS RESPONSIBLE FOR DETERMINING THE COMPENSATION OF THE OTHER MEMBERS OF TOP MANAGEMENT AND OF THE KEY EMPLOYEES WITH OVERSIGHT FROM THE COMMITTEE. AN INDEPENDENT PROFESSIONAL EXECUTIVE COMPENSATION CONSULTING COMPANY PROVIDES COMPARATIVE SALARY AND BENEFIT INFORMATION AND MAKES RECOMMENDATIONS TO THE COMMITTEE REGARDING EXECUTIVE COMPENSATION. PERIODIC SURVEYS ARE CONDUCTED TO ENSURE FAIR MARKET VALUE EXECUTIVE COMPENSATION.
SCHEDULE J, PAGE 1, PART I, LINE 4	JESSIE T. SHEPHERD 0 50,301 0 PATRICIA A. LAVELY 0 31,106 0 PETER WHEELER 0 30,618 0 PAMELA GARLAND 0 7,805 0 JAMES DENNARD, JR 0 26,901 0 MICHAEL C. BOBLITZ 0 17,037 0 SCOTT OREM 0 16,450 0 JANET SCHWALBE 0 16,312 0 THOMAS LYNCH 0 16,170 0 CATHIE L. BRAZELL 0 15,562 0
SCHEDULE J, PART III	CERTAIN DESIGNATED EMPLOYEES ARE ALLOWED TO PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE SERP IS SUBJECT TO THE PROVISIONS OF SECTION 457(F) OF THE INTERNAL REVENUE CODE. PARTICIPANTS WHO SEPARATE FROM SERVICE DUE TO VOLUNTARY SEPARATION OR AN INVOLUNTARY SEPARATION FOR REASONABLE CAUSE FORFEIT ALL NONVESTED BENEFITS. CURRENT YEAR DEFERRALS ARE REPORTED IN THE PRECEDING TABLE. THE FOLLOWING PARTICIPANTS VESTED AND RECEIVED PAYMENT OF SERP BENEFITS IN THE CALENDAR YEAR THAT ARE INCLUDED IN REPORTABLE COMPENSATION ON THIS FORM 990, PART VII AND ON SCHEDULE J. THEY WERE ALSO REPORTED AS DEFERRED COMPENSATION ON PRIOR RETURNS: PHILIP WOLFE 101,847 ALAN BIER 48,614 JESSIE T. SHEPHERD 41,427 PATRICIA LAVELY 35,380 PETER WHEELER 28,879 STEPHEN A. NADEAU 27,997 THOMAS M. LYNCH 19,182 SCOTT E. OREM 18,515 JAMES D. DENNARD, JR. 16,370 MICHAEL C. BOBLITZ 14,458 JANET M. SCHWALBE 11,534 DIANA C. POTTS 8,978 NISHITH PATEL 4,209

Schedule J (Form 990) 2018

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
GWINNETT HOSPITAL SYSTEMINC

Employer identification number
58-2002413

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	HOSPITAL AUTHORITY OF GWINNETT CO	58-6011878	403732DE7	11-12-2009	32,700,000	ADVANCE REFUND PRIOR ISSUE		X		X		X
B	HOSPITAL AUTHORITY OF GWINNETT CO	58-6011878	403732DS6	11-12-2009	36,435,000	CURRENTLY REFUND PRIOR ISSUE		X		X		X
C	HOSPITAL AUTHORITY OF GWINNETT CO	58-6011878	403732DU1	11-12-2009	19,240,000	CAPITAL IMPROVEMENTS		X		X		X
D	HOSPITAL AUTHORITY OF GWINNETT CO	58-6011878	403732DZ0	11-12-2009	61,095,000	CAPITAL IMPROVEMENTS		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	2,830,000		12,055,000		910,000		4,415,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	32,700,000		36,435,000		19,240,000		61,095,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............					19,240,000		61,095,000
11 Other spent proceeds .............	32,700,000		36,435,000
12 Other unspent proceeds .............
13 Year of substantial completion .............	2007		2007		2007		2007
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X	X		X		X
15 Were the bonds issued as part of an advance refunding issue? .....	X			X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........	X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
SCHEDULE K - DATE REBATE COMPUTATION PERFORMED	HOSPITAL AUTHORITY OF GWINNETT CO. 04/14/16 HOSPITAL AUTHORITY OF GWINNETT CO. 04/14/16 HOSPITAL AUTHORITY OF GWINNETT CO. 04/14/16 HOSPITAL AUTHORITY OF GWINNETT CO. 04/14/16 HOSPITAL AUTHORITY OF GWINNETT CO. 10/05/15 HOSPITAL AUTHORITY OF GWINNETT CO. 04/12/19

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

GWINNETT HOSPITAL SYSTEMINC

Employer identification number

58-2002413

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2018

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) GWINNETT EMERGENCY SPECIALISTS	BOARD MEMBER	351,512	MEDICAL SERVICES		No
(2) GARY LEVENGOOD MD	BOARD MEMBER	14,575	COMPENSATION		No
(3) SPORTS MEDICINE SOUTH	BOARD MEMBER	69,988	MEDICAL SERVICES		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference

Explanation

SCHEDULE L, PART V

SCHEDULE L, PART IV (A) NAME OF PERSON: GWINNETT EMERGENCY SPECIALISTS. (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: MEDICAL PRACTICE OF BOARD MEMBER CARLTON BUCHANAN, MD. (D) DESCRIPTION OF TRANSACTION: ADMINISTRATION OF EMERGENCY DEPARTMENT OF GWINNETT HOSPITAL. (A) NAME OF PERSON: GARY LEVENGOOD, MD (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: BROTHER OF A BOARD MEMBER. (D) DESCRIPTION OF TRANSACTION: COMPENSATION FOR PHYSICIAN SERVICES. (A) NAME OF PERSON: SPORTS MEDICINE SOUTH (GARY LEVENGOOD) (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: OWNED BY BROTHER OF A BOARD MEMBER. (D) DESCRIPTION FO TRANSACTION: PROVIDED MEDICAL SERVICES.

Schedule L (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

GWINNETT HOSPITAL SYSTEMINC

Employer identification number

58-2002413

Return Reference	Explanation
FORM 990 - ORGANIZATION'S MISSION	GWINNETT HOSPITAL SYSTEM, INC. IS A NOT-FOR-PROFIT HEALTHCARE NETWORK THAT PROVIDES AWARD-WINNING HEALTH CARE SERVICES TO THE GREATER GWINNETT COMMUNITY. GWINNETT HOSPITAL SYSTEM HAS TWO FACILITIES LOCATED IN DULUTH AND LAWRENCEVILLE, GEORGIA THAT TOGETHER PROVIDE ACUTE CARE, OUTPATIENT SERVICES, ORTHOPEDIC, CARDIOVASCULAR, NEUROSCIENCE SPECIALTY, OPEN HEART SURGERY, SEVERAL CLINICS, AND A FULL CONTINUUM OF WELLNESS SERVICES. THE FACILITIES EACH OPERATE A YEAR ROUND EMERGENCY ROOM OPEN 24 HOURS A DAY, 7 DAYS A WEEK.
FORM 990	PAGE 1 PRINCIPAL OFFICER AND SIGNING OFFICER - ROBERT T. QUATTROCCHI IS PRESIDENT AND CEO OF NORTHSIDE HOSPITAL, INC. MR. QUATTROCCHI SERVES AS THE PRINCIPAL OFFICER OF GWINNETT HOSPITAL SYSTEM FOR FISCAL YEAR ENDED JUNE 30, 2019 SOLELY IN HIS CAPACITY AS PRESIDENT AND CEO OF NORTHSIDE HOSPITAL, INC., SUCCESSOR-IN-INTEREST BY MERGER TO GWINNETT HOSPITAL SYSTEM, INC. SHANNON A. BANNA IS THE CFO OF NORTHSIDE HOSPITAL, INC. MS. BANNA SERVES AS THE CFO OF GWINNETT HOSPITAL SYSTEM FOR FISCAL YEAR ENDED JUNE 30, 2019 SOLELY IN HER CAPACITY AS CFO, NORTHSIDE HOSPITAL, INC., SUCCESSOR-IN- INTEREST BY MERGER TO GWINNETT HOSPITAL SYSTEM, INC.
FORM 990, PAGE 1, PART I, LINE 6	VOLUNTEER SERVICES HAS A DATABASE SYSTEM THAT TRACKS THE NUMBER OF VOLUNTEERS AND THEIR HOURS OF SERVICE.
FORM 990, PAGE 2, PART III, LINE 4A	GWINNETT HOSPITAL SYSTEM, INC.'S PRIMARY PROGRAM SERVICE ACTIVITY IS THE PROVISION OF PATIENT CARE. THE HOSPITAL PROVIDES ACUTE CARE, OUTPATIENT SERVICES, ORTHOPEDIC, CARDIOVASCULAR, OPEN HEART SURGERY, NEUROSCIENCE SPECIALTY; AND IT OPERATES TWO EMERGENCY ROOMS. IT OFFERS WELL WOMAN SERVICES, AND A FULL CONTINUUM OF WELLNESS SERVICES. IN ADDITION, THE HOSPITAL PROVIDES NURSING CARE IN THE AREAS OF MEDICAL, POST-SURGICAL, OPEN HEART, EMERGENCY CARE, CRITICAL AND INTERMEDIATE CARE TO PATIENTS. THE HOSPITAL NOW HAS AN EVER-EXPANDING GRADUATE MEDICAL EDUCATION PROGRAM WHICH SERVICES PATIENTS IN CLINICAL SETTINGS, TRAINING FUTURE PHYSICIANS. THE HOSPITAL PROVIDES SEVERAL SUBSIDIZED SERVICES TO THE PUBLIC BELOW COSTS, INCLUDING: A CARE-A-VAN FOR SPORTS MEDICINE, DIABETES AND NUTRITION SERVICES, REHAB AND RENAL SERVICES, AND A WOUND CARE CLINIC. THE HOSPITAL PROVIDES ORTHOPAEDIC TRAUMA SERVICES THROUGH AN AGREEMENT WITH HUGHSTON CLINIC, P.C. DURING FISCAL YEAR 2019, THE HOSPITAL OPENED A RADIOLOGY DEPARTMENT AT PEACHTREE CORNERS AND AN IMAGING AND SPECIALTY CENTER IN GRAYSON, GEORGIA TO BETTER SERVE THE POPULATION OF THOSE AREAS.
FORM 990, PAGE 6, PART VI, LINE 6	THE SOLE MEMBER OF GWINNETT HOSPITAL SYSTEM, INC. IS GWINNETT HEALTH SYSTEM, INC., A RELATED 501(C)(3) ORGANIZATION.
FORM 990, PAGE 6, PART VI, LINE 7A	THE BOARD OF DIRECTORS OF GWINNETT HOSPITAL SYSTEM, INC. IS APPOINTED BY THE CHARIMAN OF THE BOARD OF DIRECTORS OF GWINNETT HEALTH SYSTEM, INC.
FORM 990, PAGE 6, PART VI, LINE 7B	CERTAIN ACTIONS OF THE BOARD OF DIRECTORS OF GWINNETT HOSPITAL SYSTEM, INC. MUST BE APPROVED BY THE BOARD OF DIRECTORS OF GWINNETT HEALTH SYSTEM, INC., A RELATED 501(C)(3) ORGANIZATION.
FORM 990, PAGE 6, PART VI, LINE 11B	EFFECTIVE 12:01 A.M. ON AUGUST 28, 2019, GWINNETT HOSPITAL SYSTEM, INC. MERGED WITH AND INTO NORTHSIDE HOSPITAL,INC., AN UNRELATED GEORGIA NONPROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS EXEMPT UNDER SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE OF 1986 (THE SUCCESSOR ORGANIZATION), WITH THE SUCCESSOR ORGANIZATION SURVIVING THE MERGER. THE MERGER OCCURRED PRIORTO THE FILING OF THIS RETURN. AFTER THE RETURN WAS PREPARED AND PRIOR TO FILING, IT WAS REVIEWED IN DETAIL BY SENIOR FINANCIAL MANAGEMENT OF THE SUCCESSOR ORGANIZATION. A SHORT PERIOD FINAL RETURN FOR GWINNETT HOSPITAL SYSTEM, INC. WILL BE FILED SUBSEQUENT TO THE FILING OF THIS RETURN.
FORM 990, PAGE 6, PART VI, LINE 12C	ANNUALLY, A CONFLICTS OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO AND DISCUSSED WITH EACH MEMBER OF THE BOARD OF DIRECTORS. THE LEGAL DEPARTMENT IS RESPONSIBLE FOR ENSURING THESE QUESTIONNAIRES ARE SIGNED AND RETURNED. LEGAL MONITORS ALL TRANSACTIONS INVOLVING CONFLICTS OF INTEREST WITH BOARD MEMBERS. BOARD MEMBERS MUST DISCLOSE POTENTIAL CONFLICTS USING A REASONABLE BELIEF STANDARD; PLAY NO DIRECT OR INDIRECT PART IN DELIBERATIONS; AND ABSENT THEMSELVES FROM THE MEETING AT WHICH ANY POTENTIAL CONFLICT IS DISCUSSED. ONLY NON-CONFLICTED MEMBERS MAY DECIDE TO PURSUE A TRANSACTION OR ARRANGEMENT INVOLVING A CONFLICT IF A MAJORITY DETERMINES THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST. VIOLATION OF THE COI POLICY IS SUBJECT TO CORRECTIVE ACTION, INCLUDING EXONERATION, CENSURE, AND/OR REQUESTING THE RESIGNATION OF THE MEMBER. APPROVAL FOR ANY LOANS, PAYMENTS, HONORARIUMS, TRIP OR TRAVEL REIMBURSEMENTS, SERVICES, PRODUCTS, ENTERTAINMENT, PRIZES OR AWARDS PROVIDED TO ANY BOARD MEMBER MUST BE APPROVED BY AN ADMINISTRATIVE OFFICER OR HIS OR HER DESIGNEE. THE CEO MUST OBTAIN THE APPROVAL OF THE CHAIRMAN OF THE BOARD (AND PAYMENTS TO THE CEO ARE APPROVED BY ANOTHER ADMINISTRATIVE OFFICER). IN ADDITION, THE HUMAN RESOURCE DEPARTMENT SENDS OUT A COI POLICY AND DISCLOSURE FORM TO OFFICERS AND KEY EMPLOYEES EVERY 3 - 5 YEARS. THESE OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS THAT ARISE DURING THE FISCAL YEAR.
FORM 990, PAGE 6, PART VI, LINE 19	GOVERNING DOCUMENTS ARE FILED WITH AND AVAILABLE ON THE GEORGIA SECRETARY OF STATE WEBSITE OR THROUGH THAT OFFICE. THESE DOCUMENTS CAN ALSO BE OBTAINED BY CONTACTING GWINNETT HOSPITAL SYSTEM. THE CONFLICT OF INTEREST POLICY CAN BE OBTAINED BY CONTACTING THE HOSPITAL. THE HOSPITAL IS UNDER OBLIGATION TO DISCLOSE TO BOND HOLDERS PERTINENT FINANCIAL INFORMATION IN THE ANNUAL DISCLOSURE DOCUMENTS. CERTAIN DOCUMENTS ARE AVAILABLE UPON REQUEST AT THE HOSPITAL. FOR MORE INFORMATION VISIT - HTTPS://WWW.GWINNETTMEDICALCENTER.ORG/FACILITIES/NORTHSIDE-HOSPITAL- GWINNETT.
FORM 990, PART VII	BOARD MEMBERS OF GWINNETT ENTITIES ARE PROVIDED A SMALL STIPEND FOR THEIR SERVICES. K. CARLTON BUCHANAN, MD RECEIVES MEDICAL AND HEALTH CARE PAYMENTS AS COMPENSATION FOR PHYSICIAN SERVICES.
FORM 990, PART XI	THE 2019 STATEMENT OF CHANGES IN NET ASSETS WAS REVISED TO CORRECT NET ASSETS WITHOUT DONOR RESTRICTIONS AND TOTAL NET ASSETS AS OF JUNE 30, 2018. NET ASSETS AS OF JUNE 30, 2018 HAVE BEEN REDUCED AS A RESULT OF NET PATIENT SERVICE REVENUE ADJUSTMENTS IDENTIFIED BY MANAGEMENT SUBSEQUENT TO JUNE 30, 2019 THAT RELATE TO PRIODS PRIOR TO JULY 1, 2018. THE CORRECTION WAS CONSIDERED IMMATERIAL AS NOTED IN THE HOSPITAL'S AUDITED FINANCIAL STATEMENTS.
FORM 990, PART XI, LINE 9	BENEFICIAL INTEREST IN ASSETS OF FOUNDATION 1,340,176 ACCRUED PENSION COSTS ADJUSTMENT -4,240,973 CHANGE IN INTEREST RATE SWAP -7,381,005 UBI FROM K-1 NOT ON BOOKS 101,403 MINORITY INTEREST -480,000 ROUNDING -7 TOTAL -10,660,406

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

GWINNETT HOSPITAL SYSTEMINC

Employer identification number

58-2002413

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(f) Direct controlling entity
(1) GWINNETT HOSPITAL SYSTEM GME LLC C/O GWINNETT HOSPITAL SYSTEM INC 1000 JOHNSON FERRY ROAD ATLANTA,GA30342 46-5634252	GME	GA	GWHOSP SYS GWINNETT HOSPITAL SYSTEM INC

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)GWINNETT HEALTH SYSTEM INC 1000 JOHNSON FERRY ROAD ATLANTA,GA30342 58-2135755	PARENT	GA	501C3	12C	N/A		No
(2)GWINNETT HOSPITAL SYSTEM FOUNDATION 1755 NORTH BROWN ROAD 100 LAWRENCEVILLE,GA30046 58-1828486	FUNDRAISIN	GA	501C3	7	N/A		No
(3)GWINNETT MEDICAL GROUP INC 1000 JOHNSON FERRY ROAD ATLANTA,GA30342 58-2143107	PHYSICIAN	GA	501C3	3	HEALTH SYS	Yes
(4)GWINNETT MEDICAL PROPERTIES INC 1000 JOHNSON FERRY ROAD LAWRENCEVILLE,GA30342 58-2132516	REAL ESTAT	GA	501C3	12B	HEALTH SYS	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2018

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) GWINNETT CARDIOVASCULAR SERVICES LL 1000 JOHNSON FERRY ROAD ATLANTA,GA30342 26-3870307	MEDICAL SV	GA	GWN HOSPIT	RELATED	4,860,301	199,998	Yes				No	78.550 %
(2) GWINNETT SURGERY CENTER LLC 631 PROFESSIONAL DRIVE STE 390 LAWRENCEVILLE,GA30046 27-2819709	MEDICAL SV	GA	GWN HOSPIT	RELATED				No			No	51.000 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) GWINNETT MANAGED CARE INC 1000 JOHNSON FERRY ROAD ATLANTA,GA30342 58-2135759	PHO	GA	N/A					No
(2) SEQUENT HEALTH PHYSICIAN PARTNERS 1000 JOHNSON FERRY ROAD ATLANTA,GA30342 47-1511997	CL. INTEGR	GA	N/A					No

Schedule R (Form 990) 2018

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2018

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2018

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: GWINNETT HOSPITAL SYSTEM, INC. IS A NOT-FOR-PROFIT HEALTHCARE NETWORK THAT PROVIDES AWARD-WINNING HEALTH CARE SERVICES TO THE GREATER GWINNETT COMMUNITY. GWINNETT HOSPITAL SYSTEM HAS TWO FACILITIES LOCATED IN DULUTH AND LAWRENCEVILLE, GEORGIA THAT TOGETHER PROVIDE ACUTE CARE, OUTPATIENT SERVICES, ORTHOPEDIC, CARDIOVASCULAR, NEUROSCIENCE SPECIALTY, OPEN HEART SURGERY, SEVERAL CLINICS, AND A FULL CONTINUUM OF WELLNESS SERVICES. THE FACILITIES EACH OPERATE A YEAR ROUND EMERGENCY ROOM OPEN 24 HOURS A DAY, 7 DAYS A WEEK.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	5
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	3
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	6,005
6	Total number of volunteers (estimate if necessary) .............	6	390
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	266,217
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,822,891	3,215,796
9	Program service revenue (Part VIII, line 2g) .........	721,157,945	721,001,843
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	14,075,124	17,405,169
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	16,295,403	10,289,197
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	754,351,363	751,912,005
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	40,235,500	38,786,617
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	347,494,655	367,537,416
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	374,059,679	390,240,621
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	761,789,834	796,564,654
19	Revenue less expenses. Subtract line 18 from line 12.......	-7,438,471	-44,652,649
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	888,989,982	848,485,246
21	Total liabilities (Part X, line 26).............	396,630,542	419,510,587
22	Net assets or fund balances. Subtract line 21 from line 20.....	492,359,440	428,974,659

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 675,842,558 including grants of $ 38,786,617 ) (Revenue $ 720,909,738 )
	GWINNETT HOSPITAL SYSTEM, INC.'S PRIMARY PROGRAM SERVICE ACTIVITY IS THE PROVISION OF PATIENT CARE. THE HOSPITAL PROVIDES ACUTE CARE, OUTPATIENT SERVICES, ORTHOPEDIC, CARDIOVASCULAR, OPEN HEART SURGERY, NEUROSCIENCE SPECIALTY; AND IT OPERATES TWO EMERGENCY ROOMS. IT OFFERS WELL WOMAN SERVICES, AND A FULL CONTINUUM OF WELLNESS SERVICES. IN ADDITION, THE HOSPITAL PROVIDES NURSING CARE IN THE AREAS OF MEDICAL, POST-SURGICAL, OPEN HEART, EMERGENCY CARE, CRITICAL AND INTERMEDIATE CARE TO PATIENTS. THE HOSPITAL NOW HAS AN EVER-EXPANDING GRADUATE MEDICAL EDUCATION PROGRAM WHICH SERVICES PATIENTS IN CLINICAL SETTINGS, TRAINING FUTURE PHYSICIANS. THE HOSPITAL PROVIDES SEVERAL SUBSIDIZED SERVICES TO THE PUBLIC BELOW COSTS, INCLUDING: A CARE-A-VAN FOR SPORTS MEDICINE, DIABETES AND NUTRITION SERVICES, REHAB AND RENAL SERVICES, AND A WOUND CARE CLINIC. THE HOSPITAL PROVIDES ORTHOPAEDIC TRAUMA SERVICES THROUGH AN AGREEMENT WITH HUGHSTON CLINIC, P.C. DURING FISCAL YEAR 2019, THE HOSPITAL OPENED A RADIOLOGY DEPARTMENT AT PEACHTREE CORNERS AND AN IMAGING AND SPECIALTY CENTER IN GRAYSON, GEORGIA TO BETTER SERVE THE POPULATION OF THOSE AREAS.

4b	(Code: ) (Expenses $ 5,716,389 including grants of $ ) (Revenue $ 99,614 )
	THE HOSPITAL SYSTEM PROVIDES COMMUNITY HEALTH IMPROVEMENT SERVICES. THE LARGEST OF THESE PROGRAMS IS THE SPORTS MEDICINE SUPPORT SERVICES OFFERED THROUGH OUR SCHOOLS, COLLEGES AND THE GWINNETT COUNTY PARKS AND RECREATION DEPARTMENT. ANOTHER OF THESE PROGRAMS IS THE CANCER INSTITUTE WHICH PROVIDES NAVIGATORS, A DIETITIAN AND SOCIAL WORKERS TO SUPPORT PATIENTS WITH SPECIFIC TYPES OF CANCER. ANOTHER OF THE PROGRAMS IS THE FAITH COMMUNITY NURSING PROGRAM WHICH IS LOCATED IN MANY OF OUR FAITH-BASED ORGANIZATIONS. THESE COMMUNITY FAITH-BASED PROGRAMS PROVIDE SERVICES TO THE UNDERSERVED, LOW INCOME AND MINORITY POPULATION. THESE HEALTH IMPROVEMENT SERVICES ARE CONDUCTED IN THE COMMUNITY THROUGH 10 FAITH-HEALTH ORGANIZATIONS AND 19 SCHOOLS, AS WELL AS MANY YOUTH SPORTS LEAGUES.

4c	(Code: ) (Expenses $ 15,755,600 including grants of $ ) (Revenue $ 6,253,766 )
	THE GRADUATE MEDICAL EDUCATION PROGRAMS CONTINUE TO INCREASE THE NUMBER OF RESIDENTS WE HAVE AT GWINNETT HOSPITAL SYSTEM. THE HOSPITAL SYSTEM ALSO PROVIDES HEALTH PROFESSIONAL EDUCATION SERVICES WHICH FOCUS ON NURSING, OTHER ALLIED HEALTH PROFESSIONALS AND PHYSICIAN CONTINUING EDUCATION PROGRAMS. GWINNETT HOSPITAL SYSTEM IS ASSOCIATED WITH MORE THAN 40 ACADEMIC INSTITUTIONS FOR HEALTH PROFESSIONALS.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses697,314,547

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	10,073,965	7,724	1,219,755

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	2,008,923
e	Government grants (contributions)		1e	1,014,113

f	All other contributions, gifts, grants, and similar amounts not included above		1f	192,760

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		3,215,796

		Business Code
2a	PATIENT SERVICE REVENUE	623000	715,026,129	715,026,129
b	DISCOUNTS	623000	3,001,196	3,001,196
c	MANAGEMENT FEES	623000	2,106,514	2,106,514
d	OTHER REVENUE	623000	500,384	500,384
e	MANAGEMENT FEES - UNRELATED	561000	318,381		318,381
f	All other program service revenue.		49,239		49,239
g	Total. Add lines 2a–2f ....		721,001,843

3 Investment income (including dividends, interest, and othersimilar amounts) ......			11,650,351			11,650,351
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		661,264
b	Less: rental expenses
c	Rental income or (loss)		661,264
d	Net rental income or (loss)......			661,264			661,264
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	1,059,667	189,518,266
b	Less: cost or other basis and sales expenses	228,584	184,594,531
c	Gain or (loss)	831,083	4,923,735
d	Net gain or (loss).....			5,754,818			5,754,818
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	GME REVENUES		611600	2,886,758	2,886,758
b	CAFETERIA & VENDING		722514	2,191,180			2,191,180
c	HUGHSTON CLINIC		621110	1,245,321	1,245,321
d	All other revenue ....			3,304,674	2,496,816	-101,403	909,261
e	Total. Add lines 11a–11d ......			9,627,933
12	Total revenue. See Instructions......			751,912,005	727,263,118	266,217	21,166,874

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	38,721,851	38,721,851
2	Grants and other assistance to domestic individuals. See Part IV, line 22	64,766	64,766
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	8,641,692	1,385,463	7,256,229
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	292,610,236	259,916,124	32,694,112
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	13,033,974	11,333,445	1,700,529
9	Other employee benefits .......	33,251,974	29,505,129	3,746,845
10	Payroll taxes ...........	19,999,540	17,390,221	2,609,319
11	Fees for services (non-employees):
a	Management ......	4,868,622	4,233,418	635,204
b	Legal .........	7,047,711	5,449,659	1,598,052
c	Accounting ...........	437,783	380,666	57,117
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	353,485		353,485
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	76,280,212	48,152,876	28,127,336
12	Advertising and promotion ....	2,793,556	176,647	2,616,909
13	Office expenses .......	15,099,276	10,123,369	4,975,907
14	Information technology ......	12,037,614	4,635,762	7,401,852
15	Royalties ..
16	Occupancy ...........	14,245,453	13,386,395	859,058
17	Travel ............	439,054	276,828	162,226
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	375,169	274,519	100,650
20	Interest ...........	11,032,041	11,032,041
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	29,636,970	29,636,970
23	Insurance ...	16,927,825	16,618,676	309,149
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL & SURGICAL SUPPLI	162,059,416	161,399,284	660,132
b	EQUIPMENT RENTAL & MAINT.	15,987,606	13,772,551	2,215,055
c	PROVIDER FEES	9,766,015	9,766,015
d	FOOD	3,923,197	3,244,188	679,009
e	All other expenses	6,929,616	6,437,684	491,932
25	Total functional expenses. Add lines 1 through 24e	796,564,654	697,314,547	99,250,107	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			54,120,896	1	43,826,998
2	Savings and temporary cash investments .........			34,233,875	2	34,931,468
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			98,427,097	4	59,686,709
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L ..............
					6
7	Notes and loans receivable, net ....			7,761,737	7	10,494,002
8	Inventories for sale or use ........			7,007,484	8	7,414,592
9	Prepaid expenses and deferred charges ......			14,476,196	9	13,695,288
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	732,031,208
b	Less: accumulated depreciation	10b	514,822,055	237,105,000	10c	217,209,153
11	Investments—publicly traded securities .			390,423,778	11	411,054,265
12	Investments—other securities. See Part IV, line 11 .....			21,869,083	12	22,957,230
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			9,711,149	14	9,711,149
15	Other assets. See Part IV, line 11 ...........			13,853,687	15	17,504,392
16	Total assets. Add lines 1 through 15 (must equal line 34)...			888,989,982	16	848,485,246

17	Accounts payable and accrued expenses .....	58,325,583	17	63,642,876
18	Grants payable ...		18
19	Deferred revenue .........	148,940	19	14,849,887
20	Tax-exempt bond liabilities .........	270,740,000	20	263,460,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	67,416,019	25	77,557,824
26	Total liabilities. Add lines 17 through 25..	396,630,542	26	419,510,587

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	474,682,092	27	409,935,056
28	Temporarily restricted net assets ...........	13,416,745	28	14,243,121
29	Permanently restricted net assets	4,260,603	29	4,796,482
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	492,359,440	33	428,974,659
34	Total liabilities and net assets/fund balances ........	888,989,982	34	848,485,246