UNIVERSITY HEALTH CARE FOUNDATION INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
UNIVERSITY HEALTH CARE FOUNDATION INC (EIN 58-1343550)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-11
IRS object ID
202233159349306058
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-11-11T14:45:53-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN570381582PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ELLIOTT DAVIS LLCPLLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1ONE 10TH STREET SUITE 400AddressLine1Txt
CityAUGUSTACityNm
State AbbreviationGAStateAbbreviationCd
ZIP30901ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN581343550EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1UNIVERSITY HEALTH CARE FOUNDATION INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlUNIVBusinessNameControlTxt
Phone7067747710PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12260 WRIGHTSBORO ROADAddressLine1Txt
CityAUGUSTACityNm
State AbbreviationGAStateAbbreviationCd
ZIP30904ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAVID A BELKOSKIPersonNm
Person TitleCFOPersonTitleTxt
Phone7067747710PhoneNum
Signature2022-11-11SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstDAVIDPersonFirstNm
Person LastBELKOSKIPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJESSICA C CAINPreparerPersonNm
PTINP01276209PTIN
Phone7067229090PhoneNum
Preparation2022-10-31PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJAMES R DAVISPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11350 WALTON WAYAddressLine1Txt
CityAUGUSTACityNm
State AbbreviationGAStateAbbreviationCd
ZIP30901ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$4,935,955GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.UNIVERSITYHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1978FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionSUPPORT OF UNIVERSITY HOSPITAL RELATING TO HOSPITAL SERVICES AS WELL AS PROVIDING ASSISTANCE TO THE INDIGENT POPULATION.ActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers267TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$2,287,844PYContributionsGrantsAmt
CY Contributions Grants$2,183,937CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$1,760,835PYInvestmentIncomeAmt
CY Investment Income$1,916,251CYInvestmentIncomeAmt
PY Other Revenue$55,048PYOtherRevenueAmt
CY Other Revenue$23,433CYOtherRevenueAmt
PY Total Revenue$4,103,727PYTotalRevenueAmt
CY Total Revenue$4,123,621CYTotalRevenueAmt
PY Grants And Similar Paid$72,300PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$68,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$620,477PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$591,449CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$378,515CYTotalFundraisingExpenseAmt
PY Other Expenses$3,627,393PYOtherExpensesAmt
CY Other Expenses$2,692,341CYOtherExpensesAmt
PY Total Expenses$4,320,170PYTotalExpensesAmt
CY Total Expenses$3,351,790CYTotalExpensesAmt
PY Revenues Less Expenses-$216,443PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$771,831CYRevenuesLessExpensesAmt
Total Assets BOY$38,713,066TotalAssetsBOYAmt
Total Assets EOY$42,259,800TotalAssetsEOYAmt
Total Liabilities BOY$195,970TotalLiabilitiesBOYAmt
Total Liabilities EOY$146,167TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$38,517,096NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$42,113,633NetAssetsOrFundBalancesEOYAmt
MissionSUPPORT OF UNIVERSITY HOSPITAL RELATING TO HOSPITAL SERVICES AS WELL AS PROVIDING ASSISTANCE TO THE INDIGENT POPULATION.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$2,613,963ExpenseAmt
Grant$68,000GrantAmt
DescSUPPORT OF UNIVERSITY HOSPITAL RELATING TO HOSPITAL SERVICES AS WELL AS PROVIDING ASSISTANCE TO THE INDIGENT POPULATION.Desc
Total Program Service Expenses$2,613,963TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming ActivitiesYes (1)GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document8IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local ChaptersYes (1)LocalChaptersInd
Policies Reference ChaptersYes (1)PoliciesReferenceChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldGAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DAVID A BELKOSKI CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7067747710PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1UHI 1350 WALTON WAYAddressLine1Txt
CityAUGUSTACityNm
State AbbreviationGAStateAbbreviationCd
ZIP309012629ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt
DAVID HOGG JR
BOARD MEMBER1.00Yes (X)$0$0$0
HARRY W JERNIGAN IV
BOARD MEMBER1.00Yes (X)$0$0$0
JOSHUA B RAFOTH MD
BOARD MEMBER1.00Yes (X)$0$0$0
TAITE SASNETT
BOARD MEMBER1.00Yes (X)$0$0$0
JED W HOWINGTON MD
BOARD MEMBER1.00Yes (X)$0$0$0
BECKY SMITH
BOARD MEMBER1.00Yes (X)$0$0$0
ELAINE CLARK SMITH
BOARD MEMBER1.00Yes (X)$0$0$0
TOM WYATT
BOARD MEMBER1.00Yes (X)$0$0$0
MARK J WILLS
BOARD MEMBER1.00Yes (X)$0$0$0
WILLIAM E BARFIELD JR MD
BOARD MEMBER1.00Yes (X)$0$0$0
ANNE D TROTTER
CHAIRMAN1.00Yes (X)$0$0$0Yes (X)
PHILIP A GAFFNEY
BOARD MEMBER1.00Yes (X)$0$0$0
CARGILL ALLEYNE MD
BOARD MEMBER1.00Yes (X)$0$861,484$13,78250.00
DAVID A BELKOSKI
SYSTEM CFO5.00$0$848,041$11,442Yes (X)50.00
LAURIE SMITH
PRESIDENT UHCF25.00$0$406,322$9,528Yes (X)30.00
JAMES R DAVIS
CEO5.00$0$2,343,435$17,972Yes (X)50.00
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$4,459,282TotReportableCompRltdOrgAmt
Total Other Compensation$52,724TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$596,033FundraisingAmt
All Other Contributions$1,587,904AllOtherContributionsAmt
Noncash Contributions$86,816NoncashContributionsAmt
Total Contributions$2,183,937TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,682,438TotalRevenueColumnAmt
Exclusion$1,682,438ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$571,749SecuritiesAmt
Other$375,000OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$466,508SecuritiesAmt
Other$246,428OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$105,241SecuritiesAmt
Other$128,572OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$233,813TotalRevenueColumnAmt
Exclusion$233,813ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$94,844FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$596,033ContriRptFundraisingEventAmt
Fundraising Direct Expenses$85,471FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$9,373TotalRevenueColumnAmt
Exclusion$9,373ExclusionAmt
FieldValueIRS element (for citing)
Gaming Gross Income$27,987GamingGrossIncomeAmt
Gaming Direct Expenses$13,927GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,060TotalRevenueColumnAmt
Exclusion$14,060ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,123,621TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$1,939,684ExclusionAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$68,000TotalAmt
Program Services$68,000ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$591,449TotalAmt
Program Services$92,414ProgramServicesAmt
Management And General$269,849ManagementAndGeneralAmt
Fundraising$229,186FundraisingAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$28,541TotalAmt
Program Services$4,459ProgramServicesAmt
Management And General$13,022ManagementAndGeneralAmt
Fundraising$11,060FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$34,264TotalAmt
Fundraising$34,264FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$41,948TotalAmt
Program Services$6,553ProgramServicesAmt
Management And General$19,139ManagementAndGeneralAmt
Fundraising$16,256FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$3,895TotalAmt
Program Services$68ProgramServicesAmt
Management And General$3,660ManagementAndGeneralAmt
Fundraising$167FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$2,198TotalAmt
Program Services$343ProgramServicesAmt
Management And General$1,003ManagementAndGeneralAmt
Fundraising$852FundraisingAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$26,094TotalAmt
Fundraising$26,094FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$2,433,234TotalAmt
Program Services$2,433,234ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$10,769TotalAmt
Program Services$1,683ProgramServicesAmt
Management And General$4,913ManagementAndGeneralAmt
Fundraising$4,173FundraisingAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
OTHER MISCELLANEOUS$63,945$7,021$39,511$17,413
SUPPLIES$40,047$188$809$39,050
DUES & MEMBERSHIPS$7,406$7,406

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$3,351,790TotalAmt
Program Services$2,613,963ProgramServicesAmt
Management And General$359,312ManagementAndGeneralAmt
Fundraising$378,515FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$612,938BOYAmt
EOY$1,565,633EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,573,575BOYAmt
EOY$1,636,123EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$5,359BOYAmt
EOY$5,428EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$11,124LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$11,124LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$143,121BOYAmt
EOY$0EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$36,318,226BOYAmt
EOY$38,992,764EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$42,201BOYAmt
EOY$42,206EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$17,646BOYAmt
EOY$17,646EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$38,713,066BOYAmt
EOY$42,259,800EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$56,538BOYAmt
EOY$23,338EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$433EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$139,432BOYAmt
EOY$122,396EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$195,970BOYAmt
EOY$146,167EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$702,109BOYAmt
EOY$1,764,243EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$37,814,987BOYAmt
EOY$40,349,390EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$38,517,096BOYAmt
EOY$42,113,633EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$38,713,066BOYAmt
EOY$42,259,800EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$771,831ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$2,161,285NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$663,419OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,203,739CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,347,498CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,348,505CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,287,844CurrentTaxYearMinus1YearAmt
Current Tax Year$2,183,826CurrentTaxYearAmt
Total$13,371,412TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,203,739CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,347,498CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,348,505CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,287,844CurrentTaxYearMinus1YearAmt
Current Tax Year$2,183,826CurrentTaxYearAmt
Total$13,371,412TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$633,177SubstantialContributorsTotAmt
Public Support Total170$12,738,235PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$786,550CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$947,424CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$712,381CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$617,510CurrentTaxYearMinus1YearAmt
Current Tax Year$1,682,279CurrentTaxYearAmt
Total$4,746,144TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$133,961CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$183,448CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$84,536CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$55,048CurrentTaxYearMinus1YearAmt
Current Tax Year$23,543CurrentTaxYearAmt
Total$480,536TotalAmt
FieldValueIRS element (for citing)
Total Support$18,598,092TotalSupportAmt
Public Support CY1700.68490PublicSupportCY170Pct
Public Support PY1700.70250PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$31,823,173BeginningYearBalanceAmt
Contributions$303,819ContributionsAmt
Investment Earnings Or Losses$3,013,557InvestmentEarningsOrLossesAmt
Grants Or Scholarships$68,000GrantsOrScholarshipsAmt
Other Expenditures$643,228OtherExpendituresAmt
End Year Balance$34,429,321EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$35,231,384BeginningYearBalanceAmt
Contributions$261,269ContributionsAmt
Investment Earnings Or Losses-$2,780,261InvestmentEarningsOrLossesAmt
Grants Or Scholarships$72,300GrantsOrScholarshipsAmt
Other Expenditures$769,087OtherExpendituresAmt
Administrative Expenses$47,832AdministrativeExpensesAmt
End Year Balance$31,823,173EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$31,120,840BeginningYearBalanceAmt
Contributions$441,920ContributionsAmt
Investment Earnings Or Losses$4,552,140InvestmentEarningsOrLossesAmt
Grants Or Scholarships$43,900GrantsOrScholarshipsAmt
Other Expenditures$801,836OtherExpendituresAmt
Administrative Expenses$37,780AdministrativeExpensesAmt
End Year Balance$35,231,384EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$37,259,003BeginningYearBalanceAmt
Contributions$727,185ContributionsAmt
Investment Earnings Or Losses-$1,122,949InvestmentEarningsOrLossesAmt
Grants Or Scholarships$5,444,688GrantsOrScholarshipsAmt
Other Expenditures$226,796OtherExpendituresAmt
Administrative Expenses$70,915AdministrativeExpensesAmt
End Year Balance$31,120,840EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$33,207,579BeginningYearBalanceAmt
Contributions$405,479ContributionsAmt
Investment Earnings Or Losses$4,187,272InvestmentEarningsOrLossesAmt
Grants Or Scholarships$63,200GrantsOrScholarshipsAmt
Other Expenditures$373,383OtherExpendituresAmt
Administrative Expenses$104,744AdministrativeExpensesAmt
End Year Balance$37,259,003EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY0.44540PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.55460TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,124OtherCostOrOtherBasisAmt
Depreciation$11,124DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescCHARITABLE GIFT ANNUITY LIABILITYDesc
Amt$122,396Amt
FieldValueIRS element (for citing)
Total Liability$122,396TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4:TO ASSIST UNIVERSITY HEALTH CARE SYSTEM MEET THEIR GOALS IN PROVIDING QUALITY HEALTH CARE SERVICES TO THE CITIZENS OF THE COMMUNITY THROUGH PATIENT AND STAFF EDUCATION, QUALITY OF LIFE INITIATIVES, AND SUPPORT OF THE UNDERSERVED AND INDIGENT POPULATION.
PART X, LINE 2:UNIVERSITY HEALTH CARE FOUNDATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. ACCORDINGLY, THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. UNIVERSITY HEALTH CARE FOUNDATION HAS EVALUATED THEIR TAX POSITIONS AND DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2021. FISCAL YEARS ENDED ON OR AFTER DECEMBER 31, 2018 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1MIRACLE MILE WALKEvent1Nm
Gross Receipts Event1$457,137GrossReceiptsEvent1Amt
Charitable Contri Event1$383,514CharitableContriEvent1Amt
Gross Revenue Event1$73,623GrossRevenueEvent1Amt
Rent Facility Costs Event1$3,861RentFacilityCostsEvent1Amt
Food And Beverage Event1$2,474FoodAndBeverageEvent1Amt
Other Direct Expenses Event1$39,919OtherDirectExpensesEvent1Amt
Event2JERNIGAN GOLFEvent2Nm
Gross Receipts Event2$233,740GrossReceiptsEvent2Amt
Charitable Contri Event2$212,519CharitableContriEvent2Amt
Gross Revenue Event2$21,221GrossRevenueEvent2Amt
Non Cash Prizes Event2$15,183NonCashPrizesEvent2Amt
Rent Facility Costs Event2$17,393RentFacilityCostsEvent2Amt
Food And Beverage Event2$5,091FoodAndBeverageEvent2Amt
Other Direct Expenses Event2$1,550OtherDirectExpensesEvent2Amt
Gross Receipts Total$690,877GrossReceiptsTotalAmt
Charitable Contributions Tot$596,033CharitableContributionsTotAmt
Gross Revenue Total Events$94,844GrossRevenueTotalEventsAmt
Non Cash Prizes Total Events$15,183NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$21,254RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$7,565FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events$41,469OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$85,471DirectExpenseSummaryEventsAmt
Net Income Summary$9,373NetIncomeSummaryAmt

Gaming Information GamingInformationGrp

FieldValueIRS element (for citing)
Gross Revenue Other Gaming$27,987GrossRevenueOtherGamingAmt
Non Cash Prizes Other Gaming$13,927NonCashPrizesOtherGamingAmt
Volunteer Labor Other GamingYes (1)VolunteerLaborOtherGamingInd
Volunteer Labor Other Gaming0.75000VolunteerLaborOtherGamingPct
Gross Revenue Total Gaming$27,987GrossRevenueTotalGamingAmt
Non Cash Prizes Total Gaming$13,927NonCashPrizesTotalGamingAmt
Direct Expense Summary Gaming$13,927DirectExpenseSummaryGamingAmt
Net Gaming Income Summary$14,060NetGamingIncomeSummaryAmt
FieldValueIRS element (for citing)
States Where Gaming ConductedGAStatesWhereGamingConductedCd
LicensedYes (1)LicensedInd
License Suspended Etc0LicenseSuspendedEtcInd
Gaming With NonmembersYes (1)GamingWithNonmembersInd
Member Of Other Entity0MemberOfOtherEntityInd
Gaming Other Facility1.00000GamingOtherFacilityPct
Individual With BooksPATRICIA BENSEMAIndividualWithBooksNm

Persons With Books US Address PersonsWithBooksUSAddress

FieldValueIRS element (for citing)
Address Line11350 WALTON WAYAddressLine1Txt
CityAUGUSTACityNm
State AbbreviationGAStateAbbreviationCd
ZIP30901ZIPCd
FieldValueIRS element (for citing)
Cntrct With3rd Prty For Game Rev0CntrctWith3rdPrtyForGameRevInd
Gaming Manager PersonPATRICIA BENSEMAGamingManagerPersonNm
Gaming Manager Services ProvFUNDRAISING EVENTS COORDINATOR AND RECORD KEEPING - EMPLOYEE OF AND SALARY PAID BY RELATED ORGANIZATION (UNIVERSITY HEALTH SERVICES, INC.).GamingManagerServicesProvTxt
Gaming Manager Is EmployeeYes (X)GamingManagerIsEmployeeInd
Charitable Distribution Rqr0CharitableDistributionRqrInd

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeSCHOLARSHIP AND AWARD DISBURSEMENTSGrantTypeTxt
Recipient35RecipientCnt
Cash Grant$68,000CashGrantAmt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 2:UNIVERSITY HEALTH CARE FOUNDATION HAS A TOTAL OF THIRTY FIVE SCHOLARSHIPS. THE SCHOLARSHIP APPLICATIONS ARE DIVIDED INTO POSITION GROUPS SUCH AS ADN RN, BSN RN, MSN RN, PHD RN, RESP THERAPIST, RAD TECH. BASED ON THE NUMBER OF APPLICANTS, EACH GROUP IS ASSIGNED A PRO-RATA SHARE OF THE THIRTY FIVE SCHOLARSHIPS. GPA IS USED AS A SCREENING FACTOR BUT IS NOT USED FOR THE FINAL DETERMINATION. DEDICATION TO CAREER PROGRESSION AS EVIDENCED BY HISTORY WITH UH AND THE DIRECTOR RECOMMENDATION WAS USED AS THE FINAL DETERMINATION. THE FOUNDATION DOES NOT HAVE A FORMAL MONITORING PROCESS FOR THE GRANTS.
SCHOLARSHIP & AWARDS DISBURSEMENTS

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsYes (1)CompBsdNetEarnsRltdOrgsInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JAMES R DAVIS
CEO$0$822,804$0$364,951$0$1,155,680$0$0$0$17,972$0$2,361,407$0$714,464
CARGILL ALLEYNE MD
BOARD MEMBER$0$828,589$0$25,000$0$7,895$0$0$0$13,782$0$875,266$0$0
DAVID A BELKOSKI
SYSTEM CFO$0$489,897$0$189,830$0$168,314$0$0$0$11,442$0$859,483$0$0
LAURIE SMITH
PRESIDENT UHCF$0$261,124$0$78,961$0$66,237$0$0$0$9,528$0$415,850$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 4BJAMES R DAVIS - CAA/SERP REDEMPTION - $714,464, CAA REDEMPTION - $339,489 DAVID A BELKOSKI - ROTH IUL - $120,320 LAURIE OTT SMITH - ROTH IUL - $41,793 - SECTION 162 - $2,541 PLEASE NOTE THAT ALL OF THE BENEFITS LISTED ABOVE ARE INCLUDED IN THE TOTALS REPORTED ON FORM 990, SCHEDULE VII AS REPORTABLE COMPENSATION OR OTHER COMPENSATION AND HAVE BEEN INCLUDED IN THE INDIVIDUALS' W-2.
PART I, LINE 6THE BONUS PLAN FOR MANAGEMENT IS CALCULATED BASED ON STRATEGIC INITIATIVES AS DETERMINED BY THE COMPENSATION COMMITTEE. THESE INITIATIVES ARE GOALS THAT MUST BE ACHIEVED DURING THE YEAR IN ORDER FOR BONUS PAYOUT. FOR 2021 THESE INITIATIVES WERE WEIGHTED AS DISPLAYED IN THE FOLLOWING SCHEDULE: UNIVERSITY HEALTH SERVICES, INC 2021 STRATEGIC INITIATIVES WEIGHT QUALITY 20% ACHIEVE OVERALL RATING OF CARE SCORE (RAW SCORE) 20% MINIMIZE HOSPITAL ACQUIRED CONDITIONS PER 1,000 MEDICARE DISCHARGES GROWTH 20% GROW THE NUMBER OF ED VISITS ON THE MAIN CAMPUS PEOPLE 20% ACHIEVE RN TURNOVER RATE FOR UH IN 2021 AFFORDABILITY 20% ACHIEVE OPERATING MARGIN FOR UNIVERSITY HEALTH, INC 100% EACH GOAL THAT WAS ACHIEVED REPRESENTED THAT PERCENTAGE OF BONUS PAYOUT OUT OF A POSSIBLE 100% BASED ON A THRESHOLD LEVEL, TARGET LEVEL, OR AN EXCEED LEVEL.

Schedule M IRS990ScheduleM

Clothing And Household Goods ClothingAndHouseholdGoodsGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Noncash Contributions Rpt F990$7,500NoncashContributionsRptF990Amt
Method Of Determining RevenuesCOSTMethodOfDeterminingRevenuesTxt

Food Inventory FoodInventoryGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution14ContributionCnt
Noncash Contributions Rpt F990$14,240NoncashContributionsRptF990Amt
Method Of Determining RevenuesCOSTMethodOfDeterminingRevenuesTxt

Other Non Cash Contri Table OtherNonCashContriTableGrp (7 entries)

Non Cash CheckboxNonCashCheckboxIndDescDescContributionContributionCntNoncash Contributions Rpt F990NoncashContributionsRptF990AmtMethod Of Determining RevenuesMethodOfDeterminingRevenuesTxt
Yes (X)ADVERTISING6$38,079COST
Yes (X)EVENT TICKETS3$10,636COST
Yes (X)JEWELRY2$7,190COST
Yes (X)GOLF CARTS1$5,285COST
Yes (X)GIFT CERTIFICATE11$2,556COST
Yes (X)OTHER2$680COST
Yes (X)SKIN CARE1$650COST
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BA COPY OF THE FORM 990 AND ALL RELATED SCHEDULES WAS PROVIDED TO THE GOVERNING BOARD BEFORE FILING IN ELECTRONIC FORM. AN EMAIL WAS SENT TO ALL MEMBERS OF THE GOVERNING BODY CONTAINING A LINK TO A PASSWORD-PROTECTED WEBSITE ON WHICH THE ENTIRE 990 COULD BE VIEWED. THE EMAIL EXPLAINED THAT THE FORM 990 WAS AVAILABLE FOR REVIEW ON THE WEBSITE.
FORM 990, PART VI, SECTION B, LINE 12CEXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS THE CONFLICT OF INTEREST POLICY IS AS FOLLOWS: I. POLICY 1. EACH CORPORATE BOARD OF THE UNIVERSITY HEALTH CARE SYSTEM HAS ADOPTED A CONFLICT OF INTEREST POLICY BINDING UPON THE BOARD'S MEMBER AND THE CORPORATION CHIEF EXECUTIVE OFFICER. AS A RESULT OF THE DIVERSE INTERESTS AND BACKGROUNDS OF ADMINISTRATIVE, SUPERVISORY, AND STAFF EMPLOYEES, AT TIMES THERE MAY ARISE INSTANCES WHEN AN INDIVIDUAL'S PERSONAL OR OUTSIDE INTERESTS CONFLICT WITH THOSE OF THE SYSTEM OR A CONSTITUENT ORGANIZATION (FOR EXAMPLE, BUT NOT LIMITED TO UNIVERSITY HEALTH SERVICES D/B/A UNIVERSITY HOSPITAL, UNIVERSITY EXTENDED CARE D/B/A KENTWOOD AND WESTWOOD, UNIVERSITY HEALTH, AND UNIVERSITY HEALTH RESOURCES). POSSIBLE CONFLICTS OF INTEREST CAN OCCUR IN THE FOLLOWING INSTANCES: A. FINANCIAL INVESTMENTS AND OWNERSHIP WHEN AN EMPLOYEE OR HIS/HER IMMEDIATE FAMILY HAS A MATERIAL FINANCIAL INVESTMENT OR OWNERSHIP INTEREST IN ANY ORGANIZATION OR INSTITUTION (A SOURCE) FROM WHICH THE SYSTEM PURCHASES GOOD OR SERVICES, WITH WHICH THE SYSTEM COMPETES IN THE PROVISION OF GOODS AND SERVICES, OR FOR WHICH THE SYSTEM PROVIDES GOODS OR SERVICES. AN INVESTMENT OR OWNERSHIP INTEREST WITH A VALUE OF $2,500.00 OR MORE IS PRESUMED MATERIAL; A SMALLER INTEREST MAY BE MATERIAL DEPENDING ON THE CIRCUMSTANCES. OWNERSHIP OF PUBLICLY TRADED STOCK IS NOT CONSIDERED A MATERIAL INTEREST UNLESS THE OWNER EXERCISES DISCRETIONARY AUTHORITY WITH RESPECT TO THE SYSTEM'S BUSINESS DEALING WITH THE COMPANY IN WHICH THE PERSON OWNS STOCK WORTH $5,000.00 OR MORE. NORMALLY, ONLY AN INDIVIDUAL AT OR ABOVE THE DEPARTMENT HEAD LEVEL WOULD BE IN A POSITION TO EXERCISE THE REQUISITE DISCRETIONARY AUTHORITY. B. CONSULTING AND MANAGEMENT SERVICES WHEN AN EMPLOYEE OR HIS/HER IMMEDIATE FAMILY PROVIDES MANAGERIAL, CONSULTATIVE, OR ADVISORY SERVICES TO ANY PERSON, ORGANIZATION, OR INSTITUTION (A SOURCE) FROM WHICH THE SYSTEM PURCHASES GOODS OR SERVICES, WITH WHICH THE SYSTEM COMPLETES IN THE PROVISION OF GOODS AND SERVICES, OR FOR WHICH THE SYSTEM PROVIDES GOODS OR SERVICES OTHER THAN THE INDIVIDUAL OR FAMILY HOSPITALIZATION AND OTHER PERSONAL MEDICAL CARE SERVICES. C. GIFTS WHEN A SYSTEM EMPLOYEE OR HIS/HER IMMEDIATE FAMILY ACCEPTS GIFTS, GRATUITIES, ENTERTAINMENT, OR FAVORS INCLUDING SEMINARS, FACTORY VISITS, OR SITE VISITS FROM A PERSON, ORGANIZATION, OR INSTITUTION (A SOURCE) FROM WHICH THE SYSTEM PURCHASES GOODS OR SERVICES, WITH WHICH THE SYSTEM COMPETES IN THE PROVISION OF GOODS OR SERVICES, OR FOR WHICH THE SYSTEM PROVIDES GOODS OR SERVICES OTHER THAN INDIVIDUAL OR FAMILY HOSPITALIZATION AND OTHER PERSONAL MEDICAL CARE SERVICES. THIS DOES NOT INCLUDE THE ACCEPTANCE OF ITEMS OF NOMINAL VALUE, WHICH COULD NOT BE CONSTRUED AS INTENDED TO INFLUENCE THE INDIVIDUAL IN THE PERFORMANCE OF HIS OR HER DUTIES. DISCLOSURE IS REQUIRED WITH RESPECT TO ANY SINGLE GIFT, GRATUITY, ENTERTAINMENT, OR FAVOR WHICH HAS A FAIR MARKET VALUE IN EXCESS OF $150.00 AND WITH RESPECT TO ALL SUCH ITEMS RECEIVED DURING ANY CALENDAR YEAR FROM A SINGLE SOURCE IF THE CUMULATIVE MARKET VALUE OF THOSE ITEMS EXCEEDS $250.00. DISCLOSURE IS NOT REQUIRED WITH RESPECT TO PARTICIPATION IN HOSPITAL-SPONSORED EVENTS, FOR EXAMPLE, WHEN SOMEONE, PAY'S AN EMPLOYEE'S PARTICIPATION FEE IN A HOSPITAL-SPONSORED EVENT LIKE THE JERNIGAN CANCER GOLF TOURNAMENT. ALL VENDOR FUNDED TRAVEL (INCLUDING SITE VISITS, FACTORY VISITS, AND SEMINARS) IS PROHIBITED. THIS PROHIBITION IS NOT APPLICABLE TO VENDOR FUNDED TRAVEL APPROVED BY THE CEO USING THE POTENTIAL CONFLICT OF INTEREST DISCLOSURE FORM, PURSUANT TO A HOSPITAL CONTRACT, OR FUNDED BY A GROUP PURCHASING ORGANIZATION IN WHICH THE HOSPITAL IS A MEMBER. D. EMPLOYMENT AND GIFTS WHEN AN EMPLOYEE HAS ANY OUTSIDE EMPLOYMENT THAT MIGHT INTERFERE WITH PERFORMANCE OF HIS OR HER UNIVERSITY JOB, EACH MANAGEMENT LEVEL EMPLOYEE MUST DISCLOSE ANY OUTSIDE EMPLOYMENT, INCLUDING SELF-EMPLOYMENT, WHICH HAS GENERATED OR IS REASONABLY EXPECTED TO GENERATE MORE THAN $10,000 IN GROSS INCOME DURING THE CALENDAR YEAR. INVESTMENT INCOME IS NOT CONSIDERED TO BE DERIVED FROM EMPLOYMENT. E. NON-PUBLIC INFORMATION WHEN AN EMPLOYEE IS IN A RELATIONSHIP (EITHER PERSONAL OR BUSINESS) IN WHICH HE/SHE WOULD GAIN PERSONAL ADVANTAGE BY DISCLOSURE OF NON-PUBLIC SYSTEM INFORMATION TO A PERSON, ORGANIZATION, OR INSTITUTION (A SOURCE) FROM WHICH THE SYSTEM PURCHASES GOODS OR SERVICES, WITH WHICH THE SYSTEM COMPETES IN THE PROVISION OF GOODS AND SERVICES, OR FOR WHICH THE SYSTEM PROVIDES OR COULD PROVIDE GOODS OR SERVICES OTHER THAN INDIVIDUAL OR FAMILY HOSPITALIZATION AND OTHER MEDICAL CARE SERVICES. F. HIRING PROCESS WHEN AN EMPLOYEE PARTICIPATING IN A HIRING PROCESS COULD GAIN A PERSONAL BENEFIT FROM THE HIRING DECISION. 2. ALL SYSTEM EMPLOYEES HAVE AN OBLIGATION TO DISCLOSE RELEVANT INFORMATION ABOUT POTENTIAL CONFLICTS OF INTEREST. ALL SYSTEM EMPLOYEES HAVE AN OBLIGATION TO AVOID ACTUAL CONFLICTS OF INTEREST. AVOIDING CONFLICTS OF INTEREST INCLUDES AVOIDING OR DISENGAGING FROM ACTIVITIES AND RELATIONSHIPS WHOSE APPEARANCE UNDERMINES CONFIDENCE IN THE INTEGRITY OF THE SYSTEM. 3. EMPLOYEES WHO FAIL TO DISCLOSE OR CONTINUE TO ENGAGE IN ACTIVITIES THAT HAVE BEEN DEEMED TO BE A CONFLICT OF INTEREST WILL BE SUBJECT TO DISCIPLINARY ACTION. 4. DEFINITIONS A. IMMEDIATE FAMILY MEANS ONE'S SPOUSE, ONE'S DESCENDANTS (CHILDREN, GRANDCHILDREN, ETC.) ONE'S SIBLINGS, THE SPOUSE OF ANY OF THE FORGOING, AND ONE'S PARENTS-IN-LAW. THIS POLICY DOES NOT OBLIGATE A SYSTEM EMPLOYEE TO MAKE ANY INQUIRIES CONCERNING THE ACTIVITIES OF AND OWNERSHIP INTERESTS OF HIS/HER IMMEDIATE FAMILY, BUT THE POLICY DOES REQUIRE A SYSTEM EMPLOYEE WHO IS AWARE OF OR SHOULD BE AWARE OF A POTENTIAL CONFLICT OF INTEREST THROUGH A FAMILY MEMBER TO REPORT THAT POTENTIAL CONFLICT. B. FAIR MARKET VALUE MEANS THE AMOUNT AT WHICH PARTICULAR GOODS OR SERVICES ARE SOLD TO THE GENERAL PUBLIC. C. SYSTEM MEAN THE UNIVERSITY HOSPITAL AND ALSO ANY OTHER ORGANIZATIONAL ELEMENT OF THE UNIVERSITY HEALTH, INC. FAMILY (E.G., UNIVERSITY EXTENDED CARE, INC.) OVER WHICH AN EMPLOYEE EXERCISES DISCRETIONARY AUTHORITY WITH RESPECT TO PURCHASES OR SALES OF GOODS OR SERVICES. D. SOURCE MEANS A PERSON, INSTITUTION OR ORGANIZATION FROM WHICH THE SYSTEM PURCHASES OR IS CONSIDERING PURCHASING GOODS OR SERVICES, WITH WHICH THE SYSTEM COMPETES IN THE PROVISION OF GOODS AND SERVICES, OR FOR WHICH THE SYSTEM PROVIDES GOODS OR SERVICES. SEPARATE BUSINESS ORGANIZATIONS AND OWNERS WHICH ARE PART OF THE SAME CORPORATE FAMILY ARE ONE SOURCE. THE VALUE OF ALL ENTERTAINMENT, GIFTS, ETC. RECEIVED FROM THE DIFFERENT MEMBERS OF ONE CORPORATE FAMILY MUST BE AGGREGATED FOR PURPOSES OF COMPLIANCE WITH THIS POLICY.
FORM 990, PART VI, SECTION B, LINE 15COMPENSATION REVIEW & APPROVAL PROCESS - OFFICERS & KEY EMPLOYEES THE ORGANIZATION FOLLOWS THE PROCESS DESCRIBED IN TREASURY REGULATION 53.4958-6(C) FOR ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS IN THE REVIEW, APPROVAL, AND DOCUMENTATION OF OFFICER, KEY MANAGEMENT, AND DIRECTOR COMPENSATION. ANNUALLY, A COMPENSATION COMMITTEE OF THE UNIVERSITY HEALTH SERVICES BOARD, COMPRISED OF THREE INDEPENDENT BOARD MEMBERS, REVIEWS THE COMPENSATION OF THE CEO AND OTHER SENIOR MANAGEMENT MEMBERS. THE REVIEW IS CONDUCTED IN THE CONTEXT OF A BOARD APPROVED EXECUTIVE COMPENSATION PHILOSOPHY. BOTH THE DEVELOPMENT OF THE COMPENSATION PHILOSOPHY AND THE REVIEW INVOLVE THE ADVICE AND ASSISTANCE OF AN INDEPENDENT COMPENSATION CONSULTING FIRM. MINUTES OF THE COMPENSATION COMMITTEE ARE RECORDED. THE COMPENSATION COMMITTEE REPORTS TO THE UNIVERSITY HEALTH SERVICES BOARD EXECUTIVE COMMITTEE. ALL OF THE STAFF OF UNIVERSITY HEALTH CARE FOUNDATION ARE EMPLOYED AND THEREFORE PAID BY UNIVERSITY HEALTH SERVICES, INC. SINCE ALL STAFF MEMBERS ARE EMPLOYED BY UNIVERSITY HEALTH SERVICES, INC., UNIVERSITY HEALTH CARE FOUNDATION COMPLIES WITH THE ABOVE MENTIONED PROCEDURE.
FORM 990, PART VI, SECTION C, LINE 19ALL GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS, AND INFORMATIONAL RETURNS ARE AVAILABLE UPON REQUEST. THE FORM 990 IS ALSO AVAILBALE ON WWW.GUIDESTAR.ORG.
FORM 990, PART XI, LINE 9:EQUITY TRANSFER FROM UHS 663,419.
FORM 990, PART XII, LINE 2C:THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
UNIVERSITY HEALTH INC
1350 WALTON WAYAUGUSTAGA30901581581102CONSOLIDATING PARENTGA501(C)(3)LINE 10N/A0
RICHMOND COUNTY HOSPITAL AUTHORITY
1350 WALTON WAYAUGUSTAGA30901586001901LEASED FACILITIESGA501(C)(3)LINE 3N/A0
AUGUSTA RESOURCE CENTER ON AGING
1350 WALTON WAYAUGUSTAGA30901581728812NONPROFIT LIFE CARE COMMUNITYGA501(C)(3)LINE 100UNIVERSITY HEALTH INC
UNIVERSITY EXTENDED CARE INC
1350 WALTON WAYAUGUSTAGA30901581581105SKILLED NURSING FACILITIESGA501(C)(3)LINE 30UNIVERSITY HEALTH INC
UNIVERSITY HEALTH SERVICES INC
1350 WALTON WAYAUGUSTAGA30901581581103HOSPITALGA501(C)(3)LINE 30UNIVERSITY HEALTH INC
UNIVERSITY MCDUFFIE COUNTY REGIONAL
1350 WALTON WAYAUGUSTAGA30901454166209HOSPITALGA501(C)(3)LINE 30UNIVERSITY HEALTH INC

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
UNIVERSITY HEALTH RESOURCES INC
1350 WALTON WAYAUGUSTAGA30901581601372SERVICES TO PHYSICIAN PRACTICESGAUNIVERSITY HEALTH INCC0
UNIVERSITY HOSPITAL AIKEN INC
1350 WALTON WAYAUGUSTAGA30901472713774HOSPITALSCUNIVERSITY HEALTH INCC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.