2021-11-15T08:30:46-06:00 2020-12-31 570381582 ELLIOTT DAVIS LLCPLLC ONE 10TH STREET SUITE 400 AUGUSTA GA 30901 990 2020-01-01 454166209 UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER INC UNIV 7067747710 1350 WALTON WAY AUGUSTA GA 30901 DAVID BELKOSKI CFO 7067747710 2021-11-11 1 DAVID BELKOSKI 999009999 JESSICA C CAIN P01276209 7067229090 2021-11-08 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z UNIVERSITY HOSPITAL MCDUFFIE JAMES R DAVIS 1350 WALTON WAY AUGUSTA GA 30901 25950525 0 X WWW.UNIVERSITYHEALTH.ORG X 2012 GA THE MISSION OF THE UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC. IS TO PROVIDE HEALTH CARE SERVICES WITH THE HELP OF OUR COMMUNITIES AND PARTNERS, AND ENRICH THE LIVES WE TOUCH BY PROVIDING COMPASSIONATE QUALITY CARE IN A COST EFFECTIVE MANNER. WE STRIVE TO BE UTILIZED AS THE HEALTHCARE PARTNER OF CHOICE FOR THE COMMUNITIES WE SERVE. 5 2 202 22 0 0 0 1991134 25432540 23951880 586 610 223090 6901 25656216 25950525 0 0 0 0 7413027 7473243 0 0 0 16349980 16192240 23763007 23665483 1893209 2285042 42096335 50983222 31077279 37679124 11019056 13304098 X THE MISSION OF THE UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC. IS TO PROVIDE HEALTH CARE SERVICES WITH THE HELP OF OUR COMMUNITIES AND PARTNERS, AND ENRICH THE LIVES WE TOUCH BY PROVIDING COMPASSIONATE QUALITY CARE IN A COST EFFECTIVE MANNER. WE STRIVE TO BE UTILIZED AS THE HEALTHCARE PARTNER OF CHOICE FOR THE COMMUNITIES WE SERVE. 0 0 22005688 25949915 UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER (UHM), A 25 BED FACILITY, CARRIED OUT MEDICAL-RELATED SERVICES TO THE COMMUNITY AND CONDUCTED HEALTH EDUCATION COURSES AND HEALTH FAIRS, PROVIDED EDUCATION LITERATURE AND SPONSORED ILLNESS SUPPORT GROUPS. STAFF MEMBERS SERVE ON A VARIETY OF BOARDS AND ARE INVOLVED IN CIVIC ENDEAVORS THAT PROMOTE HEALTH AND WELLNESS. UHM PROVIDED MEDICATION AND TRANSPORTATION TO AND FROM THE HOSPITAL FOR THOSE WHO ARE UNABLE TO PAY. UNCOMPENSATED CARE WAS PROVIDED AS WELL AS IN INDIGENT AND CHARITY CARE. A HOSPITAL BASED PROGRAM ASSISTANCE COUNSELOR IS PROVIDED AT THE HOSPITAL'S EXPENSE IN ORDER TO ASSIST PATIENTS WITH QUALIFYING FOR MEDICARE DISABILITY, MEDICAID, SSI OR OTHER GOVERNMENT FINANCIAL ASSISTANCE PROGRAMS. FOR 2020, THE HOSPITAL HAD A TOTAL OF 1,674 PATIENT DAYS. 158 OF THESE PATIENT DAYS WERE FOR INDIGENT PATIENTS. SWING BEDS WERE 2,714. OBSERVATION STAYS WERE 622 DAYS. OUTPATIENT VISITS WERE 30,266. OF THE TOTAL OUTPATIENT VISITS, 15,166 WERE FOR EMERGENCY CARE. WITHIN THESE INDICATORS ARE THE EFFORTS OF UNIVERSITY HOSPITAL MCDUFFIE TO SERVICE THE NEEDS OF THE COMMUNITY, WHICH INCLUDE THE INDIGENT. IN 2020 THE COST OF INDIGENT AND CHARITY CARE PROVIDED ALONG WITH MEDICAID SHORTFALLS WAS $3,001,650. THE HOSPITAL RECEIVED DISPROPORTIONATE SHARE (DSH) FUNDS OF $1,124,247 AND UPPER PAYMENT LIMIT (UPL) FUNDS OF $155,979 TO HELP OFFSET THESE COSTS. 22005688 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 17 0 202 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 2 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 GA X X DAVID A BELKOSKI CFO 7067747710 1350 WALTON WAY AUGUSTA GA 30901 X WILLIAM P DOUPE CHAIRMAN 2.00 X 0 0 0 ROBIN S DUDLEY DIRECTOR 2.00 X 0 0 0 JOHN BIELTZ DO DIRECTOR 2.00 50.00 X 19500 471886 21959 JAMES R DAVIS UHCS CEO 2.00 50.00 X X 0 979002 435454 EDWARD L BURR LEGAL ADVISOR 2.00 50.00 X X 0 690965 24697 DAVID A BELKOSKI UHCS & UHM CFO 2.00 50.00 X 0 665796 11053 WILLIAM L FARR JR CMO 2.00 50.00 X 0 532459 24500 ELIZABETH R GALLUP COO ACUTE CARE SERVICES 2.00 50.00 X 0 602282 24622 ROBERT J KEPSHIRE ADMINISTRATIVE CNO 50.00 X 0 200897 11062 DANITA T KISER NURSE DIRECTOR MED/SERG ED 50.00 X 122832 0 18125 MARCIA V RODGERS PHARMACY MANAGER 50.00 X 126468 0 12508 SHELIA M PRINCE NURSE MANAGER 50.00 X 105692 0 11183 374492 4143287 595163 3 0 1 0 CROTHALL HEALTHCARE 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 HOUSEKEEPING SERVICES 680032 AEGIS THERAPIES INC PO BOX 936653 ATLANTA GA 311936653 THERAPY SERVICES 377778 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 30368 FOOD SERVICES 347557 AMS 28 NORTH PALAFOX STREET PENSACOLA FL 32502 ANESTHESIA SERVICES 157419 SIEMENS HEALTHCARE DIAGNOSTICS PO BOX 121102 DALLAS TX 753121102 MAINTENANCE 123466 5 1991134 1991134 PATIENT SERVICE REVENUE 621990 23951880 23951880 23951880 610 0 610 610 610 MISCELLANEOUS 900099 6901 6901 6901 25950525 23958781 0 610 X 5621312 5443679 177633 57505 55688 1817 1337901 1295623 42278 456525 442099 14426 2566865 2566865 211157 211157 6660 6660 2809554 2720772 88782 3927 3927 8187 7928 259 150514 145758 4756 309412 299635 9777 1006 974 32 743802 743802 1339747 1297411 42336 189766 183769 5997 BAD DEBT 3489751 3489751 MED/SURG SUPPLIES 2925710 2925710 REPAIRS & MAINTENANCE 835807 809395 26412 TAXES 269282 269282 331093 320631 10462 23665483 22005688 1659795 0 3403163 17569075 4900853 4749565 478508 482382 237255 192657 39021700 13388302 26368051 25633398 6708505 2356145 42096335 50983222 4238117 11441594 25501437 24481380 1337725 1756150 31077279 37679124 X 11019056 13304098 11019056 13304098 42096335 50983222 2285042 0 X X 0 1 X 1 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6660 6660 0 PART II-B, LINE 1: DESCRIPTION OF LOBBYING ACTIVITY A PART OF VARIOUS ASSOCIATION DUES INCLUDE A PERCENTAGE ALLOCATION FOR EXPENDITURES ON LOBBYING ACTIVITIES. DUES PAID TO THE GEORGIA ALLIANCE OF COMMUNITY HOSPITALS AND THE AMERICAN HOSPITAL ASSOCIATION HAVE A LOBBY COMPONENT. FOR 2020 THESE FEES AMOUNTED TO $6,660. 1683198 1683198 25605654 3878456 21727198 646378 473428 172950 11039328 9036418 2002910 47142 47142 25633398 LONG-TERM CAPITAL LEASE OBLIGATION 152650 DUE TO UNIVERSITY MEDICAL GROUP 1603500 1756150 X PART X, LINE 2: FIN 48 FOOTNOTE ACCOUNTING FOR INCOME TAXES- UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC. 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 MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC. HAS EVALUATED THEIR TAX POSITION AND DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2020. 1 1 1 X 1 X 1 1 1 0 1 1 2077881 793993 1283888 0.06360 2525645 1640982 884663 0.04380 15567 11715 3852 0.00020 4619093 2446690 2172403 0.10770 4619093 2446690 2172403 0.10770 5160 5160 0.00030 5160 5160 0.00030 1 3489751 69795 4484716 4536930 -52214 X 1 1 1 1 UNIVERSITY MCDUFFIE REGIONAL MEDICAL CENTER DBA UHM 2460 WASHINGTON ROAD NE THOMSON GA 30824 WWW.UNIVERSITYHEALTHCARE.ORG 097-107 X X X SWING-BED CERTIFIED BY MEDICARE 11/15/15 UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDI 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X WWW.UNIVERSITYHEALTH.ORG X X 1 19 1 WWW.UNIVERSITYHEALTH.ORG 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X SEE SCHEDULE H SUPPLEMENTAL INFO X SEE SCHEDULE H SUPPLEMENTAL INFO X SEE SCHEDULE H SUPPLEMENTAL INFO X X X X X X 1 X 0 X X X X 0 X X 0 0 UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: SEE PAGE 8 OF THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT LISTENING SESSIONS WERE HELD IN MCDUFFIE, WARREN, LINCOLN AND COLUMBIA COUNTIES. THOSE AGENCIES WHO PARTICIPATED IN THE SESSIONS ARE: UGA ARCHWAY PARTNERSHIP, CRAWFORD & BREAZEALE DRUG, MCDUFFIE COUNTY HEALTH DEPARTMENT, FAMILY CARE GROUP OF THOMSON, THOMSON DENTAL WELLNESS, FAMILY CONNECTION OF WARREN COUNTY, WARREN COUNTY EXTENSION, LINCOLN COUNTY COMMISSION, LINCOLN COUNTY HEALTH DEPARTMENT, LINCOLN COUNTY OFFICE OF EMERGENCY SERVICES, CITY OF HARLEM, COLUMBIA COUNTY COMMUNITY CONNECTIONS, COLUMBIA COUNTY HEALTH DEPARTMENT, HARLEM MERCHANT'S ASSOCIATION, HOPE HOUSE. THESE AGENCIES REPRESENT THE CITIZENS OF MCDUFFIE WARREN, LINCOLN AND COLUMBIA COUNTIES INCLUDING THE ELDERLY, INDIVIDUALS LIVING IN POVERTY, AS WELL AS THOSE FACING FOOD INSECURITY, MENTAL HEALTH ISSUES OR ADDICTION. THOSE WHO WERE INVITED BUT DID NOT ATTEND WERE FROM THE FOLLOWING ORGANIZATIONS: THOMSON FAMILY YMCA, PARTNERS FOR SUCCESS, SHAW, WARREN COUNTY SENIOR CENTER, HOMETOWN WARRENTON, COMMUNITY HEALTH CARE SYSTEMS, COMMUNITY MEDICAL ASSOCIATES, LINCOLNTON FAMILY DENTISTRY, LINCOLNTON FAMILY MEDICINE, COLUMBIA COUNTY COMMISSION, THE ALZHEIMER'S ASSOCIATION AND CITY OF GROVETOWN. REPRESENTATIVES FROM THESE ORGANIZATIONS WERE SENT AN EMAIL WITH THE LIST OF QUESTIONS FROM THE LISTENING SESSION AND INVITED TO PROVIDE FEEDBACK. UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 7D: CHNA MADE AVAILABLE UPON REQUEST UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: SEE IMPLEMENTATION STRATEGY PAGES 3-6 1. LEVERAGE MOBILE PLATFORM TO BRING CARDIOVASCULAR DISEASE SCREENING TO THE COMMUNITY. 2. DEVELOP A DIABETES PREVENTION PROGRAM TO EDUCATE AND ENCOURAGE DIABETICS ABOUT NUTRITION AND PHYSICAL ACTIVITY 3. TEACH EXPECTANT MOTHERS TO RECOGNIZE LIFE THREATENING POST-PARTUM WARNING SIGNS OUR PRIORITIZATION PROCESS IS DETAILED ON PAGE 33. WE CHOSE TO FOCUS ON 3 TOP PRIORITIES WHERE WE FELT WE COULD MAKE THE GREATEST IMPACT. OUR PRIORITIZATION PROCESS IS DETAILED ON PAGE 33. WE CHOSE TO FOCUS ON 3 TOP PRIORITIES WHERE WE FELT WE COULD MAKE THE GREATEST IMPACT. ON PAGE 33 OF THE CHNA, WE IDENTIFY OUR 3 PRIORITIES. THOSE THREE PRIORITIES CORRESPOND TO THE RESULTS OF THE NOMINAL GROUP PROCESS. EMBEDDED IN PRIORITY #1 AND PRIORITY #2 ARE THE TOP FOUR VOTE GETTING ITEMS "HEART DISEASE AND STROKE AS IT PERTAINS TO ACCESS AND "DIABETES AS IT PERTAINS TO NUTRITION, PHYSICAL ACTIVITY, AND WEIGHT STATUS". WE PUT A LIST OF CATEGORIES IN FRONT OF THE NOMINAL GROUP PROCESS. ONE OF THEM WAS CHRONIC KIDNEY DISEASES, BUT IT'S PRETTY CLEARLY A LOW PRIORITY. BEING A CATEGORY DOESN'T MAKE IT A PRIORITY, THE GROUP DISCUSSING THE CATEGORIES CHOOSE WHAT THEY BELIEVE ARE THE PRIORITIES AND WE ADDRESSED WHAT WE PRIORITIZED. UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 16J: WWW.UNIVERSITYHEALTH.ORG/OUR-LOCATIONS/UNIVERSITY-HOSPITAL-MCDUFFIE/PATIENT-INFORMATION/INDEGENT-AND-CHARITY-CARE UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 21D: FAP INCLUDED ER MEDICAL CARE CONDITIONS. IN ADDITION, UHM FOLLOWS EMTALA REGULATIONS. PART V, LINE 16A, FAP WEBSITE: HTTPS://WWW.UNIVERSITYHEALTH.ORG/OUR-LOCATIONS/UNIVERSITY-HOSPITAL-MCDUFFIE/PATIENT-INFORMATION/INDIGENT-CHARITY-CARE PART I, LINE 3C: MAY USE BOTH FPG AND ASSET TEST PART I, LINE 7: EXPLANATION OF COSTING METHODOLOGYUSED COST TO CHARGE RATIO CALCULATED USING WORKSHEET 2 --THE OPTIONAL WORKSHEETS PROVIDED TO ASSIST IN PREPARATION OF SCHEDULE H. PART II, COMMUNITY BUILDING ACTIVITIES: THE COMMUNITY BUILDING ACTIVITIES REPORTED ARE SUPPORT FOR THE VARIOUS CHAMBERS OF COMMERCE FOR THE COMMUNITIES THAT UHM SERVES. IN SUPPORTING THESE ORGANIZATIONS, UHM CAN SUPPORT THE DEVELOPMENT OF OUR COMMUNITY BY BRINGING IN NEW INDUSTRIES, AND JOBS, INCREASING THE AVERAGE HOUSEHOLD INCOME, IMPROVING LIVING CONDITIONS, AND IMPACTING OVERALL GENERAL HEALTH. PART III, LINE 2: FOR RECEIVABLES ASSOCIATED WITH SELFPAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), UH RECORDS PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. RECOVERIES OF ACCOUNTS PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION TO THE PROVISION FOR BAD DEBT EXPENSE WHEN RECEIVED. PART III, LINE 3: BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT SINCE THE SERVICES THAT INCUR BAD DEBT ARE PROVIDED BY THE HOSPITAL TO PROMOTE THE WELL-BEING OF THE COMMUNITY. THESE SERVICES ARE RENDERED IN CONJUNCTION WITH THE HOSPITAL'S CHARITABLE TAX-EXEMPT PURPOSES. THERE IS NO LOCAL SUPPORT FOR UNINSURED PATIENTS; THEREFORE, THE SERVICES PROVIDED BY THE HOSPITAL RELIEVE THE HEALTH CARE BURDENS OF THE LOCAL GOVERNMENTS. PART III, LINE 4: BAD DEBT EXPENSEPAGE 10- 12 OF AUDITED FINANCIAL STATEMENT FOR UNIVERSITY HEALTH, INC. PART III, LINE 8: EXPLANATION OF SHORTFALL AS COMMUNITY BENEFITTHE SERVICES PROVIDED TO THE MEDICARE BENEFICIARIES ARE TO PROMOTE THE WELL-BEING OF THE COMMUNITY WHICH IS PART OF THE HOSPITAL'S CHARITABLE TAX-EXEMPT PURPOSE. THE MEDICARE DIFFERENCE BETWEEN COST AND MEDICARE REIMBURSEMENT SHOULD BE ALLOWED AS COMMUNITY BENEFIT SINCE PROVIDERS CANNOT NEGOTIATE RATES WITH CENTERS FOR MEDICARE/MEDICAID SERVICES (CMS). CMS REGULATES THAT THE REIMBURSEMENT BE FEDERAL BUDGET NEUTRAL THUS PLACING THE COST OF THE CARING FOR MEDICARE BENEFICIARIES AS A COST TO THE HOSPITALS. PART III, LINE 9B: PROVISIONS ON COLLECTION PRACTICES FOR QUALIFIED PATIENTSAS OUTSTANDING BALANCES AGE, STATEMENT MESSAGES, COLLECTION LETTERS AND/OR TELEPHONE CALLS MAY BE USED AT APPROPRIATE INTERVALS DETERMINED BY THE PATIENT ACCOUNTING/COLLECTION DEPARTMENT. THE PATIENT ACCOUNTING/COLLECTION DEPARTMENT RECOGNIZES THAT THERE ARE OCCASIONS WHEN A PATIENT IS NOT FINANCIALLY ABLE TO PAY HIS OR HER MEDICAL BILL IN FULL AND/OR THE PATIENT IS EXPERIENCING FINANCIAL HARDSHIP. THE HOSPITAL HAS ESTABLISHED A CATASTROPHIC POLICY WHICH ALLOWS FOR THE COLLECTION DEPARTMENT TO APPLY THE INDIGENT CRITERIA AND WRITE-OFF AS MEDICALLY INDIGENT. AND AT ANY POINT DURING THE COLLECTION PROCESS IF A PATIENT STATES OR PATIENT ACCOUNTING/COLLECTIONS BELIEVES THAT THE PATIENT CANNOT AFFORD TO PAY, THEN AN INDIGENT/CHARITY CARE APPLICATION IS BEGUN BY THE COLLECTION DEPARTMENT WHERE DISCOUNTS MAY BE GIVEN. PART VI, LINE 2: NEEDS ASSESSMENTUHM WORKS WITH ER PERSONNEL AND AREA HEALTH DEPARTMENT DIRECTOR TO IDENTIFY NEEDS BASED ON PATIENTS SEEKING HELP THROUGH THE EMERGENCY ROOM AND HEALTH DEPARTMENT. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEREGISTRARS INFORM PATIENT OF FINANCIAL ASSISTANCE PROGRAMS. ALSO, THERE ARE SIGNS POSTED IN ER AND REGISTRATION AREAS WHICH DENOTE THE AVAILABILITY OF ASSISTANCE WITH HOSPITAL BILLS. IN ADDITION, UHM UTILIZES THE SERVICES OF RCA (RESOURCE CENTER OF AMERICA) WHICH AIDS PATIENTS IN GETTING CERTIFIED FOR SSI AND MEDICAID. PART VI, LINE 4: SEE COMMUNITY NEEDS ASSESSMENT PAGES 5-7MCDUFFIE COUNTY IS A COUNTY LOCATED IN THE U.S. STATE OF GEORGIA. AS OF THE 2014 CENSUS, THE POPULATION WAS 21,400.[1] THE COUNTY SEAT IS THOMSON.[2] THE COUNTY WAS CREATED ON OCTOBER 18, 1870[3] AND NAMED AFTER THE SOUTH CAROLINA GOVERNOR AND SENATOR GEORGE MCDUFFIE. MCDUFFIE COUNTY IS PART OF THE AUGUSTA-RICHMOND COUNTY, GA-SC METROPOLITAN STATISTICAL AREA. ALSO MCDUFFIE IS IN THE CMS -CORE BUSINESS STATISTICAL AREA FOR WAGE INDEX CALCULATIONS. THE % OF POPULATION THAT IS UNDER 18 YEARS IS 25%; AGE 18-64 IS 61%; OVER 65 IS 14%. THE RACE/ETHNICITY IS MADE UP OF 42% BLACK; 53% WHITE AND HISPANIC IS 3%. PART VI, LINE 5: COLLABORATION WITH/SUPPORT OF COMMUNITY ORGANIZATIONS THROUGH SEVERAL SURROUNDING CHAMBERS OF COMMERCE. - SEE PART II ABOVE.SEE PAGE 8 OF THE CHNA FOR THE LIST OF AGENCIES THAT UNIVERSITY HOSPITAL MCDUFFIE WORKS WITH TO SUPPORT AND PROMOTE HEALTH IN OUR COMMUNITY. PART VI, LINE 6: UHM GOVERNING BOARD MEMBERS ARE COMPRISED OF CITZENS WHO RESIDE IN THE UHM'S PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF UHM. UHM BOARD MEMBERS ARE ACTIVE IN THE COMMUNITY AND ARE EAGER TO IMPROVE THE HEALTH AND WELFARE OF THE COMMUNITY. UHM EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN OUR COMMUNITY FOR ALL OF THE UH DEPARTMENTS. UHM AND UHS COLLABORATE ON HEALTH FAIRS AND SCREENINGS PART VI, LINE 7, REPORTS FILED WITH STATES GA X 1 1 X X X X X 0 1 0 0 0 0 1 0 0 JAMES R DAVIS UHCS CEO 0 805317 0 144200 0 29485 0 418619 0 16835 0 1414456 0 0 EDWARD L BURR LEGAL ADVISOR 0 418171 0 73500 0 199294 0 7643 0 17054 0 715662 0 0 DAVID A BELKOSKI UHCS & UHM CFO 0 480920 0 97606 0 87270 0 0 0 11053 0 676849 0 0 ELIZABETH R GALLUP COO ACUTE CARE SERVICES 0 454176 0 81671 0 66435 0 7338 0 17284 0 626904 0 0 WILLIAM L FARR JR CMO 0 403963 0 79310 0 49186 0 7296 0 17204 0 556959 0 0 JOHN BIELTZ DO DIRECTOR 19500 438248 0 7500 0 26138 0 8400 0 13559 19500 493845 0 0 ROBERT J KEPSHIRE ADMINISTRATIVE CNO 0 182269 0 16414 0 2214 0 3231 0 7831 0 211959 0 0 PART I, LINE 1A SOCIAL CLUB DUES- THE RELATED ORGANIZATION PAYS MEMBERSHIP FEES FOR THE CEO (JAMES DAVIS) TO SAGE VALLEY AND THE AUGUSTA COUNTRY CLUB. THESE MEMBERSHIP FEES ARE PAID SO THE ORGANIZATION CAN HAVE ACCESS TO THE MEETING FACILITIES AND CATERING SERVICES THESE ORGANIZATIONS PROVIDE FOR MEETINGS THAT ARE HELD OFF CAMPUS. ANY PERSONAL USE, RELATED TO THESE MEMBERSHIPS, IS REIMBURSED BY THE CEO. PART I, LINE 4B JAMES R. DAVIS - SERP - $410,069 DAVID BELKOSKI - ROTH IUL - $65,475 ELIZABETH R GALLUP - ROTH IUL - $43,500 WILLIAM L FARR JR - CAA BENEFITS - $41,600 EDWARD L BURR - CAA BENEFITS - $192,689 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, WITH THE EXCEPTION OF THE SERP FOR JAMES R. DAVIS. PART I, LINE 6 THE 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 2020 THESE INITIATIVES WERE WEIGHTED AS DISPLAYED IN THE FOLLOWING SCHEDULE: UNIVERSITY HEALTH SERVICES, INC 2020 STRATEGIC INITIATIVES WEIGHT QUALITY 25% ACHIEVE NRC OVERALL RATING OF CARE RAW SCORE 25% MINIMIZE HOSPITAL ACQUIRED CONDITIONS PER 1,000 MEDICARE DISCHARGES GROWTH 10% INCREASE GROSS CHARGES FROM AIKEN AND COLUMBIA COUNTIES OVER 2019 LEVELS PEOPLE 10% ACHIEVE RN TURNOVER RATE FOR UH AFFORDABILITY 25% ACHIEVE OPERATING MARGIN FOR UNIVERSITY HEALTH, INC 5% IMPROVE THE ALL-MEDICARE OPERATING MARGIN LOSS 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. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS A 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 12C EXPLANATION OF MONITORING AND ENFORCEMENT CONFLICTS DUTY TO DISCLOSE: IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION ARRANGEMENT. DETERMINING WHETHER A CONFLICT EXISTS: AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, THE INTERESTED PERSON WILL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE GOVERNING BOARD OR COMMITTEE DISCUSSES AND VOTES ON A DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS. THE REMAINING BOARD OR COMMITTEE MEMBERS WILL DECIDE IF A CONFLICT OF INTEREST EXISTS. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST: AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING BUT, AFTER THE PRESENTATION, SUCH INTERESTED PERSON WILL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. THE CHAIRPERSON OR THE GOVERNING BOARD OR COMMITTEE WILL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE WILL DETERMINE WHETHER THE CORPORATION CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE WILL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IS IT FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, IT WILL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. VIOLATION OF THE CONFLICT OF INTEREST POLICY: IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER OF SUCH BOARD OR COMMITTEE HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT WILL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE MEMBER'S RESPONSE AND MAKING FURTHER INVESTIGATIONS AS WARRANTED BY THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT WILL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION 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. THE CEO AND CFO ARE PAID BY UNIVERSITY HEALTH SERVICES, INC. (58-1581103). ANNUALLY, A COMPENSATION COMMITTEE OF THE UNIVERSITY HEALTH SERVICES (UHS), 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 REVIEWS INVOLVE THE ADVICE AND ASSISTANCE OF AN INDEPENDENT COMPENSATION CONSULTING FIRM. MINUTES OF THE COMPENSATION COMMITTEE ARE RECORDED. THE COMPENSATION COMMITTEE REPORTS TO THE UHS BOARD EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE THE IRS FORM 990 IS ALSO AVAILABLE ON WWW.GUIDESTAR.ORG FORM 990, PART VII: COMPENSATION EXPLAINED JAMES R. DAVIS COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES, INC. (58-1581103) DAVID A. BELKOSKI COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES, INC. (58-1581103) ELIZABETH R. GALLUP COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES, INC. (58-1581103) WILLIAM L. FARR JR. COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES, INC. (58-1581103) EDWARD L. BURR COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES, INC. (58-1581103) JOHN BIELTZ COMPENSATION PAID BY UNIVERSITY MEDICAL GROUP, LLC. (27-4467379) FORM 990, PART IX, LINE 11G PHYSICIAN: PROGRAM SERVICE EXPENSES 583,045. MANAGEMENT AND GENERAL EXPENSES 19,025. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 602,070. PHYSICIANS-ON CALL: PROGRAM SERVICE EXPENSES 52,294. MANAGEMENT AND GENERAL EXPENSES 1,706. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,000. BANKING FEES: PROGRAM SERVICE EXPENSES 24,813. MANAGEMENT AND GENERAL EXPENSES 810. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,623. CONSULTING FEES: PROGRAM SERVICE EXPENSES 53,363. MANAGEMENT AND GENERAL EXPENSES 1,741. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 55,104. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,952,414. MANAGEMENT AND GENERAL EXPENSES 63,709. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,016,123. PURCHASED SERVICES - OTHER: PROGRAM SERVICE EXPENSES 28,845. MANAGEMENT AND GENERAL EXPENSES 941. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,786. DUES & MEMBERSHIPS: PROGRAM SERVICE EXPENSES 9,582. MANAGEMENT AND GENERAL EXPENSES 313. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,895. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 6,733. MANAGEMENT AND GENERAL EXPENSES 220. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,953. PERSONNEL RECRUITMENT: PROGRAM SERVICE EXPENSES 9,683. MANAGEMENT AND GENERAL EXPENSES 317. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,000. RICHMOND COUNTY HOSPITAL AUTHORITY 1350 WALTON WAY AUGUSTA GA 30901 586001901 LEASED FACILITIES GA 501(C)(3) LINE 3 N/A 0 UNIVERSITY HEALTH SERVICES INC 1350 WALTON WAY AUGUSTA GA 30901 581581103 HOSPITAL GA 501(C)(3) LINE 3 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH CARE FOUNDATION 2260 WRIGHTSBORO ROAD AUGUSTA GA 30904 581343550 PHILANTHROPY GA 501(C)(3) LINE 7 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH INC 1350 WALTON WAY AUGUSTA GA 30901 581581102 CONSOLIDATING PARENT GA 501(C)(3) LINE 11 N/A 0 AUGUSTA RESOURCE CENTER ON AGING INC 1350 WALTON WAY AUGUSTA GA 30901 581728812 NONPROFIT LIFE CARE COMMUNITY GA 501(C)(3) LINE 11 UNIVERSITY HEALTH INC 0 UNIVERSITY EXTENDED CARE INC 1350 WALTON WAY AUGUSTA GA 30901 581581105 SKILLED NURSING HOME GA 501(C)(3) LINE 3 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH RESOURCES I 1350 WALTON WAY AUGUSTA GA 30901 581601372 SVCS TO PHY GA UNIVERSITY HEALTH INC C 0 UNIVERSITY HOSPITAL OF AIKEN INC 1350 WALTON WAY AUGUSTA GA 30901 472713774 HOSPITAL SC UNIVERSITY HEALTH INC C 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0