2020-03-03T09:54:12-06:00 2019-06-30 BKD LLP 14241 DALLAS PARKWAY STE 1100 DALLAS TX 75254 990 2018-07-01 720995809 Union General Hospital % WILLIAM ADCOCK UNIO 3183689751 PO Box 398 Farmerville LA 71241 WILLIAM ADCOCK CFO 3183687096 2020-05-15 true Jeanette Verrelli P00742631 9727028262 167.68.126.162 70234720200635000000 2020-03-03 P BC2C8F7F1C2AD12471C74E6F8C925013EDB3E05D EB976710118F518B8933A72D91D1D85239D99EDA 2018 2020-09-23 17:36:50Z EVALYN ORMOND PO BOX 398 FARMERVILLE LA 71241 14974599 false X WWW.UNIONGEN.ORG X 1983 LA TO PROVIDE ACUTE CARE HOSPITAL services IN THE FARMERVILLE AREA. IT IS OUR GOAL TO DELIVER THE BEST POSSIBLE HEALTH CARE AVAILABLE AND SERVE THE DEDICATED PEOPLE OF...(SEE SCH.O) 7 7 163 7 0 0 486340 497507 16208826 14300376 26361 93945 75946 82771 16797473 14974599 98881 90832 0 0 6259100 6761597 0 0 0 8574944 7591207 14932925 14443636 1864548 530963 14518273 15133067 1072188 1156019 13446085 13977048 IT IS THE MISSION OF UNION GENERAL HOSPITAL TO PROVIDE QUALITY SERVICE WITH COMPASSIONATE CARE. false false 11451668 90832 14344473 PROVIDED ACUTE CARE HOSPITAL SERVICES TO INDIVIDUALS IN THE FARMERVILLE AREA; INDIVIDUALS SERVED AMOUNTED TO 1,967 PATIENT DAYSAND 7,023 EMERGENCY ROOM VISITS. THE LABORATORY PERFORMED 46,100 TESTS AND 34,011 ECG, RADIOLOGY, ULTRASOUND, CT, OT, RT, ST, AND PTPROCEDURES WERE PERFORMED. THE RURAL HEALTH CLINIC LOGGED 8,467 VISITS. 11451668 true true false true false false false false false false true false false true true false true false false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false true 113 0 163 true false false false false false false false false false false false false X 7 7 false false false false false false false true true false false true true true true true true true true false X X WILLIAM ADCOCK 3183687096 901 JAMES AVE FARMERVILLE LA 71241 X ALLYSON CROW DIRECTOR 1.0 0.0 X 0 0 0 BESSIE WARREN SECRETARY 1.0 0.0 X X 0 0 0 DANIEL HUNTER JR VICE PRESIDENT 1.0 0.0 X X 0 0 0 DANNY SMITH DIRECTOR 1.0 0.0 X 0 0 0 RALPH KELLEY DIRECTOR 1.0 0.0 X 0 0 0 TIM TETTLETON PRESIDENT 1.0 0.0 X X 0 0 0 CHRISTY FINE DIRECTOR 1.0 0.0 X 0 0 0 JOHN ELLIS DIRECTOR END: SEP 2018 1.0 0.0 X 0 0 0 DARRA JUNG DIRECTOR OF NURSING 40.0 0.0 X 126419 0 8558 DIANNE DAVIDSON COO 40.0 0.0 X 110029 0 8669 EVALYN ORMOND CEO 40.0 0.0 X 169284 0 11528 WILLIAM ADCOCK CFO 40.0 0.0 X 212617 0 21466 SHEREE HICKS PHARMACY director 40.0 0.0 X 166537 0 20395 LYNETTE WADE Nurse practitioner 40.0 0.0 X 132475 0 27131 CONNIE GINN E/R DIRECTOR 40.0 0.0 X 120827 0 12820 1038188 0 110567 7 false true false OMEGA DIAGNOSTICS 3000 KNIGHT ST BLDG 5 SUITE 220 SHREVEPORT LA 71105 LAB SERVICES 1316015 CORRECT CARE INC 229 ST JOHN LN COVINGTON LA 70433 E/R PHYSICIAN STAFF 1260022 LEGACY REHABILITATION PO BOX 843 RUSTON LA 71273 THERAPY SERVICES 961999 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 XRAY EQUIP MAINT 102210 4 465851 31656 497507 NET PATIENT REVENUE 621110 14149016 14149016 OTHER OPERATING REVENUE 621110 35511 35511 PHARMACY REVENUE 446110 115849 115849 14300376 93945 93945 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CAFETERIA AND VENDING SALES 722514 38674 38674 UTILITY DISTRICT REIMBURSEMENT 900099 1715 1715 MEDICAL RECORDS 561000 9085 9085 33297 33297 82771 14974599 14344473 132619 X 90832 90832 0 0 0 668571 499496 169075 0 5135006 3898826 1236180 70233 70233 468426 355659 112767 419361 318406 100955 0 20838 20838 71611 71611 0 0 0 4684331 4247984 436347 90503 6995 83508 314196 119619 194577 222760 222760 0 313729 256108 57621 65575 51614 13961 0 91225 30238 60987 512 512 0 603873 603873 119367 62071 57296 MEDICAL SUPPLIES 906989 906989 DUES & SUBSCRIPTIONS 29327 2031 27296 COLLECTIONS 50223 109 50114 . 0 6148 818 5330 14443636 11451668 2991968 0 6547459 6720009 1080762 898275 0 0 1467564 1056953 0 0 0 0 0 0 206323 206564 53754 64612 16750461 11656009 4800639 5094452 0 0 0 0 0 0 0 0 361772 1092202 14518273 15133067 919901 1064411 0 0 0 0 0 0 0 0 0 0 0 0 0 0 152287 91608 1072188 1156019 X 13283515 13679209 162570 297839 0 0 13446085 13977048 14518273 15133067 530963 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 3115 false true 3941 7056 false SCHEDULE C, PART II-B, LINEs 1g & 1I OTHER ACTIVITIES FOR LOBBYING PURPOSES: THE CEO AND COO MET WITH SEEMA VERNA/CMS, ALONG WITH OTHER HOSPITALS ASSOCIATED WITH THE CAH COALITION IN MAY 2019. THE HOSPITAL PAID DUES TO ORGANIZATIONS, A PORTION OF WHICH IS DESIGNATED FOR LOBBYING EXPENSES. DUES %LOBBYING $LOBBYING RURAL HOSPITAL COALITION $6,018 25% $1,505 LA HOSPITAL ASSOCIATION 10,805 18% 1,945 NATIONAL RURAL HEALTH ASSOC 1,225 5% 61 CAH Coalition 4,300 10% 430 ---------------------------------- TOTAL $22,348 $3,941 186090 186090 7986426 4313491 3672935 8428398 7192971 1235427 149547 149547 0 5094452 OTHER RECEIVABLES 312949 DUE FROM CARDINAL HEALTHCARE 36000 OTHER ASSET 112587 UTILITY DEPOSITS 1935 EST DUE FROM 3RD PARTY PAYER 628731 1092202 0 ESTIMATED SELF INSURANCE COSTS 91608 91608 14636554 14636554 338045 338045 14974599 14443636 14443636 14443636 SCHEDULE D, PART X, LINE 2 ASC 740 FOOTNOTE: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: CONTRIBUTIONS FOR ACQUISITION OF PROPERTY AND EQUIPMENT $150,181 CONTRIBUTIONS RECEIVED IN TEMPORARILY RESTRICTED NET ASSETS $187,864 ------------ TOTAL $338,045 true true X true X 250. false true true false false 10069 10069 0.00070 4875631 4626711 248920 0.01720 4885700 4626711 258989 0.01790 12389 47929 47929 0.00330 6213 119210 8938 110272 0.00760 18602 167139 8938 158201 0.01090 18602 5052839 4635649 417190 0.02880 1082 64933 64933 0.00450 1082 64933 64933 0.00450 true 1222617 5488986 5577942 -88956 X true true 1 1 UNION GENERAL HOSPITAL 901 JAMES AVE FARMERVILLE LA 71241 WWW.UNIONGEN.ORG 146 X X X UNION GENERAL HOSPITAL false false true X X X X X X X X X 17 true false false true X SEE PART V, SECTION C X true 17 true SEE PART V, SECTION C false true X 250. 0. X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 REPRESENTATIVES FROM THE COMMUNITY: THE HOSPITAL GATHERED INFORMATION FROM COMMUNITY MEETINGS, STAKEHOLDER INTERVIEWS, DISCUSSIONS WITH THE HOSPITAL LEADERSHIP TEAM, REVIEW OF DEMOGRAPHIC AND HEALTH STATUS, AND HOSPITAL UTILIZATION DATA, TO PRIORITIZE THE HEALTH NEEDS OF THE POPULATION. THE HOSPITAL'S CHIEF EXECUTIVE OFFICER DEVELOPED A HOSPITAL STEERING COMMITTEE. THE CEO APPOINTED THE FOLLOWING INDIVIDUALS AS PARTICIPANTS ON THIS COMMITTEE: EVALYN ORMOND - CHIEF EXECUTIVE OFFICER DIANNE DAVIDSON - CHIEF OPERATING OFFICER WILLIAM ADCOCK - CHIEF FINANCIAL OFFICER JULIE DUTY - COMPLIANCE/HIPAA OFFICER CLAUDIA WADE - COMMUNITY DEVELOPMENT MANAGER, GRANT WRITER DARRA JUNG - DIRECTOR OF NURSES BRITTANY SMITH - DIETARY DIRECTOR THE COMMITTEE IDENTIFIED 8 STAKEHOLDERS FOR INDIVIDUAL INTERVIEWS. BELOW IS A LIST OF THE ORGANIZATIONS REPRESENTED BY THE KEY STAKEHOLDERS. INTENSIVE OUTPATIENT PROGRAM UNION PARISH HEALTH DEPARTMENT UNION GENERAL HOSPITAL CITY OF FARMERVILLE UNION PARISH SCHOOL SYSTEM PUBLIC HEALTH NURSE, UNION PARISH HEALTH DEPARTMENT CHILDREN'S COALITION MEDICAID REPRESENTATIVE/FINANCIAL COUNSELOR SCHEDULE H, PART V, SECTION B, LINE 11 IDENTIFIED NEEDS ADDRESSED AND NOT ADDRESSED: THE MOST RECENT CHNA FOUND THAT MANY OF THE NEEDS IDENTIFIED IN THE 2015 CHNA ARE STILL A PRIORITY. THE NEEDS IDENTIFIED IN THE MOST RECENT CHNA BY THE STEERING COMMITTEE ARE: - CANCER: UNION GENERAL HOSPITAL OFFERED FREE MAMMOGRAMS TO THE COMMUNITY IN 2018 IN PARTNERSHIP WITH SUSAN G KOMEN. THE HOSPITAL FORMED A PARTNERSHIP WITH MARTIN LUTHER KING HEALTH CENTER AND PHARMACY IN SHREVEPORT EXPANDING ITS MAMMOGRAM SCREENING PROGRAM AND THE HEALTH CENTER OFFERS TRANSPORTATION TO THE PATIENTS TO COME TO THEIR APPOINTMENTS AT UNION GENERAL HOSPITAL FOR MAMMOGRAM SCREENINGS. FREE SCREENING MAMMOGRAMS ARE BEING OFFERED TO ANY PATIENT THAT QUALIFIES IN AND OUT OF STATE. THE HOSPITAL OFFERS CONTINUING BREAST CANCER EDUCATION TO THE COMMUNITY. ALSO, IN PARTNERSHIP WITH OMEGA LABS, UNION GENERAL HOSPITAL IS OFFERING FREE COLON CANCER SCREENINGS TO THE COMMUNITY. WE OFFER THE KITS AT LOCAL FAIRS OR ANYONE CAN STOP BY THE HOSPITAL AND REQUEST ONE. THE KIT AND THE TEST ARE FREE. - ADOLESCENT BEHAVIORS: THE HOSPITAL CONTINUES ITS PARTNERSHIP WITH THE SCHOOL DISTRICT UNDER THE 21ST CENTURY GRANT AFTER SCHOOL PROGRAM AND OFFERS "IT'S A GIRL THING, MAKING PROUD CHOICES," THE HOSPITAL'S STD/HIV PREGNANCY PREVENTION PROGRAM. THE HOSPITAL EDUCATES 6TH THROUGH 8TH GRADE GIRLS EVERY WEEK FOR AN HOUR. THE NEW ENROLLMENTS HAVE CONTINUED TO INCREASE THE NUMBER OF GIRLS ATTENDING THE MONTHLY MEETING AND THE INTEREST OF THE PARENTS IN HAVING THEIR GIRLS ENROLLED HAS ALSO INCREASED. THE HOSPITAL ALSO OFFERS EDUCATION TO THE HIGH SCHOOL GIRLS EVERY OTHER WEEK AT THE SCHOOL AND ONCE A MONTH AT THE HOSPITAL. 37 MEETINGS WERE CONDUCTED AT THE HOSPITAL, LOCAL CHURCHES AND SCHOOLS IN 2018 MAKING A TOTAL OF 188 MEETINGS SINCE THE PROGRAM STARTED IN 2013. "IT'S A GIRL THING, MAKING PROUD CHOICES" WON A NATIONAL AWARD FROM THE DEPARTMENT OF HEALTH AND HOSPITAL FOR INTEGRATING MENTAL HEALTH INTO PRIMARY CARE IN 2018 AND WAS RECOGNIZED AGAIN BY THE RURAL HEALTH INFORMATION HUB IN 2018. THE HOSPITAL HAS REINFORCED MENTAL HEALTH, ALCOHOL AND DRUG PREVENTION AND SUICIDE PREVENTION IN ALL THREE OF THE ADOLESCENCE HEALTH HOSPITAL'S PROGRAMS. WE DEVELOP THE PROGRAMS IN PARTNERSHIP WITH OTHER ORGANIZATIONS. UNION GENERAL HOSPITAL HAS INCREASED THE NETWORK IN THE COMMUNITY AND THE HOSPITAL HAS GOTTEN THE ATTENTION AND RECOGNITION OF OTHER HOSPITALS AND COMMUNITY ORGANIZATIONS IN AND OUT OF STATE. THE HOSPITAL HAS CONTINUED WITH THE ANTI BULLYING PROGRAM: UNION PARISH "TOGETHER, WE CAN BE BULLY FREE," THE PROGRAM WAS RECOGNIZED BY THE RURAL HEALTH INFORMATION HUB IN 2018. OVER 3,000 STUDENTS HAVE PARTICIPATED IN THE ANTI-BULLYING PROGRAM, 500 STUDENTS THE FIRST YEAR, 600 THE SECOND YEAR, AND OVER 1,000 THE FOLLOWING YEARS. STUDENTS HAVE LEARNED HOW TO RECOGNIZE, REPORT, AND REACT TO BULLYING. AS A RESULT, REPORTS OF BULLYING INCIDENTS TO THE UNION PARISH SHERIFF'S OFFICE HAVE DECREASED. THE NUMBER OF SUICIDE ATTEMPTS HAS ALSO DECREASED. THANKS TO A GRANT RECEIVED FROM THE SHIP/FLEX SUPPLEMENTAL PROGRAM WE WERE ABLE TO ESTABLISH A TEEN DRUG PREVENTION PROGRAM FOR OUR COMMUNITY. THE PROGRAM BEGAN IN MARCH OF 2018 AT THE UNION PARISH JUNIOR HIGH SCHOOL AND DOWNSVILLE COMMUNITY CHARTER SCHOOL. WE MET WITH 6TH THROUGH 12TH GRADERS DURING 2018. WE WERE ABLE TO ENROLL OVER 300 STUDENTS. THE MEETINGS TAKE PLACE AT THE SCHOOLS ON THURSDAYS AND FRIDAYS EVERY WEEK. THE EDUCATORS ARE TWO MENTAL HEALTH PROFESSIONALS TRAINED IN DRUG PREVENTION AND ONE OF THEM IS A REGISTERED NURSE. DRUG PREVENTION, SUICIDE AND ANTI BULLYING ARE TIED TOGETHER IN OUR PROGRAMS. WE HAVE SEEN THE RATES OF SUICIDE REDUCED SINCE WE BEGAN THE IMPLEMENTATION OF OUR FIRST COMMUNITY HEALTH NEEDS ASSESSMENT. SUBSTANCE ABUSE CAN RESULT IN INCREASED ILLEGAL ACTIVITIES AS WELL AS PHYSICAL AND SOCIAL HEALTH CONSEQUENCES, SUCH AS POOR ACADEMIC PERFORMANCE, POORER HEALTH STATUS, CHANGES IN BRAIN STRUCTURE, AND INCREASED RISK OF DEATH FROM OVERDOSE AND SUICIDE. THE HOSPITAL HAS MAINTAINED ITS COLLABORATION WITH THE SCHOOL DISTRICT, LAW ENFORCEMENT, CHILDREN'S COALITION, HEALTH UNIT, LOCAL CHURCHES, HEALTH CARE PROVIDERS AND OTHER CIVIC AND BUSINESS ORGANIZATIONS IN THE AREA. - CARDIOVASCULAR: UNION GENERAL HOSPITAL HAS INCREASED ACCESS TO EDUCATION AND AWARENESS FOR EARLY PREVENTION OF HEART DISEASE AND STROKE IN PARTNERSHIP WITH OCHSNER HEALTH SYSTEM. WE ARE NOW AN EMERGENCY LEVEL 3 STROKE CENTER. STROKE PATIENTS AT UNION GENERAL HAVE IMMEDIATE ACCESS TO HIGHLY SPECIALIZED VASCULAR NEUROLOGISTS AS THE RESULT OF A PARTNERSHIP BETWEEN UNION GENERAL AND OCHSNER CLINIC FOUNDATION IN NEW ORLEANS. WE HAVE ALSO PARTICIPATED IN HEALTH FAIRS PROMOTING HEALTHY HABITS AND NUTRITION, AND INVITED THE COMMUNITY FOR NUTRITION CLASSES AT THE HOSPITAL. UNION GENERAL HOSPITAL IS PARTNERING WITH THE AMERICAN HEART ASSOCIATION-GO RED FOR WOMEN AND EDUCATING THE COMMUNITY ABOUT CARDIOVASCULAR DISEASE. THE HOSPITAL OFFERS A FREE HEALTH LIFESTYLE WORKSHOP ONCE OR TWICE A MONTH IN PARTNERSHIP WITH LSU AGCENTER. - OBESITY AND DIABETES: THE HOSPITAL PARTICIPATED IN SEVERAL HEALTH FAIRS IN 2017: DIA DE LA FAMILIA AT THE D'ARBONNE STATE PARK, BACK TO SCHOOL BASHES IN TOWN IN PARTNERSHIP WITH ZION HILL BAPTIST CHURCH AND BEULAH BAPTIST CHURCH AND OTHER HEALTH FAIRS IN PARTNERSHIP WITH LSU AGCENTER, TRIAD OF UNION PARISH, SCHOOL BOARD AND THE COUNCIL ON AGING. THE EMPLOYEES HAVE CONTINUED WITH THE BIGGEST LOSER PROGRAM AND THE WALKING CHALLENGE. THE HOSPITAL IS BUILDING A WALKING TRAIL ON HOSPITAL GROUNDS TO ENCOURAGE HEALTHY HABITS AND EXERCISE IN THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 13H OTHER ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE: ANY PATIENTS WITH MEDICAID COVERAGE THAT HAVE NON-COVERED CHARGES WILL NOT REQUIRE ANY ADDITIONAL SCREENING TO QUALIFY FOR FINANCIAL ASSISTANCE. SCHEDULE H, PART V, SECTION B, LINE 16J NOTIFICATION OF FINANCIAL ASSISTANCE POLICY: DURING THE SCREENING PROCESS, PATIENTS THAT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOTIFIED OF THE POLICY. SCHEDULE H, PART V, SECTION B, LINES 7 & 10 Community Health Needs Assessment & Implementation Strategy: The hospital's CHNA and Implementation strategy are available upon request and at the following website: http://uniongen.org/community/ SCHEDULE H, PART V, SECTION B, LINES 16A, 16B & 16C FAP DOCUMENTS AVAILABLE TO THE PUBLIC: THE FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE UPON REQUEST AND AT THE FOLLOWING WEBSITE: http://uniongen.org/patient-info/financial-assistance/ SCHEDULE H, PART V, SECTION B, LINES 18, 19, & 20 ACTIONS FOR NON-PAYMENT: NEITHER UNION GENERAL HOSPITAL, NOR THIRD PARTIES AUTHORIZED BY UGH, TAKE ANY ACTIONS UPON NON-PAYMENT FROM A PATIENT BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART I, LINE 3C FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: -INSURANCE STATUS -MEDICAID COVERAGE SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: WE USE AN AGING APPROACH TO RESERVE AMOUNTS FOR BAD DEBT BY FINANCIAL CLASS. WHEN AN ACCOUNT REACHES THE STATUS THAT WE'VE DETERMINED THEM TO BE UNCOLLECTIBLE, THE ACCOUNT IS WRITTEN OFF AS A BAD DEBT. ALL APPROPRIATE DISCOUNTS AND PAYMENTS ARE APPLIED TO AN ACCOUNT, WHICH REDUCES ANY BAD DEBT WRITE-OFFS FOR THAT ACCOUNT. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT AS A COMMUNITY BENEFIT: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT FOOTNOTE: NOT APPLICABLE DUE TO ADOPTION OF ASU 606 REVENUE FROM CONTRACTS WITH CUSTOMERS SCHEDULE H, PART III, SECTION B, LINE 8 COSTING METHODOLOGY AND MEDICARE SHORTFALL: THE HOSPITAL USED MEDICARE COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS BASED ON MEDICAID OR MEDICARE DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. IN ADDITION, THE ORGANIZATION PROVIDES CARE TO ALL PATIENTS REGARDLESS OF SOURCE OF PAYMENT; THEREFORE, COSTS TO PROVIDE CARE TO MEDICARE PATIENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT TO THE EXTENT COSTS EXCEED MEDICARE REIMBURSEMENT. SCHEDULE H, PART III, SECTION C, LINE 9B PROVISIONS ON COLLECTION PRACTICES: ONCE A PATIENT IS BELIEVED TO BE INDIGENT, THEY MUST COMPLETE AN APPLICATION FOR CHARITY CARE ASSISTANCE FOR UGH TO DETERMINE THE PATIENT'S ELIGIBILITY FOR ITS CHARITY CARE PROGRAM. TO BE ELIGIBLE, A PATIENT/FAMILY'S INCOME SHALL BE COMPARED TO 250% OF THE FEDERAL POVERTY GUIDELINES. THEIR INCOME MUST BE AT OR BELOW THE CORRESPONDING AMOUNT BASED ON FAMILY SIZE. IF A PATIENT WITH MEDICAID COVERAGE HAS NON-COVERED CHARGES, NO ADDITIONAL SCREENING WILL BE REQUIRED TO QUALIFY FOR CHARITY CARE. THE HOSPITAL MAY CONSIDER OTHER FINANCIAL ASSETS AND LIABILITIES OF THE PERSON WHEN DETERMINING ELIGIBILITY. THE SCREENING PROCESS TO DETERMINE A PATIENT'S ELIGIBILITY FOR THE HOSPITAL'S CHARITY CARE PROGRAM WILL BEGIN AS SOON AS POSSIBLE FOLLOWING ADMISSION TO UGH. ONCE A PATIENT HAS BEEN DETERMINED TO QUALIFY FOR UGH'S CHARITY CARE PROGRAM, NO ADDITIONAL COLLECTION EFFORTS WILL BE MADE ON THAT ACCOUNT. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: THE HOSPITAL HAS WORKED WITH OTHER COMMUNITY ORGANIZATIONS TO ASSESS THE HEALTHCARE NEEDS OF THE COMMUNITY. THE HOSPITAL HAS COMPLETED A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT WITH ASSISTANCE FROM AN OUTSIDE FIRM. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: ALL PATIENTS WITHOUT THIRD PARTY INSURANCE RECEIVE INFORMATION WHILE AT UGH REGARDING GOVERNMENTAL ASSISTANCE AND ARE ADVISED TO MAKE AN APPOINTMENT WITH A CERTIFIED MEDICAID ENROLLMENT CENTER TO DETERMINE THEIR ELIGIBILITY FOR MEDICAID ASSISTANCE. THOSE PATIENTS ARE INFORMED THAT THEY MAY BE ELIGIBLE FOR THE HOSPITAL'S CHARITY CARE PROGRAM. ALSO, ALL INPATIENTS WITHOUT THIRD PARTY COVERAGE ARE VISITED DURING THEIR HOSPITAL STAY AND SENT INFORMATION. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: UNION GENERAL IS LOCATED IN UNION PARISH, A LARGE SPRAWLING RURAL COMMUNITY MADE UP OF 905 SQUARE MILES OF ROLLING HILLS AND TALL PINE TREES. 28% OF THE POPULATION IS BELOW 200% OF THE FEDERAL POVERTY GUIDELINES. THERE IS NO PUBLIC TRANSPORTATION IN THE PARISH AND THE TOTAL PARISH POPULATION IS 22,571 (2017 ESTIMATE). UNION PARISH IS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA (MUA) AND A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA). MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $37,049 (2017 ESTIMATE). THE COMMUNITY'S MORTALITY RATE IS NEARLY TWICE THE NATIONAL RATE DUE TO THE LACK OF EDUCATION PROGRAMS, THE HIGH RATE OF UNDIAGNOSED DISEASE, AS WELL AS POVERTY AND ISOLATION ASSOCIATED WITH THE RURAL UNDERSERVED PARISH POPULATIONS. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: UNION GENERAL HOSPITAL SERVES AS A MEDICAID ENROLLMENT CENTER FOR UNION PARISH, PROVIDES FLU SHOT CLINICS TO THE COMMUNITY AND PARTICIPATES IN HEALTH FAIRS LOCALLY. THE HOSPITAL ALSO PARTICIPATES IN CAREER FAIRS AT LOCAL COLLEGES FOR HEALTHCARE STUDENTS, REACHING OVER 200 STUDENTS, AS WELL AS SERVING AS A CLINICAL SITE FOR LPNS, RADIOLOGY, PHLEBOTOMY AND NURSE PRACTITIONERS. UGH IS INVOLVED WITH LOCAL BUSINESSES AND CHURCHES TO BRING AWARENESS AND SCREENING TO THE PUBLIC THROUGH RELAY FOR LIFE, AHA'S GO RED CAMPAIGN, UNITED WAY FUNDRAISER, SUSAN G KOMEN FUNDRAISER AND RACE FOR THE CURE, AND BY HOSTING AN ANNUAL BREAST CANCER AWARENESS DAY FOR THE COMMUNITY. UGH PARTNERS WITH SUSAN G KOMEN TO PROVIDE FREE MAMMOGRAMS AND OMEGA DIAGNOSTICS, LLC TO OFFER FREE COLON SCREENINGS FOR THE SERVICE AREA. THE HOSPITAL PROVIDED HAND WASHING INSTRUCTION FOR ELEMENTARY SCHOOL KIDS AND FOR NURSING HOME STAFF AND RESIDENTS, AS WELL AS PROVIDED NUTRITION WORKSHOPS, BLOOD SUGAR AND BLOOD PRESSURE SCREENING FOR THE COMMUNITY. UGH PARTICIPATED IN THE TOWN OF FARMERVILLE'S TOY DRIVE FOR NEEDY CHILDREN, ALONG WITH ANTI BULLYING, TEEN DRUG PREVENTION AND TEEN PREGNANCY PREVENTION SESSIONS AT THE HOSPITAL AND ALL THE SCHOOLS. UGH EMPLOYEES ARE VERY INVOLVED WITH LOCAL CHURCHES AND ORGANIZATIONS, SUCH AS ALZHEIMER'S SUPPORT GROUP, COUNCIL ON AGING, NURSING HOME COUNCILS, AND OTHERS. ALL PROPERTY OWNED BY UNION GENERAL HOSPITAL IS DESIGNATED TOBACCO-FREE. UGH OPERATES UNDER A BOARD OF DIRECTORS, WHICH IS COMPRISED OF REPRESENTATIVE MEMBERS OF THE COMMUNITY. IT MAINTAINS AN OPEN MEDICAL STAFF AND OPERATES A 24/7 EMERGENCY ROOM STAFFED WITH ON-SITE PHYSICIANS. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: N/A SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: N/A SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL HAS IDENTIFIED ISSUES IN OUR COMMUNITY THROUGH OUR CHNA, THAT INCLUDE A LACK OF EDUCATION AND MONITORING OF ADOLESCENT BEHAVIOR WITH ALCOHOL AND DRUG PREVENTION. A TEEN DRUG PREVENTION PROGRAM WAS ESTABLISHED AT TWO OF OUR LOCAL SCHOOLS TO MEET WITH 6TH-12TH GRADE STUDENTS TWICE A WEEK TO DISCUSS WAYS TO DEAL WITH DRUGS AND SUBSTANCE ABUSE. WE PARTICIPATED IN LOCAL HEALTH FAIRS TO HELP PEOPLE IN THE COMMUNITY IDENTIFY POTENTIAL HEALTH ISSUES. WE HOST NUTRITION WORKSHOPS AT THE HOSPITAL TO HELP TEACH PEOPLE IN THE COMMUNITY WAYS TO TRY TO DEAL WITH OBESITY, DIABETES, AND OTHER HEALTH-RELATED ISSUES THROUGH A PROPER DIET. WE HOST AND PARTICIPATE IN FLU DRIVES TO ENCOURAGE RESIDENTS OF THE COMMUNITY TO GET THEIR ANNUAL FLU SHOT, IN ORDER TO AVOID PREVENTABLE ILLNESS. WE HAVE PARTNERED WITH THE LSU AGCENTER TO PROVIDE HEALTH LIFESTYLE WORKSHOPS ON A REGULAR BASIS TO PROVIDE EDUCATION AND AWARENESS FOR EARLY PREVENTION OF CARDIOVASCULAR DISEASE. X X false false false false false false false true false EVALYN ORMOND CEO 144284 0 25000 0 0 0 2865 0 8663 0 180812 0 0 0 WILLIAM ADCOCK CFO 188601 0 23500 0 516 0 3293 0 18173 0 234083 0 0 0 SHEREE HICKS PHARMACY director 166537 0 0 0 0 0 2786 0 17609 0 186932 0 0 0 LYNETTE WADE Nurse practitioner 130862 0 1613 0 0 0 2631 0 24500 0 159606 0 0 0 SCHEDULE J, Part I, LINE 7 DETERMINATION OF BONUSES: THE AMOUNT OF THE CEO'S BONUS IS DETERMINED BY THE BOARD DURING AN EXECUTIVE SESSION AT THE NOVEMBER MEETING. THE CFO'S BONUS IS BASED OFF A PERCENTAGE OF ANNUAL SALARY DETERMINED BY THE CEO. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM FOLLOWING THE COMPLETION OF AN AUDIT OF FINANCIAL STATEMENTS. BOTH THE CEO AND CFO REVIEW THE RETURN, AND THE RETURN IS THEN MADE AVAILABLE TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE FULL BOARD WILL REVIEW A COPY OF THE 990 WITH RECOMMENDATIONS FROM THE FINANCE COMMITTEE PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. ALL EMPLOYEES ARE REQUIRED TO REPORT ANY CONFLICTS OF INTEREST. IN THE EVENT OF A CONFLICT, HE OR SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINES 15A & 15B REVIEW OF OFFICER COMPENSATION: INFORMATION WAS OBTAINED FROM THE 2016 LA SALARY SURVEY DONE BY THE GREATER NEW ORLEANS SOCIETY FOR H/R ADMIN AND PRESENTED TO THE UGH BOARD FOR REVIEW AND DISCUSSION. SALARIES FOR THESE POSITIONS WERE ADJUSTED BASED UPON RECOMMENDATION AND APPROVAL BY THE BOARD OF DIRECTORS DURING THE EXECUTIVE SESSION. DOCUMENTATION OF THE REVIEW IS KEPT IN THE EXECUTIVE SESSION'S MINUTES. ALL OTHER EMPLOYEES (INCLUDING OTHER OFFICERS) RECEIVE MERIT INCREASES BASED ON THEIR ANNUAL EMPLOYEE EVALUATION SCORES EVERY FEBRUARY OR MARCH. THE CEO AND CFO SET THE MAXIMUM INCREASES FOR DEPARTMENT MANAGERS, AND MAXIMUM PERCENTAGE INCREASES FOR ALL OTHER EMPLOYEES. EACH EMPLOYEE RECEIVES A PRO-RATA PERCENTAGE OF THE MAXIMUM PERCENTAGE, BASED ON THEIR ACTUAL EVALUATION SCORE COMPARED TO THE MAXIMUM SCORE POSSIBLE ON THE EVALUATION. THE EVALUATIONS ARE COMPLETED BY THE EMPLOYEE'S SUPERVISOR. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART I, LINE 1 SIGNIFICANT ACTIVITIES: (continued from PAGE 1)... UNION PARISH AND THE SURROUNDING AREAS. FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED MEDICAL SERVICES TOTAL FEES:3156149 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:1269802 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE AGREEMENTS TOTAL FEES:213889 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN RECRUITING TOTAL FEES:13888 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:28732 FORM 990 PART IX LINE 11G DESCRIPTION:OUTSIDE TESTING TOTAL FEES:1871