2018-11-15T08:14:39-06:00 2017-12-31 570381582 ELLIOTT DAVIS LLCPLLLC ONE 10TH STREET SUITE 400 AUGUSTA GA 30901 990 2017-01-01 581581103 UNIVERSITY HEALTH SERVICES INC UNIV 7068282406 1350 WALTON WAY AUGUSTA GA 30901 DAVID A BELKOSKI CFO 7068282406 2018-11-12 1 JESSICA C CAIN P01276209 7067229090 2018-11-12 24.181.201.165 2018-11-12 12:35:53 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D9C45B12E74E3E126437FD430A1A3CA8815D446F 2017 2018-06-14 16:35:46Z JAMES R DAVIS 1350 WALTON WAY AUGUSTA GA 30901 822609216 0 X WWW.UNIVERSITYHEALTH.ORG X 1984 GA THE MISSION OF UNIVERSITY HEALTH CARE SERVICES IS TO OPERATE AN ACUTE AND SUBACUTE CARE HOSPITAL PROVIDING HEALTH CARE SERVICES WHICH HELP THE CITIZENS OF OUR COMMUNITIES ACHIEVE AND MAINTAIN OPTIMAL HEALTH. 15 12 4421 313 3124056 -584444 1765563 2588433 491032119 524452965 12537652 15835249 11371452 12757585 516706786 555634232 1255521 1077377 0 0 194658829 209804129 0 0 0 268559382 299797443 464473732 510678949 52233054 44955283 810233580 885788560 375086387 400881577 435147193 484906983 X THE MISSION OF UNIVERSITY HEALTH CARE SERVICES IS TO OPERATE AN ACUTE AND SUBACUTE CARE HOSPITAL PROVIDING HEALTH CARE SERVICES WHICH HELP THE CITIZENS OF OUR COMMUNITIES ACHIEVE AND MAINTAIN OPTIMAL HEALTH. 0 0 478318359 1077377 527425070 OPERATION OF A GENERAL ACUTE CARE AND SUB-ACUTE CARE HOSPITAL WITH 812 LICENSED BEDS, TOTAL (812 ACUTE AND 0 SUB-ACUTE). PATIENT DAYS FOR ADULTS AND PEDIATRICS FOR 2017 WERE 123,758, NEWBORN DAYS WERE 12,609 (FOR BOTH TERM & ICU NURSERY), AND OUTPATIENT VISITS WERE 544,371. EMERGENCY ROOM REGISTRATIONS WERE 90,112, OBSERVATION STAYS WERE 13,827, CARDIOVASCULAR INTERVENTIONAL PROCEDURES WERE 9,259 AND RADIOLOGY PROCEDURES WERE 264,977, OCCUPATIONAL MEDICINE VISITS WERE 29,834 AND HOME HEALTH VISITS FOR 2017 WERE 54,387. WITHIN ALL THESE INDICATORS ARE THE EFFORTS OF UNIVERSITY HEALTH SERVICES, INC TO SERVICE THE NEEDS OF THE COMMUNITY, WHICH INCLUDE THE INDIGENT. IN 2017 THE COST OF INDIGENT AND CHARITY CARE PROVIDED, WITH NO LOCAL FUNDING, WAS $42,366,347. HOWEVER, THE HOSPITAL DID RECEIVE DISPROPORTIONATE SHARE (DSH) PAYMENTS TO HELP WITH THIS SERVICE OF $3,074,605 (NET) AND UPPER PAYMENT LIMITS (UPL) FUNDS OF $1,888,772 (NET). THE $42,336,347 INCLUDES THE COST FOR PROVIDING INPATIENT AND OUTPATIENT SERVICES FOR INDIGENT AND CHARITY CARE PATIENTS OF $23,299,010. ALSO $1,203,312 TO HELP SUPPORT COMMUNITY BASED CLINICS, $17,864,026 FOR UNCOMPENSATED PHYSICIAN SERVICES FOR INDIGENT AND CHARITY CARE PATIENTS. ALSO PROVIDED ARE PROGRAMS FOR CONGESTIVE HEART FAILURE AND ASTHMA/COPD, WHICH HELPED INDIGENT PATIENTS MANAGE THEIR CONDITION AND IMPROVE THE QUALITY OF THEIR LIVES. OTHER COMMUNITY OUTREACH SERVICES FOR 2017 INCLUDE DIABETES TESTING AND EDUCATION, PROSTATE SPECIFIC ANTIGEN (PSA) TESTING, SKIN CANCER SCREENINGS, FREE COUNSELING AND EDUCATION FOR WOMEN AND THEIR FAMILY MEMBERS THROUGH ALL THE STAGES OF BREAST CANCER, FREE MAMMOGRAMS, HEART HEALTH EDUCATION, AND SUPPORT GROUPS FOR CANCER, HEART ATTACK, AND STROKE. IN 2017 UNIVERSITY HOSPITAL REACHED MORE THAN 9,984 PEOPLE IN FREE SCREENINGS, COMMUNITY EDUCATION, PUBLICATIONS, AND MORE. ADDITIONALLY, IN 2017 OVER $1.4 MILLION WAS PROVIDED FOR HEALTH PROFESSIONAL EDUCATION FOR CARDIOVASCULAR AND RADIOLOGY SCHOOLS, AND INTERNS AND RESIDENTS, IN SUPPORT OF TOMORROW'S CARE GIVERS. 478318359 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 1 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 246 0 4421 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 GA SC X X DAVID A BELKOSKI 7068282406 1350 WALTON WAY AUGUSTA GA 30901 LEVI W HILL IV BOARD CHAIRMAN 2.00 1.00 X X 0 0 0 TERRY D ELAM BOARD MEMBER 2.00 1.00 X 0 0 0 W CRAIG SMITH BOARD MEMBER 2.00 1.00 X 0 0 0 NATALIE D SCHWEERS BOARD MEMBER 2.00 1.00 X 0 0 0 SANFORD LOYD BOARD MEMBER 2.00 1.00 X 0 0 0 BRIAN J MARKS BOARD SECRETARY 2.00 1.00 X X 0 0 0 EUGENE F MCMANUS BOARD MEMBER 2.00 1.00 X 0 0 0 HUGH L HAMILTON BOARD MEMBER 2.00 1.00 X 0 0 0 JEFFREY L FOREMAN BOARD MEMBER 2.00 1.00 X 0 0 0 JAMES W BENNETT JR BOARD MEMBER 2.00 1.00 X 0 0 0 DANIEL H BOONE MD BOARD MEMBER 2.00 50.00 X 0 277044 12828 CHARLES G PETE CAYE JR BOARD MEMBER 2.00 1.00 X 0 0 0 CATHERINE D KNOX BOARD MEMBER 2.00 1.00 X 0 0 0 WILLIAM P DOUPE BOARD MEMBER 2.00 1.00 X 0 0 0 JAMES C SHERMAN MD BOARD MEMBER 2.00 50.00 X 0 120006 600 DAVID A BELKOSKI UHS CFO 50.00 5.00 X 680853 0 10771 JAMES R DAVIS UHS PRESIDENT & CEO 50.00 5.00 X 1589553 0 316866 MARILYN A BOWCUTT PRESIDENT OF UNIVERSITY HO 50.00 5.00 X 712861 0 16794 WILLIAM L FARR JR CMO 50.00 5.00 X 542564 0 17838 EDWARD L BURR SR. VP LEGAL & REGULATORY 50.00 X 576630 0 21922 LAURIE OTT SMITH UHCF-VP HR & COMM SVC 50.00 X 392582 0 12929 THOMAS E LOWENCAMP VP - CONTINUING CARE 25.00 25.00 X 345792 0 24700 SHIRLEY K GABRIEL VP CHIEF INFORMATION OFFIC 50.00 X 418541 0 16256 TERESA BUSCHBACHER VP -HVI 50.00 X 257881 0 22119 SCOTT ANSEDE VP PROFESSIONAL SERVICES 50.00 X 397665 0 23226 ELIZABETH R GALLUP VP CLINICAL OPERATIONS 50.00 X 352832 0 27135 ROBERT J KEPSHIRE ADMINISTRATIVE CNO - MCDUF 50.00 X 209093 0 10244 JOHN C POPE PA ECHO CLINICAL PROG COOR 50.00 X 195969 0 9964 JACKIE KENDINGER EMPLOYEE 50.00 X 204325 0 5242 DOUGLAS D PUGH II RN 50.00 X 204518 0 17275 BEATRICE C BADGER RN 40.00 X 200508 0 12514 LYNDA JONES WATTS VP PATIENT CARE SVCS/CNO 50.00 X 341048 0 11260 7623215 397050 590483 17 1 1 0 CROTHALL HEALTHCARE 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 PLANT & HOUSEKEEPING 10366045 MORRISONS HEALTH CARE DIVISION PO BOX 102289 ATLANTA GA 30368 MANAGEMENT SUPPORT 7066853 NOVANT HEALTH INC 2085 FRONTIS PLAZA WINSTON SALEM NC 27103 SYSTEM SUPPORT 4857650 EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 53288 SYSTEM SUPPORT 4197520 COGDELL SPENCER LP CO LILLIBRIDGE HEALT PO BOX 742736 ATLANTA GA 303742736 BUILDING MANAGEMENT 2575305 110 318118 8738 2261577 2588433 PATIENT SERVICE REVENUE 900099 515488215 515488215 HOME HEALTH SERVICES 621610 8082451 8082451 PHYSICIAN ANSWERING SERVICE 541900 386202 386202 OTHER PROGRAM SERVICES 900099 317174 317174 ASK-A-NURSE 541900 150988 150988 27935 27935 524452965 8961858 8961858 4579792 3470003 1109789 1109789 58698 1051091 11811 270366561 297277 263207704 -285466 7158857 6873391 6873391 EMPLOYEE PHARMACY 446110 5607793 5607793 OUTREACH LAB 900099 3760928 3760928 MISCELLANEOUS 900099 2590097 2590097 -311022 382008 -695570 2540 11647796 555634232 527425070 3124056 22496673 1077377 1077377 7541191 1784252 5756939 144869600 143768053 1101547 3712917 3545836 167081 40286477 38473586 1812891 13393944 12791217 602727 14347309 13701680 645629 1084648 1084648 291400 291400 182043 182043 1622211 1622211 37561203 35870949 1690254 713181 681088 32093 1151175 1099372 51803 8392984 8015300 377684 6183581 5905320 278261 779107 744047 35060 14821 14821 7686806 7686806 33572890 32062110 1510780 4061043 3878296 182747 MED SURG SUPPLIES 123410506 123410506 BAD DEBT EXPENSE 32733965 32733965 0 REPAIRS AND MAINTENANCE 10993479 10498772 494707 GA DCH HOSPITAL TAX 6244526 0 6244526 8770565 8276633 493932 510678949 478318359 32360590 0 9161680 11938091 75562510 88412394 11147991 10226137 9797976 11765652 8572532 8346885 682275325 414611497 237203049 267663828 409893486 444741930 48894356 42693643 810233580 885788560 24937852 29466122 149527198 145550240 98863133 127736809 101758204 98128406 375086387 400881577 X 435112193 484871983 35000 35000 435147193 484906983 810233580 885788560 X 44955283 35264908 -30460401 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 182043 182043 0 PART II-B, LINE 1: A PART OF THE VARIOUS ASSOCIATION DUES INCLUDE A PERCENTAGE ALLOCATION FOR EXPENDITURES ON LOBBYING ACTIVITIES. DUES PAID TO THE GEORGIA HOSPITAL ASSOCIATION, THE GEORGIA ALLIANCE OF COMMUNITY HOSPITALS, THE GEORGIA INITIATIVE, THE GEORGIA CHAMBER OF COMMERCE, AND OTHER HEALTH ASSOCIATIONS ALL HAVE A LOBBYING COMPONENT. FOR 2017, THESE FEES AMOUNTED TO $155,043. ADDITIONALLY, OGLETHORPE CONSULTING GROUP WAS CONTRACTED DURING 2017 TO REVIEW AND ADVISE THE HOSPITAL ON LEGISLATIVE ISSUES. DURING 2017, $27,000 WAS PAID TO OGLETHORPE CONSULTING GROUP. 21119245 21119245 300391772 152514456 147877316 4021020 3006663 1014357 338885695 254898815 83986880 17857593 4191563 13666030 267663828 ACCRUED COMPENSATION, BENEFITS, & WITHOLDINGS 24173481 ACCRUED POSTRETIREMENT BENEFIT COST 37053223 ASSET RETIREMENT OBLIGATION 3407914 EST THIRD PARTY PAYOR SETTLEMENTS 11907761 OTHER CURRENT LIABILITIES 2604335 RESERVE FOR SELF INSURED LOSSES 15088301 DUE TO AFFILIATES 5475179 CAPITALIZED BOND COSTS -1581788 98128406 X PART X, LINE 2: UNIVERSITY HEALTH SERVICES, 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 FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL OR STATE INCOME TAXES. THE CORPORATION HAS EVALUATED ITS TAX POSITIONS AND HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2017. FISCAL YEARS ENDED ON OR AFTER DECEMBER 31, 2014 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. THERE IS PRESENTLY NO TAXATION IMPOSED BY THE GOVERNMENT OF THE CAYMAN ISLANDS ON INCOME OR PREMIUMS OF WWI. AS A RESULT, NO TAX LIABILITY OR EXPENSE HAS BEEN RECORDED. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 1 2 INSURANCE CAPTIVE 1 2 0 0 1 2 0 0 0 1 0 1 1 1 0 PART 1 - ADDITIONAL SUPPLEMENTAL INFORMATION PLEASE SEE FORM 5471 FILING FOR DETAILS RELATED TO OFFSHORE CAPTIVE INSURANCE. 1 1 1 X 1 X 1 1 1 0 0 22367051 2213716 20153335 0.03950 43049283 39904517 3144766 0.00620 65416334 42118233 23298101 0.04570 19939492 9696911 10242581 0.02010 1098065 769351 328714 0.00060 1190375 0 1190375 0.00230 22227932 10466262 11761670 0.02300 87644266 52584495 35059771 0.06870 46545 46545 0.00010 19510 19510 0.00000 66055 66055 0.00010 1 32733965 169693 122426946 172156947 -49730001 X 1 1 1 1 UNIVERSITY HEALTH SERVICES INC 1350 WALTON WAY AUGUSTA GA 30901 WWW.UNIVERSITYHEALTH.ORG 121-375 X X X X 3 HOME HEALTH AGENCIES UNIVERSITY HEALTH SERVICES INC 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X WWW.UNIVERSITYHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT X 1 16 1 WWW.UNIVERSITYHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT 1 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X 1 X SEE SCHEDULE O X SEE SCHEDULE O X SEE SCHEDULE O X X X X X 1 0 X X X X 1 X X 0 0 UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 5: PAIGE MILLER, DEVELOPMENT DIRECTOR - HOPE HOUSEREV CHARLES E GOODMAN, PASTOR - TABERNACLE BAPTIST CHURCHLATOYA HARDMAN, DIRECTOR - FAMILY PROMISEJUANITA MCDANIEL, 2-1-1 COORDINATOR - UNITED WAY 2-1-1JONATHAN ADRIANO, DISTRICT PROGRAM MANAGER - GA DEPT OF PUBLIC HEALTH, ECHD IVKELLY BUSHEY, RN, COUNTY NURSE MANAGER - GA DEPT OF PUBLIC HEALTH, RCHDJOY MILLER, EPIDEMIOLOGIST - GA DEPT OF PUBLIC HEALTH , ECHD IVROBERT CAMPBELL, MD, MEDICAL DIRECTOR - CHRIST COMMUNITY HEALTH SERVICESTHOSE WHO WERE INVITED BUT DID NOT ATTEND WERE FROM THE FOLLOWING ORGANIZATIONS: AREA AGENCY ON AGING, AUGUSTA HOUSING & COMMUNITY DEVELOPMENT, AUGUSTA RESCUE MISSION, AUGUSTA PARTNERSHIP FOR CHILDREN, COORDINATED HEALTH SERVICES INC., GARDEN CITY RESCUE MISSION, SAVANNAH RIVER REMEDIATION, GOLDEN HARVEST FOOD BANK, AUGUSTA-RICHMOND COUNTY PUBLIC LIBRARY, MERCY MINISTRIES, WALTON OPTIONS FOR INDEPENDENT LIVING, SAFE HOMES AND SENIOR CITIZEN COUNCIL. REPRESENTATIVES FROM THESE ORGANIZATIONS WERE SENT AN EMAIL WITH THE LIST OF QUESTIONS FROM THE LISTENING SESSION AND INVITED TO PROVIDE FEEDBACK.IN ADDITION ON PAGE 53, UHS REACHED OUT TO 3257 PROVIDERS.WE INVITED PROVIDERS IN OUR COMMUNITY TO, "PLEASE TELL US ABOUT A RESOURCE YOU WISH WAS MORE ACCESSIBLE TO YOUR PATIENTS THAT WOULD HELP THEM ADDRESS THEIR HEALTH NEEDS." THE SURVEY WAS MADE ACCESSIBLE BY AN ONLINE SURVEY VENDOR. WE ACCESSED THE NAME, ADDRESS, AND TYPE OF PROVIDERS IN OUR COMMUNITY THROUGH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES' NATIONAL PLAN AND PROVIDER ENUMERATION SYSTEM (NPPES). WE RESTRICTED THE SURVEY TO PHYSICIANS, MENTAL HEALTH PROVIDERS, AND PHARMACISTS. WE THEN MAILED AN INVITATION (FIGURE 38 ON PG 53) TO 3257 PROVIDERS THAT INCLUDED THE WEB ADDRESS OF THE SURVEY AND THE PROMISE OF A GIFT TO A RANDOMLY SELECTED RESPONDENT. UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 6A: N/A UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 6B: N/A UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 11: SEE PAGE 4 OF IMPLEMENTATION STRATEGY HEART DISEASE & STROKE - EXPAND ADVANCED HEALTH FAILURE PROGRAM WITH OPERATIONAL IMPROVEMENTS AND NEW PROVIDERS: CONTINUE FREE HEART ATTACK AND STROKE CLASSESCANCER - OPEN NODULE CLINIC AND THORACIC SURGERY PROGRAM; CONTINUE CANCER GROUPS ; PHYSICIAN LEAD EDUCATION PRESENTATION & COMMUNITY SCREENINGS ARTHRITIS, OSTEOPOROSIS AND CHRONIC BACK CONDITIONS - EDUCATION ON BACK INJURY PREVENTIONDIABETES - CONTINUE MONTHLY GROUPS AND EDUCATION SESSIONSNUTRITION AND WEIGHT STATUS - CONTINUE EATING WELL WITH KIM PROGRAM ON LOCAL TV AND EMAILACCESS TO HEALTH SERVICES - EXPAND PROMPT AND PRIMARY CARE AREAS; HEALTH U CALENDAR HEALTH LITERACY - HEALTHY U; EDUCATIONAL CLASSES, ETCAREAS THAT UHS WILL NOT FOCUS ON ARE:CHRONIC KIDNEY DISEASE - WHILE UH WILL CONTINUE TO TREAT KIDNEY DISEASE, WE COULD SUPPORT THIS AREA BETTER BY PLACING OUR EMPHASIS ON DIABETES, OBESITY, AND EDUCATION.RESPIRATORY DISEASE - UH WILL EMPHASIS EDUCATION; HOWEVER, THERE ARE OTHER PROVIDERS TO OFFER ASSISTANCE SUCH AS KOHL'S CARES AS WELL AS CHILDREN'S HOSPITAL OF GEORGIAMENTAL HEALTH - OTHER PROVIDERS HAVE MORE EXPERTISE IN THIS AREA; SUCH AS, AU'S PSYCHIATRY, SERENITY BEHAVIORAL HEALTH, LIGHTHOUSE CARE CENTER, AIKEN-BARNWELL MENTAL HEALTH CENTER, ETC. UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 13B: ALSO USES ASSET TEST, REGARDLESS OF INCOME, TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE. IN ADDITION THE HOSPITAL TAKES INTO CONSIDERATION BANKRUPCY AND FINANCIAL STANDING WHEN OFFERING DISCOUNTS ON PATIENT LIABILITY.USE ELECTRONIC ELIGIBILITY SYSTEM TO DETERMINE INDIGENT CARE. SCHEDULE H, PART V, SECTION B, LINE 22D USED TRADITIONAL MEDICARE , COMMERICIAL AND MANAGED CARE PROVIDERS TO COMPUTE THE AMOUNT GENERALLY BILLED. PART I, LINE 3C: IN ADDITION TO THE FPG, HOSPITAL MAY ALSO USE ASSET TEST, REGARDLESS OF INCOME, TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE FOR THOSE INDIVIDUALS THAT DO NOT QUALIFY UNDER THE ELECTRONIC ELIGIBILITY SYSTEM OR THOSE WHO HAVE INSURANCE BUT HOSPITAL BILL IS CATASTROPHIC. IN ADDITION THE HOSPITAL TAKES INTO CONSIDERATION BANKRUPCY AND FINANCIAL STANDING WHEN OFFERING DISCOUNTS ON PATIENT LIABILITY. 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 UH SERVES. IN SUPPORTING THESE ORGANIZATIONS, UH 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), UHS 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: UNIVERSITY PROVIDES ALL UNINSURED PATIENTS A DISCOUNT TO MATCH THE UNWEIGHTED AVERAGE OF DISCOUNT GIVEN TO COMMERCIAL AND MEDICARE PATIENTS . IN ADDITION UH USES ELECTRONIC ELIGIBILITY SYSTEM TO DETERMINE IF PATIENTS COULD QUALITY FOR INDIGENT STATUS AND THEN COMPARES DENIED PATIENTS WITH APPLICATIONS THE STATE DFCS SYSTEM. PLUS THE COLLECTIONS PERSONNEL WHEN CONTACTING PATIENTS WILL SEND PATIENT APPLICATIONS TO COMPLETE FOR A PERSONNAL REVIEW. HOWEVER, EVEN WITH THE ABOVE SOME PATIENTS MAY SLIP THROUGH---- THE ESTIMATED ASSUMES THE SAME % OF BAD DEBT EXPENSE TO TOTAL CHARGES IS THE SAME % OF PATIENTS THAT MAY SLIP THROUGH OUR PROCESSES AND NOT GET CLAIMED AS INDIGENT.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: PAGE 9 OF THE AUDITED FINANCIAL STATEMENTSALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE CORPORATION'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 77% AND 81% OF SELF-PAY ACCOUNTS RECEIVABLE AND PATIENT LIABILITY PORTION OF OTHER ACCOUNTS AT DECEMBER 31, 2017 AND 2016, RESPECTIVELY. 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 ASSESSMENTIN ADDITION TO THE CHNA PERFORMED IN 2016, UH WORKS WITH ER PERSONNEL TO IDENTIFY NEEDS BASED ON PATIENTS SEEKING HELP THROUGH THE EMERGENCY ROOM. THIS PROCESS STILL SHOWS THAT PATIENTS NEED A MEDICAL HOME, ASTHMA, CHF & DIABETES ASSISTANCE. THE PROGRAMS THAT UH HAS INITIATED AND CONTINUE TO SUPPORT. UH ALSO USED THE HEALTHY PEOPLE 2020 FRAMEWORK TO GUIDE DATA GATHERING FOR LEADING HEALTH INDICATORS. PART VI, LINE 3: UH HAS THE FOLLOWING INFORMATION AVAILABLE TO PATIENTS AND VISITORS ON THE ELIGIBILITY FOR ASSISTANCE. INFORMATION IS AVAILABLE ON THE UNIVERSITY HOSPITAL WEBSITE, PATIENT/VISITOR INFORMATION BOOKLET, AND UH HAS SIGNAGE AT REGISTRATION AND BILLING AREAS THAT ASK "... HELP WITH YOUR HOSPITAL BILL?" IN ADDITION, WHEN A REGISTERING PATIENT INDICATES THAT HE/SHE CAN NOT AFFORD TO PAY, UH WILL OFFER THE INDIGENT AND CHARITY CARE APPLICATION (ICCP) AND SET UP PATIENT TO SPEAK WITH THE FINANCIAL ASSISTANCE OFFICE (FAO). FAO WILL DIRECT PATIENTS TO A DEPARTMENT OF FAMILY AND CHILDREN (DFCS) CASE MANAGER LOCATED AT THE HOSPITAL TO SEE IF PATIENT QUALIFIES FOR STATE MEDICAID OR THE UH ICCP PROGRAM. THE PATIENT MAY BE DEEMED TO QUALIFY FOR OTHER STATE/FEDERAL ASSISTANCE IN WHICH THE FAO STAFF WILL HELP DIRECT THE PATIENT TO ANOTHER GROUP OPERATED OUT OF THE HOSPITAL, RESOURCE CORPORATION OF AMERICA (RCA), TO ASSIST WITH GETTING THE PATIENT QUALIFIED FOR SSI, ETC. PART VI, LINE 4: SEE PAGE 6-13 OF THE CHNAUNIVERSITY HEALTH CARE SYSTEM SERVES A DIVERSE COMMUNITY. AIKEN COUNTY HAS MORE RESIDENTS 65 AND OLDER; COLUMBIA COUNTY HAS MORE RESIDENTS BETWEEN 5 AND 17; RICHMOND COUNTY HAS MORE RESIDENTS UNDER 5 YEARS OLD. RICHMOND COUNTY IS VERY DIFFERENT RACIALLY AND ETHNICALLY FROM AIKEN COUNTY AND COLUMBIA COUNTY. WHILE AIKEN AND COLUMBIA COUNTIES HAVE SOME SIMILARITIES IN RACE AND ETHNIC ORIGINS, AIKEN COUNTY HAS FEWER COLLEGE GRADUATES AND HAS MORE POVERTY. RICHMOND COUNTY HAS EVEN FEWER GRADUATES AND AN EVEN HIGHER LEVEL OF POVERTY.RICHMOND COUNTY HAS MORE CHILDREN UNDER 5 YEARS OLD THAN ITS NEIGHBORS AND MORE THAN THE AVERAGE IN GEORGIA, SOUTH CAROLINA, AND THE UNITED STATES. AIKEN COUNTY HAS MORE PERSONS 65 YEARS AND OLDER THAN ALL OTHER GROUPS IN OUR COMPARISON. COLUMBIA COUNTY HAS MORE PERSONS BETWEEN 5 AND 17 YEARS OLD. THIS IS AN ESTIMATE OF THE POPULATION IN 2014.RICHMOND COUNTY HAS FEWER FOREIGN-BORN RESIDENTS AND SPEAKERS OF A LANGUAGE OTHER THAN ENGLISH AT HOME THAN THE REST OF THE NATION, GEORGIA, OR SOUTH CAROLINA IN GENERAL. IT HAS FEWER COLLEGE GRADUATES AND A HIGH DEGREE OF POVERTY. AIKEN COUNTY IS SIMILAR TO RICHMOND COUNTY IN THE PERCENTAGE OF FOREIGN-BORN RESIDENTS AND SPEAKERS OF A LANGUAGE OTHER THAN ENGLISH AT HOME. HOWEVER, IT HAS A HIGHER PERCENTAGE OF COLLEGE GRADUATES AND A LOWER LEVEL OF POVERTY. COLUMBIA COUNTY IS MORE DIVERSE, HAVING A HIGHER PERCENTAGE OF FOREIGN-BORN RESIDENTS AND SPEAKERS OF A LANGUAGE OTHER THAN ENGLISH AT HOME. IT ALSO HAS A HIGHER PERCENTAGE OF COLLEGE GRADUATES AND A LOWER LEVEL OF POVERTY.UNIVERSITY HEALTH CARE SYSTEM SERVES A DIVERSE COMMUNITY. AIKEN COUNTY HAS MORE RESIDENTS 65 AND OLDER; COLUMBIA COUNTY HAS MORE RESIDENTS BETWEEN 5 AND 17; RICHMOND COUNTY HAS MORE RESIDENTS UNDER 5 YEARS OLD. RICHMOND COUNTY IS VERY DIFFERENT RACIALLY AND ETHNICALLY FROM AIKEN COUNTY AND COLUMBIA COUNTY. WHILE AIKEN AND COLUMBIA COUNTIES HAVE SOME SIMILARITIES IN RACE AND ETHNIC ORIGINS, AIKEN COUNTY HAS FEWER COLLEGE GRADUATES AND HAS MORE POVERTY. RICHMOND COUNTY HAS EVEN FEWER GRADUATES AND AN EVEN HIGHER LEVEL OF POVERTY. PART VI, LINE 5: UH GOVERNING BOARD MEMBERS ARE COMPRISED OF CITZENS WHO RESIDE IN THE UH'S PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF UH. UH BOARD MEMBERS ARE ACTIVE IN THE COMMUNITY AND ARE EAGER TO IMPROVE THE HEALTH AND WELFARE OF THE COMMUNITY. SEVERAL OF UH BOARD MEMBERS WORKED WITH THE LOCAL STATE MEDICAL SCHOOL TO GET INTERNS & RESIDENTS AT THE HOSPITAL SINCE UH IS AMONG SEVERAL COUNTIES THAT HAVE BEEN DEEMED AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA). UH EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN OUR COMMUNITY FOR ALL OF THE UH DEPARTMENTS. UH WORKS WITH THE GREATER AUGUSTA HEALTHCARE NETWORK (GAHN) WHICH IS MADE UP OF AREA HOSPITALS AND THE LOCAL MEDICAL COLLEGES SCHOOL OF NURSING AND AREA PRIMARY CARE CLINICS. THIS GROUP ADDRESSES THE PRIMARY AND SPECIALTY CARE NEEDS IN THE COMMUNITY. UH SUPPORTS THE PROJECT ACCESS PROGRAM (PJA) IN RICHMOND AND COLUMBIA COUNTY. PJA IS A PROGRAM WHEREBY THE LOCAL MEDICAL SOCIETY PHYSICIANS AGREE TO TREAT A NUMBER OF INDIGENT COUNTY RESIDENTS WITHOUT PAYMENT. UH PROVIDES ALL OF THE INPATIENT HOSPITALIZATION FOR THE INDIGENT POPULATION THAT IS APPROVED FOR PROJECT ACCESS. THROUGH BOTH OF THESE GROUPS UH IS RESPONSIVE TO SUPPORT THEM IN THEIR NEEDS.UH PROVIDES MANY SCREENINGS IN THE COMMUNITY. ONE SUCH SCREENING IS THE PSA SCREENING THAT IS PERFORMED AT LOWES HOME BUILDING STORES. MANY HAVE RECEIVED THE SCREENING AND RECEIVED POSITIVE RESULTS WHICH WERE CAUGHT AT AN EARLY STAGE. UH'S MOBILE MAMMOGRAPHY UNIT TRAVELS TO AREA PLANTS AND IS AVAILABLE FOR SCREENINGS AT THE JOB SITE DURING LUNCH. THESE ARE ONLY A FEW SCREENING OF THE SCREENINGS THAT UH PROVIDES IN THE COMMUNITY BUT HAVE TREMENDOUS IMPACT WHEN JUST ONE SCREENING IDENTIFIES PROBLEMS THAT CAN BE TREATED AT AN EARLY STAGE 1 CANCER VERSES AT THE LATER STAGES OF CANCER. PART VI, LINE 7, REPORTS FILED WITH STATES GA 1 NEIGHBORHOOD IMPROVEMENT PROJECT 2467 GOLDEN CAMP ROAD AUGUSTA GA 30906 311491242 501(C)(3) 178404 CLINIC FINANCIAL SUPPORT MIRACLE MAKING MINISTRIES 1127 DRUID PARK AVE AUGUSTA GA 30904 582358627 501(C)(3) 39644 CLINIC FINANCIAL SUPPORT AMERICAN CANCER SOCIETY 250 WILLIAMS STREET NW ATLANTA GA 30303 131788491 501(C)(3) 5000 FINANCIAL SUPPORT THE FAMILY Y 3570 WHEELER ROAD AUGUSTA GA 30909 580566254 501(C)(3) 7500 FINANCIAL SUPPORT UNITED WAY 1765 BROAD STREET AUGUSTA GA 30904 580566155 501(C)(3) 5000 FINANCIAL SUPPORT HARRISBURG FAMILY HEALTH 309 CRAWFORD AVENUE AUGUSTA GA 30904 264366421 501(C)(3) 10000 FINANCIAL SUPPORT IKE AND JUSTINE WASHINGTON FOUNDATION PO BOX 31376 AUGUSTA GA 30903 274359119 501(C)(3) 10000 FINANCIAL SUPPORT COORDINATED HEALTH SERVICES 2110 BROAD STREET AUGUSTA GA 30904 582060572 501(C)(3) 138754 8243 COST OF LAB TESTS LAB TESTS CLINIC FINANCIAL SUPPORT BEULAH GROVE COMMUNITY RESOURCE 1446 LEE BEARD WAY AUGUSTA GA 30904 582159621 501(C)(3) 39644 18833 COST EPIC CLINICAL SYSTEM & LAB TESTS CLINIC FINANCIAL SUPPORT CHRIST COMMUNITY HEALTH SERVICES 519 SCOTTS WAY AUGUSTA GA 30909 205404353 501(C)(3) 356808 252797 MEDICARE COST REPORT DONATED FACILITIES CLINIC FINANCIAL SUPPORT PART I, LINE 2: UNIVERSITY HEALTH CARE SYSTEM DOES NOT PROVIDE "GRANTS" TO ASSIST OTHER ORGANIZATIONS, BUT DOES DONATE FUNDS BASED ON THE FOLLOWING POLICY AND PROCEDURES: POLICY: UNIVERSITY HEALTH CARE SYSTEM IS COMMITTED TO THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITIES IT SERVES AND RECOGNIZES THE NEED TO SUPPORT OTHER NON-PROFIT ORGANIZATIONS WHO SHARE THIS COMMITMENT. CORPORATE CONTRIBUTIONS AND SPONSORSHIPS ARE SOMETIMES AN APPROPRIATE VEHICLE FOR BUILDING PARTNERSHIPS WITH THESE NON-PROFIT ORGANIZATIONS AND MAXIMIZING OUR OVERALL POSITIVE IMPACT ON THE COMMUNITY. PROCEDURE 1.ALL CONTRIBUTION/SPONSORSHIP REQUESTS SHOULD BE SUBMITTED IN WRITING TO THE CORPORATE COMMUNICATIONS DEPARTMENT FOR CONSIDERATION. EVERY EFFORT SHOULD BE MADE TO PROCESS THESE REQUESTS AND NOTIFY THE REQUESTER WITHIN TWO WEEKS OF RECEIVING THE WRITTEN INFORMATION REQUIRED TO EVALUATE THE OPPORTUNITY. 2.IN CONSULTATION WITH THE CEO, THE DIRECTOR OF CORPORATE COMMUNICATIONS WILL PREPARE THE ANNUAL BUDGET FOR CORPORATE CONTRIBUTIONS/SPONSORSHIPS AND PROCESS/MANAGE ACTUAL DISBURSEMENTS DURING THE YEAR. 3.REQUESTS WILL BE EVALUATED BASED ON THE FOLLOWING CRITERIA: A.DOES THE ORGANIZATION, EVENT OR PUBLICATION PROMOTE THE OVERALL HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE? SPECIAL CONSIDERATION WILL BE GIVEN TO REQUESTS THAT DIRECTLY IMPACT HEALTH AND WELLNESS EVEN THOUGH SUPPORT MAY BE AVAILABLE FOR ORGANIZATIONS, EVENTS AND/OR PUBLICATIONS THAT HAVE A POSITIVE IMPACT ON THE CSRA BY: "ASSISTING IN ATTRACTING AND RETAINING A VIABLE WORK-FORCE" "ASSISTING IN ATTRACTING AND RETAINING VIABLE BUSINESSES AND EMPLOYERS IN THE CSRA" "PROMOTING THE CONTINUED GROWTH AND ECONOMIC WELL-BEING OF THE COMMUNITY" "ENHANCING THE QUALITY OF LIFE IN THE CSRA" B.DOES THE PROPOSED CONTRIBUTION/SPONSORSHIP PRIMARILY ASSIST PEOPLE LIVING LOCALLY RATHER THAN A NATIONAL EFFORT/INITIATIVE? C.DOES THE REQUESTING ORGANIZATION HAVE AN APPROVED TAX-EXEMPT STATUS? D.WILL THE PROPOSED CONTRIBUTION/SPONSORSHIP ENHANCE THE OVERALL IMAGE/REPUTATION OF UNIVERSITY HEALTH CARE SYSTEM? E.WILL THE PROPOSED CONTRIBUTION/SPONSORSHIP HEIGHTEN AWARENESS OF A SIGNIFICANT HEALTH ISSUE OR DISEASE THAT HAS A NEGATIVE IMPACT ON THE CITIZENS IN THE COMMUNITIES WE SERVE? 4.UNDER NO CIRCUMSTANCES WILL CONTRIBUTIONS BE MADE TO POLITICAL CAMPAIGNS. 5.BECAUSE OF THE LARGE NUMBER OF PUBLIC AND PRIVATE SCHOOLS IN THE CSRA, UNIVERSITY WILL LIMIT FINANCIAL SUPPORT/CONTRIBUTIONS TO THE VARIOUS BOARDS OF EDUCATION RATHER THAN INDIVIDUAL SCHOOLS (ELEMENTARY, MIDDLE, AND HIGH SCHOOLS). 6.BECAUSE OF THE LARGE NUMBER OF CHURCHES IN THE CSRA, UNIVERSITY WILL LIMIT FINANCIAL SUPPORT/CONTRIBUTIONS TO PROGRAMS THAT INCLUDE HEALTH-RELATED SERVICES FOR UNDERSERVED RESIDENTS SUCH AS COMMUNITY CLINICS. 7.EXCEPTION: FINANCIAL SUPPORT AND PARTNERSHIPS WITH AREA COLLEGES AND TECHNICAL SCHOOLS DO NOT FALL UNDER THIS POLICY. X 1 1 X X X X X 0 1 0 0 0 1 0 0 0 DANIEL H BOONE MD BOARD MEMBER 0 258275 0 16500 0 2269 0 5423 0 7405 0 289872 0 0 DAVID A BELKOSKI UHS CFO 424781 0 138195 0 117877 0 1405 0 9366 0 691624 0 0 0 JAMES R DAVIS UHS PRESIDENT & CEO 746360 0 224697 0 618496 0 298649 0 18217 0 1906419 0 0 0 MARILYN A BOWCUTT PRESIDENT OF UNIVERSITY HO 448378 0 144922 0 119561 0 7350 0 9444 0 729655 0 0 0 WILLIAM L FARR JR CMO 386872 0 111378 0 44314 0 8079 0 9759 0 560402 0 0 0 EDWARD L BURR SR. VP LEGAL & REGULATORY 383412 0 123125 0 70093 0 8104 0 13818 0 598552 0 0 0 LAURIE OTT SMITH UHCF-VP HR & COMM SVC 247747 0 95177 0 49658 0 5383 0 7546 0 405511 0 0 0 THOMAS E LOWENCAMP VP - CONTINUING CARE 244689 0 68901 0 32202 0 7564 0 17136 0 370492 0 0 0 SHIRLEY K GABRIEL VP CHIEF INFORMATION OFFIC 280417 0 90806 0 47318 0 5929 0 10327 0 434797 0 0 0 TERESA BUSCHBACHER VP -HVI 184545 0 53748 0 19588 0 5394 0 16725 0 280000 0 0 0 SCOTT ANSEDE VP PROFESSIONAL SERVICES 276270 0 82842 0 38553 0 8120 0 15106 0 420891 0 0 0 ELIZABETH R GALLUP VP CLINICAL OPERATIONS 246268 0 71095 0 35469 0 7803 0 19332 0 379967 0 0 0 ROBERT J KEPSHIRE ADMINISTRATIVE CNO - MCDUF 173125 0 34123 0 1845 0 5250 0 4994 0 219337 0 0 0 JOHN C POPE PA ECHO CLINICAL PROG COOR 176890 0 325 0 18754 0 761 0 9203 0 205933 0 0 0 JACKIE KENDINGER EMPLOYEE 173715 0 29975 0 635 0 5242 0 0 0 209567 0 0 0 DOUGLAS D PUGH II RN 191373 0 1909 0 11236 0 3077 0 14198 0 221793 0 0 0 BEATRICE C BADGER RN 196183 0 2661 0 1664 0 3311 0 9203 0 213022 0 0 0 LYNDA JONES WATTS VP PATIENT CARE SVCS/CNO -6661 0 67406 0 280303 0 0 0 11260 0 352308 0 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 INCLUDED IN THE WAGES OF THE CEO. PART I, LINE 4B JAMES R DAVIS - SERP - $290,468 DAVID A BELKOSKI - ROTH IUL - $56,036 MARILYN A BOWCUTT - CAA BENEFITS - $44,995 WILLIAM L FARR - CAA BENEFITS - $38,076 EDWARD L BURR - CAA REDEMPTION - $66,173 LAURIE OTT SMITH - ROTH IUL - $25,813, SEC. 162 - $2,541 THOMAS E LOWENCAMP - SEC. 162 - $5,946, ROTH IUL - $24,500 SHIRLEY K GABRIEL - ROTH IUL - $27,812, SEC. 162 - $7,036 THERESA BUSCHBACHER - ROTH IUL - $14,175, SEC. 162 - $4,695 SCOTT ANSEDE - ROTH IUL - $28,500, SEC. 162 - $6,626 ELIZABETH R GALLUP - ROTH IUL - $21,900, SEC. 162 - $3,187 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 2017 THESE INITIATIVES WERE WEIGHTED AS DISPLAYED IN THE FOLLOWING SCHEDULE: UNIVERSITY HEALTH SERVICES, INC 2017 STRATEGIC INITIATIVES WEIGHT QUALITY 15% ACHIEVE NRC OVERALL RATING OF CARE SCORE 15% ACHIEVE AGGREGATE COMPOSITE CORE MEASURE SCORE FOR THE 2017 CORE MEASURE SET GROWTH 10% INCREASE ADMISSIONS FROM AIKEN AND COLUMBIA COUNTIES OVER 2016 LEVELS SAFETY 15% MINIMIZE THE NUMBER OF HOSPITAL ACQUIRED CONDITIONS PER 1000 DISCHARGES PEOPLE 15% ACHIEVE EMPLOYEE TURNOVER RATE FOR UHS AFFORDABILITY 25% ACHIEVE OPERATING MARGIN FOR UNIVERSITY HEALTH, INC SERVICE 5% INCREASE THE NUMBER OF ACTIVE MYCHART ACCOUNTS 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. A THE RICHMOND COUNTY HOSPITAL AUTHORITY 586001901 764603BV7 2016-10-25 154488348 REFUND BOND CERTIFICATES (SERIES 2009) 0 0 0 A 154488348 1658616 152829732 2016 0 1 1 1 A 0 1 1 1 1 1 0.02700 0.00200 0.02900 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 NATALIE H THOMPSON DAUGHTER OF BOARD MEMBER 11502 EMPLOYEE COMP AS RN 0 FORM 990, PART VI, SECTION A, LINE 1 IN JANUARY 1985, THE FULL BOARD APPROVED THE FORMATION OF AN EXECUTIVE BOARD BY PASSING THE FOLLOWING RESOLUTION: BE IT RESOLVED THAT AN EXECUTIVE COMMITTEE OF UNIVERSITY HEALTH SERVICES, INC. BE CREATED TO MEET ON A ROUTINE BASIS, SUCH COMMITTEE BEING COMPOSED OF SEVEN MEMBERS. THE SIZE OF THE COMMITTEE MAY BE CHANGED FROM TIME TO TIME BY THE CHAIRMAN OF THE BOARD BUT MUST ALWAYS CONFORM TO THE BYLAWS. THE TASKS OF THE COMMITTEE SHALL CONSIST OF PLANNING, CAPITAL EXPENDITURE REVIEW, AND FINANCIAL REVIEW OF THE ACTIVITIES OF UNIVERSITY HEALTH SERVICES, INC. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF UNIVERSITY HEALTH SERVICES, INC AND ON BUDGETED CAPITAL REQUESTS; HOWEVER, ALL CAPITAL REQUESTS IN EXCESS OF $500,000 MUST BE ACTED ON BY THE FULL BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF 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 THE STEPS IN THE CONFLICT OF INTEREST POLICY ARE OUTLINED BELOW: 1. SENIOR MANAGEMENT (VICE PRESIDENTS AND ABOVE) SHALL COMPLETE A POTENTIAL CONFLICT OF INTEREST QUESTIONNAIRE PERIODICALLY. EACH SYSTEM ORGANIZATION'S CEO, COO, CFO AND WITHIN THEIR DIVISION'S VICE PRESIDENTS MAY REQUIRE ANY EMPLOYEE TO COMPLETE A POTENTIAL CONFLICT OF INTEREST QUESTIONNAIRE. 2.EACH EMPLOYEE IS EXPECTED TO REPORT A POTENTIAL CONFLICT OF INTEREST WHEN IT ARISES. 3. A. AN EMPLOYEE WILL REPORT A POTENTIAL CONFLICT OF INTEREST BY INITIATING A POTENTIAL CONFLICT OF INTEREST DISCLOSURE FORM AND DELIVERING IT TO HIS/HER VICE PRESIDENT. ALL EMPLOYEE POTENTIAL CONFLICTS WILL BE SCREENED BY TWO LEVELS OF SENIOR MANAGEMENT TO IDENTIFY CONFLICT OR DUALITY OF INTEREST SITUATIONS. (A DUALITY OF INTEREST EXISTS WHEN AN INDIVIDUAL HAS PERSONAL OR OUTSIDE INTERESTS THAT CAN BE AFFECTED BY DECISIONS OF THE SYSTEM. SUCH A DUALITY OR EVEN MULTIPLICITY OF INTEREST CAN BE BENEFICIAL TO AND CONSISTENT WITH THE PRIMARY GOALS OF THE INSTITUTIONS. DUALITY OF INTEREST CAN RAISE THE POTENTIAL FOR CONFLICT OF INTEREST WHEN THE PERSONAL INTERESTS OF INDIVIDUALS COME INTO CONFLICT WITH THE INTERESTS OF THE SYSTEM.) B. WHEN A DIVISION VICE PRESIDENT IS NOTIFIED OF A POTENTIAL CONFLICT/DUALITY OF INTEREST, THE VICE PRESIDENT SHALL INVESTIGATE THE SITUATION AND MAKE A REPORT OF HIS OR HER FINDINGS ALONG WITH A RECOMMENDATION TO THE EXECUTIVE VICE PRESIDENT (COO) OR CEO OF THE INVOLVED SYSTEM ORGANIZATION. C. THE EXECUTIVE VICE PRESIDENT OR CEO WHO RECEIVED THE 3.B REPORT SHALL MAKE A DECISION CONCERNING A POTENTIAL CONFLICT OF INTEREST AND ANY RESOLUTION MEASURES TO BE TAKEN. IN THE EVENT THE POTENTIAL CONFLICT INVOLVES A VICE PRESIDENT, THE PRESIDENT OF UNIVERSITY HEALTH SHALL INVESTIGATE THE SITUATION AND MAKE A DECISION CONCERNING A POTENTIAL CONFLICT OF INTEREST AND ANY RESOLUTION MEASURES TO BE TAKEN. THIS INFORMATION SHALL BE COMMUNICATED DIRECTLY TO THE CONCERNED EMPLOYEE. D. THE EMPLOYEE MAY APPEAL THE CONFLICT OF INTEREST DETERMINATION TO THE PRESIDENT OF UNIVERSITY HEALTH. THE PRESIDENT'S DECISION ABOUT A POTENTIAL CONFLICT OF INTEREST AND ANY RESOLUTION MEASURES IS FINAL AND NOT COGNIZABLE UNDER THE EMPLOYEE GRIEVANCE POLICY A-30. E. IN THE EVENT THE POTENTIAL CONFLICT INVOLVES THE CEO OF A SYSTEM ORGANIZATION, THE MATTER SHALL BE REPORTED TO THE CHAIRMAN OF THE INVOLVED SYSTEM ORGANIZATION BOARD, WHO SHALL DETERMINE IF A CONFLICT EXISTS AND WHAT, IF ANY, RESOLUTION MEASURES ARE NECESSARY IN ACCORDANCE WITH THE CORPORATION'S CONFLICT OF INTEREST POLICY. 4. FILING OF FORMS A. CONFLICT OF INTEREST QUESTIONNAIRES OF THOSE WHO ARE REQUIRED BY THIS POLICY TO COMPLETE ONE PERIODICALLY SHALL BE FILED IN THE APPLICABLE CORPORATION'S CEO'S OFFICE AND RETAINED FOR NO LESS THAN SEVEN YEARS. OPTIONAL CONFLICT OF INTEREST QUESTIONNAIRES SHALL BE FILED IN THE OFFICE OF THE VICE PRESIDENT WHO REQUESTED COMPLETION OF THE FORM. B. COMPLETED POTENTIAL CONFLICT OF INTEREST DISCLOSURE FORMS SHALL BE FILED IN THE APPLICABLE CORPORATION'S CEO'S OFFICE FOR THE CEO, COO, AND VICE PRESIDENTS AND FOR ALL OTHERS IN THE APPROPRIATE VICE PRESIDENT'S OFFICE. THE FORMS SHOULD BE RETAINED FOR NO LESS THAN SEVEN YEARS. 5.THE VICE PRESIDENT FOR LEGAL AFFAIRS WILL BE AVAILABLE TO ADVISE ON POTENTIAL CONFLICT OF INTEREST MATTERS. BOARD MEMBERS: BOARD MEMBERS ARE ALSO REQUIRED TO COMPLETE A POTENTIAL CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY. THIS QUESTIONNAIRE ASKS FOR DISCLOSURES RELATED TO ANY FAMILY RELATIONSHIPS OR BUSINESS RELATIONSHIPS WITH OTHER BOARD MEMBERS, OR BUSINESS RELATIONSHIPS WITH THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 15 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 ANY OFFICER, KEY MANAGEMENT, AND DIRECTOR COMPENSATION. ANNUALLY, A COMPENSATION COMMITTEE OF THE UNIVERSITY HEALTH SERVICES (UHS) 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 REVIEWS INVOLVE THE ADVICE AND ASSISTANCE OF AN INDEPENDENT COMPENSATION CONSULTING FIRM. MINUTES OF THE COMPENSATION ARE RECORDED. THE COMPENSATION COMMITTEE REPORTS TO THE UHS BOARD EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS, AND INFORMATIONAL RETURNS ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATION OFFICE. FORM 990, PART XI, LINE 9: CHANGE IN UNFUNDED PENSION GAINS -4,258,044. OTHER CUMULATIVE EFFECT ON ASSET RETIREMENT OBLIGATIONS -27,177. TRANSFER TO AFFILIATE -26,870,750. PTP INVESTMENT - UBTI NOT ON BOOKS 695,570. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SCHEDULE H, PART V, LINE 16A HTTPS://WWW.UNIVERSITYHEALTH.ORG/PATIENT-VISITOR-INFORMATION/FOR-PATIENT S/BILLING-INFORMATION/INDIGENT-AND-CHARITY-CARE SCHEDULE H, PART V, LINE 16B HTTPS://WWW.UNIVERSITYHEALTH.ORG/PATIENT-VISITOR-INFORMATION/FOR-PATIENT S/BILLING-INFORMATION/INDIGENT-AND-CHARITY-CARE SCHEDULE H, PART V, LINE 16C HTTPS://WWW.UNIVERSITYHEALTH.ORG/PATIENT-VISITOR-INFORMATION/FOR-PATIENT S/BILLING-INFORMATION/INDIGENT-AND-CHARITY-CARE WALTON WAY INDEMNITY SPC 2ND FL GOVERNORS SQ 23 LIME TREE WEST BAY GRAND CAYMAN CJ INSURANCE CAPTIVE CJ 3092427 21533766 UNIVERSITY HEALTH SERVICES INC UNIVERSITY EXTENDED CARE INC 1350 WALTON WAY AUGUSTA GA 30901 581581105 SKILLED NURSING HOMES GA 501(C)(3) 3 UNIVERSITY HEALTH INC 0 RICHMOND COUNTY HOSPITAL AUTHORITY 1350 WALTON WAY AUGUSTA GA 30901 586001901 LEASED FACILITIES GA 501(C)(3) 3 N/A 0 AUGUSTA RESOURCE CENTER ON AGING I 4275 OWENS ROAD EVANS GA 30809 581728812 NON PROFIT LIFE CARE COMMUNITY GA 501(C)(3) 9 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH CARE FOUNDATION 2100 CENTRAL AVENUE SUITE D-1 AUGUSTA GA 30904 581343550 PHILANTHROPY GA 501(C)(3) 7 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH INC 1350 WALTON WAY AUGUSTA GA 30901 581581102 CONSOLIDATING PARENT GA 501(C)(3) 9 N/A 0 UNIVERSITY MCDUFFIE COUNTY REGIONAL 1350 WALTON WAY AUGUSTA GA 30901 454166209 HOSPITAL GA 501(C)(3) 3 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH RESOURCES INC 1350 WALTON WAY AUGUSTA GA 30901 581601372 SVC TO PHYSICIANS GA UNIVERSITY HEALTH INC C 0 UNIVERSITY HOSPITAL AIKEN INC 1350 WALTON WAY AUGUSTA GA 30901 472713774 HOSPITAL SC UNIVERSITY HEALTH INC C 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 1 0 0 0 0