2018-11-15T08:20:43-06:00 2017-12-31 570381582 ELLIOTT DAVIS LLCPLLLC ONE 10TH STREET SUITE 400 AUGUSTA GA 30901 990 2017-01-01 581581105 UNIVERSITY EXTENDED CARE INC UNIV 7068282406 1350 WALTON WAY AUGUSTA GA 309012629 DAVID A BELKOSKI CFO 7068282406 2018-11-12 1 JESSICA C CAIN P01276209 7067229090 2018-11-12 24.181.201.165 2018-11-12 12:14:56 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D9C45B12E74E3E126437FD430A1A3CA8815D446F 2017 2018-06-14 16:35:46Z JAMES R DAVIS 1350 WALTON WAY AUGUSTA GA 30901 57242984 0 X WWW.UNIVERSITY.ORG X 1984 GA TO PROVIDE COMPETENT AND COMPASSIONATE CARE TO MEET THE HEALTH CARE NEEDS OF THE ELDERLY AND DISABLED. THE GOAL IS TO MAINTAIN THE PRESENT LEVEL OF FUNCTION IN THE PATIENT AND TRY TO IMPROVE THE ABILITY OF PATIENTS TO ASSIST WITH THE ROUTINE DAILY CARE IN A CONTROLLED SETTING. 15 13 502 0 0 0 0 0 24692803 35091984 972487 1203655 45777 13739 25711067 36309378 0 0 0 0 12122543 13230921 0 0 0 12684463 17053365 24807006 30284286 904061 6025092 43825281 52933520 2771087 2856133 41054194 50077387 X TO PROVIDE COMPETENT AND COMPASSIONATE CARE TO MEET THE HEALTH CARE NEEDS OF THE ELDERLY AND DISABLED. THE GOAL IS TO MAINTAIN THE PRESENT LEVEL OF FUNCTION IN THE PATIENT AND TRY TO IMPROVE THE ABILITY OF PATIENTS TO ASSIST WITH THE ROUTINE DAILY CARE IN A CONTROLLED SETTING. 0 0 26734713 35091984 UNIVERSITY EXTENDED CARE HAS THREE FACILITIES. THE KENTWOOD FACILITY HAS 100 SKILLED NURSING BEDS. THE WESTWOOD FACILITY HAS 149 BEDS WHICH INCLUDES AN ALZHEIMER'S UNIT AND A WING DESIGNED FOR ORTHOPAEDIC AND CARDIAC PATIENT REHABILITATION. THE AMARA FACILITY HAS 193 SKILLED NURSING BEDS. THE FACILITIES HAD 74% OCCUPANCY FOR 2017. THE TOTAL PATIENT DAYS WERE 119,083 FOR 2017. 26734713 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 16 0 502 1 0 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X X DAVID BELKOSKI CFO 7068282406 1350 WALTON WAY AUGUSTA GA 309012629 X LEVI W HILL IV BOARD CHAIRMAN 2.00 X X 0 0 0 TERRY D ELAM BOARD MEMBER 2.00 X 0 0 0 W CRAIG SMITH BOARD MEMBER 2.00 X 0 0 0 NATALIE D SCHWEERS BOARD MEMBER 2.00 X 0 0 0 SANFORD LOYD BOARD MEMBER 2.00 X 0 0 0 BRIAN J MARKS BOARD SECRETARY 2.00 X X 0 0 0 EUGENE F MCMANUS BOARD MEMBER 2.00 X 0 0 0 HUGH L HAMILTON BOARD MEMBER 2.00 X 0 0 0 JEFFREY L FOREMAN BOARD MEMBER 2.00 X 0 0 0 JAMES W BENNETT JR BOARD MEMBER 2.00 X 0 0 0 DANIEL H BOONE MD BOARD MEMBER 2.00 10.00 X 0 277044 12828 CHARLES G PETE CAYE JR BOARD MEMBER 2.00 X 0 0 0 CATHERINE D KNOX BOARD MEMBER 2.00 X 0 0 0 WILLIAM P DOUPE BOARD MEMBER 2.00 X 0 0 0 JAMES C SHERMAN MD BOARD MEMBER 2.00 50.00 X 0 120006 600 WILLIAM L FARR JR CMO 2.00 50.00 X 0 542564 17838 EDWARD L BURR CAO 2.00 50.00 X 0 576630 21922 DAVID A BELKOSKI CFO 2.00 50.00 X 0 680853 10771 JAMES R DAVIS CEO 2.00 50.00 X 0 1589553 316866 MARILYN A BOWCUTT PRESIDENT UNIVERSITY HOSPI 2.00 50.00 X 0 712861 16794 THOMAS E LOWENCAMP VP - CONTINUING CARE 25.00 25.00 X 0 345792 24700 0 4845303 422319 0 0 1 0 AEGIS THERAPIES PO BOX 8103 FORT SMITH AR 72902 THERAPY 3021057 CRITICAL SOLUTIONS INC PO BOX 1451 AUGUSTA GA 30903 STAFFING (NURSING, ASSISTANTS) 895069 MORRISON COMMUNITY LIVING PO BOX 102289 ATLANTA GA 30368 DIETARY 691921 ON CALL STAFFING LLC 4236 COLUMBIA RD MARTINEZ GA 30907 STAFFING 499852 CROTHALL HEALTHCARE 13028 COLLECTION CENTER DR CHICAGO IL 60693 HOUSEKEEPING 418493 5 INPATIENT REVENUE 623000 35076130 35076130 DIETARY SERVICE REVENUE 900099 15854 15854 35091984 693087 693087 21444174 20926589 7017 517585 -7017 510568 510568 MISCELLANEOUS 900099 13739 13739 13739 36309378 35091984 0 1217394 X 9468043 8504887 963156 267485 240736 26749 2721387 2528544 192843 774006 696605 77401 39127 39127 104924 104924 7089708 5742882 1346826 965 965 136512 38508 98004 1854423 1817335 37088 13219 5181 8038 2383 709 1674 160 160 557767 538220 19547 529068 529068 SUPPLIES 3436858 3362862 73996 BED TAXES 1729261 1729261 BAD DEBT 1049651 1049651 REPAIRS AND MAINTENANCE 292390 225537 66853 216949 148711 68238 30284286 26734713 3549573 0 1856523 4482837 2333664 2744605 37452 153189 6486197 3235382 3529493 3250815 32499457 36603144 3568692 5698930 43825281 52933520 2770379 2843021 708 13112 2771087 2856133 X 41054194 50077387 41054194 50077387 43825281 52933520 6025092 2998101 0 X X 0 1 X 1 0 X 2196186 988226 1207960 4231936 2247156 1984780 58075 58075 3250815 WORKFORCE IN PLACE 223611 DUE FROM UHS 5475179 DUE FROM UHR 140 5698930 PAYABLE TO UMG 2607 DUE FROM UHM 10505 13112 X PART X, LINE 2: UNIVERSITY EXTENDED CARE, 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. 0 1 0 0 0 0 1 0 0 DANIEL H BOONE MD BOARD MEMBER 0 258275 0 16500 0 2269 0 5423 0 7405 0 289872 0 0 WILLIAM L FARR JR CMO 0 386872 0 111378 0 44314 0 8079 0 9759 0 560402 0 0 EDWARD L BURR CAO 0 383412 0 123125 0 70093 0 8104 0 13818 0 598552 0 0 DAVID A BELKOSKI CFO 0 424781 0 138195 0 117877 0 1405 0 9366 0 691624 0 0 JAMES R DAVIS CEO 0 746360 0 224697 0 618496 0 298649 0 18217 0 1906419 0 0 MARILYN A BOWCUTT PRESIDENT UNIVERSITY HOSPI 0 448378 0 144922 0 119561 0 7350 0 9444 0 729655 0 0 THOMAS E LOWENCAMP VP - CONTINUING CARE 0 244689 0 68901 0 32202 0 7564 0 17136 0 370492 0 0 PART I, LINE 4B BENEFITS PAID BY UNIVERSITY HEALTH SERVICES INC. (58-1581103) JAMES R. DAVIS SERP - $290,468 DAVE BELKOSKI ROTH IUL - $56,036 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 FROM RELATED ORGANIZATIONS, AND HAVE BEEN INCLUDED IN THE INDIVIDUAL'S 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. 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. 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 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 VII - COMPENSATION JAMES R DAVIS COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES INC (58-1581103) DAVID A BELKOSKI COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES INC (58-1581103) MARILYN A BOWCUTT COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES INC (58-1581103) WILLIAM L FARR JR COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES INC (58-1581103) DANIEL H BOONE MD COMPENSATION PAID BY UNIVERSITY MEDICAL GROUP, LLC (27-4467379) JAMES C SHERMAN MD COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES INC (58-1581103) FORM 990, PART IX, LINE 11G CONSULTING FEES: PROGRAM SERVICE EXPENSES 122. MANAGEMENT AND GENERAL EXPENSES 29. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 151. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 53,831. MANAGEMENT AND GENERAL EXPENSES 12,625. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,456. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,573,329. MANAGEMENT AND GENERAL EXPENSES 368,979. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,942,308. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 1,025,160. MANAGEMENT AND GENERAL EXPENSES 240,422. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,265,582. OCCUPATIONAL THERAPY: PROGRAM SERVICE EXPENSES 1,104,731. MANAGEMENT AND GENERAL EXPENSES 259,082. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,363,813. SPEECH THERAPY: PROGRAM SERVICE EXPENSES 359,770. MANAGEMENT AND GENERAL EXPENSES 84,373. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 444,143. DIETICIAN FEES: PROGRAM SERVICE EXPENSES 55,652. MANAGEMENT AND GENERAL EXPENSES 13,052. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 68,704. MORRISON CONTRACT: PROGRAM SERVICE EXPENSES 570,869. MANAGEMENT AND GENERAL EXPENSES 133,881. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 704,750. PERSONNEL RECRUITMENT: PROGRAM SERVICE EXPENSES 26,731. MANAGEMENT AND GENERAL EXPENSES 6,269. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,000. MANAGEMENT: PROGRAM SERVICE EXPENSES 972,687. MANAGEMENT AND GENERAL EXPENSES 228,114. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,200,801. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. UNIVERSITY HEALTH SERVICES INC 1350 WALTON WAY AUGUSTA GA 30901 581581103 HOSPITAL 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 SERVICES 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 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0