2016-10-07T08:12:25-05:00 2015-12-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2015-01-01 581734026 UPSON COUNTY HOSPITAL INC UPSO 7066478111 801 WEST GORDON STREET THOMASTON GA 302860027 JOHN WILLIAMS CFO 7066478111 2016-10-07 1 AMY BIBBY P00445891 8282542254 2015 2017-02-10 21:41:12Z UPSON REGIONAL MEDICAL CENTER TRIPP PENN 801 WEST GORDON STREET THOMASTON GA 302860027 95264114 0 X WWW.URMC.ORG X 1951 GA UPSON REGIONAL MEDICAL CENTER'S MISSION IS TO PROVIDE QUALITY HEALTH CARE SERVICES TO THE SURROUNDING AREA, REGARDLESS OF THE ABILITY TO PAY. 9 9 735 74 570702 -21687 14343 152500 67366999 88863878 5629332 5061824 2232386 1169123 75243060 95247325 28925 29269 0 0 35454513 36896588 0 0 0 32475296 51301117 67958734 88226974 7284326 7020351 161109644 171718218 16929202 26689247 144180442 145028971 UPSON REGIONAL MEDICAL CENTER'S MISSION IS TO PROVIDE QUALITY HEALTH CARE SERVICES TO THE SURROUNDING AREA, REGARDLESS OF THE ABILITY TO PAY. 0 0 67973823 29269 88863878 UPSON REGIONAL MEDICAL CENTER OFFERS A COMPLETE LINE OF MEDICAL SERVICES INCLUDING 24-HOUR EMERGENCY CENTER, MEDICAL-SURGICAL CARE, OBSTETRICS, PEDIATRICS, WOMEN'S HEALTH SERVICES, AND MORE. PATIENT DAYS FOR THE YEAR TOTALED 13,156 IN 2015. 67973823 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 118 0 1 735 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 GA X JOHN WILLIAMS CFO 7066478111 801 WEST GORDON ST THOMASTON GA 302860227 WILLIAM HIGHTOWER CHAIRMAN 0.75 0.15 X X 0 0 0 JAMES J EDWARDS VICE CHAIRMAN/VICE PRESIDENT 0.75 0.15 X X 0 0 0 BARNEY HANCOCK SECRETARY/TREASURER 0.75 0.15 X X 0 0 0 DR RALPH WARNOCK ASSISTANT SECRETARY 0.75 0.15 X 0 0 0 KAY ROBINSON BOARD MEMBER 0.75 0.15 X 0 0 0 STEVE KEADLE BOARD MEMBER 0.75 0.15 X 0 0 0 KAY SEARCY BOARD MEMBER 0.75 0.15 X 0 0 0 SCOTT BLACKSTOCK BOARD MEMBER 0.75 0.15 X 0 0 0 DR JONATHAN BUSBEE BOARD MEMBER 0.75 0.15 X 0 0 0 DAVID CASTLEBERRY CEO THROUGH OCTOBER 40.00 1.00 X 296771 0 34252 JOHN WILLIAMS CFO 40.00 1.00 X 205131 0 14119 MARK HARTMAN INTERIM CEO AS OF OCTOBER 40.00 X 67084 0 0 DR BRANDON M BOYCE ORTHOPEDIC SURGEON 40.00 X 1062804 0 38041 DR STEVENS YANG ANESTHESIOLOGIST 40.00 X 555814 0 25143 DR ROBERT SOLYOMVARI SURGEON 40.00 X 553490 0 34009 DR DAVID PETERSON ANESTHESIOLOGIST 40.00 X 553260 0 38041 DR DANIEL A BRIDGES SURGEON 40.00 X 548762 0 37364 3843116 0 220969 30 0 1 0 INNOVATIVE THERAPY CONCEPTS LLC 2 MASHBURN STREET SUITE 102 HAWKINSVILLE GA 31036 PHYSICAL THERAPY CONTRACTOR 1214000 SODEXO INC & AFFILIATES PO BOX 536922 ATLANTA GA 30353 FOOD SERVICE CONTRACTOR 1041491 WEATHERBY LOCUMS INC 4021 SOUTH 700 EAST SUITE 300 SALT LAKE CITY UT 84107 LOCUM TENENS CONTRACTOR 680354 PELICANO CONSTRUCTION 415 PINE AVENUE SUITE 200 ALBANY GA 31701 CONSTRUCTION CONTRACTOR 592453 STEPHEN F BELL MD 914 OLD ALBAMA ROAD THOMASTON GA 30286 PEDIATRICS SERVICE CONTRACTOR 432845 27 152500 152500 GROSS PATIENT SERVICE REVENUE 621990 88774044 88774044 EHR INCENTIVES 621990 89834 89834 88863878 4157413 4157413 109000 0 109000 109000 109000 907054 14146 0 16789 907054 -2643 904411 904411 WELLNESS CENTER 713940 605894 546280 59614 MISCELLANEOUS 561499 429807 429807 OUTSIDE CATERING 722320 24422 24422 1060123 95247325 88863878 570702 5660245 X 29269 29269 550273 550273 28652238 21193146 7459092 422118 306344 115774 5271546 3825720 1445826 2000413 1451760 548653 386994 38400 348594 409435 409435 224525 224525 11075 11075 10551208 5880672 4670536 126866 406 126460 4750934 2064743 2686191 1033564 189428 844136 1523248 1523248 158459 53425 105034 406917 406917 5755316 5755316 391331 391331 BAD DEBT EXPENSE 17788682 17788682 MEDICAL SUPPLIES 7318869 7318869 MISCELLANEOUS 362569 61939 300630 FOOD EXPENSE 101125 101125 88226974 67973823 20253151 0 3787 5249 14377848 15407779 9193452 12622773 271744 1744417 1764369 975160 959821 108199908 59526925 48667132 48672983 85641271 92047245 234833 237999 161109644 171718218 5980795 5751022 9585000 8790000 1363407 12148225 16929202 26689247 X 144180442 145028971 144180442 145028971 161109644 171718218 7020351 -6171822 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11075 11075 0 PART II-B, LINE 1: THE ORGANIZATION PAYS ANNUAL DUES TO NATIONAL AND STATE INDUSTRY ORGANIZATIONS. A PORTION OF THOSE DUES ARE ATTRIBUTABLE TO THE LOBBYING ACTIVITIES OF THESE ORGANIZATIONS FOR THE BENEFIT OF THEIR MEMBERS. 1943580 1943580 58948531 28493748 30454783 951791 668678 283113 43234550 30364499 12870051 3121456 3121456 48672983 EST THIRD PARTY PAYOR SETTLEMENTS 867226 CAPITAL LEASE OBLIGATION 10000000 CAP RESERVES 1280999 12148225 X PART X, LINE 2: THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AND ARE TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE SEGREGATED PORTFOLIO INTENDS TO CONDUCT ITS AFFAIRS IN A MANNER IN WHICH IT WILL NOT BE SUBJECT TO U.S. FEDERAL INCOME TAX OR GEORGIA INCOME TAX. THE REMAINING WHOLLY OWNED SUBSIDIARIES ARE CONSIDERED DISREGARDED ENTITIES AND ARE INCLUDED IN THE HOSPITAL'S TAX FILINGS. THEREFORE, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL AND FOUNDATION APPLY ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE HOSPITAL AND FOUNDATION ONLY RECOGNIZE THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF DECEMBER 31, 2015 AND 2014 OR FOR THE YEARS THEN ENDED. THE HOSPITAL AND FOUNDATION'S TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. CENTRAL AMERICA & THE CARIBBEAN 1 1 CAPTIVE INSURANCE 2568740 1 1 0 0 1 1 2568740 0 2568740 0 0 1 0 0 0 1 1 X 1 X 125.000000000000 1 X 1 1 1 0 1 1 3738354 1720099 2018255 0.02870 12240824 7213344 5027480 0.07140 15979178 8933443 7045735 0.10010 34381 34381 0.00050 6361253 3734007 2627246 0.03730 16120 16120 0.00020 6411754 3734007 2677747 0.03800 22390932 12667450 9723482 0.13810 10 334325 334325 0.00470 10 334325 334325 0.00470 1 17099818 0 16284712 16258433 26279 X 1 1 1 1 UPSON COUNTRY HOSPITAL 801 WEST GORDON STREET THOMASTON GA 30286 HTTP://WWW.URMC.ORG/ 145-415 X X X UPSON COUNTY HOSPITAL INC 1 0 0 1 X X X X X X X X 15 1 0 0 1 X HTTP://WWW.URMC.ORG/CONTENT_PAGES/84 1 15 1 HTTP://WWW.URMC.ORG/CONTENT_PAGES/84 0 0 1 X 125.000000000000 300.000000000000 X 1 1 X X X X 1 X HTTP://WWW.URMC.ORG/DOCUMENTS?DOC_TYPE=PATIENT_DOCUMENTS X HTTP://WWW.URMC.ORG/DOCUMENTS?DOC_TYPE=PATIENT_DOCUMENTS X HTTP://WWW.URMC.ORG/DOCUMENTS?DOC_TYPE=PATIENT_DOCUMENTS X X X X X 1 X 0 X X X 1 X 0 0 UPSON COUNTY HOSPITAL INC PART V, SECTION B, LINE 5: INFORMATION GATHERED FROM STAKEHOLDER INTERVIEWS, COMMUNITY-WIDE SURVEYS, DISCUSSIONS WITH THE HOSPITAL LEADERSHIP TEAM, REVIEW OF THE DEMOGRAPHIC AND HEALTH STATUS, AND HOSPITAL UTILIZATION DATA WAS USED TO DETERMINE THE PRIORITY HEALTH NEEDS OF THE POPULATION. HEALTH PRIORITIES WERE FURTHER DEVELOPED BY THE CHNA HOSPITAL STEERING COMMITTEE (CHSC) AFTER CAREFUL REVIEW OF COMMUNITY RESOURCES AVAILABLE FOR THESE PRIORITIES AND THE FUTURE VALUE OF THE PRIORITY. THE FOLLOWING PRIORITIES WERE IDENTIFIED BY THE CHSC:1. ACCESS TO CARE2. OBESITY3. HEART DISEASE AND STROKE4. DIABETES5. TEEN PREGNANCY6. MENTAL HEALTH7. DRUG ABUSE UPSON COUNTY HOSPITAL INC PART V, SECTION B, LINE 11: UPSON REGIONAL MEDICAL CENTER HAS ADDRESSED EACH OF THE HEALTH NEEDS IDENTIFIED IN THE CHNA. URMC DEVELOPED IMPLEMENTATION STRATEGIES TO ADDRESS EACH OF THE HEALTH ISSUES IDENTIFIED OVER THE NEXT THREE YEARS, WITH THE EXCEPTION OF MENTAL HEALTH, TEEN PREGNANCY, ALCOHOL AND DRUG ABUSE. 1. ACCESS TO CARE.A. RECRUIT PRIMARY CARE PHYSICIANS, TARGETED SPECIALISTS AND MID-LEVEL PRACTITIONERS B. PROVIDE CHARITY CARE C. ALLOCATE FINANCIAL CONTRIBUTION TO THE PUBLIC HEALTH DEPARTMENT FOR THE PROVISION OF PRIMARY CARE SERVICES D. LEVERAGE 340B PROGRAM TO PROVIDE PRESCRIBED MEDICATION UPON DISCHARGE TO UNDER AND UNINSURED PERSONS. 2. OBESITY.A. PROVIDE HEALTHY EATING/ACTIVE LIVING COMMUNITY EDUCATIONB. CONDUCT BODY MASS INDEX SCREENINGS AT COMMUNITY HEALTH FAIRS C. PARTNER WITH CHILDREN'S HEALTHCARE OF ATLANTA TO OFFER STRONG4LIFE TRAINING EARLY CHILDCARE EDUCATORS (WWW.STRONG4LIFE.COM). 3. HEART DISEASE AND STROKE. A. IMPLEMENT SMOKE-FREE CAMPUS AND TOBACCO-FREE HIRING POLICY B. PROVIDE HEART DISEASE AWARENESS COMMUNITY EDUCATION AT LOCAL CHURCHES, REPRESENTATIVE OF THE UNDERSERVED COMMUNITY, AND CIVIC CLUBS. C. CONDUCT BLOOD PRESSURE CHECKS AT COMMUNITY EVENTS D. IMPLEMENT TELESTROKE IN THE EMERGENCY DEPARTMENT TO IMPROVE TIMELY DIAGNOSIS/TREATMENT. 4. DIABETES A. PROVIDE MONTHLY DIABETES EDUCATION ON DISEASE MANAGEMENT AND NUTRITIONB. PROVIDE BLOOD GLUCOSE SCREENINGS AT COMMUNITY HEALTH FAIRSC. PROVIDE INSULIN TO UNINSURED/UNDERSERVED PATIENTSD. PROVIDE, UPON MD REFERRAL, ONE-ON-ONE CONSULTS ABOUT DIABETES DISEASE MANAGEMENTE. PROVIDE LINKS TO ONLINE HEALTH EDUCATION RESOURCES VIA WWW.URMC.ORG HEALTH NEEDS WITHOUT SPECIFIC IMPLEMENTATION STRATEGIES1. TEEN PREGNANCYTHERE IS A LACK OF COMMUNITY CONSENSUS ON THE RECOMMENDED CURRICULUM FOR SEX EDUCATION. THIS LACK OF CONSENSUS CREATES A BARRIER TO THE HOSPITAL DIRECTLY ADDRESSING THE NEED. A PARTNERSHIP BETWEEN THE SCHOOL SYSTEM AND PUBLIC HEALTH WOULD BETTER SERVE THIS IDENTIFIED NEED. THE HOSPITAL WILL WORK TO ENSURE OUR PHYSICIANS ARE A PART OF THE PARTNERSHIP. 2. MENTAL HEALTHTHE COMMUNITY PREVALENCE OF MENTAL HEALTH ISSUES IS RELATIVELY SMALL IN NUMBER OF PERSONS AFFECTED. URMC IS AN ACUTE CARE HOSPITAL THAT PROVIDES EMERGENCY CARE FOR MENTAL HEALTH CONDITIONS, OFTEN ON A CHARITY CARE BASIS. URMC DOES NOT HAVE THE SPECIALIZED STAFF AND PHYSICIAN RESOURCES NEEDED TO ADDRESS MENTAL HEALTH ISSUES. MCINTOSH TRAIL AND PATHWAYS (BARNESVILLE) CURRENTLY PROVIDE FOCUSED MENTAL HEALTH SERVICES TO THE COMMUNITY. THE HOSPITAL WILL DEVELOP A RESOURCE DIRECTORY FOR THE COMMUNITY TO HELP INDIVIDUALS NAVIGATE THE HEALTHCARE SYSTEM AS IT RELATES TO MENTAL HEALTH. THE HOSPITAL WILL CONTINUE TO MEET THE ACUTE CARE AND EMERGENCY CARE NEEDS OF MENTALLY ILL PATIENTS IN THE COMMUNITY, WITH REFERRALS TO SPECIALIZED MENTAL HEALTH PROVIDERS WHEN APPROPRIATE. 3. ALCOHOL AND DRUG ABUSESUBSTANCE ABUSE TREATMENT AND PREVENTION IS BEYOND THE SCOPE OF THE HOSPITAL. URMC IS AN ACUTE CARE HOSPITAL THAT PROVIDES EMERGENCY CARE FOR MENTAL HEALTH CONDITIONS, OFTEN ON A CHARITY CARE BASIS. HOWEVER, URMC DOES NOT HAVE THE STAFF AND PHYSICIAN RESOURCES AVAILABLE TO ADDRESS ALCOHOL AND DRUG ABUSE HEALTH ISSUES ON A SPECIALIZED BASIS. MCINTOSH TRAIL AND PATHWAYS (BARNESVILLE) CURRENTLY PROVIDE ADDICTIVE DISEASE-RELATED HEALTH SERVICES TO THE COMMUNITY. THE COMMUNITY WOULD BE BETTER SERVED BY AN ORGANIZATION THAT DIRECTLY ADDRESSES THIS HEALTH CONCERN. THE HOSPITAL WILL PROVIDE A RESOURCE DIRECTORY FOR THE COMMUNITY TO HELP INDIVIDUALS NAVIGATE THE HEALTHCARE SYSTEM AS IT RELATES TO ALCOHOL AND DRUG ABUSE. UPSON COUNTY HOSPITAL INC PART V, SECTION B, LINE 22D: THE ORGANIZATION USES THE LOOK-BACK METHOD TO CALCULATE AMOUNTS GENERALLY BILLED. 6 1 - UPSON MEDICAL ASSOCIATES LLC 801 W GORDON STREET THOMASTON GA 30286 PHYSICIANS OFFICE 2 - UPSON REGIONAL WELLNESS CENTER LLC 801 W GORDON STREET THOMASTON GA 30286 WELLNESS CENTER 3 - ORTHOPEDICS SPORTS MEDICINE AND SURGERY 801 W GORDON STREET THOMASTON GA 30286 PHYSICIANS OFFICE 4 - UPSON WOMEN'S SERVICES LLC 801 W GORDON STREET THOMASTON GA 30286 PHYSICIANS OFFICE 5 - UPSON FAMILY PHYSICIANS LLC 801 W GORDON STREET THOMASTON GA 30286 PHYSICIANS OFFICE 6 - UPSON SURGICAL ASSOCIATES LLC 801 W GORDON STREET THOMASTON GA 30286 PHYSICIANS OFFICE PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES COSTS INCLUDE THOSE ATTRIBUTABLE TO UPSON MEDICAL ASSOCIATES, UPSON WOMEN'S SERVICES, UPSON SURGICAL ASSOCIATES, ORTHOPEDIC SPORTS MEDICINE, AND UPSON FAMILY PHYSICIANS TOTALING 9,533,196 THESE CLINICS PROMOTE HEALTH CARE FOR UNDESERVED POPULATIONS IN THE AREA. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 17,788,682. PART II, COMMUNITY BUILDING ACTIVITIES: HEALTH PROFESSIONALS RECRUITMENT AND STAFF MEMBER APPOINTED BY CITY MAYOR TO REPRESENT THOMASTON AND HEALTHCARE WORKFORCE NEEDS ON THE THREE RIVERS WORKFORCE INVESTMENT BOARD FOR REGION 4. PART III, LINE 2: THE BAD DEBT EXPENSE AMOUNT ABOVE REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. PART III, LINE 3: BAD DEBT EXPENSE ATTRIBUTABLE TO THE PATIENTS ELIGIBLE UNDER THE ORGANIZATIONS FINANCIAL POLICY CANNOT BE REASONABLE ESTIMATED. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY 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), THE HOSPITAL RECORDS A SIGNIFICANT 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, IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS.THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 94% FOR BOTH FISCAL YEARS 2015 AND 2014. IN ADDITION, THE HOSPITAL'S SELF-PAY WRITE-OFFS DECREASED APPROXIMATELY $3,417,000 FROM $21,563,000 FOR FISCAL YEAR 2014 TO $18,146,000 FOR FISCAL YEAR 2015. DURING FY 2014, SELF-PAY WRITE-OFFS INCREASED DUE TO ADDITIONAL WRITE-OFFS OF ACCOUNTS RECEIVABLE ASSOCIATED WITH THE SALE OF THE UPSON AMBULANCE COMPANY, LLC IN 2013. DURING FY 2015, SELF-PAY WRITE-OFFS DECREASED DUE TO A DECREASE IN SELF-PAY REVENUE. THE HOSPITAL DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DID IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD-PARTY PAYORS. PART III, LINE 8: MEDICARE COSTS REFLECT ALLOWABLE COSTS PER THE MEDICARE COST REPORT USING ACCEPTABLE ALLOCATIONS OF INDIRECT COSTS BASED ON STATISTICAL BASIS. PART III, LINE 9B: ACCOUNTS KNOWN TO HAVE QUALIFIED FOR FINANCIAL ASSISTANCE ARE WRITTEN OFF WITH AN ADJUSTMENT INDICATING INDIGENT WRITEOFF. PART VI, LINE 2: UPSON REGIONAL MEDICAL CENTER (URMC) IS A 115-BED NOT-FOR-PROFIT COMMUNITY HOSPITAL LOCATED IN THOMASTON. GEORGIA. IN 2015, THE HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) TO IDENTIFY THE HEALTH NEEDS OF UPSON COUNTY. THE IMPLEMENTATION STRATEGY FOR URMC WAS DEVELOPED BASED ON FINDINGS AND PRIORITIES ESTABLISHED IN THE CHNA AND A REVIEW OF THE HOSPITAL'S EXISTING COMMUNITY BENEFIT ACTIVITIES. URMC SUSTAINS AND DEVELOPS COMMUNITY BENEFIT PROGRAMS THAT 1) ADDRESS PRIORITIZED NEEDS FROM THE 2015 URMC CHNA AND 2) RESPOND TO OTHER IDENTIFIED COMMUNITY HEALTH NEEDS. THE FOLLOWING PRIORITIZED NEEDS WERE IDENTIFIED BY THE COMMUNITY AND THE CHNA STEERING COMMITTEE. PARTICULAR FOCUS WAS PLACED UPON THESE NEEDS IN DEVELOPING THE IMPLEMENTATION STRATEGY. 1. ACCESS TO CARE 2. OBESITY 3. HEART DISEASE AND STROKE 4. DIABETES 5. TEEN PREGNANCY 6. MENTAL HEALTH 7. DRUG ABUSE PART VI, LINE 3: UPSON REGIONAL MEDICAL CENTER INFORMS AND EDUCATES THE PATIENTS USING THE FOLLOWING PROCESSES: THE FINANCIAL ASSISTANCE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IS POSTED IN THE ADMISSION AREAS, EMERGENCY DEPARTMENTS AND OTHER AREAS OF THE FACILITY IN WHICH ELIGIBLE PATIENTS ARE PRESENT. WE PROVIDE A COPY OF THE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO THE PATIENTS AS PART OF THE ADMISSION PROCESS. ADDITIONALLY, THE POLICY IS AVAILABLE ON THE HOSPITAL WEBSITE - WITH PRINTABLE APPLICATION.A SUMMARY OF THE POLICY IS ALSO INCLUDED IN THE PATIENT BILLING. WE DISCUSS WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS QUALIFYING FOR MEDICAID OR STATE PROGRAMS AND ASSIST THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. WE PROVIDE TRAINING TO THE STAFF ON FINANCIAL ASSISTANCE AND CONTRACT WITH CHAMBERLON & EDMONDS ON SCREENING OUR PATIENTS FOR MEDICAID AND/OR OTHER SOURCES OF ASSISTANCE. WE ALSO PROVIDE INFORMATION ON THE ADMISSIONS PACKAGE EXPLAINING THE AVAILABILITY, CRITERIA, AND THE PROCESS FOR APPLYING FOR FINANCIAL ASSISTANCE. OUR EFFORTS TO INFORM NON-ENGLISH SPEAKING PATIENTS ABOUT THE FINANCIAL ASSISTANCE POLICY IS PROVIDED BY AN INTERPRETER THROUGH THE USE OF LANGUAGE LINE, A TELEPHONE INTERPRETATION SERVICE. PART VI, LINE 4: COMMUNITY INFORMATIONUPSON SERVES A SEVEN-COUNTY AREA IN MIDDLE GEORGIA, INCLUDING PIKE, LAMAR, UPSON, CRAWFORD, MONROE, MERIWETHER AND TALBOT COUNTIES. AS A WHOLE, THE SERVICE AREA, WHICH USED TO BE A BOOMING TEXTILE AREA, HAS RATES OF UNEMPLOYMENT, UNINSURED AND POVERTY THAT ARE HIGHER THAN THE STATE AVERAGE. THE POPULATION AGE MIMICS A BOWTIE, WITH LARGE NUMBERS OF ELDERLY AND LARGE NUMBERS OF CHILDREN UNDER THE AGE OF 18 AND A SHRINKING NUMBER OF MIDDLE-AGED CITIZENS. PART VI, LINE 5: UPSON MADE APPROXIMATELY 660 CONTACTS WITH COMMUNITY HEALTH EDUCATION PROGRAMS, HEALTH SCREENINGS, HEALTH CARE SUPPORT VALUED AT $16,725 TO SUPPORT BETTER HEALTH. THROUGH SPONSORSHIPS AND DONATIONS, UPSON CONTRIBUTED MORE THAN $16,120 TO LOCAL CHARITIES, LIKE THE AMERICAN CANCER SOCIETY.UPSON REGIONAL MEDICAL CENTER CONTINUES TO WORK COLLABORATIVELY WITH THE LOCAL HEALTH DEPARTMENTS, COUNTY EXTENSION SERVICES, CIVIC CLUBS, AND CHURCHES TO PROVIDE ANNUAL HEALTH FAIRS, SCREENINGS AND EDUCATIONAL PROGRAMS. DUE TO THE CONTINUAL DECLINE OF INDUSTRY IN THIS AREA BEGINNING WITH THE TEXTILE INDUSTRY SHUT-DOWN, MANY PEOPLE DEPEND ON THESE ANNUAL HEALTH FAIRS FOR THEIR PREVENTATIVE HEALTH CARE. THE NUMBER OF UNDERINSURED AND UNINSURED PEOPLE INCREASES EACH YEAR. UPSON REGIONAL OFFERS MANY FREE AND DISCOUNTED DIAGNOSTIC SCREENINGS AND TESTS. THIS HAS PROVIDED EARLY DETECTION FOR MANY DISEASES AS WELL AS PROMOTED HEALTH AND WELLNESS THROUGH ANNUAL CHECKUPS SINCE THAT TIME. THESE ANNUAL HEALTH FAIRS ARE A COOPERATIVE EFFORT AMONG MANY GROUPS IN OUR COMMUNITY.IN 2015, WE PROVIDED FREE OR DISCOUNTED TESTS AT HEALTH FAIRS, CANCER SCREENINGS, DIABETES SCREENINGS, CARDIAC SCREENINGS, EDUCATIONAL OFFERINGS AND FREE FLU IMMUNIZATIONS. PART VI, LINE 7, REPORTS FILED WITH STATES GA 1 EDUCATION SCHOLARSHIP / LOAN ASSISTANCE 2 6314 TUITION REIMBURSEMENT 10 22955 PART I, LINE 2: SCHOLARSHIP ASSISTANCE IS OFFERED TO UPSON COUNTY RESIDENTS AND FULL TIME, PART TIME AND PRN EMPLOYEES PURSUING A HEALTHCARE CAREER. EACH APPLICANT MUST COMPLETE AN APPLICATION, BE ACCEPTED BY AN ACCREDITED SCHOOL IN A HEALTHCARE PROGRAM OF THEIR CHOICE, SUBMIT TWO LETTERS OF RECOMMENDATION, A CERTIFIED COPY OF PREVIOUS EDUCATIONAL TRANSCRIPTS, AND A LETTER OF ACCEPTANCE IN THE HEALTHCARE CAREER PROGRAM, OBTAIN APPROVAL FROM THE DEPARTMENT DIRECTOR OR SENIOR MANAGEMENT, BE INTERVIEWED BY CHIEF NURSING OFFICER, MAINTAIN A 3.0 CUMULATIVE AVERAGE, SUBMIT TRANSCRIPTS OF GRADES EVERY SCHOOL TERM, AND SERVE AS AN EMPLOYEE A MINIMUM OF ONE YEAR FROM EACH SCHOOL YEAR FOR WHICH SCHOLARSHIP MONIES ARE GRANTED. TRANSCRIPTS OF GRADES MUST BE RECEIVED BEFORE REIMBURSEMENT. SHOULD THE STUDENT NOT SEEK AND MAINTAIN EMPLOYMENT WITH URMC AFTER GRADUATION, FUNDS WILL BECOME DUE AND PAYABLE IN A PRORATE FASHION BASED ON EMPLOYMENT TERM. TUITION REIMBURSEMENT IS AWARDED FULL TIME AND REGULARLY SCHEDULED PART TIME EMPLOYEES. MONIES ARE GRANTED TO COVER TUITION, BOOKS AND LABORATORY FEE. EACH APPLICANT MUST BE ENROLLED IN AN ACCREDITED COLLEGE/UNIVERSITY WITHIN A PROGRAM DIRECTLY RELATED TO THE EMPLOYEE'S PRESENT POSITION OR A FIELD THAT WILL BE OF BENEFIT TO THE MEDICAL CENTER, SEEK APPROVAL FROM MANAGEMENT, FURNISH A TRANSCRIPT OF GRADES, MAINTAIN A "C OR HIGHER AVERAGE TO BE REIMBURSED, AN EMPLOYEE MUST PRESENT A CERTIFIED COPY OF THE GRADE REPORT WITH AN AVERAGE OF "C OR HIGHER. X 1 0 X X 0 0 0 0 0 0 0 0 0 DAVID CASTLEBERRY CEO THROUGH OCTOBER 296771 0 0 0 0 0 5300 0 28952 0 331023 0 0 0 JOHN WILLIAMS CFO 205131 0 0 0 0 0 4175 0 9944 0 219250 0 0 0 DR BRANDON M BOYCE ORTHOPEDIC SURGEON 585337 0 467467 0 10000 0 5300 0 32741 0 1100845 0 0 0 DR STEVENS YANG ANESTHESIOLOGIST 555814 0 0 0 0 0 5300 0 19843 0 580957 0 0 0 DR ROBERT SOLYOMVARI SURGEON 364890 0 188600 0 0 0 5300 0 28709 0 587499 0 0 0 DR DAVID PETERSON ANESTHESIOLOGIST 553260 0 0 0 0 0 5300 0 32741 0 591301 0 0 0 DR DANIEL A BRIDGES SURGEON 504032 0 44730 0 0 0 5300 0 32064 0 586126 0 0 0 PART I, LINE 1A THE INTERIM CHIEF NURSING OFFICER AND INTERIM CHIEF EXECUTIVE OFFICER WERE PROVIDED TEMPORARY HOUSING AS PART OF THEIR CONTRACT TERMS OF EMPLOYMENT. PART III PHYSICIAN BONUSES ARE PAID BASED ON RELATIVE VALUE UNITS (RVUS) ACHIEVED DURING A SPECIFIED TIME PERIOD EACH PHYSICIAN'S EMPLOYMENT CONTRACT INCLUDES A RVU GOAL. THE PHYSICIAN IS PAID BONUSES BASED ON MEETING OR EXCEEDING THE GOAL AS DETERMINED BY THEIR CONTRACT. A HOSPITAL AUTHORITY OF UPSON COUNTY 586002427 2004-12-31 10000000 RENOVATION & EXPANSION OF HOSPITAL 0 0 0 B HOSPITAL AUTHORITY OF UPSON COUNTY 586002427 2005-01-20 6000000 RENOVATION & EXPANSION OF HOSPITAL 0 0 0 A 4510000 10000000 124175 9875825 2007 0 0 1 1 B 2700000 6000000 79846 5920154 2007 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 0 0 0 0 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: HOSPITAL AUTHORITY OF UPSON COUNTY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/30/2009 ISSUER NAME: HOSPITAL AUTHORITY OF UPSON COUNTY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/20/2010 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 WAS EMAILED TO EACH BOARD OF TRUSTEE MEMBER PRIOR TO THE IRS FILING DUE DATE FOR THEIR REVIEW. FORM 990 REVIEW WAS PLACED ON THE BOARD AGENDA FOR DISCUSSIONS SHOULD ANY QUESTIONS OCCUR. THE 990 IS REVIEWED BY THE CFO IN DETAIL PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY COVERS ALL DIRECTORS, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. SHOULD A MATTER COME BEFORE THE BOARD OF DIRECTORS WHICH CONSTITUTES A CONFLICT OF INTEREST, THE INDIVIDUAL INVOLVED WILL MAKE KNOWN THE POTENTIAL CONFLICT AND WITHDRAW FROM THE MEETING SO LONG AS THE MATTER SHALL CONTINUE UNDER DISCUSSION AND SHALL NOT EITHER VOTE ON THE MATTER UNDER DISCUSSION OR ATTEMPT TO INFLUENCE A DECISION OF THE GOVERNING AUTHORITY WITH RESPECT TO SUCH MATTERS, UPON WHICH THERE COULD POSSIBLY BE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 IN DETERMINING COMPENSATION FOR TOP OFFICIALS, HUMAN RESOURCES OBTAINS THE COMPARABLE SALARY SURVEY AND PRESENTS IT TO THE BOARD OF DIRECTORS WHO MAKE A FINAL DECISION. THE CEO IS NOT PRESENT DURING THE DISCUSSION AND DECISION-MAKING PROCESS. DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN THE MINUTES OF THE MEETING. ANNUAL MERIT ADJUSTMENT: SALARY ADJUSTMENT IS DETERMINED BY ORGANIZATIONAL PERFORMANCE AS REFLECTED IN THE SCORE OF THE ESTABLISHED PERFORMANCE MEASUREMENT INSTRUMENT. (LEM/LEADERSHIP EVALUATION MANAGEMENT). PERIODIC MARKET ADJUSTMENT: SALARY IS REVIEWED PERIODICALLY BY THE CURRENT MANAGEMENT GROUP (HEALTH TECH) AND COMPARED TO CEO SALARIES OF COMPARABLE ORGANIZATIONS TO ENSURE THAT THE CURRENT RATE IS COMPETITIVE. IN DETERMINING COMPENSATION FOR THE CFO, OTHER OFFICERS OR KEY EMPLOYEES, THE ORGANIZATION'S HUMAN RESOURCES DEPARTMENT OBTAINS COMPARABLE SALARY DATA AND PRESENTS IT TO THE GOVERNING BODY WHO MAKES THE FINAL DECISION. THE INDIVIDUAL IN THE CONSIDERATION PROCESS IS NOT PRESENT DURING THE DISCUSSION AND DECISION-MAKING PROCESS. DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN THE MINUTES OF THE MEETING. ANNUAL MERIT ADJUSTMENT: SALARY ADJUSTMENT IS DETERMINED BY ORGANIZATIONAL PERFORMANCE AS REFLECTED IN THE SCORE OF THE ESTABLISHED PERFORMANCE MEASUREMENT INSTRUMENT. (LEM/LEADERSHIP EVALUATION MANAGEMENT). PERIODIC MARKET ADJUSTMENT: SALARY OF EACH OFFICER IS REVIEWED PERIODICALLY BY HUMAN RESOURCES AND APPROPRIATE OFFICER AND COMPARED TO SALARIES OF COMPARABLE ORGANIZATIONS TO ENSURE THAT THE CURRENT RATE IS COMPETITIVE. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 900 AND 990T IS MADE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR INSPECTION, WITH NOTICE, IN THE OFFICE OF THE ORGANIZATION. FORM 990, PART IX, LINE 11G CONTRACT LABOR : PROGRAM SERVICE EXPENSES 1,714,904. MANAGEMENT AND GENERAL EXPENSES 540,990. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,255,894. OTHER FEES : PROGRAM SERVICE EXPENSES 1,981,324. MANAGEMENT AND GENERAL EXPENSES 3,114,805. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,096,129. PHYSICIAN FEES : PROGRAM SERVICE EXPENSES 2,157,369. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,157,369. CONSULTING FEES : PROGRAM SERVICE EXPENSES 27,075. MANAGEMENT AND GENERAL EXPENSES 539,525. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 566,600. COLLECTIONS AND BILLING : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 475,216. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 475,216. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. 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