2015-09-28T10:08:28-05:00 2014-12-31 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2014-01-01 581734026 UPSON COUNTY HOSPITAL INC UPSO 7066478111 801 WEST GORDON STREET THOMASTON GA 302860027 JOHN WILLIAMS CFO 7066478111 2015-11-16 true JACQUELINE G ATKINS P00861721 2298837878 2015-09-24 2014 2016-02-25 16:41:14Z UPSON REGIONAL MEDICAL CENTER DAVID CASTLEBERRY CEO 801 WEST GORDON STREET THOMASTON GA 302860027 81372251 false 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. 8 8 727 97 586415 -399631 774603 14343 73698620 67366999 3253489 5629332 2051361 2232386 79778073 75243060 30846 28925 0 37839156 35454513 0 0 34913681 32475296 72783683 67958734 6994390 7284326 155255863 161109644 16518803 16929202 138737060 144180442 UPSON REGIONAL MEDICAL CENTER'S MISSION IS TO PROVIDE QUALITY HEALTH CARE SERVICES TO THE SURROUNDING AREA, REGARDLESS OF THE ABILITY TO PAY. false false 54611200 28925 67366999 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 12,750 IN 2014. 54611200 true true false true false false false false false false true false false false true true false true false false true false false false false false true true false true true true false false false false false false false false false false false false false false true true false false false true 125 0 727 true true true true CJ false false false false false false false false X 8 8 false false false false false false false true true false false true true true true true true true true false GA X JOHN WILLIAMS CFO 7066478111 801 WEST GORDON ST THOMASTON GA 302860027 JOHN WILLIAMS CFO 39.00 1.00 X 202880 0 22871 JAMES J EDWARDS JR VICE CHAIRMA 0.75 0.15 X X 0 0 0 BARNEY HANCOCK SECRETARY/TR 0.75 0.15 X X 0 0 0 WILLIAM H HIGHTOWER IV CHAIRMAN 0.75 0.15 X X 0 0 0 KAY ROBINSON MEMBER 0.75 0.15 X 0 0 0 STEVE KEADLE MEMBER 0.75 0.15 X 0 0 0 RALPH P WARNOCK MD ASST SECRETA 0.75 0.15 X 0 0 0 DAVID CASTLEBERRY CEO 39.00 1.00 X 298313 0 36352 ROBERT SOLYOMVARI MD SURGEON 40.00 X 560271 0 36515 DAVID PETERSON MD ANESTHESIOLO 40.00 X 553801 0 36352 STEVEN YANG MD ANESTHESIOLO 40.00 X 556450 0 23899 KAY SEARCY MEMBER 0.75 0.15 X 0 0 0 BRANDON BOYCE MD SURGEON 40.00 X 751516 0 28506 DARRYL H KNIGHT MD SURGEON 40.00 X 475016 0 36352 SCOTT BLACKSTOCK MEMBER 0.75 X 0 0 0 3398247 220847 26 false true false INNOVATIVE THERAPY CONCEPTS LLC 2 MASHBURN STREET SUITE 102 HAWKINSVILLE GA 310364961 PHYSICAL THERAP 1221882 SODEXO INC & AFFILIATES PO BOX 536922 ATLANTA GA 303536922 CAFETERIA MGMT 1029820 FACILITY CONTROL GROUP INC 5174 HATHBURN COURT DUNWOODY GA 301883402 FACILITY MAINT 605939 ADAMS BARFIELD & BAITY LLP 106 N CENTER STREET THOMASTON GA 302864148 LEGAL SERVICES 432509 HOSPITAL MEDICINE ASSOCIATES LLC PO BOX 634850 CINCINNATI OH 452634850 HOSPITALISTS 319770 21 14343 14343 PATIENT SERVICE REVENUE 621990 65901534 65901534 EHR INCENTIVES 621990 1465465 1465465 67366999 2734350 2734350 535669 306744 228925 228925 228925 8697580 19849 5801924 20523 2895656 -674 2894982 2894982 WELLNESS CENTER 713940 560324 560324 MISCELLANEOUS 561499 442342 442342 CAFETERIA 722514 380028 380028 620767 26091 594676 2003461 75243060 67366999 586415 7275303 X 28925 28925 560416 560416 27285305 22583192 4702113 405454 337146 68308 5289041 4298614 990427 1914297 1555825 358472 297864 38400 259464 484189 484189 104004 104004 11125 11125 29805 29805 7178350 5274157 1904193 119371 2355 117016 2526279 1971281 554998 997614 446408 551206 1927601 1776284 151317 166310 57061 109249 10937 10937 5638983 5196323 442660 434800 406510 28290 MEDICAL SUPPLIES 8527469 8527469 REPAIRS & MAINTENANCE 2152292 986789 1165503 PROVIDER TAXES 924194 924194 MISCELLANEOUS 379926 73002 306924 564183 116140 448043 67958734 54611200 13347534 0 1428 3787 12894963 14377848 11271254 9193452 379056 271744 1909023 1744417 873058 975160 108810849 60143717 50664838 48667132 76960256 85641271 301987 234833 155255863 161109644 5897905 5980795 10350000 9585000 270898 1363407 16518803 16929202 X 138737060 144180442 138737060 144180442 155255863 161109644 7284326 -1840944 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 11125 11125 false SCHEDULE C, 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. 1962101 1962101 58886625 26142858 32743767 880281 548395 331886 47050657 33452464 13598193 31185 31185 48667132 EST. THIRD PARTY PAYOR SETTLEMENTS 1363407 1363407 X SCHEDULE D, PAGE 3, PART X 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, 2014 AND 2013 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. false CENTRAL AMERICA & THE CARIBBEAN 1 1 INVESTMENTS 2228000 1 1 1 1 2228000 2228000 false false true false false false SCHEDULE F, PAGE 1, PART I, LINE 3 CENTRAL AMERICA & THE CARIBBEAN 0 2,228,000 true true X true X 1.250000000000 true X true true true false true true 6003 3619788 3619788 0.05300 13893 9314649 9065693 248956 0.00360 19896 12934437 9065693 3868744 0.05660 1513 37613 37613 0.00060 228 4763 4763 0.00010 9494606 2450708 7043898 0.10320 20 13916 13916 0.00020 1761 9550898 2450708 7100190 0.10410 21657 22485335 11516401 10968934 0.16070 1 1 19887 19887 0.00030 1 5 259526 259526 0.00380 2 6 279413 279413 0.00410 true 20046688 15100738 15091387 9351 X true true 1 1 UPSON COUNTY HOSPITAL INC DBA UPSON REGIONAL MEDICAL CENTER 801 WEST GORDON STREET THOMASTON GA 30286 WWW.URMC.ORG 145-415 X X X O/P PHYS OFFICE; WELLNESS CTR UPSON COUNTY HOSPITAL INC 1 false false true X X X X X X X X 12 true false false true X WWW.URMC.ORG X true 13 false true false true X 125.000000000000 300.000000000000 X true true X X X true X X X X X X true X true X X X true X false false FACILITY 1, UPSON COUNTY HOSPITAL, INC. - PART V, LINE 5 THE CHNA HOSPITAL STEERING COMMITTEE ("CHSC") IDENTIFIED COMMUNITY LEADERS, PARTNERS, AND REPRESENTATIVES TO INCLUDE IN THE CHNA PROCESS. INDIVIDUALS, AGENCIES, PARTNERS, POTENTIAL PARTNERS, AND OTHERS WERE REQUESTED TO WORK WITH THE HOSPITAL TO 1) ASSESS THE NEEDS OF THE COMMUNITY, 2) REVIEW AVAILABLE COMMUNITY RESOURCES AND 3) TO PRIORITIZE THE HEALTH NEEDS OF THE COMMUNITY. REPRESENTATIVES OF GROUPS, OR INDIVIDUALS, WHO REPRESENT MEDICALLY-UNDERSERVED POPULATIONS, LOW INCOME POPULATIONS, MINORITY POPULATIONS, AND POPULATIONS WITH CHRONIC DISEASES WERE INCLUDED. COMMUNITY STAKEHOLDERS (ALSO CALLED KEY INFORMANTS) ARE PEOPLE INVESTED IN OR INTERESTED IN THE WORK OF THE HOSPITAL, PEOPLE WHO HAVE SPECIAL KNOWLEDGE OF HEALTH ISSUES, OR ARE PEOPLE IMPORTANT TO THE SUCCESS OF ANY HOSPITAL OR HEALTH PROJECT, OR ARE FORMAL OR INFORMAL COMMUNITY LEADERS. THE HOSPITAL IDENTIFIED OVER 120 COMMUNITY MEMBERS TO PARTICIPATE IN THE CHNA PROCESS. TWO-HOUR COMMUNITY HEALTH INPUT MEETINGS (COMMUNITY MEETINGS) AND ONE-HOUR COMMUNITY STAKEHOLDER INTERVIEWS (INTERVIEWS) WERE ESSENTIAL PARTS OF THE CHNA PROCESS. THREE COMMUNITY MEETINGS AND 10 STAKEHOLDER INTERVIEWS WERE CONDUCTED IN ORDER TO OBTAIN THE COMMUNITY'S INPUT INTO THE HEALTH NEEDS OF UPSON COUNTY. EACH COMMUNITY MEETING WAS DRIVEN BY AN AGENDA PLANNED IN ADVANCE. SIGN-IN SHEETS AND EVALUATIONS WERE ALSO USED. THE COMMUNITY HEALTH PROFILE WAS SHARED WITH THE PARTICIPANTS AT EACH MEETING. INFORMATION GATHERED FROM COMMUNITY MEETINGS, STAKEHOLDER INTERVIEWS, DISCUSSIONS WITH THE HOSPITAL LEADERSHIP TEAM, AS WELL AS A REVIEW OF DEMOGRAPHIC AND HEALTH STATUS, AND HOSPITAL UTILIZATION DATA WAS USED TO DETERMINE THE PRIORITY HEALTH NEEDS OF THE POPULATION. DRAFFIN & TUCKER, LLP PROVIDED THE CHSC WITH A WRITTEN REPORT OF THE OBSERVATIONS, COMMENTS, AND PRIORITIES RESULTING FROM THE COMMUNITY MEETINGS AND STAKEHOLDER INTERVIEWS. THE CHSC REVIEWED THIS INFORMATION, FOCUSING ON THE IDENTIFIED NEEDS, PRIORITIES, AND CURRENT COMMUNITY RESOURCES AVAILABLE. THE CHSC DEBATED THE MERITS OR VALUES OF THESE PRIORITIES, CONSIDERING THE RESOURCES AVAILABLE TO MEET THESE NEEDS. FROM THIS INFORMATION AND DISCUSSION, THE HOSPITAL DEVELOPED THE PRIORITY NEEDS OF THE COMMUNITY, EACH OF WHICH WILL BE ADDRESSED SEPARATELY IN THE HOSPITAL'S IMPLEMENTATION STRATEGY DOCUMENT. FACILITY 1, UPSON COUNTY HOSPITAL, INC. - PART V, LINE 7D THE FACILITY'S COMMUNITY HEALTH NEEDS ASSESSMENT FULL REPORT CAN BE FOUND AT HTTP://URMC.ORG/SYSTEM/MEDIA_FILES/ATTACHMENTS/39/ORIGINAL/URMC_REPORT_FINA LB.PDF?1355327495 FACILITY 1, UPSON COUNTY HOSPITAL, INC. - PART V, LINE 11 URMC 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, TRANSPORTATION AND SEXUALLY TRANSMITTED DISEASES. HEALTH NEEDS WITHOUT SPECIFIC IMPLEMENTATION STRATEGIES 1. MENTAL HEALTH THE 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, A NON-PROFIT MENTAL HEALTH REHAB FACILITY LOCATED IN 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. 2. TEEN PREGNANCY THERE 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. AS STATED ABOVE, URMC WILL DEVELOP IMPLEMENTATION STRATEGIES TO ADDRESS TEEN LIFESTYLE ISSUES. THROUGH THESE STRATEGIES, THE HOSPITAL WILL ADDRESS LIFESTYLE CHOICES WHICH MAY CONTRIBUTE TO TEEN PREGNANCY. THE HOSPITAL WILL ALSO PROVIDE A RESOURCE DIRECTORY TO THE COMMUNITY TO IDENTIFY HEALTH RESOURCES FOR PREGNANT TEENS. 3. ALCOHOL AND DRUG ABUSE SUBSTANCE 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, A NON-PROFIT MENTAL HEALTH REHAB FACILITY LOCATED IN 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. 4. TRANSPORTATION IT IS BEYOND THE HOSPITAL'S SCOPE TO PROVIDE PHYSICAL TRANSPORTATION TO THE COMMUNITY. COMMUNITY MEMBERS IN NEED OF TRANSPORTATION TO ACCESS CARE AND PROVIDERS RELY ON CAB SERVICE, AMBULANCE OR OTHER FORM OF VEHICLE. THE HOSPITAL WILL ADDRESS THE NEED FOR TRANSPORTATION BY PROVIDING SCREENINGS AND OTHER FORMS OF PREVENTIVE CARE IN COMMUNITY LOCATIONS IN CLOSE PROXIMITY TO VULNERABLE POPULATIONS, SUCH AS CHURCHES AND COMMUNITY CENTERS. IN ADDITION, A RESOURCE DIRECTORY WILL BE DEVELOPED TO PROVIDE THE COMMUNITY WITH PHONE NUMBERS OF TRANSPORTATION ALTERNATIVES. 5. SEXUALLY-TRANSMITTED DISEASES THERE 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. AS STATED ABOVE, URMC WILL DEVELOP IMPLEMENTATION STRATEGIES TO ADDRESS TEEN LIFESTYLE ISSUES. THROUGH THESE STRATEGIES, THE HOSPITAL WILL ADDRESS LIFESTYLE CHOICES WHICH MAY CONTRIBUTE TO INCREASED PREVALENCE OF STDS. ALTHOUGH STDS ARE MORE PREVALENT AMONG THE YOUTH AND TEEN POPULATION, IT IS ALSO AN ISSUE AMONG THE REST OF THE POPULATION. PUBLIC HEALTH WILL BETTER SERVE THE NEED FOR EDUCATION AND SCREENINGS IN THE COMMUNITY. THE HOSPITAL WILL PROVIDE A RESOURCE DIRECTORY TO THE COMMUNITY TO IDENTIFY HEALTH RESOURCES FOR SEXUAL HEALTH. PUBLIC HEALTH FACILITIES WILL BE IDENTIFIED AS RESOURCES COMMUNITY MEMBERS CAN CONTACT REGARDING SEXUAL HEALTH AND STDS. FACILITY 1, UPSON COUNTY HOSPITAL, INC. - PART V, LINE 22D THE HOSPITAL USED ALL PAYERS WITH THE EXCEPTION OF MEDICAID, MEDICAID CMO, AND SELF PAY TO DETERMINE THE MAXIMUM AMOUNTS TO BE CHARGED FOR FAP ELIGIBLE INDIVIDUALS. 6 UPSON MEDICAL ASSOCIATES LLC 801 WEST GORDON STREET THOMASTON GA 30286 PHYSICIANS OFFICE UPSON REGIONAL WELLNESS CENTER LLC 801 WEST GORDON STREET THOMASTON GA 30286 WELLNESS CENTER UPSON WOMEN'S SERVICES LLC 801 WEST GORDON STREET THOMASTON GA 30286 PHYSICIANS OFFICE UPSON FAMILY PHYSICIANS LLC 801 WEST GORDON STREET THOMASTON GA 30286 PHYSICIANS OFFICE UPSON SURGICAL ASSOCIATES LLC 801 WEST GORDON STREET THOMASTON GA 30286 PHYSICIANS OFFICE ORTHOPEDICS SPORTS MEDICINE & SURGE 801 WEST GORDON STREET THOMASTON GA 30286 PHYSICIANS OFFICE PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION 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 UNDERSERVED POPULATIONS IN THE AREA. PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN (F), THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25: FORM 990, PART IX, LINE 25 67,958,734 ADD: EXPENSES ON PART VIII 306,744 DENOMINATOR FOR COLUMN (F) 68,265,478 PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008". FOR LINE 7A, COSTS WERE CALCULATED USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 AS PROVIDED IN THE IRS INSTRUCTIONS. SUBSIDIZED HEALTH SERVICES PRESENTED ON LINE 7G WERE BASED ON ACTUAL COSTS PER THE MEDICARE COST REPORT NET OF ASSOCIATED BAD DEBT, CHARITY AND MEDICAID EXPENSE. ALL OTHER COSTS PRESENTED IN THE TABLE WERE ACCUMULATED THROUGH THE COST ACCOUNTING SOFTWARE CBISA. PART II - COMMUNITY BUILDING ACTIVITIES AS ONE OF THE REGIONS LARGEST EMPLOYERS, UPSON REGIONAL MEDICAL CENTER INVESTS IN ITS SERVICE AREA TO DEVELOP WORKFORCE AND LEADERSHIP CAPACITY NEEDED TO STRENGTHEN THE REGION. THESE ACTIVITIES PROVIDE OPPORTUNITIES TO ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS. THESE ACTIVITIES SUPPORT COMMUNITY ASSETS BY OFFERING THE EXPERTISE AND RESOURCES OF HEALTHCARE ORGANIZATIONS. THESE INCLUDE INVOLVEMENT WITH THE LOCAL AND STATE CHAMBERS OF COMMERCE PROVIDING LEADERSHIP TRAINING AND PARTICIPATION IN YOUTH LEADERSHIP PROGRAMS. PART OF THE COMMUNITY HEALTH IMPROVEMENT ADVOCACY INCLUDES OUR PHYSICIAN RECRUITMENT ACTIVITIES TO MEET THE HEALTH NEEDS OF THE UNDERSERVED, AND PHYSICIAN STUDENT LOAN REPAYMENT FOR 5 PRIMARY CARE PHYSICIANS WHO HAVE COME TO SERVE OUR COMMUNITIES. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS 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% AND 82% FOR FISCAL YEARS 2014 AND 2013, RESPECTIVELY. IN ADDITION, THE HOSPITAL'S SELF-PAY WRITE-OFFS INCREASED APPROXIMATELY 2,714,000 FROM 18,849,000 FOR FISCAL YEAR 2013 TO 21,563,000 FOR FISCAL YEAR 2014. THE INCREASE WAS A RESULT OF AN OVERALL INCREASE IN REVENUES FOR FY 2014, WHICH INCLUDED UNINSURED SELF-PAY PATIENTS AS WELL AS ADDITIONAL WRITE-OFFS OF ACCOUNTS RECEIVABLE ASSOCIATED WITH THE SALE OF THE UPSON AMBULANCE COMPANY, LLC IN 2013. 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 EXPLANATION MEDICARE COSTS REFLECT ALLOWABLE COSTS PER THE MEDICARE COST REPORT USING ACCEPTABLE ALLOCATIONS OF INDIRECT COSTS BASED ON STATISTICAL BASIS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION ACCOUNTS KNOWN TO HAVE QUALIFIED FOR FINANCIAL ASSISTANCE ARE WRITTEN OFF WITH AN ADJUSTMENT INDICATING INDIGENT WRITEOFF. PART VI, LINE 2 - NEEDS ASSESSMENT UPSON REGIONAL MEDICAL CENTER (URMC) IS AN 115-BED NOT-FOR-PROFIT COMMUNITY HOSPITAL LOCATED IN THOMASTON. GEORGIA. IN 2012, 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 2012 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. HEART DISEASE AND STROKE 3. CANCER 4. DIABETES 5. OBESITY 6. TEEN LIFESTYLE 7. RESPIRATORY 8 MENTAL HEALTH 9. TEEN PREGNANCY 10 ALCOHOL AND DRUG ABUSE 11. TRANSPORTATION 12. SEXUALLY TRANSMITTED DISEASES PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE 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 INFORMATION UPSON 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 - PROMOTION OF COMMUNITY HEALTH UPSON MADE APPROXIMATELY 1,500 CONTACTS WITH COMMUNITY HEALTH EDUCATION PROGRAMS, HEALTH SCREENINGS, HEALTH CARE SUPPORT VALUED AT 16,559 TO SUPPORT BETTER HEALTH. THROUGH SPONSORSHIPS AND DONATIONS, UPSON CONTRIBUTED MORE THAN 13,916 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 2014, WE PROVIDED FREE OR DISCOUNTED TESTS AT HEALTH FAIRS, CANCER SCREENINGS, DIABETES SCREENINGS, CARDIAC SCREENINGS, AND EDUCATIONAL OFFERINGS. WE PROVIDED FREE FLU IMMUNIZATIONS AND HELPED UPSON-LEE SCHOOLS EQUIP FOR AND LAUNCH TELEMEDICINE. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT GEORGIA true TUITION REIMBURSEMENT 10 18828 SCHOLARSHIP PROGRAM 4 10097 SCHEDULE I, PAGE 4, PART IV SCHEDULE I, PART III - GRANTS AND OTHER ASSISTANCE TO INDIVIDUALS IN THE UNITED STATES 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 FOR EACH SCHOOL YEAR FOR WHICH SCHOLARSHIP MONIES WERE 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 PRORATA 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 FEES. 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 GRADE AVERAGE. TO BE REIMBURSED, AN EMPLOYEE MUST PRESENT A CERTIFIED COPY OF THE GRADE REPORT WITH AN AVERAGE OF "C" OR HIGHER. X X false false false false false false false false false JOHN WILLIAMS CFO 202880 4172 18699 225751 DAVID CASTLEBERRY CEO 298313 5200 31152 334665 ROBERT SOLYOMVARI MD SURGEON 365338 194933 5200 31315 596786 DAVID PETERSON MD ANESTHESIOLOGIST 553801 5200 31152 590153 STEVEN YANG MD ANESTHESIOLOGIST 556450 5200 18699 580349 BRANDON BOYCE MD SURGEON 474951 261565 15000 5200 23306 780022 DARRYL H KNIGHT MD SURGEON 310389 144627 20000 5200 31152 511368 SCHEDULE J, 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 NONENONEN 2004-12-30 10000000 RENOVATION & EXPANSION OF HOSPITAL false false false B HOSPITAL AUTHORITY OF UPSON COUNTY 586002427 NONENONEN 2005-01-20 6000000 RENOVATION & EXPANSION OF HOSPITAL false false false A 4015000 10000000 124175 9875825 2007 false false true true B 2400000 6000000 79846 5920154 2007 false false true true A false false false false false false true B false false false false false false true A false false false false false false false false false B false false false false false false false false false FORM 990, PART V, LINE 4B CAYMAN ISLANDS FORM 990, PAGE 6, PART VI, LINE 11B 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 DISCUSSION SHOULD ANY QUESTIONS OCCUR. THE 990 IS REVIEWED BY THE CFO IN DETAIL PRIOR TO FILING WITH THE IRS. FORM 990, PAGE 6, PART VI, 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, PAGE 6, PART VI, LINE 15A 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. FORM 990, PAGE 6, PART VI, LINE 15B 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. FORM 990, PAGE 6, PART VI, LINE 19 ALL DOCUMENTS ARE AVAILABLE FOR INSPECTION, WITH NOTICE, IN THE OFFICE OF THE ORGANIZATION. FORM 990, PART IX, LINE 11G CONTRACT LABOR 1,656,485 399,314 0 PROFESSIONAL SERVICES 232,374 45,930 0 PHYSICIAN FEES 1,562,500 0 0 PURCHASED SERVICES 1,170,637 318,266 0 THERAPISTS 14,048 0 0 ALL OTHER FEES 638,113 620,145 0 CONSULTING FEES 0 520,538 0 UPSON MEDICAL ASSOCIATES LLC 801 WEST GORDON STREET THOMASTON GA 30286 550840991 PHYS OFC GA -1446729 487932 UCH UPSON COUNTY HOSPITAL INC UPSON REGIONAL WELLNESS CENTER LLC 801 WEST GORDON STREET THOMASTON GA 30286 205095610 WELLNESS C GA -70029 508364 UCH UPSON COUNTY HOSPITAL INC UPSON WOMEN'S SERVICES LLC 801 WEST GORDON STREET THOMASTON GA 30286 263227893 PHYS OFC GA -1195952 499610 UCH UPSON COUNTY HOSPITAL INC UPSON FAMILY PHYSICIANS LLC 801 WEST GORDON STREET THOMASTON GA 30286 270192553 PHYS OFC GA -419962 346217 UCH UPSON COUNTY HOSPITAL INC UPSON SURGICAL ASSOCIATES LLC 801 WEST GORDON STREET THOMASTON GA 30286 275252545 PHYS OFC GA -776032 504904 UCH UPSON COUNTY HOSPITAL INC ORTHOPEDICS SPORTS MEDICINE & SURGE 801 WEST GORDON STREET THOMASTON GA 30286 272123255 PHYS OFC GA -467205 458146 UCH UPSON COUNTY HOSPITAL INC URMC HEALTH FOUNDATION P O BOX 1089 THOMASTON GA 30286 830411781 FOUNDATION GA 501C3 11A UCH UPSON COUNTY HOSPITAL true false false false false false false false false false false false false true true true false false false false URMC HEALTH FOUNDATION M 302262 NET REVENUES FORM 990 URMC HEALTH FOUNDATION N NOT DETERMINABLE URMC HEALTH FOUNDATION O INDETERMINABLE