2015-11-13T09:44:49-06:00 2014-12-31 570381582 ELLIOTT DAVIS DECOSIMO LLCPLLC ONE 10TH STREET SUITE 400 AUGUSTA GA 30901 990 2014-01-01 581581103 UNIVERSITY HEALTH SERVICES INC UNIV 7068282406 1350 WALTON WAY AUGUSTA GA 30901 DAVID A BELKOSKI CFO 7068282406 2015-11-12 1 DERON B STANCIL CPA P00221718 7067229090 2014 2016-03-07 17:11:31Z JAMES R DAVIS 1350 WALTON WAY AUGUSTA GA 30901 643814648 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. 13 9 3704 310 3666035 209741 834964 549477 405371876 429182253 27833246 29035888 11650585 12747062 445690671 471514680 1133963 1431678 0 0 169837230 166713645 0 0 0 233181101 246708990 404152294 414854313 41538377 56660367 781621660 801429617 319595107 363246541 462026553 438183076 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 389414771 1431678 433771359 OPERATION OF A GENERAL ACUTE CARE AND SUB-ACUTE CARE HOSPITAL WITH 551 LICENSED BEDS, TOTAL (551 ACUTE AND 0 SUB-ACUTE). PATIENT DAYS FOR ADULTS AND PEDIATRICS FOR 2014 WERE 114,592, NEWBORN DAYS WERE 12,630 (FOR BOTH TERM & ICU NURSERY), AND OUTPATIENT VISITS WERE 449,599. EMERGENCY ROOM REGISTRATIONS WERE 74,609, OBSERVATION STAYS WERE 8,631, CARDIOVASCULAR INTERVENTIONAL PROCEDURES WERE 13,781 AND RADIOLOGY PROCEDURES WERE 176,074, OCCUPATIONAL MEDICINE VISITS WERE 27,588 AND HOME HEALTH VISITS FOR 2014 WERE 52,291. WITHIN ALL THESE INDICATORS ARE THE EFFORTS OF UNIVERSITY HEALTH SERVICES, INC TO SERVICE THE NEEDS OF THE COMMUNITY, WHICH INCLUDE THE INDIGENT. IN 2014 THE COST OF INDIGENT AND CHARITY CARE PROVIDED, WITH NO LOCAL FUNDING, WAS $34,692,975. HOWEVER, THE HOSPITAL DID RECEIVE DISPROPORTIONATE SHARE (DSH) PAYMENTS TO HELP WITH THIS SERVICE OF $3,796,686 (NET) AND UPPER PAYMENT LIMITS (UPL) FUNDS OF $528,124 (NET). THE $34,692,975 INCLUDES THE COST FOR PROVIDING INPATIENT AND OUTPATIENT SERVICES FOR INDIGENT AND CHARITY CARE PATIENTS OF $20,353,582. ALSO $1,591,998 TO HELP SUPPORT COMMUNITY BASED CLINICS, $12,555,683 FOR UNCOMPENSATED PHYSICIAN SERVICES FOR INDIGENT AND CHARITY CARE PATIENTS, AND $191,713 FOR DISEASE MANAGEMENT. 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 2014 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 2014 UNIVERSITY HOSPITAL REACHED MORE THAN 500,000 PEOPLE AND INVESTED MORE THAN $250,000 IN FREE SCREENINGS, COMMUNITY EDUCATION, PUBLICATIONS, AND MORE. ADDITIONALLY, IN 2014 OVER $617,000 WAS PROVIDED FOR HEALTH PROFESSIONAL EDUCATION FOR CARDIOVASCULAR AND RADIOLOGY SCHOOLS, AND DIETETIC INTERNSHIPS, IN SUPPORT OF TOMORROW'S CARE GIVERS. 389414771 1 1 0 1 0 0 0 0 0 0 1 0 0 1 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 1 440 0 3704 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 13 9 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 GA SC X X DAVID A BELKOSKI 7068282406 1350 WALTON WAY AUGUSTA GA 30901 RANDOLPH R SMITH BOARD CHAIRMAN 2.00 1.00 X X 0 0 0 TERRY D ELAM BOARD MEMBER 2.00 1.00 X 0 0 0 LEVI W HILL IV BOARD MEMBER 2.00 1.00 X 0 0 0 DANA T ATKINS 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 10.00 1.00 X 35000 0 0 WILLIAM P DOUPE BOARD MEMBER 2.00 1.00 X 0 0 0 DAVID A BELKOSKI UHS CFO 50.00 5.00 X 559019 0 19967 JAMES R DAVIS UHS PRESIDENT & CEO 50.00 5.00 X 785464 0 283187 MARILYN A BOWCUTT PRESIDENT OF UNIVERSITY HOSPITAL 50.00 5.00 X 555941 0 14746 WILLIAM L FARR CMO 50.00 5.00 X 423886 0 20315 EDWARD L BURR SR. VP LEGAL & REGULATORY AFFIRS 50.00 X 378483 0 59472 SANDRA MCVICKER CEO UNIVERSITY HOSPITAL MCDUFFIE 50.00 X 281404 0 15003 LAURIE OTT UHCF-VP HR & COMM SVC 50.00 X 333929 0 6858 KYLE HOWELL VP SUPPORT/ANCILLARY SYSTEMS 50.00 X 265791 0 16516 LESLIE A CLONCH VP CHIEF INFORMATION OFFICER 50.00 X 301632 0 14477 STEPHEN M GOODEN VP CLINICAL TRANSFORMATION CMIO 50.00 X 341252 0 9874 LYNDA JONES WATTS VP PATIENT CARE SVCS/CNO 50.00 X 286690 0 17615 SCOTT ANSEDE VP PROFESSIONAL SERVICES 50.00 X 214018 0 13446 TERESA BUSCHBACHER ADMINISTRATIVE DIRECTOR HEART & VASCULAR INSTITUTE 50.00 0.00 X 182625 0 11636 JOHN C POPE PA ECHO CLINICAL PROG COORD 50.00 0.00 X 187545 0 8306 ELLEN C TERESHINSKI ADMINISTRATIVE DIRECTOR HOME HEALTH & HOSPICE 50.00 0.00 X 197618 0 17866 BEATRICE BADGER CRITICAL CARE RN 50.00 0.00 X 186777 0 10110 TARA A KATTINE PHYSICIAN 50.00 0.00 X 254296 0 7478 5771370 0 546872 153 0 1 0 CROTHALL HEALTHCARE 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 PLANT & HOUSEKEEPING 9756143 MORRISON MANAGEMENT HEALTHCARE INC 5353 REYNOLDS STREET SAVANNAH GA 31405 FOOD SERVICES 5821819 NACR INC NW 5806 PO BOX 1450 MINNEAPOLIS MN 55485 IT SERVICES 2297141 NOVANT HEALTH INC 2085 FRONTIS PLAZA WINSTON SALEM NC 27103 SYSTEM SUPPORT 2051073 PHILIPS HEALTHCARE PO BOX 100355 ATLANTA GA 30384 SYSTEM SUPPORT 1967734 68 224862 24000 300615 549477 PATIENT SERVICE REVENUE 900099 420346509 420346509 HOME HEALTH SERVICES 621610 7939630 7939630 PHYSICIAN ANSWERING SERVICE 541900 365432 365432 OTHER PROGRAM SERVICES 900099 295897 295897 ASK-A-NURSE 541900 202281 202281 32504 32504 429182253 12765240 12765240 3699367 2806482 892885 892885 49224 843661 185714313 49821 169333866 159620 16380447 -109799 16270648 16270648 EHR INCENTIVE PROGRAM 900099 4068783 4068783 EMPLOYEE PHARMACY 446110 3647593 3647593 OUTREACH LAB 900099 3560901 3560901 576900 520323 55910 667 11854177 471514680 433771359 3666035 33527809 1431678 1431678 5253984 1050797 4203187 122734119 122578981 155138 374452 362807 11645 27156059 26689401 466658 11195031 10846866 348165 14791919 14331890 460029 811988 811988 258336 258336 248902 248902 1400935 1400935 22312638 21618715 693923 1208308 1170730 37578 1281685 1241825 39860 6027204 5839758 187446 6333173 6136211 196962 975165 944837 30328 2351 2351 9242923 9242923 31261390 30289161 972229 4792008 4642977 149031 MED SURG SUPPLIES 88570364 88570364 BAD DEBT EXPENSE 36639169 36639169 REPAIRS AND MAINTENANCE 7967582 7719790 247792 GA DCH HOSPITAL TAX 4960050 0 4960050 7622900 7308814 314086 414854313 389414771 25439542 0 26777647 18120209 17338179 17237758 64366859 54559348 12617422 9821172 8156732 8930546 7569241 7279469 565731674 330948736 231298370 234782938 383590238 400737136 29906972 49961041 781621660 801429617 16879455 22926675 143820264 141275025 63830027 78812885 95065361 120231956 319595107 363246541 X 461991553 438148076 35000 35000 462026553 438183076 781621660 801429617 X 56660367 -5672338 -74831506 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 248902 248902 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, AND THE GEORGIA CHAMBER OF COMMERCE, ALL HAVE A LOBBYING COMPONENT. FOR 2014, THESE FEES AMOUNTED TO $200,902. ADDITIONALLY, OGLETHORPE CONSULTING GROUP WAS CONTRACTED DURING 2014 TO REVIEW AND ADVISE THE HOSPITAL ON LEGISLATIVE ISSUES. DURING 2014, $48,000 WAS PAID TO OGLETHORPE CONSULTING GROUP. 18077550 18077550 260307984 126789187 133518797 3030074 2504314 525760 272376521 201655235 70721286 11939545 11939545 234782938 457(B) DEFERRED COMP ASSET 860686 AMOUNTS DUE FROM AFFILIATES 39474272 BOND START UP COST 1587726 CVS LIFE INSURANCE 735477 LEASEHOLD RIGHTS 467132 PHOENIX HEALTH CARE MGMT SVCS 84169 PHYSICAN GUARANTEE ASSET 436566 PHYSICIANS LIFE INSURACE COLI 3328837 RBC 114 TRUST ACCOUNT 756518 SOFTWARE LICENSE 805382 VHA STOCK INVESTMENT 138416 WORK FORCE IN PLACE 1285860 49961041 ACCRUED COMPENSATION, BENEFITS, & WITHOLDINGS 17449544 ACCRUED PENSION COST 36421943 ACCRUED PORTRETIREMENT BENEFIT COST 30805347 AMOUNT DUE TO AFFILIATE 90644 ASSET RETIREMENT OBLIGATION 1286714 EST THIRD PARTY PAYOR SETTLEMENTS 17339893 OTHER CURRENT LIABILITIES 2506120 RESERVE FOR SELF INSURED LOSSES 14331751 120231956 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, 2014. FISCAL YEARS ENDED ON OR AFTER DECEMBER 31, 2011 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 1 1 19626668 2505813 17120855 0.04130 36453388 33790707 2662681 0.00640 56080056 36296520 19783536 0.04770 15574033 6908213 8665820 0.02090 946299 530142 416157 0.00100 1528469 0 1528469 0.00370 18048801 7438355 10610446 0.02560 74128857 43734875 30393982 0.07330 10980 10980 0.00000 43348 43348 0.00010 45841 45841 0.00010 100169 100169 0.00020 1 36639169 5129484 112135306 141562977 -29427671 X 1 1 1 1 UNIVERSITY HEALTH SERVICES INC 1350 WALTON WAY AUGUSTA GA 30901 WWW.UNIVERSITYHEALTH.ORG 121-375 X X X X HOME HEALTH AGENCIES UNIVERSITY HEALTH SERVICES INC 1 0 0 1 X X X X X X X X X 13 1 1 1 1 X WWW.UNIVERSITYHEALTH.ORG X 1 14 1 WWW.UNIVERSITYHEALTH.ORG 1 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X 1 X X X X X 1 X X X 0 X X X X 1 X 0 0 UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 5: MANY LOCAL ORGANIZATION AND HOSPITAL STAFF CONTRIBUTED TO THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT. THESE INDIVIDUALS AND THEIR LOCAL ORGANIZATIONS REPRESENT AN INVENTORY OF COMMUNITY SERVICES ALREADY AVAILABLE TO ADDRESS NEEDS OF THE AUGUSTA AREA. THE FOLLOWING IS A SUMMARY OF THOSE ORGANIZATIONS AND INDIVIDUALS. PLEASE SEE PAGE 28 OF THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT FOR MORE DETAILS.PUBLIC HEALTH DEPARTMENTS KEY STAFF- DR. KETTY GONZALES, DIRECTOR GEORGIA REGENTS UNIVERSITY AUGUSTA SCHOOL OF NURSINGKEY STAFF- CHRISTINE O'MEARA, SPECIAL PROJECTS COORDINATORPROJECT ACCESSKEY STAFF-DR. TERENCE COOK GREATER AUGUSTA HEALTHCARE NETWORK (GAHN) KEY STAFF- LUCY MARION, DEAN OF THE SCHOOL OF NURSING, GRUCHRIST COMMUNITY CLINICKEY STAFF- DR. ROBERT CAMPBELLUNITED WAY'S 1ST STOP 211KEY STAFF - AMY RICKARDUNIVERSITY MEDICAL ASSOCIATESKEY STAFF - DR. DANIEL BOONEUNIVERSITY HEALTH CARE FOUNDATIONKEY STAFF - LAURIE OTT, PRESIDENT OF UHCFUNIVERSITY HEALTH CARE SYSTEM DEPARTMENTS KEY STAFF- LYNDA WATTS , CNO LYNN BEAULIEU, EMERGENCY DEPT DIRECTOR, EMS COUNCIL GAHN DENISE GIBSON-CATO, EMERGENCY DEPT NURSE MANAGER MARIE JACKSON, PHARMACY DIRECTOR HEIDI NELSON, DISEASE MANAGEMENT DIRECTOR ELLEN TERESHINSKI, HOME HEALTH/ HOSPICE UNIVERSITY EXTENDED CARE DIRECTOR MARY GOOLSBY, NATIONAL NURSE PRACTITIONER DEBRA WHITLEY, MANAGER OF DIABETES SERVICES EMORY UNIVERSITY NELL HODGSON WOODRUFF SCHOOL OF NURSING KEY STAFF- DR. BONNIE JENNINGS, PROFESSORAREA AGENCY ON AGING KEY STAFF- JEANETTE CUMMINGS UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 6A: GEORGIA REGENTS UNIVERSITY MEDICAL CENTER OF AUGUSTA UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 11: OTHER ORGANIZATIONS WERE/ARE PROVIDING THE SERVICES.TEEN PREGNANCY - AREA SCHOOLS AND THE HEALTH DEPARTMENT HAVE PROGRAMS GEARED TO ADDRESS THIS ISSUE.SEXUALLY TRANSMITTED STIS - AREA SCHOOLS AND THE HEALTH DEPARTMENT HAVE PROGRAMS TO ADDRESS THIS ISSUE. 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. AN ELECTRONIC ELIGIBILITY SYSTEM IS USED TO DETERMINE INDIGENT CARE. UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 16I: FINANCIAL COUNSELORS AND ACCESS COORDINATORS EXPLAIN TO PATIENT AND OFFER FINANCIAL ASSISTANCE FORM TO PATIENT. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 16A WEBSITE: WWW.UNIVERSITYHEALTH.ORG PART I, LINE 3C: CHARITY CARE ELIGIBILITY CRITERIA (FPG IS NOT USED)ALSO USES ASSET TEST, REGARDLESS OF INCOME, TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE. IN ADDITION THE HOSPITAL TAKES INTO CONSIDERATION BANKRUPTCY 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 COMMERCES FOR THE COMMUNITIES THAT WE SERVE. IN SUPPORTING THESE ORGANIZATIONS WE 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. IN 2014, UNIVERSITY HEALTH SERVICES, INC. INVESTED $100,169 IN THIS SUPPORT (SEE PART II. SCH H). ALSO UNIVERSITY HEALTH SERVICES ALSO WORKS WITH THE FOLLOWING COMMUNITY ORGANIZATIONS TO SUPPORT AND PROMOTE HEALTH IN OUR COMMUNITY:THE PUBLIC HEALTH DEPARTMENTGEORGIA REGENTS UNIVERSITY AUGUSTA SCHOOL OF NURSING PROJECT ACCESS GREATER AUGUSTA HEALTHCARE NETWORK (GAHN) CHRIST COMMUNITY HEALTH SERVICES BEULAH GROVE COMMUNITY RESOURCES COORDINATED HEALTH SERVICES HARRISBURG FAMILY HEALTH MIRACLE MAKING MINISTRIES NEIGHBORHOOD IMPROVEMENT PROJECT UNITED WAY'S 1ST STOP 211 AREA AGENCY ON AGING 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: 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 8 OF THE AUDITED FINANCIAL STATEMENTSPATIENT ACCOUNTS RECEIVABLE - PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE CORPORATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL 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 DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, UHS ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY.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), UHS RECORDS A 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.ALLOWANCE 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. UHS'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 76% AND 58% OF SELF-PAY ACCOUNTS RECEIVABLE AND PATIENT LIABILITY PORTION OF OTHER ACCOUNTS AT DECEMBER 31, 2014 AND 2013, 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 2013, 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. UH HAS INITIATED AND CONTINUES TO SUPPORT THESE PROGRAMS. 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 WEB SITE, 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: RICHMOND COUNTY IS A COUNTY LOCATED IN THE U.S. STATE OF GEORGIA. AS OF THE 2010 CENSUS, THE POPULATION WAS 200,549. IT IS ONE OF THE ORIGINAL COUNTIES OF GEORGIA, CREATED FEBRUARY 5, 1777.FOLLOWING AN ELECTION IN 1995, THE CITY OF AUGUSTA ( THE COUNTY SEAT) CONSOLIDATED GOVERNMENTS WITH RICHMOND COUNTY. THE CONSOLIDATED ENTITY IS KNOWN AS AUGUSTA-RICHMOND COUNTY, OR SIMPLY AUGUSTA. THE CITIES OF HEPHZIBAH AND BLYTHE IN SOUTHERN RICHMOND COUNTY VOTED TO REMAIN SEPARATE AND NOT CONSOLIDATE. RICHMOND COUNTY IS INCLUDED IN THE AUGUSTA-RICHMOND COUNTY, GA-SC METROPOLITAN STATISTICAL AREA. AS OF THE CENSUS OF 2000, THERE WERE 199,775 PEOPLE, 73,920 HOUSEHOLDS, AND 49,526 FAMILIES RESIDING IN THE COUNTY. THE POPULATION DENSITY WAS 616 PEOPLE PER SQUARE MILE (238/KM2 ). THERE WERE 82,312 HOUSING UNITS AT AN AVERAGE DENSITY OF 254 PER SQUARE MILE (98/KM2 ). THE RACIAL MAKEUP OF THE COUNTY WAS 49.75% BLACK OR AFRICAN AMERICAN, 45.55% WHITE, 0.28% NATIVE AMERICAN, 1.50% ASIAN, 0.12% PACIFIC ISLANDER, 1.01% FROM OTHER RACES, AND 1.78% FROM TWO OR MORE RACES. 2.78% OF THE POPULATION WERE HISPANIC OR LATINO OF ANY RACE.THERE WERE 73,920 HOUSEHOLDS OUT OF WHICH 33.60% HAD CHILDREN UNDER THE AGE OF 18 LIVING WITH THEM, 41.80% WERE MARRIED COUPLES LIVING TOGETHER, 20.80% HAD A FEMALE HOUSEHOLDER WITH NO HUSBAND PRESENT, AND 33.00% WERE NON-FAMILIES. 27.70% OF ALL HOUSEHOLDS WERE MADE UP OF INDIVIDUALS AND 8.50% HAD SOMEONE LIVING ALONE WHO WAS 65 YEARS OF AGE OR OLDER. THE AVERAGE HOUSEHOLD SIZE WAS 2.55 AND THE AVERAGE FAMILY SIZE WAS 3.13. IN THE COUNTY THE POPULATION WAS SPREAD OUT WITH 26.80% UNDER THE AGE OF 18, 12.00% FROM 18 TO 24, 29.90% FROM 25 TO 44, 20.50% FROM 45 TO 64, AND 10.80% WHO WERE 65 YEARS OF AGE OR OLDER. THE MEDIAN AGE WAS 32 YEARS. FOR EVERY 100 FEMALES THERE WERE 93.20 MALES. FOR EVERY 100 FEMALES AGE 18 AND OVER, THERE WERE 89.80 MALES. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $38,004, AND THE MEDIAN INCOME FOR A FAMILY WAS $52,892. MALES HAD A MEDIAN INCOME OF $30,028 VERSUS $23,512 FOR FEMALES. THE PER CAPITA INCOME FOR THE COUNTY WAS $18,133. ABOUT 16.20% OF FAMILIESAND 19.60% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 27.20% OF THOSE UNDER AGE 18 AND 14.10% OF THOSE AGE 65 OR OVER. PART VI, LINE 6: 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 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 CHRIST COMMUNITY HEALTH SERVICES 519 SCOTTS WAY AUGUSTA GA 30909 205404353 501(C)(3) 360000 211519 MEDICARE COST REPORT DONATED FACILITIES CLINIC FINANCIAL SUPPORT NEIGHBORHOOD IMPROVEMENT PROJECT 2467 GOLDEN CAMP ROAD AUGUSTA GA 30906 311491242 501(C)(3) 180000 CLINIC FINANCIAL SUPPORT HARRISBURG FAMILY HEALTH 423 CRAWFORD AVE AUGUSTA GA 30904 264366421 501(C)(3) 80000 CLINIC FINANCIAL SUPPORT COORDINATED HEALTH SERVICES 2110 BROAD STREET AUGUSTA GA 30904 582060572 501(C)(3) 140000 7199 COST OF THE TEST LAB TESTS CLINIC FINANCIAL SUPPORT MIRACLE MAKING MINISTRIES 1127 DRUID PARK AVE AUGUSTA GA 30904 582358627 501(C)(3) 40000 CLINIC FINANCIAL SUPPORT BEULAH GROVE COMMUNITY RESOURCE 1446 LEE BEARD WAY AUGUSTA GA 30904 582159621 501(C)(3) 40000 23260 COST EPIC CLINICAL SYSTEM AND LAB TEST CLINIC FINANCIAL SUPPORT 6 0 PART I, LINE 2: UNIVERSITY HEALTH CARE SYSTEM DOES NOT PROVIDE "GRANTS" TO ASSIST OTHER ORGANIZATION, 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 DAVID A BELKOSKI UHS CFO 398409 0 60000 0 100610 0 7823 0 12144 0 578986 0 0 0 JAMES R DAVIS UHS PRESIDENT & CEO 630798 0 70000 0 84666 0 268961 0 14226 0 1068651 0 0 0 MARILYN A BOWCUTT PRESIDENT OF UNIVERSITY HOSPITAL 393567 0 70000 0 92374 0 6960 0 7786 0 570687 0 0 0 WILLIAM L FARR CMO 355187 0 20000 0 48699 0 7811 0 12504 0 444201 0 0 0 EDWARD L BURR SR. VP LEGAL & REGULATORY AFFIRS 268895 0 70000 0 39588 0 45699 0 13773 0 437955 0 0 0 SANDRA MCVICKER CEO UNIVERSITY HOSPITAL MCDUFFIE 245417 0 0 0 35987 0 6736 0 8267 0 296407 0 0 0 LAURIE OTT UHCF-VP HR & COMM SVC 227570 0 60000 0 46359 0 5232 0 1626 0 340787 0 0 0 KYLE HOWELL VP SUPPORT/ANCILLARY SYSTEMS 176632 0 20000 0 69159 0 6234 0 10282 0 282307 0 0 0 LESLIE A CLONCH VP CHIEF INFORMATION OFFICER 210119 0 60000 0 31513 0 1030 0 13447 0 316109 0 0 0 STEPHEN M GOODEN VP CLINICAL TRANSFORMATION CMIO 275225 0 35000 0 31027 0 1326 0 8548 0 351126 0 0 0 LYNDA JONES WATTS VP PATIENT CARE SVCS/CNO 205356 0 35000 0 46334 0 6856 0 10759 0 304305 0 0 0 SCOTT ANSEDE VP PROFESSIONAL SERVICES 154667 0 26845 0 32506 0 5262 0 8184 0 227464 0 0 0 TERESA BUSCHBACHER ADMINISTRATIVE DIRECTOR HEART & VASC 146583 0 35500 0 542 0 4987 0 6649 0 194261 0 0 0 JOHN C POPE PA ECHO CLINICAL PROG COORD 148394 0 350 0 38801 0 761 0 7545 0 195851 0 0 0 ELLEN C TERESHINSKI ADMINISTRATIVE DIRECTOR HOME HEALTH 177816 0 5500 0 14302 0 5469 0 12397 0 215484 0 0 0 BEATRICE BADGER CRITICAL CARE RN 116575 0 13601 0 56601 0 3075 0 7035 0 196887 0 0 0 TARA A KATTINE PHYSICIAN 120420 0 0 0 133876 0 3744 0 3734 0 261774 0 0 0 PART I, LINE 1A SOCIAL CLUB DUES - THE ORGANIZATION PAYS MEMBERSHIP FEES FOR THE CEO (JAMES DAVIS) AND CFO (DAVID BELKOSKI) TO THE AUGUSTA COUNTY CLUB AND THE WEST LAKE 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 ARE INCLUDED IN THE WAGES OF THE CEOS AND CFO. PART I, LINE 4B JAMES R DAVIS - SERP - $261,080 DAVID A BELKOSKI - ROTH IUL - $54,619 MARILYN A BOWCUTT - CAA BENEFITS - $49,079 WILLIAM L FARR - CAA BENEFITS - $42,790 EDWARD L BURR - CAA REDEMPTION - $36,613 SANDRA MCVICKER - ROTH IUL - $7,784 - SECT 162 - $25,000 LAURIE OTT SMITH - ROTH IUL - $24,330 - SECT 162 - $2,541 KYLE E HOWELL - CAA BENEFITS - $45,566 LESLIE A CLONCH - ROTH IUL - $16,562 - SECT 162 - $5,982 STEPHEN M GOODEN - ROTH IUL - $27,583 LYNDA JONES WATTS - ROTH IUL - $22,855 - SECT 162 - $4,779 SCOTT ANSEDE - ROTH IUL - $7,125 - SECT 162 - 6,626 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 2014 THESE INITIATIVES WERE WEIGHTED AS DISPLAYED IN THE FOLLOWING SCHEDULE: UNIVERSITY HEALTH SERVICES, INC 2014 STRATEGIC INITIATIVES WEIGHT QUALITY 12.75% IMPROVE AGGREGATE CORE MEASURE SCORE 12.75% OVERALL RATING OF CARE GROWTH 8.50% DEVELOP AIKEN STRATEGY 8.50% COMPLETE CONSTRUCTION OF UNIVERSITY HOSPITAL MCDUFFIE FINANCE 17% UHS OPERATING MARGIN 17% UHI OPERATING MARGIN PEOPLE 8.50% REDUCE 365-DAY NEW HIRE TURNOVER RATE 15% PERSONAL 100% EACH GOAL THAT WAS ACHIEVED REPRESENTED THAT PERCENTAGE OF BONUS PAYOUT OUT OF A POSSIBLE 100% BASED ON THRESHOLD LEVEL, TARGET LEVEL OR AN EXCEED LEVEL. A THE RICHMOND COUNTY HOSPITAL AUTHORITY 586001901 764603AV8 2009-12-03 150901243 REFUND BOND CERTIFICATES (BOND 0 0 0 A 9626218 150901243 1243 150900000 2008 1 0 1 1 A 0 1 0 0 0.03000 0.00200 0.03200 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 ADDITIONAL INFORMATION $150,900,000 WAS USED TO REFUND PRIOR BONDS ISSUED 1999, 2003, AND 2008. RACHEL N FOREMAN DAUGHTER OF BOARD MEMBER 46511 EMPLOYEE COMP AS RN 0 REBECCA E SMITH DAUGHTER OF BOARD MEMBER 33748 EMPLOYEE COMP AS RN 0 NATALIE H THOMPSON DAUGHTER OF BOARD MEMBER 30349 EMPLOYEE COMP AS RN 0 RHONDA J BELKOSKI SPOUSE OF CFO 19116 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 11 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 -48,678,282. OTHER CUMULATIVE EFFECT ON ASSET RETIREMENT OBLIGATIONS 547,362. TRANSFER TO AFFILIATE -26,644,676. PTP INVESTMENT - UBTI NOT ON BOOKS -55,910. WALTON WAY INDEMNITY SPC 2ND FL GOVERNORS SQ 23 LIME TREE WEST BAY GRAND CAYMAN CJ INSURANCE CAPTIVE CJ 2686053 27128812 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 HOSPICE INC 1350 WALTON WAY AUGUSTA GA 30901 275008428 END OF LIFE SUPPORT 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