2013-11-11T14:04:51-06:00 2012-12-31 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2012-01-01 581734026 UPSON COUNTY HOSPITAL INC D/B/A UPSON REGIONAL MEDICAL CENTER UPSO 7066478111 801 WEST GORDON STREET THOMASTON GA 30286 JOHN WILLIAMS 7066478111 2013-11-15 true JACQUELINE G ATKINS 2298837878 2013-11-11 2012 2016-02-24 21:20:13Z UPSON REGIONAL MEDICAL CENTER DAVID CASTLEBERRY CEO 801 WEST GORDON STREET THOMASTON GA 30286 78418467 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. 7 7 719 70 634243 -417384 715610 674701 92347876 68626046 1864406 2270564 2515875 1694519 97443767 73265830 63112 29751 0 37588078 37327409 0 0 50201078 33162904 87852268 70520064 9591499 2745766 136992212 143577199 20099130 19356200 116893082 124220999 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 57134023 29751 68626046 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 14,363 IN 2012. 57134023 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 128 0 719 true true true true CJ false false false false false false false false X 7 7 false true 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 30286 NORMAN MORRIS 0.75 0.15 X X 0 0 0 JAMES J EDWARDS JR 0.75 0.15 X X 0 0 0 DORIS GRACE 0.75 0.15 X X 0 0 0 BARNEY HANCOCK 0.75 0.15 X X 0 0 0 WILLIAM H HIGHTOWER IV 0.75 0.15 X 0 0 0 KAY ROBINSON 0.75 0.15 X 0 0 0 STEVE KEADLE 0.75 0.15 X 0 0 0 RALPH P WARNOCK MD 0.75 0.15 X 0 0 0 JOHN WILLIAMS 40.00 1.00 X 200139 0 4085 DAVID CASTLEBERRY 40.00 1.00 X 0 0 0 ROBERT SOLYOMVARI MD 40.00 X 712353 0 5000 DAVID PETERSON MD 40.00 X 558726 0 5000 STEVEN YANG MD 40.00 X 528414 0 5000 OLUWASEUM COLE MD 40.00 X 389244 0 5000 SANDEEP DATA MD 40.00 X 310693 0 5000 2699569 29085 29 false true true WEST CENTRAL GA RADIOLOGY ASSOCIATES 115 COTTAGE COURTS THOMASTON GA 30286 RADIOLOGY CONTR 1589624 INNOVATIVE THERAPY CONCEPTS LLC 2 MASHBURN STREET SUITE 102 HAWKINSVILLE GA 31036 PHYSICAL THER 1340472 SODEXO INC & AFFILIATES PO BOX 536922 ATLANTA GA 303536922 CAFETERIA MGMT 1140532 BRASFIELD & GORRIE LLC 3021 7TH AVENUE SOUTH BIRMINGHAM AL 35233 BLDG CONTRACTOR 885307 HEALTHTECH MANAGEMENT SERVICES INC 105 WESTWOOD PLACE SUITE 300 BRENTWOOD TN 37027 HOSPITAL MNGT 636565 21 640991 33710 674701 PATIENT SERVICE REVENUE 621990 68626046 68626046 68626046 2311342 2311342 406129 201609 204520 204520 204520 4908750 1500 4951028 -42278 1500 -40778 -40778 WELLNESS CENTER 713940 634243 634243 CAFETERIA 722514 420316 420316 PHYSICIAN BILLING SVC. 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A PORTION OF THOSE DUES ARE ATTRIBUTABLE TO THE LOBBYING ACTIVITIES OF THESE ORGANIZATIONS FOR THE BENEFIT OF THEIR MEMBERS. 1458199 1458199 56471451 21644940 34826511 753581 466534 287047 41586400 27784773 13801627 1087990 1087990 51461374 EST. THIRD PARTY PAYOR SETTLEMENTS 2029633 2029633 X LIABILITY UNDER FIN 48 FOOTNOTE 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 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, 2012 AND 2011 OR FOR THE YEARS THEN ENDED. 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801 WEST GORDON STREET THOMASTON GA 30286

X X X O/P PHYS OFC; WELLNS CTR; AMB UPSON COUNTY HOSPITAL INC 1 true X X X X X X X X 12 true false true X X X X X X X X false false true true 125.0 true 300.0 true X true true X X X X X X true false X X X true X false false 7 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 AMBULANCE CO LLC

801 WEST GORDON STREET THOMASTON GA 30286

AMBULANCE SERVICE 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 SUBSIDIZED HEALTH SERVICES EXPLANATION PART I LINE 7G SUBSIDIZED HEALTH SERVICES COSTS INCLUDE THOSE ATTRIBUTABLE TO UPSON MEDICAL ASSOCIATES UPSON WOMENS SERVICES AND UPSON FAMILY PHYSICIANS TOTALING 10022165 THESE CLINICS PROMOTE HEALTH CARE FOR UNDERSERVED POPULATIONS IN THE AREA EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE PART I LINE 7 COLUMN F 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 70520064 ADD EXPENSES ON PART VIII 201609 DENOMINATOR FOR COLUMN F 71721673 COSTING METHODOLOGY EXPLANATION PART I LINE 7 THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATIONS A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS 2008 FOR LINE 7A COSTS WERE CALCULATED USING THE COSTTOCHARGE 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 CALCULATED THROUGH THE COST ACCOUNTING SOFTWARE CBISA COMMUNITY BUILDING ACTIVITIES PART II 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 2 PRIMARY CARE PHYSICIANS AND 1 OBSTETRICIANGYNECOLOGIST WHO HAVE COME TO SERVE OUR COMMUNITIES BAD DEBT EXPENSE EXPLANATION PART III LINE 4 AUDITED FINANCIAL STATEMENTS FOOTNOTE ON ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS THE HOSPITAL PROVIDES AN ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS BASED ON EVALUATION OF THE OVERALL COLLECTABILITY OF THE ACCOUNTS RECEIVABLE AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE 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 MEDICARE EXPLANATION PART III LINE 8 MEDICARE COSTS REFLECT ALLOWABLE COSTS PER THE MEDICARE COST REPORT USING ACCEPTABLE ALLOCATIONS OF INDIRECT COSTS BASED ON STATISTICAL BASIS COLLECTION PRACTICES EXPLANATION PART III LINE 9B ACCOUNTS KNOWN TO HAVE QUALIFIED FOR FINANCIAL ASSISTANCE ARE WRITTEN OFF WITH AN ADJUSTMENT INDICATING INDIGENT WRITEOFF NEEDS ASSESSMENT PART VI UPSON REVIEWED ITS SERVICE AREAS POPULATION HEALTH STATISTICS PER THE GEORGIA DIVISION OF PUBLIC HEALTH THE GEORGIA DEPARTMENT OF COMMUNITY HEALTHS MINORITY HEALTH AND HEALTH DISPARITIES REPORT KIDS COUNT BY COUNTY REPORT OF THE ANNIE E CASEY FOUNDATIONFAMILY CONNECTIONS PARTNERSHIP THE FIVEYEAR NEEDS ASSESSMENT COMPILED BY A LOCAL CONSORTIUM FAMILY YOUTH AND CHILDREN ALLIANCE AS WELL AS EMERGENCY ROOM DISCHARGE DATA FOR THE TOP FIVE DIAGNOSIS RELATED GROUPS AMONG INDIGENT AND UNDERSERVED PATIENTS PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI UPSON REGIONAL MEDICAL CENTER INFORMS AND EDUCATES THE PATIENTS USING THE FOLLOWING PROCESSES THE CHARITY CARE 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 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 HOW TO QUALIFY PATIENTS FOR MEDICAID SCHIP AND OTHER GOVERNMENT PROGRAMS WE ALSO PROVIDE BROCHURES IN THE ADMISSIONS PACKAGE EXPLAINING THE AVAILABILITY CRITERIA AND THE PROCESS FOR APPLYING FOR FINANCIAL ASSISTANCE OUR EFFORTS TO INFORM NONENGLISH SPEAKING PATIENTS ABOUT THE FINANCIAL ASSISTANCE POLICY IS PROVIDED BY AN INTERPRETER THROUGH THE USE OF LANGUAGE LINE A TELEPHONE INTERPRETATION SERVICE COMMUNITY INFORMATION PART VI UPSON SERVES A SEVENCOUNTY 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 MIDDLEAGED CITIZENS HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI UPSON MADE APPROXIMATELY 9700 CONTACTS WITH COMMUNITY HEALTH EDUCATION PROGRAMS HEALTH SCREENINGS HEALTH CARE SUPPORT VALUED AT 170000 TO SUPPORT BETTER HEALTH THROUGH SPONSORSHIPS AND DONATIONS UPSON CONTRIBUTED MORE THAN 7000 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 SHUTDOWN 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 2012 WE PROVIDED FREE OR DISCOUNTED TESTS AT HEALTH FAIRS CANCER SCREENINGS DIABETES SCREENINGS CARDIAC SCREENINGS AND EDUCATIONAL OFFERINGS WE PROVIDED FREE FLU IMMUNIZATIONS LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED PART VI GEORGIA UPSON COUNTY HOSPITAL INC LINE NUMBER 1 PART V LINE 3 PART V LINE 3 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 MEDICALLYUNDERSERVED 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 TWOHOUR COMMUNITY HEALTH INPUT MEETINGS COMMUNITY MEETINGS AND ONEHOUR 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 COMMUNITYS INPUT INTO THE HEALTH NEEDS OF UPSON COUNTY EACH COMMUNITY MEETING WAS DRIVEN BY AN AGENDA PLANNED IN ADVANCE SIGNIN 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 HOSPITALS IMPLEMENTATION STRATEGY DOCUMENT UPSON COUNTY HOSPITAL INC LINE NUMBER 1 PART V LINE 5C PART V LINE 5C THE FACILITYS COMMUNITY HEALTH NEEDS ASSESSMENT FULL REPORT CAN BE FOUND AT HTTPWWWURMCORGSYSTEMMEDIAFILESATTACHMENTS39ORIGINALURMCREPORT FINALBPDF1355327495 UPSON COUNTY HOSPITAL INC LINE NUMBER 1 PART V LINE 7 PART V LINE 7 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 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 UPSON COUNTY HOSPITAL INC LINE NUMBER 1 PART V LINE 14G PART V LINE 14G NOTICE EXPLAINING POLICY POSTED IN THE LOCAL NEWSPAPER QUARTERLY UPSON COUNTY HOSPITAL INC LINE NUMBER 1 PART V LINE 20D PART V LINE 20D THE FACILITY USES AN ESTIMATE OF THE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES IN DETERMINING WHAT TO BILL INDIVIDUALS WITH NO INSURANCE FOR PROVIDED SERVICES true TUITION REIMBURSEMENT 6 10684 SCHOLARSHIP PROGRAM 4 17866 ADDITIONAL INFORMATION 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 RECEIVES 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 200139 4085 204224 DAVID CASTLEBERRY ROBERT SOLYOMVARI MD 417210 295143 5000 717353 DAVID PETERSON MD 484725 74001 5000 563726 STEVEN YANG MD 521013 7401 5000 533414 OLUWASEUM COLE MD 234244 130000 25000 5000 394244 SANDEEP DATA MD 295892 14801 5000 315693 OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III CEO AND MANAGEMENT COMPANY AN UNRELATED ORGANIZATION, HEALTHTECH MANAGEMENT SERVICES, PROVIDES THE CEO FOR THE FILING ORGANIZATION. THE FILING ORGANIZATION COMPENSATES THE MANAGEMENT COMPANY APPROXIMATELY 364,000 FOR THE SERVICES OF CEO, DAVID CASTLEBERRY. OTHER SERVICES PROVIDED BY HEALTHTECH INCLUDE CONSULTING, REVENUE CYCLE, LICENSURE, INFORMATION SYSTEMS, AND PRODUCTIVITY REPORTING. 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 3075000 10000000 124175 9875825 2007 false false true true B 1840000 6000000 79846 5920154 2007 false false true true A false false false false false false false true B false 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 A false FINANCIAL ACCOUNTS IN FOREIGN COUNTRIES FORM 990, PART V, LINE 4B CAYMAN ISLANDS MANAGEMENT DELEGATED FORM 990, PAGE 6, PART VI, LINE 3 THE ORGANIZATION ENGAGES THE MANAGEMENT SERVICES OF HEALTHTECH MANAGEMENT SERVICES TO PROVIDE THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION. SUCH CEO BEARS THE FULL DUTIES AND RESPONSIBILITIES OF THE SAME POSITION THROUGHOUT THE HOSPITAL INDUSTRY. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 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. ENFORCEMENT OF CONFLICTS POLICY 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. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A HEALTHTECH MANAGEMENT SERVICES, THE MANAGEMENT COMPANY ENGAGED TO PROVIDE THE CEO, OBTAINS COMPARABLE SALARY DATA FOR CEOS 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. COMPENSATION PROCESS FOR OFFICERS 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. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 ALL DOCUMENTS ARE AVAILABLE FOR INSPECTION, WITH NOTICE, IN THE OFFICE OF THE ORGANIZATION. OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G CONTRACT LABOR 1,761,918 519,368 0 PROFESSIONAL SERVICES 384,713 39,191 0 PHYSICIAN FEES 925,122 0 0 PURCHASED SERVICES 2,064,999 505,489 0 THERAPISTS 15,058 0 0 ALL OTHER FEES 1,012,029 1,025,694 0 OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 9 UNREALIZED GAIN ON INVESTMENTS 4,582,151 UPSON MEDICAL ASSOCIATES LLC 801 WEST GORDON STREET THOMASTON GA 30286 550840991 PHYS OFC GA -1742323 948631 UCH UPSON COUNTY HOSPITAL INC UPSON REGIONAL WELLNESS CENTER LLC 801 WEST GORDON STREET THOMASTON GA 30286 205095610 WELLNESS C GA -104442 405010 UCH UPSON COUNTY HOSPITAL INC UPSON AMBULANCE COMPANY LLC 801 WEST GORDON STREET THOMASTON GA 30286 205095675 AMBULANCE GA -330346 1439680 UCH UPSON COUNTY HOSPITAL INC UPSON WOMEN'S SERVICES LLC 801 WEST GORDON STREET THOMASTON GA 30286 263227893 PHYS OFC GA -1011112 751489 UCH UPSON COUNTY HOSPITAL INC UPSON FAMILY PHYSICIANS LLC 801 WEST GORDON STREET THOMASTON GA 30286 270192553 PHYS OFC GA -419516 339785 UCH UPSON COUNTY HOSPITAL INC UPSON SURGICAL ASSOCIATES LLC 801 WEST GORDON STREET THOMASTON GA 30286 275252545 PHYS OFC GA -476503 328743 UCH UPSON COUNTY HOSPITAL INC ORTHOPEDICS SPORTS MEDICINE & SURGE 801 WEST GORDON STREET THOMASTON GA 30286 272123255 PHYS OFC GA -206370 320857 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 413017 NET REVENUES FORM 990