2012-10-25T07:45:45-05:00 2011-12-31 DRAFFIN & TUCKER LLP PO BOX 6 ALBANY GA 317020006 990 2011-01-01 581734026 UPSON COUNTY HOSPITAL INC UPSO 7066478111 801 WEST GORDON STREET THOMASTON GA 30286 JOHN WILLIAMS 7066478111 2012-10-31 true JACQUELINE G ATKINS 2298837878 2012-10-19 2011 2016-02-24 21:20:13Z UPSON REGIONAL MEDICAL CENTER DAVID CASTLEBERRY CEO 801 WEST GORDON STREET THOMASTON GA 30286 109902523 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 8 719 57 729089 -594706 648995 715610 91631490 92347876 2171135 1864406 1998831 2515875 96450451 97443767 23676 63112 0 36408646 37588078 0 0 48933509 50201078 85365831 87852268 11084620 9591499 129992214 136992212 20391713 20099130 109600501 116893082 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 74074861 63112 92347876 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 15,705 IN 2011. 74074861 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true true true true false false false false false false false false false false false false false false true true false false false false true 155 0 719 true true true true CJ false false false false false false false false false false X 8 8 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 X NORMAN MORRIS 0.75 X X 0 0 0 JAMES J EDWARDS JR 0.75 X X 0 0 0 DORIS GRACE 0.75 X X 0 0 0 BARNEY HANCOCK 0.75 X X 0 0 0 WILLIAM H HIGHTOWER IV 0.75 X 0 0 0 KAY ROBINSON 0.75 X 0 0 0 STEVE KEADLE 0.75 X 0 0 0 RALPH P WARNOCK MD 0.75 X 0 0 0 JOHN WILLIAMS 40.00 X 191708 0 3886 DAVID CASTLEBERRY 40.00 X 0 0 0 JOSEE GILL 40.00 X 156329 0 2819 SANDEEP DATTA 40.00 X 553243 0 4900 DAVID A PETERSON 40.00 X 529446 0 4900 STEVENS YANG 40.00 X 495594 0 4554 LOUIS MAMELI MD 40.00 X 266050 0 4866 HUGH D SMITHII MD 40.00 X 247781 0 4650 2440151 30575 23 false true true BRASFIELD & GORRIE LLC 3021 7TH AVENUE SOUTH BIRMINGHAM AL 35233 BLDG CONTRACTOR 3082467 INNOVATIVE THERAPY CONCEPTS LLC 2 MASHBURN STREET SUITE 102 HAWKINSVILLE GA 31036 PHYSICAL THER 1600000 PRODIGY HEALTHCARE INC 200 ARIZONA AVE SUITE 200 ATLANTA GA 30307 RADIOLOGY 1071137 SODEXO INC & AFFILIATES PO BOX 536922 ATLANTA GA 303536922 CAFETERIA MGMT 1001974 HEALTHTECH MANAGEMENT SERVICES INC 105 WESTWOOD PLACE SUITE 300 BRENTWOOD TN 37027 HOSPITAL MNGT 639712 23 668461 47149 715610 PATIENT SERVICE REVENUE 621990 92347876 92347876 92347876 1813034 1813034 401205 191740 209465 209465 209465 12310338 8050 12179184 87832 131154 -79782 51372 51372 WELLNESS CENTER 713940 729089 729089 MISCELLANEOUS 722210 727182 727182 CAFETERIA 561499 476521 476521 373618 373618 2306410 97443767 92347876 729089 3651192 41410 41410 21702 21702 696582 696582 28789175 24487978 4301197 507242 431940 75302 5557684 4670881 886803 2037395 1712302 325093 387311 74185 313126 439642 439642 124435 124435 10762 10762 28228 28228 8232634 6133938 2098696 190933 33310 157623 3622864 2236862 1386002 575322 301523 273799 3072048 2880138 191910 355578 237098 118480 16046 16046 5068138 4703232 364906 499684 456805 42879 BAD DEBTS 16733573 16733573 MEDICAL SUPPLIES 7592429 7592429 REPAIRS & MAINTENANCE 2312534 1090411 1222123 MISCELLANEOUS 537773 87902 449871 401144 147242 253902 87852268 74074861 13777407 0 3413 4182 20567608 18265287 6604419 7867549 125000 1766683 1752973 946527 1128521 95521071 44505737 48401679 51015334 51341976 56248316 359909 585050 129992214 136992212 6105577 6876877 13035000 11790000 1251136 1432253 20391713 20099130 X 109600501 116893082 109600501 116893082 129992214 136992212 X 9591499 -2298918 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false false false true 10762 10762 false false false false 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. false false false false false false false false false false 1371229 1371229 50060728 19468143 30592585 753581 431619 321962 38195601 24605975 13589626 5139932 5139932 51015334 EST. THIRD PARTY PAYOR SETTLEMENTS 1432253 1432253 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, 2011 AND 2010 OR FOR THE YEARS THEN ENDED. THE HOSPITAL AND FOUNDATION'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2008-2010. true true true X 1.25000 true X true true true false true true 5023 3229836 3229836 0.04530 17042 12523917 9380328 3143589 0.04410 22065 15753753 9380328 6373425 0.08940 7508 103101 103101 0.00140 460 8194 8194 0.00010 9864289 6819814 3044475 0.04270 47398 47398 0.00070 7968 10022982 6819814 3203168 0.04490 30033 25776735 16200142 9576593 0.13430 212 267652 267652 0.00380 7202 74204 74204 0.00100 7414 341856 341856 0.00480 true 16733573 17136224 16435813 700411 X true true 1 1 UPSON COUNTY HOSPITAL INC DBA UPSON REGIONAL MEDICAL CENTER

801 WEST GORDON STREET THOMASTON GA 30286

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

801 WEST GORDON STREET THOMASTON GA 30286

PHYSICIANS OFFICE UPSON CO HOSPITAL WELLNESS CENTER

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 UPSON ORTHOPEDIC ASSOCIATES LLC

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 1344196 UPSON WOMENS SERVICES 948267 AND UPSON FAMILY PHYSICIANS 305072 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 87852265 LESS BAD DEBTS IN PART IX 16733573 ADD EXPENSES ON PART VIII 191740 DENOMINATOR FOR COLUMN F 71310432 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 AUDITED FINANCIAL STATEMENTS NET OF ASSOCIATED BAD DEBT 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 COST OF BAD DEBTS FOLLOWS THE METHODOLOGY PRESCRIBED ON WORKSHEET 2 USING THE COSTTOCHARGE RATIO BASED ON AUDITED FINANCIAL STATEMENTS 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 7414 CONTACTS WITH COMMUNITY HEALTH EDUCATION PROGRAMS HEALTH SCREENINGS HEALTH CARE SUPPORT VALUED AT 74000 TO SUPPORT BETTER HEALTH THROUGH SPONSORSHIPS AND DONATIONS UPSON CONTRIBUTED MORE THAN 47000 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 2011 WE PROVIDED FREE OR DISCOUNTED TESTS AT HEALTH FAIRS CANCER SCREENINGS DIABETES SCREENINGS CARDIAC SCREENINGS AND EDUCATIONAL OFFERINGS WE PROVIDED FREE FLU IMMUNIZATIONS UPSON ALSO CONTRIBUTED 10000 EACH TO THE HEALTH DEPARTMENTS OF LAMAR PIKE UPSON AND MERIWETHER COUNTIES TO SUPPORT IMMUNIZATIONS PRENATAL CLINICS FAMILY PLANNING AND MEDICATION ASSISTANCE PROGRAMS LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED PART VI GEORGIA UPSON COUNTY HOSPITAL INC LINE NUMBER 1 PART V LINE 13G PART V LINE 13G NOTICE EXPLAINING POLICY POSTED IN THE LOCAL NEWSPAPER QUARTERLY UPSON COUNTY HOSPITAL INC LINE NUMBER 1 PART V LINE 15E PART V LINE 15E IF PAYMENT IS NOT RECEIVED AFTER OUR INHOUSE COLLECTION PROCESSES ARE EXHAUSTED ACCOUNTS ARE PLACED WITH ONE OF THE TWO AGENCIES WE CONTRACT WITH FOR COLLECTIONS THE COLLECTION AGENCY IS PERMITTED TO FILE SUIT FOR GARNISHMENT OF WAGES ONLY AGAINST A PATIENT WHO HAS THE RESOURCES TO PAY A SECONDARY AGENCY IS USED IF THE PRIMARY AGENCY HAS BEEN UNSUCCESSFUL UPSON COUNTY HOSPITAL INC LINE NUMBER 1 PART V LINE 16E PART V LINE 16E STATEMENTS ARE MAILED AND COLLECTION CALLS ARE MADE IF THE PATIENT HAS THE RESOURCES TO PAY SUIT MAY BE APPROVED BY THE PFS DIRECTOR OF THE HOSPITAL FOR THE PURPOSE OF GARNISHMENT OF WAGES TO COLLECT THE ACCOUNT UPSON COUNTY HOSPITAL INC LINE NUMBER 1 PART V LINE 17E PART V LINE 17E PATIENTS ARE SENT STATEMENTS BEGINNING ON THE DATE THE ACCOUNT IS FINAL BILLED USUALLY ABOUT FIVE DAYS FROM THE DATE OF SERVICE STATEMENTS ARE GENERATED EVERY 30 DAYS EACH STATEMENT INDICATES THE FINANCIAL POLICY AND WHO TO CONTACT TO APPLY FOR FINANCIAL ASSISTANCE ON THE LAST STATEMENT ON OR AROUND 120 DAYS THE PATIENT IS ADVISED THE ACCOUNT MAY BE PLACED WITH AN OUTSIDE AGENCY WHICH MAY ALSO INVOLVE APPROPRIATE LEGAL PROCEDURES true LAMAR COUNTY HEALTH DEPT 118 ACADEMY DRIVE 8 BARNESVILLE GA 30204 586000365 GOV 10000 HEALTHCARE PROGRAMS MERIWETHER COUNTY HEALTH DEPT 51 GAY CONNECTOR GREENVILLE GA 30222 581379373 GOV 10000 HEALTHCARE PROGRAMS PIKE COUNTY HEALTH DEPT 541 GRIFFIN ST ZEBULON GA 30295 586002843 GOV 10000 HEALTHCARE PROGRAMS UPSON COUNTY HEALTH DEPT 314 E LEE ST THOMASTON GA 30286 586002312 GOV 10000 HEALTHCARE PROGRAMS 4 TUITION REIMBURSEMENT 11 21702 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 191708 3886 195594 DAVID CASTLEBERRY JOSEE GILL 156329 2819 159148 SANDEEP DATTA 492884 18759 41600 4900 558143 DAVID A PETERSON 502073 9835 17538 4900 534346 STEVENS YANG 432492 7102 56000 4554 500148 LOUIS MAMELI MD 266050 4866 270916 HUGH D SMITHII MD 247781 4650 252431 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 342,000 FOR THE SERVICES OF CEO, DAVID CASTLEBERRY. OTHER SERVICES PROVIDED BY HEALTHTECH INCLUDE CONSULTING, REVENUE CYCLE, LICENSURE, INFORMATION SYSTEMS, AND PRODUCTIVITY REPORTING. HOSPITAL AUTHORITY OF UPSON COUNTY 586002427 NONENONEN 2004-12-30 10000000 RENOVATION & EXPANSION OF HOSPITAL false false false HOSPITAL AUTHORITY OF UPSON COUNTY 586002427 NONENONEN 2005-01-20 6000000 RENOVATION & EXPANSION OF HOSPITAL false false false 2635000 10000000 124175 9875825 2007 false false true true 1575000 6000000 79846 5920154 2007 false false true true false false false false false false true false false false false false false true false false false false false false false false false false false 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, THE ORGANIZATION'S HUMAN RESOURCES DEPARTMENT OBTAINS COMPARABLE SALARY DATA AND PRESENTS IT TO THE GOVERNING BODY WHO MAKES THE FINAL DECISION. THE CFO 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. RELATED ORGANIZATIONS FORM 990, PAGE 7, PART VII AVERAGE HOURS SPENT AT OTHER RELATED ORGANIZATIONS: DAVID CASTLEBERRY 1 HOUR JOHN WILLIAMS 1 HOUR OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 5 UPSON COUNTY HOSPITAL, INC. HAD 2,298,918 IN UNREALIZED LOSSES ON INVESTMENTS FOR FY11. 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