2011-10-18T14:30:53-05:00 2010-12-31 DRAFFIN & TUCKER LLP PO BOX 6 ALBANY GA 317020006 990 2010-01-01 581734026 UPSON COUNTY HOSPITAL INC UPSO 7066478111 801 WEST GORDON STREET THOMASTON GA 30286 JOHN WILLIAMS 7066478111 2011-10-15 true JACQUELINE G ATKINS 2298837878 2011-10-18 2010 2016-03-07 17:11:31Z UPSON REGIONAL MEDICAL CENTER DAVID CASTLEBERRY CEO 801 WEST GORDON STREET THOMASTON GA 30286 112682949 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 8 743 74 859944 -547527 657934 648995 88339605 91631490 1729513 2171135 2198386 1998831 92925438 96450451 38519 23676 0 36375195 36408646 0 0 46343588 48933509 82757302 85365831 10168136 11084620 118143724 129992214 22680583 20391713 95463141 109600501 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 72472362 23676 91631490 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 17,184 IN 2010. 72472362 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 false true true true false false false false false false false false false false false false false false true true false false false false true 151 0 true 743 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 182068 0 3693 DAVID CASTLEBERRY 40.00 X 0 0 0 JOSEE GILL 40.00 X 150449 0 2705 SANDEEP DATTA 40.00 X 605130 0 4900 DAVID A PETERSON 40.00 X 505647 0 4900 HUGH D SMITHII MD 40.00 X 271602 0 4865 LOUIS MAMELI MD 40.00 X 270440 0 4865 TONYA ROBINSON MD 40.00 X 230826 0 4400 2216162 30328 19 false true true BRASFIELD & GORRIE LLC P O BOX 11407 BIRMINGHAM AL 352460351 BLDG CONTRACTOR 2377786 SODEXHO OPERATIONS LLC 86 HOPMEADOW STREET SIMSBURY CT 060899693 CAFETERIA MGMT 2064422 REDDY SOLUTIONS 200 ARIZONA AVE NE SUITE 200 ATLANTA GA 30307 RADIOLOGY SVC 1587304 SODEXO INC & AFFILIATES PO BOX 536922 ATLANTA GA 303536922 CAFETERIA MGMT 1117922 INNOVATIVE THERAPY CONCEPTS LLC 174 COMMERCE STREET HAWKINSVILLE GA 31036 PHYSICAL THER 1066664 27 32044 616951 648995 PATIENT SERVICE REVENUE 621990 91631490 91631490 91631490 1803069 1803069 350200 136917 213283 213283 213283 16463447 200 16093564 2017 369883 -1817 368066 368066 WELLNESS CENTER 713940 859944 859944 CAFETERIA 722210 389600 389600 PHYSICIAN BILLING SVC. FEE 561499 307214 307214 228790 228790 1785548 96450451 91631490 859944 3310022 23676 23676 665966 665966 28359994 24278615 4081379 656609 561014 95595 4685388 3964614 720774 2040689 1726761 313928 387031 76690 310341 441277 441277 129617 129617 7541 7541 27299 27299 8100119 6458492 1641627 149990 15532 134458 11119982 9799665 1320317 524206 226762 297444 2619802 2430925 188877 348063 249468 98595 31808 31808 4726031 4385757 340274 506294 463363 42931 BAD DEBTS 16588974 16588974 REPAIRS & MAINTENANCE 2120251 968624 1151627 MISCELLANEOUS 738299 148691 589608 RECRUITMENT 222098 9126 212972 DUES & SUBSCRIPTIONS 138151 88937 49214 6676 6676 85365831 72472362 12893469 0 2131 3413 19042006 20567608 6323156 6604419 1643151 1766683 974579 946527 88136996 39735317 44932745 48401679 44107989 51341976 1117967 359909 118143724 129992214 6450103 6105577 14240000 13035000 1990480 1251136 22680583 20391713 X 95463141 109600501 95463141 109600501 118143724 129992214 X 11084620 3052740 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 7541 7541 false false false false false SCHEDULE C, PART II-B, LINE 1I 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 1327323 1327323 49180019 17347048 31832971 753581 395979 357602 34651541 21992290 12659251 2224532 2224532 48401679 EST. THIRD PARTY PAYOR SETTLEMENTS 1251136 1251136 96450451 85365831 11084620 98793 98793 11183413 96781713 408222 408222 96373491 76960 76960 96450451 85598300 232469 232469 85365831 85365831 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, 2010 AND 2009 OR FOR THE YEARS THEN ENDED. THE HOSPITAL AND FOUNDATION'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2007-2009. RECONCILIATION OF CHANGES - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 8 FOUNDATION REVENUES 175,753 RENTAL EXPENSES 136,917 INTERCOMPANY AMBULANCE TRANSPORT FEES 95,552 CAPITAL CONTRIBUTIONS -76,960 RENTAL EXPENSES -136,917 INTERCOMPANY AMBULANCE TRANSPORT FEES -95,552 REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 2D FOUNDATION REVENUES 175,753 RENTAL EXPENSES 136,917 INTERCOMPANY AMBULANCE TRANSPORT FEES 95,552 REVENUE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 4B CAPITAL CONTRIBUTIONS 76,960 EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XIII, LINE 2D RENTAL EXPENSES 136,917 INTERCOMPANY AMBULANCE TRANSPORT FEES 95,552 true true true X 1.25000 true X true true true false true true 5143 2926787 2926787 0.04240 18427 11700445 11296729 403716 0.00590 23570 14627232 11296729 3330503 0.04830 6828 61314 61314 0.00090 147 9697 9697 0.00010 10290995 6552381 3738614 0.05420 9596 9596 0.00010 6975 10371602 6552381 3819221 0.05530 30545 24998834 17849110 7149724 0.10360 15 105883 105883 0.00150 6728 56686 630 56056 0.00080 100625 100625 0.00150 6743 263194 630 262564 0.00380 true 4796569 17616348 15520122 2096226 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 5 UPSON MEDICAL ASSOCIATES INC

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 SUBSIDIZED HEALTH SERVICES EXPLANATION PART I LINE 7G SUBSIDIZED HEALTH SERVICES COSTS INCLUDE THOSE ATTRIBUTABLE TO UPSON MEDICAL ASSOCIATES 1481990 UPSON WOMENS SERVICES 604226 AND UPSON FAMILY PHYSICIANS 411169 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 85365831 LESS BAD DEBTS IN PART IX 16588974 ADD EXPENSES ON PART VIII 232469 DENOMINATOR FOR COLUMN F 69009326 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 LINES 7A AND 7B COSTS WERE CALCULATED USING THE COSTTOCHARGE RATIO DERIVED FROM WORKSHEET 2 AS PROVIDED IN THE IRS INSTRUCTIONS SUBSIDIZED HEALTH SERVICES AND CASH AND INKIND CONTRIBUTIONS PRESENTED ON LINES 7G AND 7I WERE BASED ON ACTUAL COSTS PER THE AUDITED FINANCIAL STATEMENTS NET OF ANY BAD DEBT EXPENSE 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 MD RECRUITMENT ACTIVITIES TO MEET THE HEALTH NEEDS OF THE UNDERSERVED AND MD STUDENT LOAN REPAYMENT FOR 2 PRIMARY CARE PHYSICIANS AND 1 OBSTETRICIANGYNECOLOGIST WHO HAVE COME TO OUR COMMUNITIES TO SERVE UPSON REVIEWED ITS SERVICE AREAS POPULATION HEALTH STATISTICS PER THE GEORGIA DIVISON 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 CONNECTION 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 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 6793 CONTACTS WITH COMMUNITY HEALTH EDUCATION PROGRAMS HEALTH SCREENINGS HEALTH CARE SUPPORT VALUED AT 56000 TO SUPPORT BETTER HEALTH THROUGH SPONSORSHIPS AND DONATIONS UPSON CONTRIBUTED MORE THAN 88000 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 2010 WE PROVIDED FOR MORE THAN 1800 FREE OR DISCOUNTED TESTS VALUED AT 146790 AT HEALTH FAIRS CANCER SCREENINGS DIABETES SCREENINGS CARDIAC SCREENINGS AND EDUCATIONAL OFFERINGS WE PROVIDED FREE FLU IMMUNIZATIONS UPSON ALSO CONTRIBUTED 10000 EACH TO THE 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 true TUITION REIMBURSEMENT 8 23676 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 182068 3693 185761 DAVID CASTLEBERRY JOSEE GILL 150449 2705 153154 SANDEEP DATTA 506380 25150 73600 4900 610030 DAVID A PETERSON 466947 14787 23913 4900 510547 HUGH D SMITHII MD 271602 4865 276467 LOUIS MAMELI MD 263391 7049 4865 275305 TONYA ROBINSON MD 218826 12000 4400 235226 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 327,000 FOR THE SERVICES OF CEO, DAVID CASTLEBERRY. HOSPITAL AUTHORITY OF UPSON COUNTY 586002427 NONENONEN 2003-06-12 4745000 REDEEM SERIES 1993 BONDS false false false 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 4180000 4175000 565000 2003 true false false true 2210000 10000000 124175 9875825 2007 false false true true 1320000 6000000 79846 5920154 2007 false false true true false false false false false true false false false false false true false false false false false true false false false false false false 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. ADDITIONAL INFORMATION FORM 990, 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 3,052,740 IN UNREALIZED GAINS/LOSS FOR FY10. 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