2023-05-15T12:22:31-05:00 2022-06-30 570381582 ELLIOTT DAVIS LLCPLLC 500 EAST MOREHEAD STREET SUITE 700 CHARLOTTE NC 28202 990 2022-01-01 581581103 UNIVERSITY HEALTH SERVICES INC UNIV 7067747710 1350 WALTON WAY AUGUSTA GA 30901 MARIE GAFFNEY VP CORPORATE FINANCE 7067747710 2023-05-15 1 MARIE GAFFNEY XXX-XX-XXXX 1 JANICE A RATICA P00358837 7043338881 2023-05-15 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z JAMES R DAVIS 1350 WALTON WAY AUGUSTA GA 30901 592948390 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 8 0 101 1706102 64312 8683825 763052 506675793 281167807 48475798 28860515 5898194 5526486 569733610 316317860 661223 401948 0 0 226816836 153271748 0 0 0 299159526 164938859 526637585 318612555 43096025 -2294695 1036274638 1018157642 390889159 405715976 645385479 612441666 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 299081119 401948 281167807 OPERATION OF A GENERAL ACUTE CARE AND SUB-ACUTE CARE HOSPITAL WITH 812 LICENSED BEDS, TOTAL (812 ACUTE AND 0 SUB-ACUTE). PATIENT DAYS FOR ADULTS AND PEDIATRICS FOR JANUARY 1 - JUNE 30, 2022 WERE 62,477, NEWBORN DAYS WERE 5,160 (FOR BOTH TERM & ICU NURSERY), AND OUTPATIENT VISITS WERE 255,229. EMERGENCY ROOM REGISTRATIONS WERE 30,804, OBSERVATION STAYS WERE 6,989, CARDIOVASCULAR INTERVENTIONAL PROCEDURES WERE 4,129, RADIOLOGY PROCEDURES WERE 130,356 AND OCCUPATIONAL MEDICINE VISITS WERE 24,879. WITHIN ALL THESE INDICATORS ARE THE EFFORTS OF UNIVERSITY HEALTH SERVICES, INC TO SERVICE THE NEEDS OF THE COMMUNITY, WHICH INCLUDE THE INDIGENT. FROM JANUARY 1 - JUNE 30, 2022 THE COST OF INDIGENT AND CHARITY CARE PROVIDED, WITH NO LOCAL FUNDING, WAS $21,602,036. INCLUDED IN THIS AMOUNT WAS $9,904,896 FOR INPATIENT AND OUTPATIENT SERVICES, $11,352,807 FOR PHYSICIAN SERVICES AND $344,333 TO HELP SUPPORT COMMUNITY BASED CLINICS. THE HOSPITAL RECEIVED PAYMENTS OF $6,900,856 (NET) FROM UPPER PAYMENT LIMITS (UPL) TO HELP WITH THIS SERVICE. WE OFFERED SEVERAL COMMUNITY EDUCATION CLASSES FOR BARIATRIC SUPPORT, WEIGHT LOSS SURGERY, DIABETES AND BREAST CANCER. HEALTH SCREENINGS WERE PROVIDED FOR BLOOD PRESSURE, PLAQUE AND CHOLESTEROL SCREENINGS TO VARIOUS GROUPS AND COMMUNITY EVENTS. WE PROVIDED LABS AND X-RAYS TO LOCAL CHARITIES HARRISBURG FAMILY HEALTH, BEULAH GROVE, CHRIST COMMUNITY AND ST. VINCENT DE PAUL. WE DONATED COVID TESTS, SANITIZER AND PILL HOLDERS FOR SENIORS AND UNDERSERVED COMMUNITIES. 299081119 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 1 1 1 CJ 0 0 0 0 0 0 0 0 1 0 X 13 8 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 GA SC X X DAVID A BELKOSKI 7067747710 1350 WALTON WAY AUGUSTA GA 30901 X LEVI W HILL IV BOARD MEMBER 2.00 1.00 X 0 0 0 TERRY D ELAM BOARD MEMBER 2.00 1.00 X 0 0 0 BECKY SMITH BOARD MEMBER 2.00 1.00 X 0 0 0 SANFORD LOYD BOARD MEMBER 2.00 1.00 X 0 0 0 DANIEL H BOONE MD BOARD MEMBER 2.00 38.00 X 0 0 0 EDWARD TARVER BOARD MEMBER 2.00 1.00 X 0 0 0 WILLIAM P DOUPE BOARD MEMBER 2.00 1.00 X 0 0 0 JAMES C SHERMAN MD BOARD MEMBER 2.00 38.00 X 0 0 0 KEVIN BROWN BOARD MEMBER 2.00 1.00 X 0 0 0 CHARLIE BROWN BOARD MEMBER 2.00 1.00 X 0 0 0 EUGENE F MCMANUS VICE CHAIRMAN 2.00 1.00 X X 0 0 0 HUGH L HAMILTON CHAIRMAN 2.00 1.00 X X 0 0 0 JAMES R DAVIS UHS PRESIDENT & CEO 35.00 5.00 X X 0 0 0 BARRY J JENKINS CMO 35.00 5.00 X 0 0 0 DAVID A BELKOSKI UHS CFO 35.00 5.00 X 0 0 0 EDWARD L BURR SR. VP LEGAL & REGULATORY 35.00 5.00 X 0 0 0 ELIZABETH R GALLUP COO ACUTE CARE SERVICES 35.00 5.00 X 0 0 0 0 0 0 0 0 0 0 QUALIVIS PO BOX 123847 DALLAS TX 753123847 AGENCY - HEALTHCARE/WORKFORCE SOLUTIONS 15154107 CROTHALL HEALTHCARE 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 HOUSEKEEPING/LAUNDRY SERVICES 6183516 MORRISONS HEALTH CARE DIVISION PO BOX 102289 ATLANTA GA 30368 FOOD SERVICES 4201774 TRIMEDX PO BOX 636129 CINCINNATI OH 45263 BIOMED CONTRACT 2812399 EPIC SYSTEMS CORPORATION PO BOX 88314 MILWAUKEE WI 532880314 SYSTEM SUPPORT 1703645 63 579452 171132 12468 763052 PATIENT SERVICE REVENUE 812900 257465344 257465344 PHYSICIAN FEES 621110 23471983 23471983 PHYSICIAN ANSWERING SERVICE 541900 172352 172352 OTHER PROGRAM SERVICES 812900 27244 27244 HOME HEALTH SERVICES 621610 13086 13086 17798 17798 281167807 8925040 8925040 1990245 1531836 458409 458409 97125 361284 3421448 291612721 3832047 271266647 -410599 20346074 19935475 19935475 HOSPITAL SERVICES 812900 2102109 2102109 OUTREACH LAB 812900 1698977 90000 1608977 MISCELLANEOUS 812900 933730 933730 333261 333261 5068077 316317860 284626907 1706102 29221799 309097 309097 92851 92851 3840958 1052082 2788876 118879684 116119767 2759917 1734919 1655057 79862 20880425 19759398 1121027 7935762 7547685 388077 8142319 7744974 397345 245918 7325 238593 500379 172713 327666 53030 53030 620213 620213 25136329 23508505 1627824 232401 221060 11341 618549 552127 66422 6223337 5910907 312430 6191767 5963780 227987 13154 13154 2907124 1680 2905444 22011304 20951373 1059931 4119056 3931490 187566 MED SURG SUPPLIES 58456016 58455873 143 BAD DEBT EXPENSE 13402479 13390914 11565 REPAIRS AND MAINTENANCE 7111381 6768776 342605 GA DCH HOSPITAL TAX 3683958 3683958 5270145 4963685 306460 318612555 299081119 19531436 0 26514578 57534333 96327581 111702035 6455170 6753551 12653275 12473491 9580795 8964852 866021813 568435732 283111853 297586081 536757805 456228380 64873581 66914919 1036274638 1018157642 23976346 41335237 126867409 120548930 73038745 62662185 167006659 181169624 390889159 405715976 X 645350479 612406666 35000 35000 645385479 612441666 1036274638 1018157642 X -2294695 -73286098 42636980 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 53030 53030 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 ALLIANCE OF COMMUNITY HOSPITALS, THE GEORGIA CHAMBER OF COMMERCE, AND OTHER HEALTH ASSOCIATIONS ALL HAVE A LOBBYING COMPONENT. FOR 2022, THESE FEES AMOUNTED TO $45,030. ADDITIONALLY, OGLETHORPE CONSULTING GROUP WAS CONTRACTED DURING 2022 TO REVIEW AND ADVISE THE HOSPITAL ON LEGISLATIVE ISSUES. DURING 2022, $8,000 WAS PAID TO OGLETHORPE CONSULTING GROUP. 24756476 24756476 355953411 192098033 163855378 13833106 9369860 4463246 437014568 353369119 83645449 34464252 13598720 20865532 297586081 457(B) DEFERRED COMP ASSET 351558 AMOUNTS DUE FROM AFFILIATES 30563047 LEASEHOLD RIGHTS 171062 PHOENIX HEALTH CARE MGMT SVCS 84169 PHYSICAN GUARANTEE ASSET 1467287 PHYSICIANS LIFE INSURACE COLI 8182916 SOFTWARE LICENSE 690268 VHA STOCK INVESTMENT 138416 WORK FORCE IN PLACE 597006 WC ESCROW - SANFORD 108705 PL GI ESCROW - SANFORD 183094 TD BANK DEPOSITORY ACCOUNT 8567044 DUE FROM RELATED ORGANIZATIONS 15810347 66914919 ACCRUED COMPENSATION, BENEFITS, & WITHOLDINGS 22853521 ACCRUED POSTRETIREMENT BENEFIT COST 22209607 ASSET RETIREMENT OBLIGATION 3797461 EST THIRD PARTY PAYOR SETTLEMENTS 18246780 OTHER CURRENT LIABILITIES 2180555 RESERVE FOR SELF INSURED LOSSES 19299442 DUE TO AFFILIATES 52697408 CAPITALIZED BOND COSTS -1186342 ACCRUED PENSION COST 5107 LONG TERM OPERATING LEASE OBLIGATION 17865251 CURRENT PORTION - OPERATING LEASES 3996107 MEDICARE ADVANCE PAYMENTS 19143379 CAPITAL LEASE LIABILITY 61348 181169624 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 JUNE 30, 2022. FISCAL YEARS ENDED ON OR AFTER DECEMBER 31, 2019 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 0 0 0 PART III ACCOUNTING METHOD: 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 0 1 1 12466769 4247121 8219648 0.02690 24674261 20754937 3919324 0.01280 37141030 25002058 12138972 0.03970 14029416 4598432 9430984 0.03090 487350 330690 156660 0.00050 273763 273763 0.00090 14790529 4929122 9861407 0.03230 51931559 29931180 22000379 0.07200 1 13402479 48892 70444353 12759431 57684922 X 1 1 1 1 UNIVERSITY HEALTH SERVICES INC 1350 WALTON WAY AUGUSTA GA 30901 WWW.UNIVERSITYHEALTH.ORG 121-375 X X X X UNIVERSITY HEALTH SERVICES INC 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X WWW.UNIVERSITYHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT X 1 19 1 WWW.UNIVERSITYHEALTH.ORG/ABOUT-US/COMMUNITY-BENEFIT 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X 1 X SEE SCHEDULE O X SEE SCHEDULE O X SEE SCHEDULE O X X X X X X 1 X 0 X X X X 1 X 0 0 UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 5: LISTENING SESSIONS WERE HELD IN RICHMOND, COLUMBIA AND AIKEN COUNTIES. INDIVIDUALS FROM VARIOUS HEALTH AND SOCIAL SERVICE AGENCIES WERE INVITED TO ATTEND. THOSE AGENCIES WHO PARTICIPATED IN THE SESSIONS ARE: RAPE CRISIS AND SEXUAL ASSAULT SERVICES, I AM MY BROTHER'S KEEPER, GAP MINISTRIES, GOLDEN HARVEST FOOD BANK, AREA AGENCY ON AGING, GEORGIA DEPARTMENT OF PUBLIC HEALTH- RICHMOND COUNTY HEALTH DEPARTMENT, MENTAL HEALTH AMERICA OF AIKEN COUNTY, RURAL HEALTH SERVICES, INC, AIKEN COUNTY HEALTH DEPARTMENT, LONG TERM LIAISONS, THE AIKEN CENTER FOR ALCOHOL AND OTHER DRUG SERVICES, CITY OF HARLEM, COLUMBIA COUNTY COMMUNITY CONNECTIONS, COLUMBIA COUNTY HEALTH DEPARTMENT, HARLEM MERCHANT'S ASSOCIATION AND HOPE HOUSE. THESE AGENCIES REPRESENT THE HOMELESS, THE ELDERLY, INDIVIDUALS LIVING IN POVERTY, AS WELL AS THOSE FACING FOOD INSECURITY, MENTAL HEALTH ISSUES OR ADDICTION. THOSE WHO WERE INVITED BUT DID NOT ATTEND WERE FROM THE FOLLOWING ORGANIZATIONS: ACTION MINISTRIES, AUGUSTA HOUSING & COMMUNITY DEVELOPMENT, AUGUSTA PARTNERSHIP FOR CHILDREN, AUGUSTA RESCUE MISSION, CHRIST COMMUNITY HEALTH, COORDINATED HEALTH SERVICES INC., FAMILY PROMISE OF AUGUSTA, GARDEN CITY RESCUE MISSION, HOPE FOR AUGUSTA, MERCY MINISTRIES, RICHMOND COUNTY SCHOOL SYSTEM, SAFE HOMES, SENIOR CITIZEN COUNCIL, UNITED WAY OF THE CSRA, WALTON OPTIONS FOR INDEPENDENT LIVING, UNITED WAY OF AIKEN COUNTY, COMMUNITY MINISTRY OF NORTH AUGUSTA, AIKEN SENIOR LIFE SERVICES, AIKEN COUNTY HELP LINE, ACTS- AREA CHURCHES TOGETHER SERVING, COMMUNITY MEDICAL CLINIC OF AIKEN COUNTY, JACKSON FIRST ALERT RESCUE SQUAD, LOWER SAVANNAH COUNCIL OF GOVERNMENTS, THE RECING CREW, THE SALVATION ARMY- AIKEN, CUMBEE CENTER TO ASSIST ABUSED PERSONS, MEGIDDO DREAM STATION, THE ALZHEIMER'S ASSOCIATION AND CITY OF GROVETOWN. REPRESENTATIVES FROM THESE ORGANIZATIONS WERE SENT AN EMAIL WITH THE LIST OF QUESTIONS FROM THE LISTENING SESSION AND INVITED TO PROVIDE FEEDBACK. UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 6A: N/A UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 6B: N/A UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 11: SEE PAGE 3-6 OF IMPLEMENTATION STRATEGY FOR A LIST OF ACTION STEPS WE ARE TAKING TO ADDRESS THE ADOPTED HEALTH NEEDS 1. LEVERAGE MOBILE PLATFORM TO BRING CARDIOVASCULAR DISEASE SCREENING TO THE COMMUNITY. 2. DEVELOP A DIABETES PREVENTION PROGRAM TO EDUCATE AND ENCOURAGE DIABETICS ABOUT NUTRITION AND PHYSICAL ACTIVITY 3. TEACH EXPECTANT MOTHERS TO RECOGNIZE LIFE THREATENING POST-PARTUM WARNING SIGNS OUR PRIORITIZATION PROCESS IS DETAILED ON PAGE 34. WE CHOSE TO FOCUS ON 3 TOP PRIORITIES WHERE WE FELT WE COULD MAKE THE GREATEST IMPACT. 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 BANKRUPTCY AND FINANCIAL STANDING WHEN OFFERING DISCOUNTS ON PATIENT LIABILITY.USE ELECTRONIC ELIGIBILITY SYSTEM TO DETERMINE INDIGENT CARE. UNIVERSITY HEALTH SERVICES INC PART V, SECTION B, LINE 21D: EMTALA FOLLOWED AND INCLUDED IN POLICY B130. 17 1 - UNIVERSITY CARDIOLOGY ASSOCIATES LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 2 - UNIVERSITY MEDICAL GROUP LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 3 - UMG HOSPITALIST LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 4 - UMG NEUROSURGERY LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 5 - UMG PRIMARY CARE SOUTH CAROLINA LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 6 - UMG PROMPT CARE LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 7 - UMG GENERAL SURGERY LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 8 - UNIVERSITY CRITICAL CARE MEDICINE LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 9 - UMG VASCULAR LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 10 - UMG PROMPT CARE SOUTH CAROLINA LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 11 - UMG CONGESTIVE HEART FAILURE LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 12 - UMG ENDOCRINOLOGY LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 13 - UMG CARDIOTHORACIC SURGERY LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 14 - UMG INFECTIOUS DISEASE 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 15 - UMG NEUROLOGY LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 16 - UMG GASTROENTEROLOY LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES 17 - UMG PALLIATIVE CARE LLC 1350 WALTON WAY AUGUSTA GA 30901 PHYSICIAN PRACTICES PART I, LINE 3C: IN ADDITION TO THE FPG, HOSPITAL MAY ALSO USE ASSET TEST, REGARDLESS OF INCOME, TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE FOR THOSE INDIVIDUALS THAT DO NOT QUALIFY UNDER THE ELECTRONIC ELIGIBILITY SYSTEM OR THOSE WHO HAVE INSURANCE BUT HOSPITAL BILL IS CATASTROPHIC. 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 COMMERCE FOR THE COMMUNITIES THAT UH SERVES. IN SUPPORTING THESE ORGANIZATIONS, UH 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. 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), UH 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 PORVISION 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 RELIEF THE HEALTH CARE BURDENS OF THE LOCAL GOVERNMENTS. PART III, LINE 4: PAGES 15-17 OF THE AUDITED FINANCIAL STATEMENT FOR PIEDMONT HEALTHCARE INC AND AFFILIATES 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 2019, 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. THE PROGRAMS THAT UH HAS INITIATED AND CONTINUE TO SUPPORT. 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 WEBSITE, 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: SEE PAGE 5-7 OF THE CHNAUHS HAS DEFINED THE COMMUNITY AS ALL PEOPLE IN THOSE COUNTIES REPRESENTING AT LEAST 80% OF THE EMERGENCY DEPARTMENT VISITS WHICH WOULD BE RICHMOND AND COLUMBIA COUNTIES IN GEORGIA AND AIKEN, SOUTH CAROLINA. THE POPULATION IN RICHMOND COUNTY IS THE LARGEST BUT THE NUMBER OF SENIORS IN AIKEN COUNTY IS LARGER. RICHMOND COUNTY HAS THE HIGHEST PERCENTAGE OF NON-WHITE RESIDENTS ALONG WITH THE HIGHEST POVERTY RATES AND LOWEST EDUCATION RATES. PART VI, LINE 5: COLLABORATION WITH/SUPPORT OF COMMUNITY ORGANIZATIONS THROUGH SEVERAL SURROUNDING CHAMBERS OF COMMERCE.--- SEE PART II ABOVE. SEE PAGE 9 OF THE CHNA FOR THE LIST OF AGENCIES THAT UNIVERSITY WORKS WITH TO SUPPORT AND PROMOTE HEALTH IN OUR COMMUNITY. PART VI, LINE 6: UH GOVERNING BOARD MEMBERS ARE COMPRISED OF CITZENS WHO RESIDE IN 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 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 LOWE'S 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 OF THE 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) 75000 0 CLINIC FINANCIAL SUPPORT HARRISBURG FAMILY HEALTH CARE 423 CRAWFORD AVE AUGUSTA GA 30904 264366421 501(C)(3) 60000 0 CLINIC FINANCIAL SUPPORT COORDINATED HEALTH SERVICES 2110 BROAD STREET AUGUSTA GA 30904 582060572 501(C)(3) 60000 0 CLINIC FINANCIAL SUPPORT NEIGHBORHOOD IMPROVEMENT PROJECT 2467 GOLDEN CAMP ROAD AUGUSTA GA 30906 311491242 501(C)(3) 45000 0 CLINIC FINANCIAL SUPPORT BEULAH GROVE COMMUNITY RESOURCE 1446 LEE BEARD WAY AUGUSTA GA 30904 582159621 501(C)(3) 10000 9517 COST EPIC CLINICAL SYSTEM & LAB TESTS CLINIC FINANCIAL SUPPORT MIRACLE MAKING MINISTRIES 1127 DRUID PARK AVE AUGUSTA GA 30904 582358627 501(C)(3) 10000 0 CLINIC FINANCIAL SUPPORT 6 SCHOLARSHIP AND AWARD DISBURSEMENTS 15 89856 PART I, LINE 2: UNIVERSITY HEALTH CARE SYSTEM DOES NOT PROVIDE "GRANTS" TO ASSIST OTHER ORGANIZATIONS, 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. SCHOLARSHIP & AWARDS DISBURSEMENTS A THE RICHMOND COUNTY HOSPITAL AUTHORITY 586001901 764603BV7 2016-10-25 154488348 REFUND BOND CERTIFICATES (SERIES 2009) 0 0 0 A 154488348 1658616 152829732 2016 0 1 1 1 A 0 1 1 1 1 1 0.02700 0.00200 0.02900 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 1A 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 11B 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: OTHER CUMULATIVE EFFECT ON ASSET RETIREMENT OBLIGATIONS 222,257. TRANSFER TO AFFILIATE 1,198,955. ACQUISITION OF UNIVERSITY HEALTH INC. 41,215,768. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, HEADER, PART A: CHANGE OF ACCOUNTING PERIOD: THE ORGANIZATION PREVIOUSLY REPORTED ON A CALENDAR YEAR ACCOUNTING PERIOD. EFFECTIVE 01/01/22, THE ORGANIZATION WILL BE REPORTED ON THE FISCAL YEAR ENDED JUNE 30TH. A SHORT TAX PERIOD IS BEING REPORTED FOR 01/01/22 TO 06/30/22. THE RULES UNDER IRS REVENUE PROCEDURE 85-58 APPLY FOR THIS CHANGE IN ACCOUNTING PERIOD SCHEDULE H, PART V, LINE 16A HTTPS://WWW.UNIVERSITYHEALTH.ORG/PATIENT-VISITOR-INFORMATION/FOR-PATIENT S/BILLING-INFORMATION/INDIGENT-AND-CHARITY-CARE WALTON WAY INDEMNITY SPC 2ND FL GOVERNORS SQ 23 LIME TREE WEST BAY GRAND CAYMAN CJ INSURANCE CAPTIVE CJ 2446257 25339883 UNIVERSITY HEALTH SERVICES INC UNIVERSITY HEALTHCARE PHYSICIANS LLC 1350 WALTON WAY AUGUSTA GA 30901 272042386 PHYSICIAN OFFICES GA 0 0 UNIVERSITY HEALTH SERVICES INC UNIVERSITY MEDICAL GROUP LLC 1350 WALTON WAY AUGUSTA GA 30901 274467379 PHYSICIAN OFFICES GA 3298008 30742966 UNIVERSITY HEALTH SERVICES INC UNIVERSITY CARDIOLOGY ASSOCIATES 1350 WALTON WAY AUGUSTA GA 30901 451437971 PHYSICIAN OFFICES GA 5891748 7727713 UNIVERSITY HEALTH SERVICES INC MEDICAL ONCOLOGY LLC 1350 WALTON WAY AUGUSTA GA 30901 452695782 PHYSICIAN OFFICES GA 0 0 UNIVERSITY HEALTH SERVICES INC UMG NEUROLOGY LLC 1350 WALTON WAY AUGUSTA GA 30901 463326102 PHYSICIAN OFFICES GA 335252 70738 UNIVERSITY HEALTH SERVICES INC UMG VASCULAR LLC 1350 WALTON WAY AUGUSTA GA 30901 463342973 PHYSICIAN OFFICES GA 1284118 354228 UNIVERSITY HEALTH SERVICES INC UNIVERSITY CRITICAL CARE MEDICINE LLC 1350 WALTON WAY AUGUSTA GA 30901 463105093 PHYSICIAN OFFICES GA 1499599 82280 UNIVERSITY HEALTH SERVICES INC UMG HOSPITALIST LLC 1350 WALTON WAY AUGUSTA GA 30901 463347646 PHYSICIAN OFFICES GA 2516859 231987 UNIVERSITY HEALTH SERVICES INC UMG INFECTIOUS DISEASE 1350 WALTON WAY AUGUSTA GA 30901 464694861 PHYSICIAN OFFICES GA 442610 52086 UNIVERSITY HEALTH SERVICES INC UMG CARDIOTHORACIC SURGERY LLC 1350 WALTON WAY AUGUSTA GA 30901 463295395 PHYSICIAN OFFICES GA 502807 124946 UNIVERSITY HEALTH SERVICES INC UNIVERSITY PRIMARY CARE AIKEN LLC (1) 1350 WALTON WAY AUGUSTA GA 30901 461175328 PHYSICIAN OFFICES GA 0 0 UNIVERSITY HEALTH SERVICES INC UMG ENDOCRINOLOGY LLC 1350 WALTON WAY AUGUSTA GA 30901 463316180 PHYSICIAN OFFICES GA 627233 81034 UNIVERSITY HEALTH SERVICES INC UMG GASTROENTEROLOY LLC 1350 WALTON WAY AUGUSTA GA 30901 471564753 PHYSICIAN OFFICES GA 134185 25630 UNIVERSITY HEALTH SERVICES INC UMG NEUROSURGERY LLC 1350 WALTON WAY AUGUSTA GA 30901 471125478 PHYSICIAN OFFICES GA 2468518 582265 UNIVERSITY HEALTH SERVICES INC UMG GENERAL SURGERY LLC 1350 WALTON WAY AUGUSTA GA 30901 471016310 PHYSICIAN OFFICES GA 1659238 371932 UNIVERSITY HEALTH SERVICES INC UMG PROMPT CARE LLC 1350 WALTON WAY AUGUSTA GA 30901 472519838 PHYSICIAN OFFICES GA 1668698 426393 UNIVERSITY HEALTH SERVICES INC UMG PRIMARY CARE SOUTH CAROLINA LLC 1350 WALTON WAY AUGUSTA GA 30901 472345170 PHYSICIAN OFFICES GA 1712754 259157 UNIVERSITY HEALTH SERVICES INC UMG PROMPT CARE SOUTH CAROLINA LLC 1350 WALTON WAY AUGUSTA GA 30901 472361218 PHYSICIAN OFFICES GA 1177118 259555 UNIVERSITY HEALTH SERVICES INC UMG RHEUMATOLOGY LLC 1350 WALTON WAY AUGUSTA GA 30901 474285985 PHYSICIAN OFFICES GA 0 0 UNIVERSITY HEALTH SERVICES INC UMG CONGESTIVE HEART FAILURE LLC 1350 WALTON WAY AUGUSTA GA 30901 812205908 PHYSICIAN OFFICES GA 694720 120232 UNIVERSITY HEALTH SERVICES INC UMG PALLATIVE CARE LLC 1350 WALTON WAY AUGUSTA GA 30901 820648367 PHYSICIAN OFFICES GA 5397 0 UNIVERSITY HEALTH SERVICES INC RICHMOND COUNTY HOSPITAL AUTHORITY 1350 WALTON WAY AUGUSTA GA 30901 586001901 LEASED FACILITIES GA 501(C)(3) LINE 3 N/A 0 AUGUSTA RESOURCE CENTER ON AGING I 1350 WALTON WAY AUGUSTA GA 30901 581728812 NON PROFIT LIFE CARE COMMUNITY GA 501(C)(3) LINE 10 UNIVERSITY HEALTH SERVICES INC 0 UNIVERSITY HEALTH CARE FOUNDATION 2260 WRIGHTSBORO ROAD AUGUSTA GA 30904 581343550 PHILANTHROPY GA 501(C)(3) LINE 7 UNIVERSITY HEALTH SERVICES INC 0 UNIVERSITY MCDUFFIE COUNTY REGIONAL 1350 WALTON WAY AUGUSTA GA 30901 454166209 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 UNIVERSITY EXTENDED CARE INC 1350 WALTON WAY AUGUSTA GA 30901 581581105 HEALTHCARE GA 501(C)(3) LINE 3 UNIVERSITY HEALTH SERVICES INC 0 PIEDMONT HEALTHCARE INC 1800 HOWELL MILL RD STE 850 ATLANTA GA 30318 581503902 MANAGEMENT GA 501(C)(3) LINE 12C, III-FI N/A 0 PIEDMONT HOSPITAL INC 1968 PEACHTREE ROAD NW ATLANTA GA 30309 580566213 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 FAYETTE COMMUNITY HOSPITAL INC 1255 HIGHWAY 54 WEST FAYETTEVILLE GA 30214 582232328 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 PIEDMONT MOUNTAINSIDE HOSPITAL INC 1266 HIGHWAY 515 SOUTH JASPER GA 30143 352228583 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 PIEDMONT NEWNAN HOSPITAL INC 745 POPLAR ROAD NEWNAN GA 30265 205077249 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 PIEDMONT HEALTHCARE FOUNDATION INC 2001 PEACHTREE ROAD NE SUITE ATLANTA GA 30309 581272768 FUNDRAISING GA 501(C)(3) LINE 12B, II PIEDMONT HEALTHCARE INC 0 PIEDMONT HENRY HOSPITAL INC 1133 EAGLES LANDING PWKY STOCKBRIDGE GA 30281 582200195 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 PIEDMONT NEWTON HOSPITAL INC 5126 HOSPITAL DRIVE NE COVINGTON GA 30014 582155150 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 PIEDMONT ATHENS REGIONAL FOUNDATION INC 1199 PRINCE AVENUE ATHENS GA 30606 581978389 FUNDRAISING GA 501(C)(3) LINE 12B, II PIEDMONT ATHENS REGIONAL MEDICAL CENTER 0 PIEDMONT ATHENS REGIONAL HEALTH RESOURCE 1199 PRINCE AVENUE ATHENS GA 30606 581930580 DEVELOPMENT GA 501(C)(3) LINE 12B, II PIEDMONT ATHENS REGIONAL MEDICAL CENTER 0 ATHENS REGIONAL PHYSICIAN SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 582332921 HEALTHCARE GA 501(C)(3) LINE 12B, II PIEDMONT ATHENS REGIONAL MEDICAL CENTER 0 PIEDMONT ATHENS REGIONAL MEDICAL CENTER 1199 PRINCE AVENUE ATHENS GA 30606 582179986 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 COLUMBUS REGIONAL SENIOR LIVING INC 707 CENTER STREET COLUMBUS GA 31901 582628502 HEALTHCARE GA 501(C)(3) LINE 12C, III-FI PIEDMONT HEALTHCARE INC 0 ATHENS REGIONAL SPECIALITY SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 271975001 HEALTHCARE GA 501(C)(3) LINE 3 PIEDMONT ATHENS REGIONAL MEDICAL CENTER 0 REGIONAL FIRSTCARE INC 1199 PRINCE AVENUE ATHENS GA 30606 582362733 URGENT CARE GA 501(C)(3) LINE 12B, II PIEDMONT ATHENS REGIONAL MEDICAL CENTER 0 THE MEDICAL CENTER INC 707 CENTER STREET COLUMBUS GA 31901 581685139 HEALTHCARE GA 501(C)(3) LINE 3 COLUMBUS REGIONAL HEALTHCARE SYSTEM 0 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 707 CENTER STREET COLUMBUS GA 31901 581719994 MANAGEMENT GA 501(C)(3) LINE 12B, II PIEDMONT HEALTHCARE INC 0 COLUMBUS REGIONAL MEDICAL FOUNDATION INC 707 CENTER STREET COLUMBUS GA 31901 581501642 FUNDRAISING GA 501(C)(3) LINE 7 COLUMBUS REGIONAL HEALTHCARE SYSTEM 0 HUGHSTON HOSPITAL INC 707 CENTER STREET COLUMBUS GA 31901 331216751 HOSPITAL GA 501(C)(3) LINE 3 COLUMBUS REGIONAL HEALTHCARE SYSTEM 0 PIEDMONT ROCKDALE HOSPITAL INC 1412 MILSTEAD AVE CONYERS GA 30012 300999841 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 PIEDMONT WALTON HOSPITAL INC 2151 WEST SPRING ST MONROE GA 30655 824194264 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 PIEDMONT HEART INSTITUTE INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 263553500 HEALTHCARE GA 501(C)(3) LINE 10 PIEDMONT HEALTHCARE INC 0 COLUMBUS AMBULATORY HEALTHCARE SERVICES INC 707 CENTER STREET COLUMBUS GA 31901 581719867 AMBULATORY GA 501(C)(3) LINE 3 COLUMBUS REGIONAL HEALTHCARE SYSTEM 0 PIEDMONT CARTERSVILLE HOSPITAL INC 960 JOE FRANK HARRIS PKWY SE CARTERSVILLE GA 30120 870963633 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 PIEDMONT EASTSIDE HOSPITAL INC 1700 MEDICAL WAY SNELLVILLE GA 30078 870982886 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 PIEDMONT MACON HOSPITAL INC 350 HOSPITAL DR MACON GA 31217 871006981 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 PIEDMONT MACON NORTH HOSPITAL INC 400 CHARTER BLVD MACON GA 31210 871031034 HOSPITAL GA 501(C)(3) LINE 3 PIEDMONT HEALTHCARE INC 0 GA SURG CTR PCHTREE 2061 PCHTREE ATLANTA GA 30309 582394271 SURGERY GA N/A 0 0 ORTHOATL SURG FAYET 900 CIR 75 ATLANTA GA 30339 202961633 SURGERY GA N/A 0 0 ATHENS ASC HOLDINGS 2142 BROAD ST ATHENS GA 30606 454014891 SURGERY GA N/A 0 0 COLUMBUS DIAG IMAG 116 IC POINTE JUPITER FL 33477 262291768 IMAGING GA N/A 0 0 THE SURGERY CTR LLC 100 FIRST CT COLUMBUS GA 31909 582520623 SURGERY GA N/A 0 0 PIED ENCOMPASS REHAB 9001 LIBERTY BIRMINGHAM AL 35204 853544795 HEALTHCARE DE N/A 0 0 COLISEUM SAME DAY 340 HOSPITAL DR MACON GA 31217 621805346 SURGERY GA N/A 0 0 UNIVERSITY HEALTH RESOURCES INC 1350 WALTON WAY AUGUSTA GA 30901 581601372 PHYSICIAN SUPPORT SERVICES GA UNIVERSITY HEALTH SERVICES INC C 1.00000 0 UNIVERSITY HOSPITAL AIKEN INC 1350 WALTON WAY AUGUSTA GA 30901 472713774 HOSPITAL SC UNIVERSITY HEALTH SERVICES INC C 1.00000 0 PIEDMONT MEDICAL CARE CORPORATION 2727 PACES FERRY ROAD SUITE 1-1100 ATLANTA GA 30339 582092768 HEALTHCARE GA C 0 THE PIEDMONT CLINIC INC 2727 PACES FERRY ROAD SUITE 1-1100 ATLANTA GA 30339 582005358 HEALTHCARE GA C 0 PIEDMONT HEART INSTITUTE PHYSICIANS INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 260593850 HEALTHCARE GA C 0 AMSTER MCRAE INSURANCE COMPANY PO BOX 1159 GRAND CAYMAN CJ 980427603 RELATED INSURANCE CJ C 0 COLUMBUS HEALTHCARE RESOURCES PO BOX 790 COLUMBUS GA 31902 581717754 HEALTHCARE GA C 0 COLUMBUS HEALTH SERVICES INC PO BOX 790 COLUMBUS GA 31902 581640939 HOSPITAL GA C 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 1 0 0 0 1