2023-06-21T12:40:18-05:00 2021-12-31 570381582 ELLIOTT DAVIS LLCPLLC ONE 10TH STREET SUITE 400 AUGUSTA GA 30901 990 2021-01-01 581581103 UNIVERSITY HEALTH SERVICES INC UNIV 7067747710 1350 WALTON WAY AUGUSTA GA 30901 DAVID A BELKOSKI CFO 7067747710 2023-06-21 1 DAVID BELKOSKI 999009999 JESSICA C CAIN P01276209 7067229090 2023-06-21 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JAMES R DAVIS 1350 WALTON WAY AUGUSTA GA 30901 1355572154 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. 15 13 4536 140 3643228 199315 47655258 8683825 496318657 506675793 48135670 48475798 6183221 5898194 598292806 569733610 923929 661223 0 0 225983797 226816836 0 0 0 310268948 299159526 537176674 526637585 61116132 43096025 1020272774 1036274638 420146668 390889159 600126106 645385479 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 487009626 661223 508197900 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 2021 WERE 124,397 NEWBORN DAYS WERE 10,132 (FOR BOTH TERM & ICU NURSERY), AND OUTPATIENT VISITS WERE 501,370. EMERGENCY ROOM REGISTRATIONS WERE 63,186, OBSERVATION STAYS WERE 12,585, CARDIOVASCULAR INTERVENTIONAL PROCEDURES WERE 9,094, RADIOLOGY PROCEDURES WERE 262,863 AND OCCUPATIONAL MEDICINE VISITS WERE 41,192. WITHIN ALL THESE INDICATORS ARE THE EFFORTS OF UNIVERSITY HEALTH SERVICES, INC TO SERVICE THE NEEDS OF THE COMMUNITY, WHICH INCLUDE THE INDIGENT. IN 2021 THE COST OF INDIGENT AND CHARITY CARE PROVIDED, WITH NO LOCAL FUNDING, WAS $38,751,131. INCLUDED IN THIS AMOUNT WAS $18,287,838 FOR INPATIENT AND OUTPATIENT SERVICES, $19,750,123 FOR PHYSICIAN SERVICES AND $713,170 TO HELP SUPPORT COMMUNITY BASED CLINICS. THE HOSPITAL RECEIVED DISPROPORTIONATE SHARE (DSH) PAYMENTS TO HELP WITH THIS SERVICE OF $4,738,229 (NET) AND UPPER PAYMENT LIMITS (UPL) FUNDS OF $4,275,630 (NET). DURING 2021, WE PROVIDED 55 COVID-19 CLINICS VACCINATING MORE THAN 33,000 COMMUNITY MEMBERS AND OPENED A MONOCLONAL ANTIBODY SITE TO HELP MANAGE COMPLICATIONS OF COVID-19. WE INVESTED NEARLY $35,000 TO PROVIDE EDUCATION AND SUPPORT TO AREA INDUSTRY AND FAITH COMMUNITIES, AND OUR SERVICE LINE LEADERS CONVERTED MUCH OF THEIR PATIENT EDUCATION AND SUPPORT GROUP ACTIVITIES TO ONLINE AND VIRTUAL EVENTS. ADDITIONALLY, $1.4 MILLION WAS PROVIDED FOR HEALTH PROFESSIONAL EDUCATION FOR CARDIOVASCULAR AND RADIOLOGY SCHOOLS, NURSING STUDENTS AND RESIDENTS IN SUPPORT OF TOMORROW'S CAREGIVERS. 487009626 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 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 259 0 1 4536 1 1 1 1 CJ 0 0 0 0 0 0 0 0 1 0 X 15 13 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 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 NATALIE D SCHWEERS BOARD MEMBER 2.00 1.00 X 0 0 0 SANFORD LOYD BOARD MEMBER 2.00 1.00 X 0 0 0 BRIAN J MARKS BOARD VICE CHAIRMAN 2.00 1.00 X X 0 0 0 EUGENE F MCMANUS BOARD MEMBER 2.00 1.00 X 0 0 0 HUGH L HAMILTON BOARD CHAIRMAN 2.00 1.00 X X 0 0 0 JEFFREY L FOREMAN BOARD MEMBER 2.00 1.00 X 0 0 0 JAMES W BENNETT JR BOARD MEMBER 2.00 1.00 X 0 0 0 DANIEL H BOONE MD BOARD MEMBER 2.00 50.00 X 0 296767 10765 CHARLES G PETE CAYE JR BOARD MEMBER 2.00 1.00 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 50.00 X 120006 0 0 DAVID A BELKOSKI UHS CFO 50.00 5.00 X 848041 0 11442 JAMES R DAVIS UHS PRESIDENT & CEO 50.00 5.00 X 2343435 0 17972 WILLIAM L FARR JR CMO 50.00 5.00 X 211210 0 8976 EDWARD L BURR SR. VP LEGAL & REGULATORY 50.00 5.00 X 1164057 0 14943 ELIZABETH R GALLUP COO ACUTE CARE SERVICES 50.00 5.00 X 768742 0 17976 BARRY J JENKINS CMO 50.00 5.00 X 435269 0 9660 LAURIE OTT SMITH PRES UHCF-VP HR & COMM SVC 30.00 25.00 X 406322 0 9528 SHIRLEY K GABRIEL VP CHIEF INFORMATION OFFIC 50.00 X 496170 0 11902 TERESA BUSCHBACHER VP -HVI 50.00 X 372366 0 12974 SCOTT ANSEDE COO UHCP 1.00 50.00 X 516960 0 18866 LISA RITCH VP FINIANCE 50.00 X 329519 0 17118 JANEE S DOCK VP NURSING CNO 50.00 X 385931 0 14337 KELLY DUNAVANT VP SUPPORT SERVICES 50.00 X 289945 0 23985 ROBERT J KEPSHIRE ADMINISTRATIVE CNO - MCDUF 1.00 50.00 X 195399 0 10293 JACKIE KENDINGER SENIOR GENERAL COUNSEL 50.00 X 216889 0 3420 DOUGLAS D PUGH II PATIENT CARE SERVICES SUPERVISOR 50.00 X 278033 0 18366 AMY D PRESLEY RN 2 50.00 X 284529 0 7746 TARA SCICCHITANO ASSISTANT NURSE MANAGER 50.00 X 252527 0 9519 THOMAS E LOWENCAMP VP - CONTINUING CARE 25.00 25.00 X 104128 0 4081 10019478 296767 253869 20 1 1 0 QUALIVIS PO BOX 123847 DALLAS TX 753123847 AGENCY - HEALTHCARE/WORKFORCE SOLUTIONS 11970165 CROTHALL HEALTHCARE 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 HOUSEKEEPING/LAUNDRY SERVICES 11359358 MORRISONS HEALTH CARE DIVISION PO BOX 102289 ATLANTA GA 30368 FOOD SERVICES 8214838 TRIMEDX PO BOX 636129 CINCINNATI OH 45263 BIOMED CONTRACT 6570452 DYNAMIX PO BOX 116609 ATLANTA GA 303686609 MAINTENANCE CONTRACT 2853334 102 498210 6567702 1617913 8683825 PATIENT SERVICE REVENUE 812900 506011850 506011850 PHYSICIAN ANSWERING SERVICE 541900 366582 366582 OTHER PROGRAM SERVICES 812900 170757 170757 HOME HEALTH SERVICES 621610 89908 89908 ASK-A-NURSE 541900 21575 21575 15121 15121 506675793 21549248 21549248 4307257 3473484 833773 833773 80026 753747 10076 809281534 109030 782256030 -98954 27025504 26926550 26926550 OUTREACH LAB 812900 3563824 3563824 MISCELLANEOUS 812900 876907 876907 REBATES & DISCOUNTS 812900 497473 497473 126217 147727 -622 -20888 5064421 569733610 508197900 3643228 49208657 589338 589338 71885 71885 9293390 2273434 7019956 163248762 159105241 4143521 1488525 1392217 96308 38073408 35610059 2463349 14712751 13760836 951915 16276641 15223542 1053099 959719 959719 286649 286649 105468 105468 1215927 1215927 35152176 32877830 2274346 565218 528648 36570 1154245 1079565 74680 9637360 9013823 623537 7027966 6573257 454709 146369 136899 9470 22540 22540 5951798 5951798 39344557 36798964 2545593 5746453 5374657 371796 MED SURG SUPPLIES 117495543 117495543 BAD DEBT EXPENSE 26920216 26920216 REPAIRS AND MAINTENANCE 14021212 13114040 907172 GA DCH HOSPITAL TAX 7323289 7323289 9806180 9069632 736548 526637585 487009626 39627959 0 15553694 26514578 95397524 96327581 7434821 6455170 12933187 12653275 10145500 9580795 815361931 532250078 289280341 283111853 517126934 536757805 72400773 64873581 1020272774 1036274638 24822640 23976346 133394367 126867409 80726752 73038745 181202909 167006659 420146668 390889159 X 600091106 645350479 35000 35000 600126106 645385479 1020272774 1036274638 X 43096025 11998721 -9835373 X X 0 1 X 1 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 105468 105468 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 2021, THESE FEES AMOUNTED TO $56,584. ADDITIONALLY, OGLETHORPE CONSULTING GROUP WAS CONTRACTED DURING 2021 TO REVIEW AND ADVISE THE HOSPITAL ON LEGISLATIVE ISSUES. DURING 2021, $48,884 WAS PAID TO OGLETHORPE CONSULTING GROUP. 23577356 23577356 354246252 187847930 166398322 7945322 6452916 1492406 420315703 331806345 88509358 9277298 6142887 3134411 283111853 457(B) DEFERRED COMP ASSET 440417 AMOUNTS DUE FROM AFFILIATES 33609665 LEASEHOLD RIGHTS 190800 PHOENIX HEALTH CARE MGMT SVCS 84169 PHYSICAN GUARANTEE ASSET 975000 PHYSICIANS LIFE INSURACE COLI 9719256 SOFTWARE LICENSE 1340867 VHA STOCK INVESTMENT 138416 WORK FORCE IN PLACE 642929 WC ESCROW - SANFORD 54797 PL GI ESCROW - SANFORD 568752 BOND ESCROW 5550000 TD BANK DEPOSITORY ACCOUNT 11558513 64873581 ACCRUED COMPENSATION, BENEFITS, & WITHOLDINGS 16824814 ACCRUED POSTRETIREMENT BENEFIT COST 22589473 ASSET RETIREMENT OBLIGATION 4298472 EST THIRD PARTY PAYOR SETTLEMENTS 20962391 OTHER CURRENT LIABILITIES 2497966 RESERVE FOR SELF INSURED LOSSES 18680730 DUE TO AFFILIATES 38673352 CAPITALIZED BOND COSTS -1230280 ACCRUED PENSION COST 5107 LONG TERM OPERATING LEASE OBLIGATION 1264391 CURRENT PORTION - OPERATING LEASES 1486722 MEDICARE ADVANCE PAYMENTS 40953521 167006659 X PART X, LINE 2: UNIVERSITY HEALTH SERVICES, INC. IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. ACCORDINGLY, THE FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL OR STATE INCOME TAXES. THE CORPORATION HAS EVALUATED ITS TAX POSITIONS AND HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2021. FISCAL YEARS ENDED ON OR AFTER DECEMBER 31, 2018 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. THERE IS PRESENTLY NO TAXATION IMPOSED BY THE GOVERNMENT OF THE CAYMAN ISLANDS ON INCOME OR PREMIUMS OF WWI. AS A RESULT, NO TAX LIABILITY OR EXPENSE HAS BEEN RECORDED. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 1 2 INSURANCE CAPTIVE 1 2 0 0 1 2 0 0 0 1 0 1 1 1 0 PART 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 19966964 3411525 16555439 0.03310 32152228 21571235 10580993 0.02120 31935 24582 7353 0.00000 52151127 25007342 27143785 0.05430 21724867 11538567 10186300 0.02040 1422352 965135 457217 0.00090 626025 626025 0.00130 23773244 12503702 11269542 0.02260 75924371 37511044 38413327 0.07690 30000 30000 0.00010 30000 30000 0.00010 1 26920216 79361 104433274 130584226 -26150952 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 19 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. PART V, LINE 21D: EMTALA FOLLOWED AND INCLUDED IN POLICY B130. 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), UHS RECORDS PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. RECOVERIES OF ACCOUNTS PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION TO THE PROVISION FOR BAD DEBT EXPENSE WHEN RECEIVED. PART III, LINE 3: UNIVERSITY PROVIDES ALL UNINSURED PATIENTS A DISCOUNT TO MATCH THE UNWEIGHTED AVERAGE OF DISCOUNT GIVEN TO COMMERCIAL AND MEDICARE PATIENTS . IN ADDITION UH USES ELECTRONIC ELIGIBILITY SYSTEM TO DETERMINE IF PATIENTS COULD QUALITY FOR INDIGENT STATUS AND THEN COMPARES DENIED PATIENTS WITH APPLICATIONS IN THE STATE DFCS SYSTEM. PLUS THE COLLECTIONS PERSONNEL, WHEN CONTACTING PATIENTS WILL SEND PATIENT APPLICATIONS TO COMPLETE FOR A PERSONNAL REVIEW. HOWEVER, EVEN WITH THE ABOVE SOME PATIENTS MAY SLIP THROUGH---- THE ESTIMATE ASSUMES THE SAME % OF BAD DEBT EXPENSE TO TOTAL CHARGES IS THE SAME % OF PATIENTS THAT MAY SLIP THROUGH OUR PROCESSES AND NOT GET CLAIMED AS INDIGENT.BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT SINCE THE SERVICES THAT INCUR BAD DEBT ARE PROVIDED BY THE HOSPITAL TO PROMOTE THE WELL-BEING OF THE COMMUNITY. THESE SERVICES ARE RENDERED IN CONJUNCTION WITH THE HOSPITAL'S CHARITABLE TAX-EXEMPT PURPOSES. THERE IS NO LOCAL SUPPORT FOR UNINSURED PATIENTS; THEREFORE, THE SERVICES PROVIDED BY THE HOSPITAL RELIEVE THE HEALTH CARE BURDENS OF THE LOCAL GOVERNMENTS. PART III, LINE 4: PAGE 10 OF THE AUDITED FINANCIAL STATEMENTSTHE CORPORATION DETERMINES THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR GOODS AND SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD-PARTY PAYORS, DISCOUNTS PROVIDED TO UNINSURED PATIENTS IN ACCORDANCE WITH THE CORPORATION'S POLICY AND IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED PATIENTS. THE CORPORATION DETERMINES ITS ESTIMATES OF EXPLICIT PRICE CONCESSIONS FOR CONTRACTUAL ADJUSTMENTS BASED ON CONTRACTUAL AGREEMENTS, OR DISCOUNT POLICIES AND HISTORICAL EXPERIENCE. THE CORPORATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS USING A PORTFOLIO APPROACH AS A PRACTICAL EXPEDIENT TO ACCOUNT FOR PATIENT CONTRACTS AS COLLECTIVE GROUPS RATHER THAN INDIVIDUALLY. MANAGEMENT BELIEVES THAT THE FINANCIAL EFFECTS OF USING THIS PRACTICAL EXPEDIENT ARE NOT MATERIALLY DIFFERENT FROM AN INDIVIDUAL CONTRACT APPROACH. 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 NEIGHBORHOOD IMPROVEMENT PROJECT 2467 GOLDEN CAMP ROAD AUGUSTA GA 30906 311491242 501(C)(3) 90000 0 CLINIC FINANCIAL SUPPORT MIRACLE MAKING MINISTRIES 1127 DRUID PARK AVE AUGUSTA GA 30904 582358627 501(C)(3) 20000 0 CLINIC FINANCIAL SUPPORT COORDINATED HEALTH SERVICES 2110 BROAD STREET AUGUSTA GA 30904 582060572 501(C)(3) 120000 0 COST OF LAB TESTS LAB TESTS CLINIC FINANCIAL SUPPORT BEULAH GROVE COMMUNITY RESOURCE 1446 LEE BEARD WAY AUGUSTA GA 30904 582159621 501(C)(3) 20000 23072 COST EPIC CLINICAL SYSTEM & LAB TESTS CLINIC FINANCIAL SUPPORT CHRIST COMMUNITY HEALTH SERVICES 519 SCOTTS WAY AUGUSTA GA 30909 205404353 501(C)(3) 150000 70936 MEDICARE COST REPORT DONATED FACILITIES CLINIC FINANCIAL SUPPORT HARRISBURG FAMILY HEALTH CARE 423 CRAWFORD AVE AUGUSTA GA 30904 264366421 501(C)(3) 90000 0 CLINIC FINANCIAL SUPPORT 5 SCHOLARSHIP AND AWARD DISBURSEMENTS 6 53914 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 X 1 1 X X X X X 0 1 0 0 0 1 0 0 0 JAMES R DAVIS UHS PRESIDENT & CEO 822804 0 364951 0 1155680 0 0 0 17972 0 2361407 0 714464 0 EDWARD L BURR SR. VP LEGAL & REGULATORY 428561 0 244388 0 491108 0 2710 0 12233 0 1179000 0 0 0 DAVID A BELKOSKI UHS CFO 489897 0 189830 0 168314 0 0 0 11442 0 859483 0 0 0 ELIZABETH R GALLUP COO ACUTE CARE SERVICES 493138 0 188100 0 87504 0 1142 0 16834 0 786718 0 0 0 SCOTT ANSEDE COO UHCP 334730 0 133568 0 48662 0 4016 0 14850 0 535826 0 0 0 SHIRLEY K GABRIEL VP CHIEF INFORMATION OFFIC 326416 0 127650 0 42104 0 1421 0 10481 0 508072 0 0 0 BARRY J JENKINS CMO 387520 0 0 0 47749 0 0 0 9660 0 444929 0 0 0 LAURIE OTT SMITH PRES UHCF-VP HR & COMM SVC 261124 0 78961 0 66237 0 0 0 9528 0 415850 0 0 0 JANEE S DOCK VP NURSING CNO 279258 0 61165 0 45508 0 3069 0 11268 0 400268 0 0 0 TERESA BUSCHBACHER VP -HVI 264009 0 61563 0 46794 0 1491 0 11483 0 385340 0 0 0 LISA RITCH VP FINIANCE 224108 0 53143 0 52268 0 3797 0 13321 0 346637 0 0 0 KELLY DUNAVANT VP SUPPORT SERVICES 198808 0 49365 0 41772 0 3554 0 20431 0 313930 0 0 0 DANIEL H BOONE MD BOARD MEMBER 0 271469 0 3500 0 21798 0 340 0 10425 0 307532 0 0 DOUGLAS D PUGH II PATIENT CARE SERVICES SUPERVISOR 254320 0 9219 0 14494 0 1639 0 16727 0 296399 0 0 0 AMY D PRESLEY RN 2 268533 0 6012 0 9984 0 1022 0 6724 0 292275 0 0 0 TARA SCICCHITANO ASSISTANT NURSE MANAGER 242027 0 5834 0 4666 0 1688 0 7831 0 262046 0 0 0 JACKIE KENDINGER SENIOR GENERAL COUNSEL 196666 0 0 0 20223 0 3420 0 0 0 220309 0 0 0 WILLIAM L FARR JR CMO 145582 0 54080 0 11548 0 0 0 8976 0 220186 0 0 0 ROBERT J KEPSHIRE ADMINISTRATIVE CNO - MCDUF 178132 0 0 0 17267 0 2471 0 7822 0 205692 0 0 0 THOMAS E LOWENCAMP VP - CONTINUING CARE -1549 0 0 0 105677 0 0 0 4081 0 108209 0 0 0 PART I, LINE 1A SOCIAL CLUB DUES- THE RELATED ORGANIZATION PAYS MEMBERSHIP FEES FOR THE CEO (JAMES DAVIS) TO SAGE VALLEY AND THE AUGUSTA COUNTRY CLUB. THESE MEMBERSHIP FEES ARE PAID SO THE ORGANIZATION CAN HAVE ACCESS TO THE MEETING FACILITIES AND CATERING SERVICES THESE ORGANIZATIONS PROVIDE FOR MEETINGS THAT ARE HELD OFF CAMPUS. ANY PERSONAL USE, RELATED TO THESE MEMBERSHIPS, IS REIMBURSED BY THE CEO. PART I, LINE 4B JAMES R DAVIS- CAA/SERP REDEMPTION - $714,464, CAA REDEMPTION - $339,489 DAVID BELKOSKI- ROTH IUL - $120,320 ELIZABETH R GALLUP- ROTH IUL - $49,500 BARRY JENKINS - SEC. 162 - $7,169, ROTH IUL - $40,000 WILLIAM L. FARR - CAA REDEMPTION - $10,400 EDWARD BURR- CAA REDEMPTION - $109,707 LAURIE OTT SMITH - ROTH IUL - $41,793, SEC. 162 - $2,541 THOMAS E LOWENCAMP - SEC. 162 - $1,487, ROTH IUL - $8,040 SHIRLEY K GABRIEL - ROTH IUL - $33,592, SEC. 162 - $7,036 THERESA BUSCHBACHER - ROTH IUL - $26,202, SEC. 162 - $7,043 SCOTT ANSEDE - ROTH IUL - $35,150, SEC. 162 - $6,626 JANEE S DOCK - ROTH IUL - $25,126, SEC. 162 - $3,265 LISA RITCH - ROTH IUL - $22,801, SEC. 162 - $6,876 KELLY DUNAVANT - ROTH IUL - $21,050, SEC. 162 - $10,264 PLEASE NOTE THAT ALL OF THE BENEFITS LISTED ABOVE ARE INCLUDED IN THE TOTALS REPORTED ON FORM 990, SCHEDULE VII AS REPORTABLE COMPENSATION OR OTHER COMPENSATION AND HAVE BEEN INCLUDED IN THE INDIVIDUALS W-2. PART I, LINE 6 THE BONUS PLAN FOR MANAGEMENT IS CALCULATED BASED ON STRATEGIC INITIATIVES AS DETERMINED BY THE COMPENSATION COMMITTEE. THESE INITIATIVES ARE GOALS THAT MUST BE ACHIEVED DURING THE YEAR IN ORDER FOR BONUS PAYOUT. FOR 2021 THESE INITIATIVES WERE WEIGHTED AS DISPLAYED IN THE FOLLOWING SCHEDULE: UNIVERSITY HEALTH SERVICES, INC 2021 STRATEGIC INITIATIVES WEIGHT QUALITY 20% ACHIEVE OVERALL RATING OF CARE SCORE (RAW SCORE) 20% MINIMIZE HOSPITAL ACQUIRED CONDITIONS PER 1,000 MEDICARE DISCHARGES GROWTH 20% GROW THE NUMBER OF ED VISITS ON THE MAIN CAMPUS PEOPLE 20% ACHIEVE RN TURNOVER RATE FOR UH IN 2021 AFFORDABILITY 20% ACHIEVE OPERATING MARGIN FOR UNIVERSITY HEALTH, INC 100% EACH GOAL THAT WAS ACHIEVED REPRESENTED THAT PERCENTAGE OF BONUS PAYOUT OUT OF A POSSIBLE 100% BASED ON A THRESHOLD LEVEL, TARGET LEVEL, OR AN EXCEED LEVEL. 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 SCHEDULE K, PART IV, LINE 2C: DATE REBATE COMPUTATION WAS PERFORMED: 12/16/2021 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: CHANGE IN UNFUNDED PENSION GAINS 16,975,437. OTHER CUMULATIVE EFFECT ON ASSET RETIREMENT OBLIGATIONS 542,389. TRANSFER TO AFFILIATE -27,353,821. PTP INVESTMENT - UBTI NOT ON BOOKS 622. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART XII, LINE 3B: UNIVERSITY HEALTH SERVICES, INC. SPENT MORE THAN $750,000 IN PROVIDER RELIEF FUNDS IN 2021. HOWEVER, THE SINGLE AUDIT IS NOT DUE UNTIL 2022 BECAUSE THE ENTITY HAS A 12/31 FISCAL YEAR END. 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 -207568 27648032 UNIVERSITY HEALTH SERVICES INC UNIVERSITY EXTENDED CARE INC 1350 WALTON WAY AUGUSTA GA 30901 581581105 SKILLED NURSING HOMES GA 501(C)(3) 3 UNIVERSITY HEALTH INC 0 RICHMOND COUNTY HOSPITAL AUTHORITY 1350 WALTON WAY AUGUSTA GA 30901 586001901 LEASED FACILITIES GA 501(C)(3) 3 N/A 0 AUGUSTA RESOURCE CENTER ON AGING I 1350 WALTON WAY AUGUSTA GA 30901 581728812 NON PROFIT LIFE CARE COMMUNITY GA 501(C)(3) 10 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH CARE FOUNDATION 2260 WRIGHTSBORO ROAD AUGUSTA GA 30904 581343550 PHILANTHROPY GA 501(C)(3) 7 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH INC 1350 WALTON WAY AUGUSTA GA 30901 581581102 CONSOLIDATING PARENT GA 501(C)(3) 10 N/A 0 UNIVERSITY MCDUFFIE COUNTY REGIONAL 1350 WALTON WAY AUGUSTA GA 30901 454166209 HOSPITAL GA 501(C)(3) 3 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH RESOURCES INC 1350 WALTON WAY AUGUSTA GA 30901 581601372 SVC TO PHYSICIANS GA UNIVERSITY HEALTH INC C 0 UNIVERSITY HOSPITAL AIKEN INC 1350 WALTON WAY AUGUSTA GA 30901 472713774 HOSPITAL SC UNIVERSITY HEALTH INC C 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 1 0 0 0 1