2022-11-11T14:46:37-06:00 2021-12-31 570381582 ELLIOTT DAVIS LLCPLLC ONE 10TH STREET SUITE 400 AUGUSTA GA 30901 990 2021-01-01 454166209 UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER INC UNIV 7067747710 1350 WALTON WAY AUGUSTA GA 30901 DAVID BELKOSKI CFO 7067747710 2022-11-11 1 DAVID BELKOSKI 999009999 JESSICA C CAIN P01276209 7067229090 2022-11-11 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z UNIVERSITY HOSPITAL MCDUFFIE JAMES R DAVIS 1350 WALTON WAY AUGUSTA GA 30901 30087839 0 X WWW.UNIVERSITYHEALTH.ORG X 2012 GA THE MISSION OF THE UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC. IS TO PROVIDE HEALTH CARE SERVICES WITH THE HELP OF OUR COMMUNITIES AND PARTNERS, AND ENRICH THE LIVES WE TOUCH BY PROVIDING COMPASSIONATE QUALITY CARE IN A COST EFFECTIVE MANNER. WE STRIVE TO BE UTILIZED AS THE HEALTHCARE PARTNER OF CHOICE FOR THE COMMUNITIES WE SERVE. 5 2 210 15 0 0 1991134 3562189 23951880 26294861 610 229539 6901 1250 25950525 30087839 0 0 0 0 7473243 8187895 0 0 0 16192240 17071502 23665483 25259397 2285042 4828442 50983222 54263219 37679124 36130679 13304098 18132540 X THE MISSION OF THE UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC. IS TO PROVIDE HEALTH CARE SERVICES WITH THE HELP OF OUR COMMUNITIES AND PARTNERS, AND ENRICH THE LIVES WE TOUCH BY PROVIDING COMPASSIONATE QUALITY CARE IN A COST EFFECTIVE MANNER. WE STRIVE TO BE UTILIZED AS THE HEALTHCARE PARTNER OF CHOICE FOR THE COMMUNITIES WE SERVE. 0 0 23886918 26296111 UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER (UHM), A 25 BED FACILITY, PROVIDES MUCH OF THEIR EDUCATION AND SUPPORT GROUP ACTIVITIES ONLINE SINCE COVID-19. STAFF MEMBERS SERVE ON A VARIETY OF BOARDS AND ARE INVOLVED IN CIVIC ENDEAVORS THAT PROMOTE HEALTH AND WELLNESS. UNCOMPENSATED CARE WAS PROVIDED AS WELL AS IN INDIGENT AND CHARITY CARE. A HOSPITAL BASED PROGRAM ASSISTANCE COUNSELOR IS PROVIDED AT THE HOSPITAL'S EXPENSE IN ORDER TO ASSIST PATIENTS WITH QUALIFYING FOR MEDICARE DISABILITY, MEDICAID, SSI OR OTHER GOVERNMENT FINANCIAL ASSISTANCE PROGRAMS. FOR 2021, THE HOSPITAL HAD A TOTAL OF 2,184 PATIENT DAYS. 183 OF THESE PATIENT DAYS WERE FOR INDIGENT PATIENTS. SWING BEDS WERE 1,652. OBSERVATION STAYS WERE 677 DAYS. OUTPATIENT VISITS WERE 29,171. OF THE TOTAL OUTPATIENT VISITS, 15,514 WERE FOR EMERGENCY CARE. WITHIN THESE INDICATORS ARE THE EFFORTS OF UNIVERSITY HOSPITAL MCDUFFIE TO SERVICE THE NEEDS OF THE COMMUNITY, WHICH INCLUDE THE INDIGENT. IN 2021 THE COST OF INDIGENT AND CHARITY CARE PROVIDED ALONG WITH MEDICAID SHORTFALLS WAS $2,467,601. THE HOSPITAL RECEIVED DISPROPORTIONATE SHARE (DSH) FUNDS OF $1,244,830 AND UPPER PAYMENT LIMIT (UPL) FUNDS OF $141,002 TO HELP OFFSET THESE COSTS. 23886918 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 24 0 1 210 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 2 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 GA X DAVID A BELKOSKI CFO 7067747710 1350 WALTON WAY AUGUSTA GA 30901 X WILLIAM P DOUPE CHAIRMAN 1.00 X X 0 0 0 ROBIN S DUDLEY DIRECTOR 1.00 X 0 0 0 JOHN BIELTZ DO DIRECTOR 2.00 50.00 X 19500 456453 16028 JAMES R DAVIS UHCS CEO 5.00 50.00 X X 0 2343435 17972 EDWARD L BURR LEGAL ADVISOR 5.00 50.00 X X 0 1164057 14943 DAVID A BELKOSKI UHCS & UHM CFO 5.00 50.00 X 0 848041 11442 WILLIAM L FARR JR CMO 5.00 50.00 X 0 211210 8976 ELIZABETH R GALLUP COO ACUTE CARE SERVICES 5.00 50.00 X 0 768742 17976 BARRY J JENKINS CMO 5.00 50.00 X 0 435269 9660 ROBERT J KEPSHIRE ADMINISTRATIVE CNO 50.00 X 0 195399 10293 DANITA T KISER NURSE DIRECTOR MED/SERG ED 50.00 X 118042 0 15671 MARCIA V RODGERS PHARMACY MANAGER 50.00 X 122110 0 12262 259652 6422606 135223 2 0 1 0 MORRISON HEALTHCARE PO BOX 102289 ATLANTA GA 30368 FOOD SERVICES 359358 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 72902 THERAPY SERVICES 261946 CROTHALL HEALTHCARE 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 HOUSEKEEPING SERVICES 260960 AMS 28 NORTH PALAFOX STREET PENSACOLA FL 32502 ANESTHESIA SERVICES 220000 CROTHALL LAUNDRY SERVICES INC 13028 COLLECTION CENTER DRIVE CHICAGO IL 60693 LINEN/LAUNDRY SERVICE 162086 5 2662123 900066 3562189 PATIENT SERVICE REVENUE 621990 26294861 26294861 26294861 798 798 228741 0 228741 228741 228741 MISCELLANEOUS 812900 1250 1250 1250 30087839 26296111 0 229539 X 19500 18983 517 6263074 6097103 165971 55638 54164 1474 1356821 1320865 35956 492862 479801 13061 2464689 2464689 5007 5007 2732787 2660368 72419 6375 6375 11268 10969 299 163860 159518 4342 358729 349223 9506 92 90 2 717197 717197 1311900 1277135 34765 174986 170349 4637 BAD DEBT 3944615 3944615 MED/SURG SUPPLIES 3751896 3751896 REPAIRS & MAINTENANCE 748570 728733 19837 TAXES 270269 270269 409262 398417 10845 25259397 23886918 1372479 0 17569075 10454327 4749565 4848838 482382 592259 192657 281153 39438082 14236951 25633398 25201131 2356145 12885511 50983222 54263219 11441594 11979513 24481380 23461322 1756150 689844 37679124 36130679 X 13304098 18132540 13304098 18132540 50983222 54263219 4828442 0 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 5007 5007 0 PART II-B, LINE 1: DESCRIPTION OF LOBBYING ACTIVITY A PART OF VARIOUS ASSOCIATION DUES INCLUDE A PERCENTAGE ALLOCATION FOR EXPENDITURES ON LOBBYING ACTIVITIES. DUES PAID TO THE GEORGIA ALLIANCE OF COMMUNITY HOSPITALS AND THE AMERICAN HOSPITAL ASSOCIATION HAVE A LOBBY COMPONENT. FOR 2021 THESE FEES AMOUNTED TO $5,007. 1683198 1683198 25657962 4550118 21107844 472974 73503 399471 11341569 9613330 1728239 282379 282379 25201131 PHYSICIAN GUARANTEE ASSET 404786 DUE FROM UEC 13127 DUE FROM UHS 12467598 12885511 LONG-TERM CAPITAL LEASE OBLIGATION 323203 DUE TO UNIVERSITY MEDICAL GROUP 366641 689844 X PART X, LINE 2: FIN 48 FOOTNOTE ACCOUNTING FOR INCOME TAXES- UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, 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 ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC. HAS EVALUATED THEIR TAX POSITION AND DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2021. 1 1 1 X 1 X 1 1 0 1 1 1482592 715712 766880 0.03600 2734770 2019063 715707 0.03360 1524 1991 0 0.00000 4218886 2736766 1482587 0.06950 4218886 2736766 1482587 0.06950 5000 5000 0.00030 5000 5000 0.00030 1 3944615 78892 4433622 5986879 -1553257 X 1 1 1 1 UNIVERSITY MCDUFFIE REGIONAL MEDICAL CENTER DBA UHM 2460 WASHINGTON ROAD NE THOMSON GA 30824 WWW.UNIVERSITYHEALTHCARE.ORG 097-107 X X X SWING-BED CERTIFIED BY MEDICARE 11/15/15 UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDI 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X HTTP://WWW.UNIVERSITYHEALTH.ORG/FULLPANEL/UPLOADS/FILES/CHNA-2019-MCDUFFIE- X X 1 19 1 HTTP://WWW.UNIVERSITYHEALTH.ORG/FULLPANEL/UPLOADS/FILES/CHNA-2019-MCDUFFIE- 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X SEE SCHEDULE H SUPPLEMENTAL INFO X SEE SCHEDULE H SUPPLEMENTAL INFO X SEE SCHEDULE H SUPPLEMENTAL INFO X X X X X X 1 X 0 X X X X 0 X X 0 0 UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: SEE PAGE 8 OF THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT LISTENING SESSIONS WERE HELD IN MCDUFFIE, WARREN, LINCOLN AND COLUMBIA COUNTIES. THOSE AGENCIES WHO PARTICIPATED IN THE SESSIONS ARE: UGA ARCHWAY PARTNERSHIP, CRAWFORD & BREAZEALE DRUG, MCDUFFIE COUNTY HEALTH DEPARTMENT, FAMILY CARE GROUP OF THOMSON, THOMSON DENTAL WELLNESS, FAMILY CONNECTION OF WARREN COUNTY, WARREN COUNTY EXTENSION, LINCOLN COUNTY COMMISSION, LINCOLN COUNTY HEALTH DEPARTMENT, LINCOLN COUNTY OFFICE OF EMERGENCY SERVICES, CITY OF HARLEM, COLUMBIA COUNTY COMMUNITY CONNECTIONS, COLUMBIA COUNTY HEALTH DEPARTMENT, HARLEM MERCHANT'S ASSOCIATION, HOPE HOUSE. THESE AGENCIES REPRESENT THE CITIZENS OF MCDUFFIE WARREN, LINCOLN AND COLUMBIA COUNTIES INCLUDING 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: THOMSON FAMILY YMCA, PARTNERS FOR SUCCESS, SHAW, WARREN COUNTY SENIOR CENTER, HOMETOWN WARRENTON, COMMUNITY HEALTH CARE SYSTEMS, COMMUNITY MEDICAL ASSOCIATES, LINCOLNTON FAMILY DENTISTRY, LINCOLNTON FAMILY MEDICINE, COLUMBIA COUNTY COMMISSION, 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 MCDUFFIE COUNTY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 7D: CHNA MADE AVAILABLE UPON REQUEST UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: SEE IMPLEMENTATION STRATEGY PAGES 3-6 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 33. WE CHOSE TO FOCUS ON 3 TOP PRIORITIES WHERE WE FELT WE COULD MAKE THE GREATEST IMPACT. OUR PRIORITIZATION PROCESS IS DETAILED ON PAGE 33. WE CHOSE TO FOCUS ON 3 TOP PRIORITIES WHERE WE FELT WE COULD MAKE THE GREATEST IMPACT. ON PAGE 33 OF THE CHNA, WE IDENTIFY OUR 3 PRIORITIES. THOSE THREE PRIORITIES CORRESPOND TO THE RESULTS OF THE NOMINAL GROUP PROCESS. EMBEDDED IN PRIORITY #1 AND PRIORITY #2 ARE THE TOP FOUR VOTE GETTING ITEMS "HEART DISEASE AND STROKE AS IT PERTAINS TO ACCESS AND "DIABETES AS IT PERTAINS TO NUTRITION, PHYSICAL ACTIVITY, AND WEIGHT STATUS". WE PUT A LIST OF CATEGORIES IN FRONT OF THE NOMINAL GROUP PROCESS. ONE OF THEM WAS CHRONIC KIDNEY DISEASES, BUT IT'S PRETTY CLEARLY A LOW PRIORITY. BEING A CATEGORY DOESN'T MAKE IT A PRIORITY, THE GROUP DISCUSSING THE CATEGORIES CHOOSE WHAT THEY BELIEVE ARE THE PRIORITIES AND WE ADDRESSED WHAT WE PRIORITIZED. UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 16J: WWW.UNIVERSITYHEALTH.ORG/OUR-LOCATIONS/UNIVERSITY-HOSPITAL-MCDUFFIE/PATIENT-INFORMATION/INDEGENT-AND-CHARITY-CARE UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 21D: FAP INCLUDED ER MEDICAL CARE CONDITIONS. IN ADDITION, UHM FOLLOWS EMTALA REGULATIONS. PART V, LINE 16A, FAP WEBSITE: HTTPS://WWW.UNIVERSITYHEALTH.ORG/INDIGENT-AND-CHARITY-CARE PART V, LINE 16B, FAP WEBSITE: HTTPS://WWW.UNIVERSITYHEALTH.ORG/FULLPANEL/UPLOADS/FILES/UHM--8310-123-INDIGENT-CARE---ICCP.PDF PART V, LINE 16C, FAP WEBSITE: HTTPS://WWW.UNIVERSITYHEALTH.ORG/FULLPANEL/UPLOADS/FILES/UHM-PLAIN-LANGUAGE-SUMMARY---2020-00001.PDF PART I, LINE 3C: MAY USE BOTH FPG AND ASSET TEST 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 UHM SERVES. IN SUPPORTING THESE ORGANIZATIONS, UHM 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 PROVISION 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 RELIEVE THE HEALTH CARE BURDENS OF THE LOCAL GOVERNMENTS. PART III, LINE 4: BAD DEBT EXPENSEPAGE 10- 12 OF AUDITED FINANCIAL STATEMENT FOR UNIVERSITY HEALTH, INC. 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 ASSESSMENTUHM WORKS WITH ER PERSONNEL AND AREA HEALTH DEPARTMENT DIRECTOR TO IDENTIFY NEEDS BASED ON PATIENTS SEEKING HELP THROUGH THE EMERGENCY ROOM AND HEALTH DEPARTMENT. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEREGISTRARS INFORM PATIENT OF FINANCIAL ASSISTANCE PROGRAMS. ALSO, THERE ARE SIGNS POSTED IN ER AND REGISTRATION AREAS WHICH DENOTE THE AVAILABILITY OF ASSISTANCE WITH HOSPITAL BILLS. IN ADDITION, UHM UTILIZES THE SERVICES OF RCA (RESOURCE CENTER OF AMERICA) WHICH AIDS PATIENTS IN GETTING CERTIFIED FOR SSI AND MEDICAID. PART VI, LINE 4: SEE COMMUNITY NEEDS ASSESSMENT PAGES 5-7MCDUFFIE COUNTY IS A COUNTY LOCATED IN THE U.S. STATE OF GEORGIA. AS OF THE 2014 CENSUS, THE POPULATION WAS 21,400.[1] THE COUNTY SEAT IS THOMSON.[2] THE COUNTY WAS CREATED ON OCTOBER 18, 1870[3] AND NAMED AFTER THE SOUTH CAROLINA GOVERNOR AND SENATOR GEORGE MCDUFFIE. MCDUFFIE COUNTY IS PART OF THE AUGUSTA-RICHMOND COUNTY, GA-SC METROPOLITAN STATISTICAL AREA. ALSO MCDUFFIE IS IN THE CMS -CORE BUSINESS STATISTICAL AREA FOR WAGE INDEX CALCULATIONS. THE % OF POPULATION THAT IS UNDER 18 YEARS IS 25%; AGE 18-64 IS 61%; OVER 65 IS 14%. THE RACE/ETHNICITY IS MADE UP OF 42% BLACK; 53% WHITE AND HISPANIC IS 3%. PART VI, LINE 5: COLLABORATION WITH/SUPPORT OF COMMUNITY ORGANIZATIONS THROUGH SEVERAL SURROUNDING CHAMBERS OF COMMERCE. - SEE PART II ABOVE.SEE PAGE 8 OF THE CHNA FOR THE LIST OF AGENCIES THAT UNIVERSITY HOSPITAL MCDUFFIE WORKS WITH TO SUPPORT AND PROMOTE HEALTH IN OUR COMMUNITY. PART VI, LINE 6: UHM GOVERNING BOARD MEMBERS ARE COMPRISED OF CITZENS WHO RESIDE IN THE UHM'S PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF UHM. UHM BOARD MEMBERS ARE ACTIVE IN THE COMMUNITY AND ARE EAGER TO IMPROVE THE HEALTH AND WELFARE OF THE COMMUNITY. UHM EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN OUR COMMUNITY FOR ALL OF THE UH DEPARTMENTS. UHM AND UHS COLLABORATE ON HEALTH FAIRS AND SCREENINGS PART VI, LINE 7, REPORTS FILED WITH STATES GA 0 1 0 0 0 0 1 0 0 JAMES R DAVIS UHCS CEO 0 822804 0 364951 0 1155680 0 0 0 17972 0 2361407 0 714464 EDWARD L BURR LEGAL ADVISOR 0 428561 0 244388 0 491108 0 2710 0 12233 0 1179000 0 0 DAVID A BELKOSKI UHCS & UHM CFO 0 489897 0 189830 0 168314 0 0 0 11442 0 859483 0 0 ELIZABETH R GALLUP COO ACUTE CARE SERVICES 0 493138 0 188100 0 87504 0 1142 0 16834 0 786718 0 0 JOHN BIELTZ DO DIRECTOR 19500 424402 0 9375 0 22676 0 2469 0 13559 19500 472481 0 0 BARRY J JENKINS CMO 0 387520 0 0 0 47749 0 0 0 9660 0 444929 0 0 WILLIAM L FARR JR CMO 0 145582 0 54080 0 11548 0 0 0 8976 0 220186 0 0 ROBERT J KEPSHIRE ADMINISTRATIVE CNO 0 178132 0 0 0 17267 0 2471 0 7822 0 205692 0 0 PART I, LINE 4B BENEFITS PAID BY UNIVERSITY HEALTH SERVICES INC. (58-1581103) JAMES R. DAVIS - CAA/SERP REDEMPTION - $714,464, CAA REDEMPTION - $339,489 DAVE BELKOSKI - ROTH IUL - $120,320 ELIZABETH 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 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 FROM RELATED ORGANIZATIONS, AND HAVE BEEN INCLUDED IN THE INDIVIDUAL'S 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. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS A COPY OF THE 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 EXPLANATION OF MONITORING AND ENFORCEMENT CONFLICTS DUTY TO DISCLOSE: IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION ARRANGEMENT. DETERMINING WHETHER A CONFLICT EXISTS: AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, THE INTERESTED PERSON WILL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE GOVERNING BOARD OR COMMITTEE DISCUSSES AND VOTES ON A DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS. THE REMAINING BOARD OR COMMITTEE MEMBERS WILL DECIDE IF A CONFLICT OF INTEREST EXISTS. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST: AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING BUT, AFTER THE PRESENTATION, SUCH INTERESTED PERSON WILL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. THE CHAIRPERSON OR THE GOVERNING BOARD OR COMMITTEE WILL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE WILL DETERMINE WHETHER THE CORPORATION CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE WILL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IS IT FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, IT WILL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. VIOLATION OF THE CONFLICT OF INTEREST POLICY: IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER OF SUCH BOARD OR COMMITTEE HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT WILL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE MEMBER'S RESPONSE AND MAKING FURTHER INVESTIGATIONS AS WARRANTED BY THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT WILL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION REVIEW & APPROVAL PROCESS - OFFICERS & KEY EMPLOYEES 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 OFFICER, KEY MANAGEMENT, AND DIRECTOR COMPENSATION. THE CEO AND CFO ARE PAID BY UNIVERSITY HEALTH SERVICES, INC. (58-1581103). ANNUALLY, A COMPENSATION COMMITTEE OF THE UNIVERSITY HEALTH SERVICES (UHS), 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 COMMITTEE ARE RECORDED. THE COMPENSATION COMMITTEE REPORTS TO THE UHS BOARD EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE THE IRS FORM 990 IS ALSO AVAILABLE ON WWW.GUIDESTAR.ORG FORM 990, PART VII: COMPENSATION EXPLAINED JAMES R. DAVIS COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES, INC. (58-1581103) DAVID A. BELKOSKI COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES, INC. (58-1581103) ELIZABETH R. GALLUP COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES, INC. (58-1581103) WILLIAM L. FARR JR. COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES, INC. (58-1581103) EDWARD L. BURR COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES, INC. (58-1581103) JOHN BIELTZ COMPENSATION PAID BY UNIVERSITY MEDICAL GROUP, LLC. (27-4467379) FORM 990, PART IX, LINE 11G PHYSICIAN: PROGRAM SERVICE EXPENSES 451,815. MANAGEMENT AND GENERAL EXPENSES 12,299. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 464,114. PHYSICIANS-ON CALL: PROGRAM SERVICE EXPENSES 52,569. MANAGEMENT AND GENERAL EXPENSES 1,431. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,000. BANKING FEES: PROGRAM SERVICE EXPENSES 30,275. MANAGEMENT AND GENERAL EXPENSES 824. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,099. CONSULTING FEES: PROGRAM SERVICE EXPENSES 179,358. MANAGEMENT AND GENERAL EXPENSES 4,882. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 184,240. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,834,557. MANAGEMENT AND GENERAL EXPENSES 49,939. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,884,496. PURCHASED SERVICES - OTHER: PROGRAM SERVICE EXPENSES 15,228. MANAGEMENT AND GENERAL EXPENSES 415. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,643. DUES & MEMBERSHIPS: PROGRAM SERVICE EXPENSES 12,365. MANAGEMENT AND GENERAL EXPENSES 337. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,702. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 33,903. MANAGEMENT AND GENERAL EXPENSES 923. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 34,826. PERSONNEL RECRUITMENT: PROGRAM SERVICE EXPENSES 50,298. MANAGEMENT AND GENERAL EXPENSES 1,369. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,667. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR FORM 990, PART XII, LINE 3B: UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, 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. RICHMOND COUNTY HOSPITAL AUTHORITY 1350 WALTON WAY AUGUSTA GA 30901 586001901 LEASED FACILITIES GA 501(C)(3) LINE 3 N/A 0 UNIVERSITY HEALTH SERVICES INC 1350 WALTON WAY AUGUSTA GA 30901 581581103 HOSPITAL GA 501(C)(3) LINE 3 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH CARE FOUNDATION 2260 WRIGHTSBORO ROAD AUGUSTA GA 30904 581343550 PHILANTHROPY GA 501(C)(3) LINE 7 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH INC 1350 WALTON WAY AUGUSTA GA 30901 581581102 CONSOLIDATING PARENT GA 501(C)(3) LINE 10 N/A 0 AUGUSTA RESOURCE CENTER ON AGING INC 1350 WALTON WAY AUGUSTA GA 30901 581728812 NONPROFIT LIFE CARE COMMUNITY GA 501(C)(3) LINE 10 UNIVERSITY HEALTH INC 0 UNIVERSITY EXTENDED CARE INC 1350 WALTON WAY AUGUSTA GA 30901 581581105 SKILLED NURSING HOME GA 501(C)(3) LINE 3 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH RESOURCES I 1350 WALTON WAY AUGUSTA GA 30901 581601372 SVCS TO PHY GA UNIVERSITY HEALTH INC C 0 UNIVERSITY HOSPITAL OF AIKEN INC 1350 WALTON WAY AUGUSTA GA 30901 472713774 HOSPITAL SC UNIVERSITY HEALTH INC C 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0