UNIVERSITY EXTENDED CARE INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- UNIVERSITY EXTENDED CARE INC (EIN 58-1581105)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-15
- IRS object ID
- 202103199349303465
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-15T08:30:15-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 570381582 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ELLIOTT DAVIS LLCPLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | ONE 10TH STREET SUITE 400 | AddressLine1Txt |
| City | AUGUSTA | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581581105 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNIVERSITY EXTENDED CARE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UNIV | BusinessNameControlTxt |
| Phone | 7067747710 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1350 WALTON WAY | AddressLine1Txt |
| City | AUGUSTA | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 309012629 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID A BELKOSKI | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7067747710 | PhoneNum |
| Signature | 2021-11-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DAVID | PersonFirstNm |
| Person Last | BELKOSKI | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JESSICA C CAIN | PreparerPersonNm |
| PTIN | P01276209 | PTIN |
| Phone | 7067229090 | PhoneNum |
| Preparation | 2021-11-08 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JAMES R DAVIS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1350 WALTON WAY | AddressLine1Txt |
| City | AUGUSTA | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30901 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $40,304,479 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.UNIVERSITY.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1984 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE COMPETENT AND COMPASSIONATE CARE TO MEET THE HEALTH CARE NEEDS OF THE ELDERLY AND DISABLED. THE GOAL IS TO MAINTAIN THE PRESENT LEVEL OF FUNCTION IN THE PATIENT AND TRY TO IMPROVE THE ABILITY OF PATIENTS TO ASSIST WITH THE ROUTINE DAILY CARE IN A CONTROLLED SETTING. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 396 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,054,275 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $36,873,680 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $35,646,462 | CYProgramServiceRevenueAmt |
| PY Investment Income | $68,083 | PYInvestmentIncomeAmt |
| CY Investment Income | $175 | CYInvestmentIncomeAmt |
| PY Other Revenue | $20,367 | PYOtherRevenueAmt |
| CY Other Revenue | $2,603,567 | CYOtherRevenueAmt |
| PY Total Revenue | $36,962,130 | PYTotalRevenueAmt |
| CY Total Revenue | $40,304,479 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $12,228,013 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,462,681 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $17,741,193 | PYOtherExpensesAmt |
| CY Other Expenses | $16,233,742 | CYOtherExpensesAmt |
| PY Total Expenses | $29,969,206 | PYTotalExpensesAmt |
| CY Total Expenses | $27,696,423 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $6,992,924 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $12,608,056 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $29,069,346 | TotalAssetsBOYAmt |
| Total Assets EOY | $43,852,393 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,942,031 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,117,022 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $26,127,315 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $38,735,371 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE COMPETENT AND COMPASSIONATE CARE TO MEET THE HEALTH CARE NEEDS OF THE ELDERLY AND DISABLED. THE GOAL IS TO MAINTAIN THE PRESENT LEVEL OF FUNCTION IN THE PATIENT AND TRY TO IMPROVE THE ABILITY OF PATIENTS TO ASSIST WITH THE ROUTINE DAILY CARE IN A CONTROLLED SETTING. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $24,307,206 | ExpenseAmt |
| Revenue | $35,646,462 | RevenueAmt |
| Desc | UNIVERSITY EXTENDED CARE HAS THREE FACILITIES. THE KENTWOOD FACILITY HAS 100 SKILLED NURSING BEDS. THE WESTWOOD FACILITY HAS 149 BEDS WHICH INCLUDES AN ALZHEIMER'S UNIT AND A WING DESIGNED FOR ORTHOPAEDIC AND CARDIAC PATIENT REHABILITATION. THE AMARA FACILITY HAS 193 SKILLED NURSING BEDS. THE FACILITIES HAD 63% OCCUPANCY FOR 2020. THE TOTAL PATIENT DAYS WERE 102,115 FOR 2020. | Desc |
| Total Program Service Expenses | $24,307,206 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 16 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 396 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVID BELKOSKI CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7067747710 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1350 WALTON WAY | AddressLine1Txt |
| City | AUGUSTA | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 309012629 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| LEVI W HILL IV | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| TERRY D ELAM | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| W CRAIG SMITH | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| NATALIE D SCHWEERS | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| SANFORD LOYD | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| BRIAN J MARKS | |||||||||
| VICE CHAIRMAN | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| EUGENE F MCMANUS | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| HUGH L HAMILTON | |||||||||
| BOARD CHAIRMAN | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |||
| JEFFREY L FOREMAN | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| JAMES W BENNETT JR | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| DANIEL H BOONE MD | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $322,280 | $14,510 | 10.00 | |||
| CHARLES G PETE CAYE JR | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| CATHERINE D KNOX | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| WILLIAM P DOUPE | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||||
| JAMES C SHERMAN MD | |||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $125,136 | $0 | 50.00 | |||
| DAVID A BELKOSKI | |||||||||
| CFO | 2.00 | $0 | $665,796 | $11,053 | Yes (X) | 50.00 | |||
| JAMES R DAVIS | |||||||||
| CEO | 2.00 | $0 | $979,002 | $435,454 | Yes (X) | 50.00 | |||
| WILLIAM L FARR JR | |||||||||
| CMO | 2.00 | $0 | $532,459 | $24,500 | Yes (X) | 50.00 | |||
| EDWARD L BURR | |||||||||
| CAO | 2.00 | $0 | $690,965 | $24,697 | Yes (X) | 50.00 | |||
| ELIZABETH R GALLUP | |||||||||
| COO ACUTE CARE SERVICES | 2.00 | $0 | $602,282 | $24,622 | Yes (X) | 50.00 | |||
| THOMAS E LOWENCAMP | |||||||||
| VP - CONTINUING CARE | 25.00 | $0 | $446,944 | $20,664 | 25.00 | Yes (X) | |||
| BENJAMEN GUEST | |||||||||
| DIRECTOR | 25.00 | $0 | $200,139 | $15,791 | 25.00 | Yes (X) | |||
| DAWN C BRUCE | |||||||||
| ADMINISTRATOR | 2.00 | $139,868 | $0 | $2,682 | 2.00 | Yes (X) | |||
| ERICA DUGGER | |||||||||
| ADMINISTRATOR | 2.00 | $123,728 | $0 | $10,262 | 2.00 | Yes (X) | |||
| CRISTAL L BURNETTE | |||||||||
| ADMINISTRATOR | 2.00 | $148,322 | $0 | $8,747 | 2.00 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $411,918 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,565,003 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $592,982 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| AEGIS THERAPIES | |||||
| PO BOX 8103 | FORT SMITH | AR | 72902 | THERAPY | $2,692,519 |
| CRITICAL SOLUTIONS INC | |||||
| PO BOX 1451 | AUGUSTA | GA | 30903 | STAFFING (NURSING, ASSISTANTS) | $1,827,832 |
| MORRISON HEALTHCARE | |||||
| PO BOX 102289 | ATLANTA | GA | 30368 | DIETARY | $964,015 |
| CROTHALL HEALTHCARE | |||||
| 13028 COLLECTION CENTER DR | CHICAGO | IL | 60693 | HOUSEKEEPING | $343,042 |
| CROTHALL LAUNDRY SERVICES INC | |||||
| 13028 COLLECTION CENTER DR | CHICAGO | IL | 60693 | LAUNDRY | $264,815 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $2,054,275 | AllOtherContributionsAmt |
| Total Contributions | $2,054,275 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| INPATIENT REVENUE | 623000 | $35,633,382 | $35,633,382 |
| DIETARY SERVICE REVENUE | 900099 | $13,080 | $13,080 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $35,646,462 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $175 | TotalRevenueColumnAmt |
| Exclusion | $175 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $2,603,567 | TotalRevenueColumnAmt |
| Exclusion | $2,603,567 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,603,567 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,304,479 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,646,462 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $2,603,742 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,379,081 | TotalAmt |
| Program Services | $7,607,817 | ProgramServicesAmt |
| Management And General | $771,264 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,196 | TotalAmt |
| Program Services | $80,258 | ProgramServicesAmt |
| Management And General | $7,938 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,305,677 | TotalAmt |
| Program Services | $2,165,628 | ProgramServicesAmt |
| Management And General | $140,049 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $689,727 | TotalAmt |
| Program Services | $627,742 | ProgramServicesAmt |
| Management And General | $61,985 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,000 | TotalAmt |
| Management And General | $19,000 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,888,885 | TotalAmt |
| Program Services | $6,315,807 | ProgramServicesAmt |
| Management And General | $1,573,078 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,602 | TotalAmt |
| Program Services | $39,315 | ProgramServicesAmt |
| Management And General | $85,287 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,861,241 | TotalAmt |
| Program Services | $1,824,016 | ProgramServicesAmt |
| Management And General | $37,225 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,497 | TotalAmt |
| Program Services | $1,839 | ProgramServicesAmt |
| Management And General | $4,658 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,113 | TotalAmt |
| Management And General | $4,113 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $556,138 | TotalAmt |
| Program Services | $536,988 | ProgramServicesAmt |
| Management And General | $19,150 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $445,384 | TotalAmt |
| Management And General | $445,384 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $2,607,448 | $2,531,912 | $75,536 |
| BED TAXES | $1,599,949 | $1,599,949 | |
| BAD DEBT | $630,386 | $630,386 | |
| REPAIRS AND MAINTENANCE | $338,871 | $267,412 | $71,459 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $151,228 | TotalAmt |
| Program Services | $78,137 | ProgramServicesAmt |
| Management And General | $73,091 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,696,423 | TotalAmt |
| Program Services | $24,307,206 | ProgramServicesAmt |
| Management And General | $3,389,217 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,400,291 | BOYAmt |
| EOY | $20,890,396 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,484,861 | BOYAmt |
| EOY | $1,675,542 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $97,560 | BOYAmt |
| EOY | $51,085 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $7,175,190 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,882,218 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,464,395 | BOYAmt |
| EOY | $2,292,972 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,622,239 | BOYAmt |
| EOY | $18,942,398 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,069,346 | BOYAmt |
| EOY | $43,852,393 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,930,519 | BOYAmt |
| EOY | $4,138,029 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $966,108 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,512 | BOYAmt |
| EOY | $12,885 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,942,031 | BOYAmt |
| EOY | $5,117,022 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,127,315 | BOYAmt |
| EOY | $38,735,371 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,127,315 | BOYAmt |
| EOY | $38,735,371 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,069,346 | BOYAmt |
| EOY | $43,852,393 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $12,608,056 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | 0 | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,557,753 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,482,876 | DepreciationAmt |
| Book Value | $1,074,877 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,592,266 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,399,342 | DepreciationAmt |
| Book Value | $1,192,924 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,171 | OtherCostOrOtherBasisAmt |
| Book Value | $25,171 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,292,972 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| WORKFORCE IN PLACE | $173,611 |
| DUE FROM UHS | $16,764,182 |
| DUE FROM UCA | $1,596 |
| DUE FROM UMG | $2,003,009 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $18,942,398 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO UHM | Desc |
| Amt | $12,885 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $12,885 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | UNIVERSITY EXTENDED CARE, 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, 2020. FISCAL YEARS ENDED ON OR AFTER DECEMBER 31, 2017 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES R DAVIS | ||||||||||||||
| CEO | $0 | $805,317 | $0 | $144,200 | $0 | $29,485 | $0 | $418,619 | $0 | $16,835 | $0 | $1,414,456 | $0 | $0 |
| EDWARD L BURR | ||||||||||||||
| CAO | $0 | $418,171 | $0 | $73,500 | $0 | $199,294 | $0 | $7,643 | $0 | $17,054 | $0 | $715,662 | $0 | $0 |
| DAVID A BELKOSKI | ||||||||||||||
| CFO | $0 | $480,920 | $0 | $97,606 | $0 | $87,270 | $0 | $0 | $0 | $11,053 | $0 | $676,849 | $0 | $0 |
| ELIZABETH R GALLUP | ||||||||||||||
| COO ACUTE CARE SERVICES | $0 | $454,176 | $0 | $81,671 | $0 | $66,435 | $0 | $7,338 | $0 | $17,284 | $0 | $626,904 | $0 | $0 |
| WILLIAM L FARR JR | ||||||||||||||
| CMO | $0 | $403,963 | $0 | $79,310 | $0 | $49,186 | $0 | $7,296 | $0 | $17,204 | $0 | $556,959 | $0 | $0 |
| THOMAS E LOWENCAMP | ||||||||||||||
| VP - CONTINUING CARE | $0 | $100,130 | $0 | $59,898 | $0 | $286,916 | $0 | $2,857 | $0 | $17,807 | $0 | $467,608 | $0 | $0 |
| DANIEL H BOONE MD | ||||||||||||||
| BOARD MEMBER | $0 | $288,213 | $0 | $9,500 | $0 | $24,567 | $0 | $4,085 | $0 | $10,425 | $0 | $336,790 | $0 | $0 |
| BENJAMEN GUEST | ||||||||||||||
| DIRECTOR | $0 | $151,107 | $0 | $30,338 | $0 | $18,694 | $0 | $3,153 | $0 | $12,638 | $0 | $215,930 | $0 | $0 |
| CRISTAL L BURNETTE | ||||||||||||||
| ADMINISTRATOR | $123,228 | $0 | $19,199 | $0 | $5,895 | $0 | $2,174 | $0 | $6,573 | $0 | $157,069 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4B | BENEFITS PAID BY UNIVERSITY HEALTH SERVICES INC. (58-1581103) JAMES R. DAVIS SERP - $410,069 DAVE BELKOSKI ROTH IUL - $65,475 ELIZABETH GALLUP - ROTH IUL - $43,500 WILLIAM L. FARR - CAA REDEMPTION - $41,600 EDWARD BURR - CAA REDEMPTION - $192,689 THOMAS LOWENCAMP - SEC. 162 - $5,946, ROTH IUL - $32,161 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, WITH THE EXCEPTION OF THE SERP FOR JAMES R. DAVIS. |
| 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 2020 THESE INITIATIVES WERE WEIGHTED AS DISPLAYED IN THE FOLLOWING SCHEDULE: UNIVERSITY HEALTH SERVICES, INC 2020 STRATEGIC INITIATIVES WEIGHT QUALITY 25% ACHIEVE NRC OVERALL RATING OF CARE RAW SCORE 25% MINIMIZE HOSPITAL ACQUIRED CONDITIONS PER 1,000 MEDICARE DISCHARGES GROWTH 10% INCREASE GROSS CHARGES FROM AIKEN AND COLUMBIA COUNTIES OVER 2019 LEVELS PEOPLE 10% ACHIEVE RN TURNOVER RATE FOR UH AFFORDABILITY 25% ACHIEVE OPERATING MARGIN FOR UNIVERSITY HEALTH, INC 5% IMPROVE THE ALL-MEDICARE OPERATING MARGIN LOSS 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. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. 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 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 VII - COMPENSATION | 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) DANIEL H BOONE MD COMPENSATION PAID BY UNIVERSITY MEDICAL GROUP, LLC (27-4467379) JAMES C SHERMAN MD COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES INC (58-1581103) |
| FORM 990, PART IX, LINE 11G | PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 87,310. MANAGEMENT AND GENERAL EXPENSES 21,746. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 109,056. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 448,794. MANAGEMENT AND GENERAL EXPENSES 111,781. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 560,575. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 848,391. MANAGEMENT AND GENERAL EXPENSES 211,309. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,059,700. OCCUPATIONAL THERAPY: PROGRAM SERVICE EXPENSES 1,016,841. MANAGEMENT AND GENERAL EXPENSES 253,265. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,270,106. SPEECH THERAPY: PROGRAM SERVICE EXPENSES 230,789. MANAGEMENT AND GENERAL EXPENSES 57,483. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 288,272. DIETICIAN FEES: PROGRAM SERVICE EXPENSES 34,421. MANAGEMENT AND GENERAL EXPENSES 8,573. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42,994. MORRISON CONTRACT: PROGRAM SERVICE EXPENSES 855,524. MANAGEMENT AND GENERAL EXPENSES 213,085. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,068,609. MANAGEMENT: PROGRAM SERVICE EXPENSES 1,139,840. MANAGEMENT AND GENERAL EXPENSES 283,900. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,423,740. CONSULTING: PROGRAM SERVICE EXPENSES 2,139. MANAGEMENT AND GENERAL EXPENSES 533. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,672. AGENCIES: PROGRAM SERVICE EXPENSES 1,651,758. MANAGEMENT AND GENERAL EXPENSES 411,403. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,063,161. |
| FORM 990, PART XII, LINE 2C | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. UNIVERSITY EXTENDED CARE, INC. SPENT MORE THAN $750,000 IN PROVIDER RELIEF FUNDS IN 2020. HOWEVER, THE SINGLE AUDIT IS NOT DUE UNTIL 2022 BECAUSE THE ENTITY HAS A 12/31 FISCAL YEAR END. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| UNIVERSITY HEALTH SERVICES INC | |||||||||||
| 1350 WALTON WAY | AUGUSTA | GA | 30901 | 581581103 | HOSPITAL | 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 | 0 | N/A | |
| AUGUSTA RESOURCE CENTER ON AGING I | |||||||||||
| 1350 WALTON WAY | AUGUSTA | GA | 30901 | 581728812 | NON PROFIT LIFE CARE COMMUNITY | GA | 501(C)(3) | 11 | 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) | 11 | 0 | N/A | |
| UNIVERSITY MCDUFFIE COUNTY REGIONAL | |||||||||||
| 1350 WALTON WAY | AUGUSTA | GA | 30901 | 454166209 | HOSPITAL | GA | 501(C)(3) | 3 | UNIVERSITY HEALTH INC | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| UNIVERSITY HEALTH RESOURCES INC | |||||||||
| 1350 WALTON WAY | AUGUSTA | GA | 30901 | 581601372 | SERVICES 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |