2021-02-23T16:06:30-06:00 2020-06-30 BKD LLP 14241 DALLAS PARKWAY STE 1100 DALLAS TX 75254 990 2019-07-01 720995809 Union General Hospital % WILLIAM ADCOCK UNIO 3183689751 PO Box 398 Farmerville LA 71241 WILLIAM ADCOCK CFO 3183687096 2021-05-17 true Jeanette Verrelli P00742631 9727028262 2019 2022-09-23 18:48:47Z EVALYN ORMOND PO BOX 398 FARMERVILLE LA 71241 16061717 false X WWW.UNIONGEN.ORG X 1983 LA TO PROVIDE ACUTE CARE HOSPITAL SERVICES IN THE FARMERVILLE AREA. IT IS OUR GOAL TO DELIVER THE BEST POSSIBLE HEALTH CARE AVAILABLE AND SERVE THE DEDICATED PEOPLE OF...(SEE SCH. O) 7 7 172 7 0 0 497507 1258021 14300376 14582612 93945 63752 82771 86085 14974599 15990470 90832 30382 0 0 6761597 7322601 0 0 0 7591207 7414491 14443636 14767474 530963 1222996 15133067 21302078 1156019 6102034 13977048 15200044 IT IS THE MISSION OF UNION GENERAL HOSPITAL TO PROVIDE QUALITY SERVICE WITH COMPASSIONATE CARE. false false 11597053 30382 14627277 PROVIDED ACUTE CARE HOSPITAL SERVICES TO INDIVIDUALS IN THE FARMERVILLE AREA; INDIVIDUALS SERVED AMOUNTED TO 1,914 PATIENT DAYS AND 6,649 EMERGENCY ROOM VISITS. THE LABORATORY PERFORMED 44,447 TESTS AND 32,125 ECG, RADIOLOGY, ULTRASOUND, CT, OT, RT, ST,AND PT PROCEDURES WERE PERFORMED. THE RURAL HEALTH CLINIC LOGGED 8,116 VISITS. In March 2020, when the COVID pandemic hit our area, UGH set up temporary tents outside the Hospital Emergency Room and Rural Health Clinic, in order to provide necessary testing for our community in a safe environment under emergency State and Federal guidelines. We set up negative pressure rooms in our Emergency Room and Nursing area, in order to provide additional care needed by our COVID patients. We admitted 67 Inpatients with the COVID virus, for a total of 213 Patient Days. UGH tested 470 Outpatients, with 170 of those testing positive for COVID-19. We expanded the telemedicine services in our Rural Health Clinic (236 visits) and Intensive Outpatient Psychiatric program (323 visits), in order to provide needed services for those patients as well. 11597053 true true false true false false false false false false true false false true true false true false false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false true 115 0 172 true false false false false false false false false false false false false X 7 7 false false false false false false false true true false false true true true true true true true true false X X WILLIAM ADCOCK 3183687096 901 JAMES AVE FARMERVILLE LA 71241 X EVALYN ORMOND CEO 40.0 0.0 X 232186 0 9137 WILLIAM ADCOCK CFO 40.0 0.0 X 228288 0 8519 CONNIE GINN ER DIRECTOR 40.0 0.0 X 151364 0 6433 LYNETTE WADE NURSE PRACTITIONER 40.0 0.0 X 144654 0 8352 SHEREE HICKS PHARMACIST 40.0 0.0 X 141142 0 4797 DARRA JUNG DIRECTOR OF NURSING 40.0 0.0 X 134605 0 7177 DIANNE DAVIDSON COO 40.0 0.0 X 116010 0 5878 KATE COOK PHARMACIST 40.0 0.0 X 112679 0 5779 Michael Williams Info Systems Director 40.0 0.0 X 101425 0 2721 ALLYSON CROW DIRECTOR 1.0 0.0 X 0 0 0 BESSIE WARREN SECRETARY 1.0 0.0 X X 0 0 0 DANIEL HUNTER JR VICE PRESIDENT 1.0 0.0 X X 0 0 0 DANNY SMITH DIRECTOR 1.0 0.0 X 0 0 0 RALPH KELLEY DIRECTOR 1.0 0.0 X 0 0 0 TIM TETTLETON PRESIDENT 1.0 0.0 X X 0 0 0 CHRISTY FINE DIRECTOR 1.0 0.0 X 0 0 0 1362353 0 58793 11 false true false OMEGA DIAGNOSTICS 3000 KNIGHT ST BLDG 5 SUITE 220 SHREVEPORT LA 71105 LAB SERVICES 1315806 CORRECT CARE INC 229 ST JOHN LN COVINGTON LA 70433 E/R PHYSICIAN STAFF 1294016 LEGACY REHABILITATION PO BOX 843 RUSTON LA 71273 THERAPY SERVICES 885203 BYRNES MECHANICAL CONTRACTOR 115 RIDGEDALE DR WEST MONROE LA 71291 BLDG REPAIR/CONSTRUC 616107 MEDHOST OF TENNESSEE 2739 MOMENTUM PL CHICAGO IL 60689 Software Services 316004 6 685488 572533 1258021 NET PATIENT SERVICE FEES 621110 14294191 14294191 Other Operating Revenue 621110 77768 77768 Pharmacy Revenue 446110 210653 210653 14582612 61453 61453 0 0 0 0 0 73546 71247 2299 2299 2299 0 0 0 0 0 0 0 0 0 CAFETERIA AND VENDING MACHINE 722514 41420 41420 UTILITY DISTRICT REIMBURSEMENT 900099 2336 2336 MEDICAL RECORDS 561000 7117 7117 35212 35212 86085 15990470 14627277 105172 X 30382 30382 0 0 0 742340 555665 186675 0 5413548 4116649 1296899 57422 57422 682976 518559 164417 426315 323686 102629 0 31698 31698 79899 79899 0 0 0 4463439 4045358 418081 62025 6043 55982 257728 104324 153404 182929 182929 0 276711 224688 52023 64204 53594 10610 0 68259 17456 50803 207 207 0 692252 548853 143399 121844 67096 54748 MEDICAL SUPPLIES 801653 801653 DUES & SUBSCRIPTIONS 61019 1251 59768 COLLECTIONS 37070 887 36183 . 0 213554 180909 32645 14767474 11597053 3170421 0 6720009 11747308 898275 795085 0 436500 1056953 982141 0 0 0 0 0 0 206564 217705 64612 80662 17691023 12140712 5094452 5550311 0 0 0 0 0 0 0 0 1092202 1492366 15133067 21302078 1064411 1059105 0 0 0 4951321 0 0 0 0 0 0 0 0 0 0 91608 91608 1156019 6102034 X 13679209 14424732 297839 775312 13977048 15200044 15133067 21302078 1222996 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 650 false true 3619 4269 false SCHEDULE C, PART II-B, LINEs 1g & 1I OTHER ACTIVITIES FOR LOBBYING PURPOSES: THE CEO AND COO MET WITH SEEMA VERNA/CMS, ALONG WITH OTHER HOSPITALS ASSOCIATED WITH THE CAH COALITION IN MAY 2020. THE HOSPITAL PAID DUES TO ORGANIZATIONS, A PORTION OF WHICH IS DESIGNATED FOR LOBBYING EXPENSES. DUES %LOBBYING $LOBBYING RURAL HOSPITAL COALITION $5,496 25% $1,374 LA HOSPITAL ASSOCIATION 11,694 15% 1,754 NATIONAL RURAL HEALTH ASSOC 1,225 5% 61 CAH Coalition 4,300 10% 430 ---------------------------------- TOTAL $22,715 $3,619 186090 186090 8529702 4589340 3940362 8663333 7369480 1293853 311898 181892 130006 5550311 Other Receivables 81201 EMPLOYEE RECEIVABLES 140 Due from Cardinal Hthcare 36000 Other Asset 148670 Utility Deposits 1935 Est due from 3rd Party Payers 1224420 1492366 0 Estimated self-insurance costs 91608 91608 15093503 15093503 896967 896967 15990470 14767474 14767474 14767474 SCHEDULE D, PART X, LINE 2 ASC 740 FOOTNOTE: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: CONTRIBUTIONS FOR ACQUISITION OF PROPERTY AND EQUIPMENT $161,655 CONTRIBUTIONS RECEIVED WITH DONOR RESTRICTIONS $735,312 ------------ TOTAL $896,967 true true X true X 250. false true true false false 27241 27241 0.00180 5220735 4934114 286621 0.01940 5247976 4934114 313862 0.02120 1830 15495 15495 0.00100 8043 49162 49162 0.00330 9873 64657 64657 0.00430 9873 5312633 4934114 378519 0.02550 492 18850 18850 0.00130 203 2147 2147 0.00010 695 20997 20997 0.00140 true 947167 5337471 5410459 -72988 X true true 1 1 UNION GENERAL HOSPITAL 901 JAMES AVE FARMERVILLE LA 71241 WWW.UNIONGEN.ORG 146 X X X UNION GENERAL HOSPITAL false false true X X X X X X X X X 17 true false false true X SEE PART V, SECTION C X true 17 true SEE PART V, SECTION C false true X 250. 0. X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 REPRESENTATIVES FROM THE COMMUNITY: THE HOSPITAL GATHERED INFORMATION FROM COMMUNITY MEETINGS, STAKEHOLDER INTERVIEWS, DISCUSSIONS WITH THE HOSPITAL LEADERSHIP TEAM, REVIEW OF DEMOGRAPHIC AND HEALTH STATUS, AND HOSPITAL UTILIZATION DATA, TO PRIORITIZE THE HEALTH NEEDS OF THE POPULATION. THE HOSPITAL'S CHIEF EXECUTIVE OFFICER DEVELOPED A HOSPITAL STEERING COMMITTEE. THE CEO APPOINTED THE FOLLOWING INDIVIDUALS AS PARTICIPANTS ON THIS COMMITTEE: EVALYN ORMOND - CHIEF EXECUTIVE OFFICER DIANNE DAVIDSON - CHIEF OPERATING OFFICER WILLIAM ADCOCK - CHIEF FINANCIAL OFFICER JULIE DUTY - COMPLIANCE/HIPAA OFFICER CLAUDIA WADE - COMMUNITY DEVELOPMENT MANAGER, GRANT WRITER DARRA JUNG - DIRECTOR OF NURSES BRITTANY SMITH - DIETARY DIRECTOR THE COMMITTEE IDENTIFIED 8 STAKEHOLDERS FOR INDIVIDUAL INTERVIEWS. BELOW IS A LIST OF THE ORGANIZATIONS REPRESENTED BY THE KEY STAKEHOLDERS. INTENSIVE OUTPATIENT PROGRAM UNION PARISH HEALTH DEPARTMENT UNION GENERAL HOSPITAL CITY OF FARMERVILLE UNION PARISH SCHOOL SYSTEM PUBLIC HEALTH NURSE, UNION PARISH HEALTH DEPARTMENT CHILDREN'S COALITION MEDICAID REPRESENTATIVE/FINANCIAL COUNSELOR SCHEDULE H, PART V, SECTION B, LINE 11 IDENTIFIED NEEDS ADDRESSED AND NOT ADDRESSED: THE MOST RECENT CHNA FOUND THAT MANY OF THE NEEDS IDENTIFIED IN THE 2015 CHNA ARE STILL A PRIORITY. THE NEEDS IDENTIFIED IN THE MOST RECENT CHNA BY THE STEERING COMMITTEE ARE: CANCER: UNION GENERAL HOSPITAL OFFERED FREE MAMMOGRAMS TO THE COMMUNITY IN 2019 IN PARTNERSHIP WITH SUSAN G KOMEN AND PUBLIC HEALTH. FREE SCREENING MAMMOGRAMS WERE OFFERED TO ANY PATIENT THAT QUALIFIES IN AND OUT OF STATE. THE HOSPITAL OFFERS CONTINUING BREAST CANCER EDUCATION TO THE COMMUNITY. ALSO, IN PARTNERSHIP WITH OMEGA LABS, UNION GENERAL HOSPITAL IS OFFERING FREE COLON CANCER SCREENINGS TO THE COMMUNITY. WE OFFER THE KITS AT LOCAL FAIRS AND ANYONE CAN STOP BYE THE HOSPITAL AND REQUEST ONE. THE KIT AND THE TEST ARE FREE. ADOLESCENT BEHAVIORS: THE HOSPITAL CONTINUES ITS PARTNERSHIP WITH THE SCHOOL DISTRICT UNDER THE 21ST CENTURY GRANT AFTER SCHOOL PROGRAM AND OFFERS "ITS A GIRL THING, MAKING PROUD CHOICES," THE HOSPITALS STD/HIV PREGNANCY PREVENTION PROGRAM. THE HOSPITAL EDUCATES 6TH THROUGH 9TH GRADE GIRLS EVERY WEEK FOR AN HOUR. THE NEW ENROLLMENTS HAVE CONTINUED TO INCREASE THE NUMBER OF GIRLS ATTENDING THE MONTHLY MEETINGS AND THE INTEREST OF THE PARENTS IN HAVING THEIR GIRLS ENROLLED HAS ALSO INCREASED. THE HOSPITAL ALSO OFFERS EDUCATION TO THE HIGH SCHOOL GIRLS EVERY OTHER WEEK AT THE SCHOOL AND ONCE A MONTH AT THE HOSPITAL. 27 MEETINGS WERE CONDUCTED AT THE HOSPITAL, SCHOOLS AND VIA ZOOM MAKING A TOTAL OF 215 MEETINGS SINCE THE PROGRAM STARTED IN 2013. THE HOSPITAL HAS REINFORCED MENTAL HEALTH, ALCOHOL AND DRUG PREVENTION AND SUICIDE PREVENTION IN ALL THREE OF THE ADOLESCENCE HEALTH HOSPITALS PROGRAMS. WE DEVELOPED THE PROGRAMS IN PARTNERSHIP WITH OTHER ORGANIZATIONS. UNION GENERAL HOSPITAL HAS INCREASED THE NETWORK IN THE COMMUNITY AND THE HOSPITAL HAS GOTTEN THE ATTENTION AND RECOGNITION OF OTHER HOSPITALS AND COMMUNITY ORGANIZATIONS IN AND OUT OF STATE. THE HOSPITAL HAS CONTINUED WITH THE ANTI BULLYING PROGRAM: UNION PARISH "TOGETHER, WE CAN BE BULLY FREE," THE PROGRAM WAS REQUESTED BY THE UNION PARISH ELEMENTARY SCHOOL IN 2019 TO TEACH ONCE A WEEK TO 3RD AND 4TH GRADERS. 157 CHILDREN WERE ADDED TO THE PROGRAM AND IT EXPANDED THE PROGRAM AND NOW WE ARE DOING ANTI-BULLYING/SUICIDE PREVENTION IN ALL THE SCHOOLS IN UNION PARISH MAKING THE PROGRAM AVAILABLE TO STUDENTS 3RD THROUGH 12 GRADES. OVER 3,000 STUDENTS HAVE PARTICIPATED IN THE ANTI-BULLYING PROGRAM, 500 STUDENTS THE FIRST YEAR, 600 THE SECOND YEAR AND OVER 1,000 THE FOLLOWING YEARS. STUDENTS HAVE LEARNED HOW TO RECOGNIZE, REPORT, AND REACT TO BULLYING. AS A RESULT, REPORTS OF BULLYING INCIDENTS TO THE UNION PARISH SHERIFFS OFFICE HAVE DECREASED. THE NUMBER OF SUICIDE ATTEMPTS HAS ALSO DECREASED. 83 BULLYING/SUICIDE CLASSES WERE CONDUCTED AT THE SCHOOLS IN UNION PARISH. THANKS TO A GRANT RECEIVED FROM THE SHIP/FLEX SUPPLEMENTAL PROGRAM WE WERE ABLE TO ESTABLISH A TEEN DRUG PREVENTION PROGRAM FOR OUR COMMUNITY. THE PROGRAM BEGAN IN MARCH 2018 AT THE UNION PARISH JUNIOR HIGH SCHOOL AND DOWNSVILLE COMMUNITY CHARTER SCHOOL. WE MET WITH 6TH THROUGH 12 GRADERS DURING 2019. OVER 300 STUDENTS ARE ENROLLED IN THE PROGRAM. THE MEETINGS TAKE PLACE AT THE SCHOOLS TUESDAYS AND FRIDAYS EVERY WEEK. THE EDUCATOR IS A MENTAL HEALTH PROFESSIONAL TRAINED IN DRUG PREVENTION. UNION GENERAL HOSPITAL TEEN DRUG AND ALCOHOL PREVENTION PROGRAM RECEIVED THE OUTSTANDING RURAL HEALTH PROGRAM OF THE YEAR AWARD BY THE LOUISIANA RURAL HEALTH ASSOCIATION IN 2019. THE OUTSTANDING RURAL HEALTH PROGRAM OF THE YEAR AWARD RECOGNIZES A STATEWIDE OR REGIONAL PROGRAM THAT PROMOTES THE DEVELOPMENT OF RURAL HEALTH CARE DELIVERY SYSTEMS; PROMOTES AND/OR PROVIDES INCREASED ACCESS TO HEALTH CARE SERVICES FOR RURAL POPULATIONS OR THAT IMPROVES THE QUALITY OF RURAL HEALTH CARE THROUGH OUTREACH AND EDUCATION. FACTORS TAKEN INTO CONSIDERATION INCLUDE COORDINATION, NETWORKING, INNOVATION, AND LASTING IMPACT. DRUG PREVENTION, SUICIDE AND ANTI-BULLYING ARE TIED TOGETHER IN OUR PROGRAMS. WE HAVE SEEN THE RATES OF SUICIDE REDUCED SINCE WE BEGAN THE IMPLEMENTATION OF OUR FIRST COMMUNITY HEALTH NEEDS ASSESSMENT. SUBSTANCE ABUSE CAN RESULT IN INCREASED ILLEGAL ACTIVITIES AS WELL AS PHYSICIAL AND SOCIAL HEALTH CONSEQUENCES, SUCH AS POOR ACADEMIC PERFORMANCE, POORER HEALTH STATUS, CHANGES IN BRAIN STRUCTURE, AND INCREASED RISK OF DEATH FROM OVERDOSE AND SUICIDE. THE HOSPITAL HAS MAINTAINED ITS COLLABORATION WITH THE SCHOOL DISTRICT, LAW ENFORCEMENT, CHILDRENS COALITION, HEALTH UNIT, LOCAL CHURCHES, HEALTH CARE PROVIDERS AND OTHER CIVIC AND BUSINESS ORGANIZATIONS IN THE AREA. 149 DRUG/ALCOHOL/TOBACCO PREVENTION MEETINGS WERE CONDUCTED IN 2019. CARDIOVASCULAR: UNION GENERAL HOSPITAL HAS INCREASED ACCESS TO EDUCATION AND AWARENESS FOR EARLY PREVENTION OF HEART DISEASE AND STROKE IN PARTNERSHIP WITH OCHSNER HEALTH SYSTEM. WE ARE NOW AN EMERGENCY LEVEL 3 STROKE CENTER. STROKE PATIENTS AT UNION GENERAL HAVE IMMEDIATE ACCESS TO HIGHLY SPECIALIZED VASCULAR NEUROLOGISTS AS THE RESULT OF A PARTNERSHIP BEWEEN UNION GENERAL AND OCHSNER CLINIC FOUNDATION IN NEW ORLEANS. WE HAVE ALSO PARTICIPATED IN HEALTH FAIRS PROMOTING HEALTHY HABITS AND NUTRITION, AND INVITED THE COMMUNITY FOR NUTRITION CLASSES AT THE HOSPITAL. THE HOSPITAL OFFERS A FREE HEALTH LIFESTYLE WORKSHOP ONCE OR TWICE A MONTH IN PARTNERSHIP WITH LSU AGCENTER. OBESITY AND DIABETES: THE HOSPITAL PARTICIPATED IN SEVERAL HEALTH FAIRS IN 2019: BACK TO SCHOOL BASHES IN PARTNERSHIP WITH THE UNION PARISH SCHOOL DISTRICT, UNION PARISH LIBRARY, FIRST BAPTIST CHURCH FARMERVILLE, LOCAL THRIFT STORES AND THE COUNCIL ON AGING. THE EMPLOYEES HAVE CONTINUED WITH THE BIGGEST LOSER PROGRAM AND THE HOSPITAL BUILT A WALKING TRAIL ON HOSPITAL GROUNDS TO ENCOURAGE HEALTHY HABITS AND EXERCISE IN THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 13H OTHER ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE: ANY PATIENTS WITH MEDICAID COVERAGE THAT HAVE NON-COVERED CHARGES WILL NOT REQUIRE ANY ADDITIONAL SCREENING TO QUALIFY FOR FINANCIAL ASSISTANCE. SCHEDULE H, PART V, SECTION B, LINES 7 & 10 Community Health Needs Assessment & Implementation Strategy: The hospital's CHNA and Implementation strategy are available upon request and at the following website: http://uniongen.org/community/ SCHEDULE H, PART V, SECTION B, LINES 16A, 16B & 16C FAP DOCUMENTS AVAILABLE TO THE PUBLIC: THE FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE UPON REQUEST AND AT THE FOLLOWING WEBSITE: http://uniongen.org/patient-info/financial-assistance/ SCHEDULE H, PART V, SECTION B, LINES 18, 19, & 20 ACTIONS FOR NON-PAYMENT: NEITHER UNION GENERAL HOSPITAL, NOR THIRD PARTIES AUTHORIZED BY UGH, TAKE ANY ACTIONS UPON NON-PAYMENT FROM A PATIENT BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART V, SECTION B, LINE 16J NOTIFICATION OF FINANCIAL ASSISTANCE POLICY: DURING THE SCREENING PROCESS, PATIENTS THAT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOTIFIED OF THE POLICY. SCHEDULE H, PART V, SECTION B, LINE 20D PRESUMPTIVE ELIGIBILITY DETERMINATIONS: THE HOSPITAL DOES NOT MAKE PRESUMPTIVE ELIGIBILITY DETERMINATIONS AS DESCRIBED UNDER SECTION 501(R) AS THEY REQUIRE ALL PATIENTS TO COMPLETE AN APPLICATION. HOWEVER, IF A PATIENT IS FOUND TO QUALIFY FOR MEDICAID, THEY WILL ALSO QUALIFY FOR FINANCIAL ASSISTANCE WITH NO FURTHER SCREENING REQUIRED. SCHEDULE H, PART I, LINE 3C FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: -UNDERINSURANCE STATUS -INSURANCE STATUS -MEDICAID COVERAGE SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: WE USE AN AGING APPROACH TO RESERVE AMOUNTS FOR BAD DEBT BY FINANCIAL CLASS. WHEN AN ACCOUNT REACHES THE STATUS THAT WE'VE DETERMINED THEM TO BE UNCOLLECTIBLE, THE ACCOUNT IS WRITTEN OFF AS A BAD DEBT. ALL APPROPRIATE DISCOUNTS AND PAYMENTS ARE APPLIED TO AN ACCOUNT, WHICH REDUCES ANY BAD DEBT WRITE-OFFS FOR THAT ACCOUNT. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT AS A COMMUNITY BENEFIT: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT FOOTNOTE: NOT APPLICABLE DUE TO ADOPTION OF ASU 606 REVENUE FROM CONTRACTS WITH CUSTOMERS SCHEDULE H, PART III, SECTION B, LINE 8 COSTING METHODOLOGY AND MEDICARE SHORTFALL: THE HOSPITAL USED MEDICARE COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS BASED ON MEDICAID OR MEDICARE DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. IN ADDITION, THE ORGANIZATION PROVIDES CARE TO ALL PATIENTS REGARDLESS OF SOURCE OF PAYMENT; THEREFORE, COSTS TO PROVIDE CARE TO MEDICARE PATIENTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT TO THE EXTENT COSTS EXCEED MEDICARE REIMBURSEMENT. SCHEDULE H, PART III, SECTION C, LINE 9B PROVISIONS ON COLLECTION PRACTICES: ONCE A PATIENT IS BELIEVED TO BE INDIGENT, THEY MUST COMPLETE AN APPLICATION FOR CHARITY CARE ASSISTANCE FOR UGH TO DETERMINE THE PATIENT'S ELIGIBILITY FOR ITS CHARITY CARE PROGRAM. TO BE ELIGIBLE, A PATIENT/FAMILY'S INCOME SHALL BE COMPARED TO 250% OF THE FEDERAL POVERTY GUIDELINES. THEIR INCOME MUST BE AT OR BELOW THE CORRESPONDING AMOUNT BASED ON FAMILY SIZE. IF A PATIENT WITH MEDICAID COVERAGE HAS NON-COVERED CHARGES, NO ADDITIONAL SCREENING WILL BE REQUIRED TO QUALIFY FOR CHARITY CARE. THE HOSPITAL MAY CONSIDER OTHER FINANCIAL ASSETS AND LIABILITIES OF THE PERSON WHEN DETERMINING ELIGIBILITY. THE SCREENING PROCESS TO DETERMINE A PATIENT'S ELIGIBILITY FOR THE HOSPITAL'S CHARITY CARE PROGRAM WILL BEGIN AS SOON AS POSSIBLE FOLLOWING ADMISSION TO UGH. ONCE A PATIENT HAS BEEN DETERMINED TO QUALIFY FOR UGH'S CHARITY CARE PROGRAM, NO ADDITIONAL COLLECTION EFFORTS WILL BE MADE ON THAT ACCOUNT. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: THE HOSPITAL HAS WORKED WITH OTHER COMMUNITY ORGANIZATIONS TO ASSESS THE HEALTHCARE NEEDS OF THE COMMUNITY. THE HOSPITAL HAS COMPLETED A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT WITH ASSISTANCE FROM AN OUTSIDE FIRM. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: ALL PATIENTS WITHOUT THIRD PARTY INSURANCE RECEIVE INFORMATION WHILE AT UGH REGARDING GOVERNMENTAL ASSISTANCE AND ARE ADVISED TO MAKE AN APPOINTMENT WITH A CERTIFIED MEDICAID ENROLLMENT CENTER TO DETERMINE THEIR ELIGIBILITY FOR MEDICAID ASSISTANCE. THOSE PATIENTS ARE INFORMED THAT THEY MAY BE ELIGIBLE FOR THE HOSPITAL'S CHARITY CARE PROGRAM. ALSO, ALL INPATIENTS WITHOUT THIRD PARTY COVERAGE ARE VISITED DURING THEIR HOSPITAL STAY AND SENT INFORMATION. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: UNION GENERAL IS LOCATED IN UNION PARISH, A LARGE SPRAWLING RURAL COMMUNITY MADE UP OF 905 SQUARE MILES OF ROLLING HILLS AND TALL PINE TREES. 28% OF THE POPULATION IS BELOW 200% OF THE FEDERAL POVERTY GUIDELINES. THERE IS NO PUBLIC TRANSPORTATION IN THE PARISH AND THE TOTAL PARISH POPULATION IS 22,571 (2017 ESTIMATE). UNION PARISH IS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA (MUA) AND A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA). MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $37,049 (2017 ESTIMATE). THE COMMUNITY'S MORTALITY RATE IS NEARLY TWICE THE NATIONAL RATE DUE TO THE LACK OF EDUCATION PROGRAMS, THE HIGH RATE OF UNDIAGNOSED DISEASE, AS WELL AS POVERTY AND ISOLATION ASSOCIATED WITH THE RURAL UNDER SERVED PARISH POPULATIONS. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: UNION GENERAL HOSPITAL SERVES AS A MEDICAID ENROLLMENT CENTER FOR UNION PARISH, PROVIDES FLU SHOT CLINICS TO THE COMMUNITY AND PARTICIPATES IN HEALTH FAIRS LOCALLY. THE HOSPITAL ALSO PARTICIPATES IN CAREER FAIRS AT LOCAL COLLEGES FOR HEALTHCARE STUDENTS, REACHING OVER 200 STUDENTS, AS WELL AS SERVING AS A CLINICAL SITE FOR LPNS, RADIOLOGY, PHLEBOTOMY AND NURSE PRACTITIONERS. UGH IS INVOLVED WITH LOCAL BUSINESSES AND CHURCHES TO BRING AWARENESS AND SCREENING TO THE PUBLIC THROUGH RELAY FOR LIFE, AHA'S GO RED CAMPAIGN, UNITED WAY FUNDRAISER, SUSAN G KOMEN FUNDRAISER AND RACE FOR THE CURE, AND BY HOSTING AN ANNUAL BREAST CANCER AWARENESS DAY FOR THE COMMUNITY. UGH PARTNERS WITH SUSAN G KOMEN TO PROVIDE FREE MAMMOGRAMS AND OMEGA DIAGNOSTICS, LLC TO OFFER FREE COLON SCREENINGS FOR THE SERVICE AREA. THE HOSPITAL PROVIDED HAND WASHING INSTRUCTION FOR ELEMENTARY SCHOOL KIDS AND FOR NURSING HOME STAFF AND RESIDENTS, AS WELL AS PROVIDED NUTRITION WORKSHOPS, BLOOD SUGAR AND BLOOD PRESSURE SCREENING FOR THE COMMUNITY. UGH PARTICIPATED IN THE TOWN OF FARMERVILLE'S TOY DRIVE FOR NEEDY CHILDREN, ALONG WITH ANTI BULLYING, TEEN DRUG PREVENTION AND TEEN PREGNANCY PREVENTION SESSIONS AT THE HOSPITAL AND ALL THE SCHOOLS. UGH EMPLOYEES ARE VERY INVOLVED WITH LOCAL CHURCHES AND ORGANIZATIONS, SUCH AS ALZHEIMER'S SUPPORT GROUP, COUNCIL ON AGING, NURSING HOME COUNCILS, AND OTHERS. ALL PROPERTY OWNED BY UNION GENERAL HOSPITAL IS DESIGNATED TOBACCO-FREE. UGH OPERATES UNDER A BOARD OF DIRECTORS, WHICH IS COMPRISED OF REPRESENTATIVE MEMBERS OF THE COMMUNITY. IT MAINTAINS AN OPEN MEDICAL STAFF AND OPERATES A 24/7 EMERGENCY ROOM STAFFED WITH ON-SITE PHYSICIANS. As part of the hospitals response to caring for community members that contracted the COVID-19 virus, we assisted those patients without the ability to pay in checking their eligibility for the HHS COVID-19 Uninsured Program. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: N/A SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: N/A SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL HAS IDENTIFIED ISSUES IN OUR COMMUNITY THROUGH OUR CHNA, THAT INCLUDE A LACK OF EDUCATION AND MONITORING OF ADOLESCENT BEHAVIOR WITH ALCOHOL AND DRUG PREVENTION. A TEEN DRUG PREVENTION PROGRAM WAS ESTABLISHED AT TWO OF OUR LOCAL SCHOOLS TO MEET WITH 6TH-12TH GRADE STUDENTS TWICE A WEEK TO DISCUSS WAYS TO DEAL WITH DRUGS AND SUBSTANCE ABUSE. WE PARTICIPATED IN LOCAL HEALTH FAIRS TO HELP PEOPLE IN THE COMMUNITY IDENTIFY POTENTIAL HEALTH ISSUES. WE HOST NUTRITION WORKSHOPS AT THE HOSPITAL TO HELP TEACH PEOPLE IN THE COMMUNITY WAYS TO TRY TO DEAL WITH OBESITY, DIABETES, AND OTHER HEALTH-RELATED ISSUES THROUGH A PROPER DIET. WE HOST AND PARTICIPATE IN FLU DRIVES TO ENCOURAGE RESIDENTS OF THE COMMUNITY TO GET THEIR ANNUAL FLU SHOT, IN ORDER TO AVOID PREVENTABLE ILLNESS. WE HAVE PARTNERED WITH THE LSU AGCENTER TO PROVIDE HEALTH LIFESTYLE WORKSHOPS ON A REGULAR BASIS TO PROVIDE EDUCATION AND AWARENESS FOR EARLY PREVENTION OF CARDIOVASCULAR DISEASE. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. THE COSTS COMPUTED ON IRS WORKSHEET 4 WERE COMPUTED FROM THE MEDICARE COST REPORT, INCLUDING DIRECT COSTS PLUS OVERHEAD ALLOCATIONS COMPUTED IN THE COST REPORT. THE COSTS COMPUTED ON WORKSHEET 8 WERE FROM THE HOSPITAL'S INCOME STATEMENT. X X X false false false false false false false true false EVALYN ORMOND CEO 207176 0 25000 0 10 0 3327 0 5810 0 241323 0 0 0 WILLIAM ADCOCK CFO 203978 0 23780 0 530 0 3600 0 4919 0 236807 0 0 0 LYNETTE WADE NURSE PRACTITIONER 139558 0 5086 0 10 0 2696 0 5656 0 153006 0 0 0 CONNIE GINN ER DIRECTOR 151364 0 0 0 0 0 2930 0 3503 0 157797 0 0 0 SCHEDULE J, PART I, LINE 7 DETERMINATION OF BONUSES: THE AMOUNT OF THE CEO'S BONUS IS DETERMINED BY THE BOARD DURING AN EXECUTIVE SESSION AT THE NOVEMBER MEETING. THE CFO'S BONUS IS BASED OFF A PERCENTAGE OF ANNUAL SALARY DETERMINED BY THE CEO. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM FOLLOWING THE COMPLETION OF AN AUDIT OF FINANCIAL STATEMENTS. BOTH THE CEO AND CFO REVIEW THE RETURN, AND THE RETURN IS THEN MADE AVAILABLE TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. THE FULL BOARD WILL REVIEW A COPY OF THE 990 WITH RECOMMENDATIONS FROM THE FINANCE COMMITTEE PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: ALL BOARD MEMBERS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. ALL EMPLOYEES ARE REQUIRED TO REPORT ANY CONFLICTS OF INTEREST. IN THE EVENT OF A CONFLICT, HE OR SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A & 15B REVIEW OF OFFICER COMPENSATION: INFORMATION WAS OBTAINED FROM MODERN HEALTHCARE ARTICLES AND 2019 SALARY SURVEYS BY YAFFE & COMPANY, AND PRESENTED TO THE UGH BOARD FOR REVIEW AND DISCUSSION. SALARIES FOR THESE POSITIONS WERE ADJUSTED BASED UPON RECOMMENDATION AND APPROVAL BY THE BOARD OF DIRECTORS DURING THE EXECUTIVE SESSION. DOCUMENTATION OF THE REVIEW IS KEPT IN THE EXECUTIVE SESSION'S MINUTES. ALL OTHER EMPLOYEES (INCLUDING OTHER OFFICERS) RECEIVE MERIT INCREASES BASED ON THEIR ANNUAL EMPLOYEE EVALUATION SCORES EVERY FEBRUARY OR MARCH. THE CEO AND CFO SET THE MAXIMUM INCREASES FOR DEPARTMENT MANAGERS, AND MAXIMUM PERCENTAGE INCREASES FOR ALL OTHER EMPLOYEES. EACH EMPLOYEE RECEIVES A PRO-RATA PERCENTAGE OF THE MAXIMUM PERCENTAGE, BASED ON THEIR ACTUAL EVALUATION SCORE COMPARED TO THE MAXIMUM SCORE POSSIBLE ON THE EVALUATION. THE EVALUATIONS ARE COMPLETED BY THE EMPLOYEE'S SUPERVISOR. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART I, LINE I SIGNIFICANT ACTIVITES: (CONTINUED FROM PAGE 1)... UNION PARISH AND THE SURROUNDING AREAS. FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED MEDICAL SERVICES TOTAL FEES:2976095 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:1294496 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE AGREEMENTS TOTAL FEES:185534 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN RECRUITING TOTAL FEES:3971 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:3343