2019-11-14T12:30:02-06:00 2018-12-31 570381582 ELLIOTT DAVIS LLCPLLC ONE 10TH STREET SUITE 400 AUGUSTA GA 30901 990 2018-01-01 581728812 AUGUSTA RESOURCE CENTER ON AGING INC AUGU 7068282406 1350 WALTON WAY AUGUSTA GA 30901 DAVE BELKOSKI UHS CFO 7068282406 2019-11-11 1 JESSICA C CAIN P01276209 7067229090 2019-11-05 24.181.201.165 2019-11-11 15:17:12 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 EE19CDB7BF410A3C2153627D186B7E0F9253318E 2018 2020-03-31 21:24:44Z JAMES R DAVIS 1350 WALTON WAY AUGUSTA GA 30901 31575870 0 X WWW.UNIVERSITY.ORG X 1986 GA TO DEVELOP AND OPERATE COMPREHENSIVE PROGRAMS FOR THE AGING POPULATION IN THE AREA SURROUNDING AUGUSTA, GA INCLUDING DEVELOPMENT AND OPERATION OF A CONTINUING CARE RETIREMENT COMMUNITY AND NURSING HOME. X 6 2 222 91 0 0 17090 122054 19319948 12718874 1016177 1600950 25177 15110 20378392 14456988 0 0 0 0 6758828 4401060 0 0 0 9198724 6156786 15957552 10557846 4420840 3899142 85753763 82381852 52963165 4339712 32790598 78042140 RETIREMENT COMMUNITY - RETIREMENT CENTER SPECIFICALLY DESIGNED TO SATISFY THREE PRIMARY NEEDS OF THE AGING - HOUSING, HEALTH CARE, AND FINANCIAL SECURITY. 0 0 8823194 12247024 RETIREMENT COMMUNITY - RETIREMENT CENTER SPECIFICALLY DESIGNED TO SATISFY THREE PRIMARY NEEDS OF THE AGING - HOUSING, HEALTH CARE, AND FINANCIAL SECURITY. 8823194 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 0 1 37 0 222 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 2 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 GA X X MIKE BYRD 7068282406 1350 WALTON WAY AUGUSTA GA 30901 TOM DOZIER CHAIRMAN 1.00 X 0 0 0 GERALD MATHEIS BOARD MEMBER 1.00 X 0 0 0 CHRISTA MICHAEL ACTING RESIDENT COUNCIL CH 1.00 X 0 0 0 JAMES R DAVIS BOARD MEMBER 1.00 50.00 X 0 979349 307362 DAVE BELKOSKI BOARD MEMBER 1.00 50.00 X 0 665756 15779 MARILYN A BOWCUTT BOARD MEMBER 1.00 50.00 X 0 451708 12155 WILLIAM L FARR JR CMO 40.00 50.00 X 0 545056 25671 EDWARD L BURR CAO 40.00 50.00 X 0 545817 19183 BENJAMIN GUEST DIRECTOR OF NETWORK DEVELOPMENT 40.00 X 0 186899 17508 CHERYL TAYLOR EMPLOYEE 40.00 X 109245 0 7542 109245 3374585 405200 1 0 1 0 MORRISON COMMUNITY LIVING PO BOX 102289 ATLANTA GA 30368 FOOD SUPPLIER 1847786 AEGIS THERAPIES INC PO BOX 8103 FT SMITH AR 72902 STAFFING 377769 BRIARWOOD GROUP INC PO BOX 16423 AUGUSTA GA 30919 LANDSCAPING 193676 MERIT COMMERCIAL FLOORING 3114 WRIGHTSBORO RD PO BOX 14519 AUGUSTA GA 30909 FLOORING 137207 LITE ELECTRICAL SERVICES 3205 EASY STREET AUGUSTA GA 30904 ELECTRICAL 109578 5 122054 122054 PATIENT CARE SERVICES 623000 8789567 8789567 ENTRANCE FEES 623000 2972130 2972130 OTHER PROGRAM SERVICE 623000 502517 390372 112145 MEALS 623000 344511 344511 MEDICAL SUPPLIES 623000 110149 110149 12718874 1418577 1418577 20145 5035 15110 15110 15110 17296220 17098653 15194 197567 -15194 182373 -15194 197567 14456988 12247024 0 2087910 109245 91296 17949 2948081 2463711 484370 109107 91181 17926 990549 827802 162747 244078 203976 40102 308 257 51 30233 25266 4967 81779 68343 13436 58619 48988 9631 31644 26445 5199 667409 557754 109655 8681 7255 1426 154470 129091 25379 1673364 1398430 274934 155812 130212 25600 CONTRACT LABOR AND EXPE 1956929 1635406 321523 MISCELLANEOUS 631132 527437 103695 REPAIRS AND MAINTENANCE 425864 355895 69969 SUPPLIES 245576 205228 40348 34966 29221 5745 10557846 8823194 1734652 0 3962040 1976746 1520573 1927426 50946 0 2830605 0 2709710 0 46480490 2709710 30909109 67106877 0 8661093 85753763 82381852 17122033 25978 28726239 0 7114893 4313734 52963165 4339712 X 32790598 78042140 32790598 78042140 85753763 82381852 X 3899142 -5299915 46652315 X 0 1 X 1 0 X 853850 132749 17090 122054 1125743 17801044 19048381 18895859 19319948 12718874 87784106 18654894 19048381 19028608 19337038 12840928 88909849 0 0 0 88909849 1360940 438268 1041354 1616060 4456622 1360940 438268 1041354 1616060 4456622 20015834 19048381 19466876 20378392 14456988 93366471 0.95230 0.96600 0.04770 0.03400 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2709710 2709710 2709710 STATE STREET INVESTMENTS 67106877 C 67106877 DUE FROM UHS 8661093 8661093 DUE TO UHI 4278150 DUE TO UEC 35584 4313734 X PART X, LINE 2: AUGUSTA RESOURCE CENTER ON AGING, INC. IS EXEMPT FROM FEDERAL INCOME TAX UNDER 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, 2018. FISCAL YEARS ENDED ON OR AFTER DECEMBER 31, 2015 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. X X 0 1 0 0 0 1 0 0 0 JAMES R DAVIS BOARD MEMBER 0 752167 0 200156 0 27026 0 298718 0 8644 0 1286711 0 0 DAVE BELKOSKI BOARD MEMBER 0 460144 0 115117 0 90495 0 1248 0 14531 0 681535 0 0 MARILYN A BOWCUTT BOARD MEMBER 0 207820 0 130259 0 113629 0 6053 0 6102 0 463863 0 0 WILLIAM L FARR JR CMO 0 399812 0 100742 0 44502 0 9336 0 16335 0 570727 0 0 EDWARD L BURR CAO 0 397173 0 104344 0 44300 0 9343 0 9840 0 565000 0 0 BENJAMIN GUEST DIRECTOR OF NETWORK DEVELOPMENT 0 130313 0 53837 0 2749 0 3738 0 13770 0 204407 0 0 PART I, LINE 4B BENEFITS PAID BY UNIVERSITY HEALTH SERVICES INC. (58-1581103) JAMES R. DAVIS SERP - $290,468 DAVE BELKOSKI ROTH IUL - $58,839 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 2018 THESE INITIATIVES WERE WEIGHTED AS DISPLAYED IN THE FOLLOWING SCHEDULE: UNIVERSITY HEALTH SERVICES, INC. 2018 STRATEGIC INITIATIVES WEIGHT QUALITY 15% ACHIEVE NRC OVERALL RATING OF CARE SCORE 15% ACHIEVE MEDICARE ALL CAUSE 30-DAY READMISSION RATE TO UNIVERSITY GROWTH 10% INCREASE ADMISSIONS FROM AIKEN & COLUMBIA COUNTIES OVER 2017 LEVELS SAFETY 15% MINIMIZE THE NUMBER OF HOSPITAL ACQUIRED CONDITITION PER 1000 MEDICARE DISCHARGES AS MEASURED BY MIDAS SYSTEM PEOPLE 15% ACHIEVE RN TURNOVER RATE FOR UHS AFFORDABILITY 25% ACHIEVE OPERATING MARGIN FOR UNIVERSITY HEALTH, INC SERVICE 5% INCREASE THE NUMBER OF ACTIVE MYCHART ACCOUNTS 100% EACH GOAL THAT WAS ACHIEVED REPRESENTED THAT PERCENTAGE OF BONUS PAY OUT OF A POSSIBLE 100% BASED ON A THRESHOLD LEVEL, TARGET LEVEL, OR AN EXCEEL LEVEL. THOMAS DOZIER BOARD CHAIRMAN 69866 THOMAS DOZIER IS 71% OWNER OF GOLD MECH SERVICES, INC. THE ORGANIZATION PAID GOLD MECH SERVICES, INC. FOR MECHANICAL SERVICES. 0 THOMAS DOZIER BOARD CHAIRMAN 14788 THOMAS DOZIER IS 63% OWNER OF GOLD MECH, INC. THE ORGANIZATION PAID GOLD MECH, INC. FOR MECHANICAL SERVICES. 0 THOMAS DOZIER III SON OF BOARD CHAIRMAN 37222 THOMAS DOZIER, III OWNS 27% OF GOLD MECH, INC. AND 29% OF GOLD MECH SERVICES, INC. THE ORGANIZATION PAID BOTH OF THESE ORGNAIZATIONS FOR MECHANICAL SERVICES. 0 BRANDONWILDE ASSISTED LIVING FACILITY 2018-08-17 48537825 THIRD PARTY PURCHASE PRICE 830666542 LCS BRANDON WILDE LLC 4275 OWENS ROAD EVANS GA 30809 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 SOLE CORPORATE MEMBER IS UNIVERSITY HEALTH, INC. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT REVIEWED THE ORGANIZATION'S FORM 990. A COPY OF THE 990 WAS PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR A CONFLICT OF INTEREST QUESTIONNAIRE SHALL BE DISTRIBUTED TO ALL BOARD MEMBERS AND SENIOR MANAGEMENT FOR COMPLETION. QUESTIONNAIRES SHALL BE REVIEWED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS AND ANY CONFLICTS SHALL BE DISCUSSED WITH THE FULL BOARD. THE FULL BOARD SHALL DISCUSS THE POTENTIAL CONFLICT AND SHALL DETERMINE IF THE CONFLICT REQUIRES ACTION IN ACCORDANCE WITH THE NOT FOR PROFIT STATUTES OF THE STATE OF GEORGIA. SHOULD A CONFLICT EXIST THAT REQUIRES ACTION, THE BOARD OF DIRECTORS AT ITS SOLE DISCRETION SHALL HAVE THE AUTHORITY TO, BY MAJORITY VOTE, TAKE ANY AND ALL ACTIONS REQUIRED TO ADDRESS THE CONFLICT. THE BOARD OF DIRECTORS SHALL ALSO HAVE THE AUTHORITY TO DIRECT MANAGEMENT TO TAKE ACTIONS ON A CONSULTATIVE BASIS TO MODIFY, LESSEN, OR CONTROL THE CONFLICT WHERE IT MAY DEEM SUCH ACTION AS PRUDENT. IF A BOARD MEMBER HAS A CONFLICT OF INTEREST, THEY RECUSE THEMSELVES FROM THE DELIBERATION. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S SIX-MEMBER BOARD SETS THE EXECUTIVE DIRECTOR'S SALARY, WHICH IS BASED ON THE AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING (AAHSA) SALARY SURVEY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL PROVIDE COPIES OF THE FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY TO THE PUBLIC UPON REQUEST. HOWEVER, THE ORGANIZATION WILL NOT MAKE ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: GAIN ON DISCONTINUED OPERATIONS 46,652,315. UNIVERSITY HEALTH INC 1350 WALTON WAY AUGUSTA GA 30901 581581102 CONSOLIDATING PARENT GA 501(C)(3) LINE 11 N/A 0 RICHMOND COUNTY HOSPITAL AUTHORITY 1350 WALTON WAY AUGUSTA GA 30901 586001901 LEASED FACILITIES GA 501(C)(3) LINE 3 N/A 0 UNIVERSITY HEALTH CARE FOUNDATION INC 2100 CENTRAL AVE SUITE D-1 AUGUSTA GA 30904 581343550 PHILANTHROPY GA 501(C)(3) LINE 7 UNIVERSITY HEALTH INC 0 UNIVERSITY EXTENDED CARE INC 1350 WALTON WAY AUGUSTA GA 30901 581581105 SKILLED NURSING FACILITIES GA 501(C)(3) LINE 3 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH SERVICES INC 1350 WALTON WAY AUGUSTA GA 30901 581581103 HOSPITAL GA 501(C)(3) LINE 3 UNIVERSITY HEALTH INC 0 UNIVERSITY MCDUFFIE COUNTY REGIONAL 1350 WALTON WAY AUGUSTA GA 30901 454166209 HOSPITAL GA 501(C)(3) LINE 3 UNIVERSITY HEALTH INC 0 UNIVERSITY HEALTH RESOURCES INC 1350 WALTON WAY AUGUSTA GA 30901 581601372 SERVICES TO PHYSICIAN PRACTICES GA UNIVERSITY HEALTH INC C 0 UNIVERSITY HOSPITAL AIKEN INC 1350 WALTON WAY AUGUSTA GA 30901 472713774 HOSPITAL SC UNIVERSITY HEALTH INC C 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 0 0 0 UNIVERSITY HEALTH SERVICES O 298349 COST UNIVERSITY HEALTH INC E 4278150 BOOK VALUE UNIVERSITY HEALTH SERVICES P 1844905 COST UNIVERSITY HEALTH SERVICES D 8661093 BOOK VALUE