2018-03-05T07:30:34-06:00 2017-06-30 BKD LLP 14241 DALLAS PKWY STE 1100 DALLAS TX 75254 990 2016-07-01 720995809 Union General Hospital % WILLIAM ADCOCK UNIO 3183689751 PO Box 398 Farmerville LA 71241 WILLIAM ADCOCK CFO 3183687096 2018-05-15 true Jeanette Verrelli P00742631 9727028262 167.68.126.162 70234720180645000000 2018-03-05 P ACBA2431EF37DEF71821A9057AFD5F2E9C389335 ACBA2431EF37DEF71821A9057AFD5F2E9C389335 2016 2021-01-29 14:40:06Z EVALYN ORMOND PO BOX 398 FARMERVILLE LA 71241 18135291 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 7 158 7 0 0 1635724 3429839 13645859 14582322 6029 16771 77968 106359 15365580 18135291 55497 69355 0 0 5935666 6029125 0 0 0 8924841 8113931 14916004 14212411 449576 3922880 11481380 12494062 1620128 912525 9861252 11581537 IT IS THE MISSION OF UNION GENERAL HOSPITAL TO PROVIDE QUALITY SERVICE WITH COMPASSIONATE CARE. false false 11550189 69355 14646100 PROVIDED ACUTE CARE HOSPITAL SERVICES TO INDIVIDUALS IN THE FARMERVILLE AREA; INDIVIDUALS SERVED AMOUNTED TO 1,935 PATIENT DAYS AND 6,880 EMERGENCY ROOM VISITS. THE LABORATORY PERFORMED 37,977 TESTS AND 34,449 ECG, RADIOLOGY, ULTRASOUND, CT, OT, RT, ST, AND PT PROCEDURES WERE PERFORMED. THE RURAL HEALTH CLINICS LOGGED 12,289 VISITS. 11550189 true true false true false false false false false false true false false false 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 111 0 158 true false false false false false false false false false false X 7 7 false true 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 TIM TETTLETON PRESIDENT 1.0 0.0 X X 0 0 0 BESSIE WARREN SECRETARY 1.0 0.0 X X 0 0 0 JOHN ELLIS DIRECTOR 1.0 0.0 X 0 0 0 ALLYSON CROW DIRECTOR 1.0 0.0 X 0 0 0 DANIEL HUNTER JR VICE PRESIDENT 1.0 0.0 X X 0 0 0 RALPH KELLEY DIRECTOR 1.0 0.0 X 0 0 0 DANNY SMITH DIRECTOR 1.0 0.0 X 0 0 0 EDDYE JO ALBRITTON DIRECTOR-END APRIL 2017 1.0 0.0 X 0 0 0 DIANNE DAVIDSON COO 40.0 0.0 X 95794 0 3522 EVALYN ORMOND CONTRACTED CEO 40.0 0.0 X 12000 0 743 WILLIAM ADCOCK CFO 40.0 0.0 X 163484 0 8975 DARRA JUNG DIRECTOR OF NURSING 40.0 0.0 X 115550 0 7913 HOLLY CORLEY MD PHYSICIAN 40.0 0.0 X 195641 0 7323 SHEREE HICKS PHARMACIST 40.0 0.0 X 199830 0 7250 LYNETTE WADE NP NURSE PRACTITIONER 40.0 0.0 X 118384 0 6584 LISA POST PHYSICIAN 24.64 0.0 X 131840 0 876 1032523 0 43186 6 false true false CORRECT CARE INC 111 N CAUSEWAY BLVD MANDEVILLE LA 70471 E.R. STAFFING 1169559 OMEGA DIAGNOSTICS LLC ONE ST MARY PLACE SHREVEPORT LA 71101 LABORATORY 1062909 LEGACY REHABILITATION 1817 NORTHPOINTE LANE RUSTON LA 71273 THERAPY SERVICES 898844 MEDHOST OF TENNESSEE INC 6550 CAROTHERS PKWY 100 FRANKLIN TN 37067 IT SERVICES 351642 LINCOLN BUILDERS OF RUSTON INC 1809 NORTHPOINTE LN 201 RUSTON LA 71270 BUILDING CONTRACTOR 690153 7 3377244 52595 3429839 NET PATIENT SERVICE REVENUE 621110 14358972 14358972 E.H.R. Incentive Revenue 900099 128096 128096 Pharmacy Revenue 446110 95254 95254 14582322 15571 15571 0 0 0 0 0 1200 0 1200 1200 1200 0 0 0 0 0 0 0 0 0 CAFETERIA AND VENDING SALES 722514 42581 42581 MEDICAL RECORDS 561000 8648 8648 UTILITIES DISTRICT REIMBURSEMENT 900099 1510 1510 53620 53620 106359 18135291 14646100 59352 X 69355 69355 0 0 0 404205 316442 87763 0 4806577 3859483 947094 41969 41969 405710 325768 79942 370664 297628 73036 209292 209292 18459 18459 73189 73189 0 0 0 4127979 3794529 333450 72097 8644 63453 349236 128837 220399 203929 203929 0 304316 237117 67199 65261 54675 10586 0 108944 36645 72299 521 521 0 501175 501175 132499 69752 62747 BAD DEBT EXPENSE 1026928 1026928 MEDICAL SUPPLIES 799605 799605 DUES & SUBSCRIPTIONS 42652 7607 35045 COLLECTIONS 58365 1155 57210 19484 14844 4640 14212411 11550189 2662222 0 4081640 4874672 783019 887283 0 0 1048665 920223 0 0 0 0 0 0 198474 197290 76187 72193 15708330 10501603 4231493 5206727 0 0 0 0 0 0 0 0 1061902 335674 11481380 12494062 1320308 812423 0 0 0 0 0 0 0 0 0 0 0 0 0 0 299820 100102 1620128 912525 X 7526992 11449872 2334260 131665 0 0 9861252 11581537 11481380 12494062 X 3922880 -2202595 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 3205 3205 false SCHEDULE C, PART II-B, LINE 1I OTHER ACTIVITIES FOR LOBBYING PURPOSES: THE HOSPITAL PAID DUES TO ORGANIZATIONS, A PORTION OF WHICH IS DESIGNATED FOR LOBBYING EXPENSES. DUES %LOBBYING $LOBBYING RURAL HOSPITAL COALITION $12,270 7% $859 LA HOSPITAL ASSOCIATION 10,881 21% 2,285 NATIONAL RURAL HEALTH ASSOC 1,225 5% 61 LA RURAL HEALTH ASSOC 700 0% 0 -------------------------------------- TOTAL $25,076 $3,205 186090 186090 7789773 3669082 4120691 7547797 6708303 839494 184670 124218 60452 5206727 0 Long Term Capital Lease Obligation 45418 DUE TO 3RD PARTY PAYER 13934 Estimated Self-Insurance Costs 40750 100102 13973781 -1026928 -1026928 15000709 3134582 3134582 18135291 13185483 13185483 1026928 1026928 14212411 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 2D RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: BAD DEBT EXPENSE $(1,026,928) SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: CONTRIBUTIONS FOR ACQUISITION OF PROPERTY AND EQUIPMENT $931,987 NET ASSETS RELEASED FROM RESTRICTIONS RELATED TO PROPERTY AND EQUIPMENT 2,202,595 ------------------- TOTAL $3,134,582 SCHEDULE D, PART XII, LINE 4B RECONCILIATION OF EXPENSE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: BAD DEBT EXPENSE $1,026,928 true true X true X false true true false false 4209 4209 0.00030 4446285 4305237 141048 0.01070 4450494 4305237 145257 0.01100 12341 106157 106157 0.00810 11673 118985 118985 0.00900 24014 225142 225142 0.01710 24014 4675636 4305237 370399 0.02810 310 2346 2346 0.00020 1981 2852 2852 0.00020 2 980 980 0.00010 2293 6178 6178 0.00050 true 1026928 5240003 5322046 -82043 X true true 1 1 UNION GENERAL HOSPITAL 901 JAMES AVE FARMERVILLE LA 71241 WWW.UNIONGEN.ORG 146 X X X UNION GENERAL HOSPITAL 1 false false true X X X X X X X X X 14 true false false true X SEE PART V, SECTION C X true 14 true SEE PART V, SECTION C false true X 200. 0. 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 CHNA HOSPITAL STEERING COMMITTEE (CHSC) IDENTIFIED COMMUNITY LEADERS, PARTNERS, AND REPRESENTATIVES TO INCLUDE IN THE CHNA PROCESS. THE HOSPITAL IDENTIFIED 10 KEY STAKEHOLDERS FOR INDIVIDUAL INTERVIEWS WHO REPRESENTED MEDICALLY UNDERSERVED POPULATIONS, LOW INCOME POPULATIONS, MINORITY POPULATIONS, AND POPULATIONS WITH CHRONIC DISEASES. THESE INDIVIDUALS INCLUDED: THE SUPERINTENDENT OF THE UNION PARISH SCHOOL SYSTEM, THE MAYOR OF THE CITY, A PRIEST FROM OUR LADY PERPETUAL HEALTH CATHOLIC CHURCH, A CANCER CONTROL OFFICER FROM AHEC, A MINISTER FROM BLOOMING GROVE BAPTIST CHURCH, A NURSE FROM THE UNION PARISH HEALTH UNIT, A DIRECTOR ON THE COUNCIL OF AGING, A CHILD SAFETY COORDINATOR FROM THE CHILDREN'S COALITION, A PHYSICIAN FROM THE HOSPITAL AND A BUSINESS OWNER ON UNION GENERAL'S BOARD OF DIRECTORS. DURING THE INTERVIEW PROCESS, STAKEHOLDERS WERE ASKED QUESTIONS RELATED TO BOTH HEALTH AND ECONOMIC ISSUES WITHIN THE COMMUNITY. THEY WERE THEN ASKED TO RANK CERTAIN ISSUES IN ORDER OF IMPORTANCE FOR THE PURPOSE OF INCLUDING THEIR VOTES IN THE COMMUNITY'S HEALTH PRIORITIES. ADDITIONALLY, THE UNION GENERAL COMMUNITY HEALTH NEEDS SURVEY OBTAINED INPUT FROM VARIOUS MEMBERS OF THE COMMUNITY IN FOCUS GROUP MEETINGS. 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 11 IDENTIFIED NEEDS ADDRESSED AND NOT ADDRESSED: THE FOLLOWING PRIORITY NEEDS WERE IDENTIFIED BY THE COMMUNITY AND THE CHNA STEERING COMMITTEE: -CANCER: UNION GENERAL HOSPITAL CONTINUES WITH ITS BREAST CANCER PREVENTION PROGRAM IN PARTNERSHIP WITH SUSAN G KOMEN. THE HOSPITAL HAS FORMED A PARTNERSHIP WITH MARTIN LUTHER KING HEALTH CENTER AND PHARMACY IN SHREVEPORT EXPANDING ITS MAMMOGRAM SCREENING PROGRAM AND THE HEALTH CENTER WILL TRANSPORT PATIENTS IN THEIR VAN TO COME TO UNION GENERAL HOSPITAL FOR MAMMOGRAM SCREENINGS ONCE A MONTH. FREE SCREENING MAMMOGRAMS ARE BEING OFFERED TO ANY PATIENT THAT QUALIFIES IN AND OUT OF STATE. THE HOSPITAL ALSO HOSTS A COMMUNITY HEALTH EDUCATION AND CANCER SURVIVOR'S GALA EVERY YEAR IN OCTOBER FOR BREAST CANCER AWARENESS MONTH. -ADOLESCENT BEHAVIORS (SEXUAL HEALTH): THE HOSPITAL EXPANDED "IT'S A GIRL THING, MAKING PROUD CHOICES," THE HOSPITAL'S STD/HIV PREGNANCY PREVENTION PROGRAM, SIGNING A MEMORANDUM OF UNDERSTANDING WITH THE SCHOOL DISTRICT UNDER THE 21ST CENTURY GRANT AFTER SCHOOL PROGRAM IN ORDER TO ADD A NEW COMPONENT TO THE PROGRAM AND TEACH 6TH THROUGH 8TH GRADE GIRLS EVERY WEEK FOR AN HOUR. THE NEW ENROLLMENTS INCREASED THE NUMBER OF GIRLS ATTENDING THE MONTHLY MEETING BY 40%. 45 MEETINGS WERE CONDUCTED AT THE HOSPITAL AND THE SCHOOLS IN 2017, MAKING A TOTAL OF 151 MEETINGS SINCE THE PROGRAM STARTED IN 2013. "IT'S A GIRL THING, MAKING PROUD CHOICES" WON A NATIONAL AWARD FROM THE JACKSON HEALTHCARE FOUNDATION IN 2017 AND WAS RECOGNIZED BY THE RURAL HEALTH INFORMATION HUB AND REGISTRY PARTNERS FOR RURAL HEALTH DAY IN 2017. THE HOSPITAL HAS REINFORCED MENTAL HEALTH, ALCOHOL AND DRUG PREVENTION AND SUICIDE PREVENTION IN BOTH OF THE HOSPITAL'S YOUTH PROGRAMS IN PARTNERSHIP WITH OTHER ORGANIZATIONS. WE HAVE DISCUSSIONS WITH THE GIRLS AT THE SCHOOLS AND THE HOSPITAL EVERY WEEK ABOUT THESE TOPICS. SEVERAL GIRLS HAVE REACHED OUT TO THE PROGRAM TEAM LOOKING FOR HELP, AND THEY HAVE BEEN HELPED. 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. WE HAVE CONTINUED WITH OUR ANTI BULLYING PROGRAM: UNION PARISH "TOGETHER, WE CAN BE BULLY FREE", PROGRAM WAS RECOGNIZED BY THE RURAL HEALTH INFORMATION HUB IN 2017. THE HOSPITAL HAS MAINTAINED ITS COLLABORATION WITH THE SCHOOL BOARD, LAW ENFORCEMENT, CHILDREN'S COALITION, HEALTH UNIT, CHURCHES, HEALTH CARE PROVIDERS AND OTHER CIVIC AND BUSINESS ORGANIZATIONS IN THE AREA. -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 HOSPITAL HAVE IMMEDIATE ACCESS TO HIGHLY SPECIALIZED VASCULAR NEUROLOGISTS AS THE RESULT OF A PARTNERSHIP BETWEEN 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. UNION GENERAL HOSPITAL IS PARTNERING WITH THE AMERICAN HEART ASSOCIATION GO RED FOR WOMEN AND EDUCATING THE COMMUNITY ABOUT CARDIOVASCULAR DISEASE. -OBESITY AND DIABETES: THE HOSPITAL PARTICIPATED IN SEVERAL HEALTH FAIRS IN 2017: DA DE LA FAMILIA AT THE D'ARBONNE STATE PARK, BACK TO SCHOOL BASHES IN TOWN IN PARTNERSHIP WITH ZION HILL BAPTIST CHURCH AND BEULAH BAPTIST CHURCH AND OTHER HEALTH FAIRS IN PARTNERSHIP WITH LSU AGCENTER, TRIAD OF UNION PARISH, SCHOOL BOARD AND THE COUNCIL ON AGING. THE HOSPITAL'S EMPLOYEES HAVE CONTINUED WITH THE BIGGEST LOSER PROGRAM AND THE WALKING CHALLENGE. THE FOLLOWING ARE HEALTH NEEDS WITHOUT SPECIFIC IMPLEMENTATION STRATEGIES: -DENTAL AND ORAL HEALTH: IT IS BEYOND THE SCOPE OF THE HOSPITAL'S SERVICES TO OFFER DENTAL CARE. A FEDERALLY QUALIFIED HEALTHCARE CENTER (FQHC) IN MARION OFFERS DENTAL SERVICES TO THE UNINSURED OR UNDERINSURED ON A SLIDING FEE SCALE. THE HOSPITAL AND RURAL HEALTH CLINIC WILL EDUCATE AND REFER PATIENTS TO MOREHOUSE COMMUNITY MEDICAL CENTER (MCMC) OF MARION. -SEXUAL HEALTH: SEXUAL HEALTH WILL BE ADDRESSED THROUGH ANOTHER HEALTH PRIORITY "ADOLESCENT BEHAVIORS". UGH WILL DEVELOP IMPLEMENTATION STRATEGIES TO ADDRESS TEEN LIFESTYLE ISSUES WHICH INCLUDE SEXUAL HEALTH. ADDITIONALLY, PUBLIC HEALTH FACILITIES WILL BE IDENTIFIED AS RESOURCES COMMUNITY MEMBERS CAN CONTACT REGARDING SEXUAL HEALTH AND STD PREVENTION AND TREATMENT. -MENTAL HEALTH: MENTAL HEALTH SERVICES ARE BEYOND THE SCOPE OF THE SERVICES PROVIDED AT THE HOSPITAL. UGH WILL HELP IDENTIFY MENTAL HEALTH RESOURCES WITHIN ITS RESOURCE DIRECTORY. -RESPIRATORY AND ASTHMA: AFTER FURTHER REVIEW OF THIS HEALTH PRIORITY, THE SOURCE OF THE PRIORITY NEED WAS FROM THE SELF-REPORTED SURVEY THAT ASKED ABOUT ONE'S HEALTH CHALLENGES. THERE WAS NO OTHER EVIDENCE TO SUPPORT THIS AS A MAJOR HEALTH ISSUE. THE HOSPITAL WILL CONTINUE TO MONITOR THIS HEALTH CONDITION TO DETERMINE IF IT IS A SUBSTANTIAL HEALTH ISSUE IN THE FUTURE. ADDITIONALLY, THE HOSPITAL WILL HELP IDENTIFY RESPIRATORY SERVICES WITHIN ITS RESOURCE DIRECTORY. UNION GENERAL HOSPITAL WILL CONTINUE TO OFFER AN ANNUAL FLU SHOT DRIVE TO THE COMMUNITY AND EMPLOYEES TO REDUCE RESPIRATORY ILLNESSES. -ALCOHOL AND DRUG USE (ADULTS): ALCOHOL AND DRUG USE AMONG ADULTS WILL NOT BE ADDRESSED AT THIS TIME. SUBSTANCE ABUSE TREATMENT IS BEYOND THE SCOPE OF THE HOSPITAL'S SERVICES. UGH WILL CONTINUE TO REFER PATIENTS TO OTHER ORGANIZATIONS THAT ADDRESS THIS ISSUE. -ACCESS TO CARE (TRANSPORTATION, PHYSICIANS, JOB OPPORTUNITIES, AND WELLNESS): ACCESS TO WELLNESS SERVICES WILL BE ADDRESSED THROUGH THE OBESITY AND DIABETES HEALTH PRIORITY. ACCESS TO CARE RELATED TO SPECIALTY PHYSICIANS, LACK OF TRANSPORTATION, AND LACK OF JOB OPPORTUNITIES IS BEYOND THE SCOPE OF THE HOSPITAL'S SERVICES TO THE COMMUNITY. THE HOSPITAL WILL HELP IDENTIFY THESE TYPES OF SERVICES WITHIN ITS RESOURCE DIRECTORY. WELLNESS CARE IS CURRENTLY AVAILABLE IN ALL LOCAL PHYSICIAN OFFICES AS WELL AS AT MCMC OF MARION WHICH OFFERS SERVICES TO INDIGENT AND UNDERINSURED AT REDUCED RATES OR FREE THROUGH SLIDING FEE SCALES. THE HOSPITAL BELIEVES THAT RESPONDENTS TO SURVEY MAY NOT HAVE BEEN AWARE OF ALL WELLNESS SERVICES OFFERED BY CURRENT HEALTHCARE PROVIDERS OR MAY HAVE BEEN REFERRING TO A HEALTH CLUB TYPE FACILITY WHICH IS OUTSIDE THE SCOPE OF HOSPITAL SERVICES. -JOINT AND BACK PAIN: AFTER FURTHER REVIEW OF THIS HEALTH PRIORITY, THE SOURCE OF THIS PROIRITY WAS FROM THE SELF-REPORTED SURVEY THAT ASKED ABOUT ONE'S HEALTH CHALLENGES. THE HOSPITAL WILL CONTINUE TO MONITOR THIS HEALTH CONDITION TO DETERMINE IF THIS IS A SUBSTANTIAL HEALTH ISSUE IN THE FUTURE. 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, LINE 7 COMMUNITY HEALTH NEEDS ASSESSMENT: THE HOSPITAL'S CHNA IS AVAILABLE UPON REQUEST AND AT THE FOLLOWING WEBSITE: HTTP://WWW.UNIONGEN.ORG/2015%20CHNA%20REPORT_UNION%20GENERAL.PDF SCHEDULE H, PART V, SECTION B, LINE 10A IMPLEMENTATION STRATEGY: THE HOSPITAL'S IMPLEMENTATION STRATEGY IS AVAILABLE UPON REQUEST AND AT THE FOLLOWING WEBSITE: HTTP://WWW.UNIONGEN.ORG/2015%20IMPLEMENTATION%20STRATEGY%20UNION%20GENERAL %20HOSPITAL%20FINAL.PDF SCHEDULE H, PART V, SECTION B, LINE 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/page44.html 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 COMPLIANCE WITH 501R: UNION GENERAL HOSPITAL IDENTIFIED A COUPLE OF AREAS WHERE IT WAS NOT YET FULLY COMPLIANT WITH THE FINAL 501R REGULATIONS. THE HOSPITAL WAS NOTIFIED THE PRIOR CHNA AND IMPLEMENTATION STRATEGY WERE NOT ON THE HOSPITAL'S WEBSITE. THE HOSPITAL HAS NOW ADDED THE PRIOR CHNA AND IMPLEMENTATION STRATEGY TO THE SAME WEBPAGE AS THE CURRENT ASSESSMENTS. DURING THIS TIME, THE EXHIBITS MENTIONED IN THE FINANCIAL ASSISTANCE POLICY (FAP) WERE NOT INCLUDED ON THE WEBSITE. ONCE NOTIFIED OF THIS ERROR, EXHIBITS B & C WERE UPLOADED. WHILE THE HOSPITAL DID HAVE SOME PROCEDURES IN PLACE COMPLIANT WITH 501R REGARDING EFFORTS MADE TO NOTIFY PATIENTS BEFORE INITIATING COLLECTION ACTIONS, A WRITTEN NOTICE ABOUT UPCOMING EXTRAORDINARY COLLECTION ACTIONS (ECA'S) ALONG WITH THE PLAIN LANGUAGE SUMMARY WERE NOT SENT TO PATIENTS 30 DAYS BEFORE INITIATING THE ECA. THE HOSPITAL HAS NOW SET UP A PROCESS WITHIN THE EHR SYSTEM TO SEND A LETTER WITH THE REQUIRED INFORMATION TO PROCESS AN APPLICATION, AS WELL AS THE ECA THE HOSPITAL INTENDS TO INITIATE IF REQUIRED INFORMATION IS NOT PROVIDED TO ALL SELF-PAY ACCOUNTS AS SOON AS THEY ARE PLACED IN A SELF-PAY FINANCIAL CLASS. THE SAME WORDING WILL BE IN A SEPARATE LETTER FOR ALL ACCOUNTS IN A SELF-PAY FINANCIAL CLASS AFTER 90 DAYS WITH NO PAYMENT ACTIVITY. ACCOUNTS ARENT TURNED OVER TO AN OUTSIDE AGENCY UNTIL NO PAYMENT ACTIVITY FOR AT LEAST 125 DAYS. UNION GENERAL PERSONNEL ARE WORKING DILIGENTLY TOWARD COMPLIANCE AND WILL CORRECT ANY ADDITIONAL FAILURES TO COMPLY AS THEY ARE IDENTIFIED. TOP MANAGEMENT WILL MONITOR THE WEBSITE QUARTERLY TO CONFIRM THE HOSPITAL CONTINUES TO STAY COMPLIANT WITH THE WIDELY PUBLICIZED REQUIREMENTS UNDER 501R. 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. THE AMOUNT REPORTED ON LINE 2 IS THE BAD DEBT EXPENSE REPORTED ON THE AUDITED FINANCIAL STATEMENTS. 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: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY 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), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS 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 NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS APPROXIMATELY 87% OF SELF-PAY PATIENTS RECEIVABLE AT JUNE 30, 2017 AND 2016. IN ADDITION, THE HOSPITAL'S WRITE-OFFS DECREASED APPROXIMATELY $390,000 FROM APPROXIMATELY $1,684,000 FOR THE YEAR ENDED JUNE 30, 2016, TO APPROXIMATELY $1,294,000 FOR THE YEAR ENDED JUNE 30, 2017. THE INCREASE IN THE WRITE-OFFS IS PRIMARILY THE RESULT OF NEGATIVE CHANGES IN THE AGE AND PAYER MIX OF ACCOUNTS RECEIVABLE AT JUNE 30, 2017 AS COMPARED TO JUNE 30, 2016. 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 200% 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 22,576 (2013 ESTIMATE). UNION PARISH IS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA (MUA) AND A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA). MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $35,064 (2013 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 UNDERSERVED 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, AHAS 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 COLON SCREENING 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 BLOOD SUGAR AND BLOOD PRESURE SCREENING FOR THE COMMUNITY. UGH PARTICIPATED IN THE TOWN OF FARMERVILLES TOY DRIVE FOR NEEDY CHILDREN, ALONG WITH ANTI BULLYING AND TEEN PREGNANCY PREVENTION SESSIONS AT THE HOSPITAL AND ALL THE SCHOOLS. UGH EMPLOYEES ARE VERY INVOLVED WITH LOCAL ORGANIZATIONS, SUCH AS ALZHEIMERS 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. 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 I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: BAD DEBT EXPENSE OF $1,026,928 WAS INCLUDED ON FORM 990, PART IX LINE 25 IN TOTAL EXPENSES. HOWEVER, THIS AMOUNT WAS EXCLUDED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF PATIENT CARE COST TO CHARGES. 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: -INSURANCE STATUS -MEDICAID COVERAGE X X false false false false false false false false false WILLIAM ADCOCK CFO 153484 0 10000 0 0 0 4557 0 4418 0 172459 0 0 0 HOLLY CORLEY MD PHYSICIAN 192753 0 2888 0 0 0 3999 0 3324 0 202964 0 0 0 SHEREE HICKS PHARMACIST 199830 0 0 0 0 0 3907 0 3343 0 207080 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 DELEGATION OF CONTROL OVER MANAGEMENT DUTIES: THE HOSPITAL HAS ENTERED INTO A CONTRACT FOR ADMINISTRATIVE SERVICES WITH IASIS GLENWOOD REGIONAL MEDICAL CENTER, WHICH AUTOMATICALLY RENEWS EACH YEAR. THIS CONTRACT REQUIRES THAT THE MANAGEMENT COMPANY PROVIDE PERSONNEL TO PERFORM DUTIES AS THE HOSPITAL ADMINISTRATOR. FEES PAID TO IASIS WERE $209,292. PER IRS GUIDANCE, NO COMPENSATION PAID BY IASIS IS SHOWN ON PART VII FOR THIS INDIVIDUAL: EVALYN ORMOND $209,292 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 FULL BOARD OF DIRECTORS FOR REVIEW 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 CEO AND OTHER OFFICER OFFICIAL COMPENSATION: INFORMATION WAS OBTAINED FROM THE 2016 LA SALARY SURVEY DONE BY THE GREATER NEW ORLEANS SOCIETY FOR H/R ADMIN 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. THE CEO AND CFO SET THE MAXIMUM INCREASES FOR DEPARTMENT MANAGERS, AND MAXIMUM PERCENTAGE INCREASES FOR ALL OTHER EMPLOYEES. EACH EMPLOYEE RECEIVES A PRORATA 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 VII, SECTION A CONTRACTED CEO POSITION: THE POSITION OF CEO IS CONTRACTED THROUGH IASIS GLENWOOD REGIONAL MEDICAL CENTER, AN UNRELATED ORGANIZATION. UNION GENERAL HOSPITAL REIMBURSES GLENWOOD FOR THE CEO'S SALARY. THIS INDIVIDUAL IS LISTED ON PART VII, SECTION A OF FORM 990, ALONG WITH THE AMOUNT OF BONUS AND BENEFITS PAID DIRECTLY BY UNION GENERAL. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: NET ASSETS RELEASED FROM RESTRICTION $(2,202,595) FORM 990, PART I, LINE 1 (CONTINUED FROM PAGE 1)...UNION PARISH AND THE SURROUNDING AREAS. FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED MEDICAL SERVICES TOTAL FEES:2748771 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:1152974 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE AGREEMENTS TOTAL FEES:213714 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN RECRUITING TOTAL FEES:9079 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:3176 FORM 990 PART IX LINE 11G DESCRIPTION:OUTSIDE TESTING TOTAL FEES:265