2017-11-15T09:27:11-06:00 2016-12-31 570381582 ELLIOTT DAVIS LLC PLLC ONE 10TH STREET SUITE 400 AUGUSTA GA 30901 990 2016-01-01 581728812 AUGUSTA RESOURCE CENTER ON AGING INC AUGU 7068689800 4275 OWENS ROAD EVANS GA 30809 DAVE BELKOSKI UHS CFO 7068689800 2017-11-13 1 JESSICA C CAIN CPA P01276209 7067229090 165.225.34.66 2017-11-13 11:49:36 ES P FA911B7747AA32E893665EE7CE6220A1088A557E FA911B7747AA32E893665EE7CE6220A1088A557E 2016 2021-01-29 14:40:06Z JAMES R DAVIS 1350 WALTON WAY EVANS GA 30901 19796834 0 X WWW.BRANDONWILDE.COM 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. 6 3 321 200 0 0 0 132749 19048381 18895859 -81880 718899 14505 10725 18981006 19758232 0 0 0 0 7216575 7678795 0 0 0 8191730 8183894 15408305 15862689 3572701 3895543 77687758 81485811 56674499 55647766 21013259 25838045 RETIREMENT COMMUNITY - RETIREMENT CENTER SPECIFICALLY DESIGNED TO SATISFY THREE PRIMARY NEEDS OF THE AGING - HOUSING, HEALTH CARE, AND FINANCIAL SECURITY. 0 0 13256449 17989269 RETIREMENT COMMUNITY - RETIREMENT CENTER SPECIFICALLY DESIGNED TO SATISFY THREE PRIMARY NEEDS OF THE AGING - HOUSING, HEALTH CARE, AND FINANCIAL SECURITY. 13256449 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 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 0 0 1 0 0 0 1 39 0 321 1 0 0 0 0 0 0 0 0 0 0 X 6 3 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 GA X X CHERYL TAYLOR 7068683522 4275 OWENS ROAD EVANS GA 30809 TOM DOZIER CHAIRMAN 1.00 X 0 0 0 JAMES R DAVIS BOARD MEMBER 1.00 50.00 X 0 965846 304207 GERALD MATHEIS BOARD MEMBER 1.00 X 0 0 0 DAVE BELKOSKI BOARD MEMBER 1.00 50.00 X 0 605375 14858 CHRISTA MICHAEL ACTING RESIDENT COUNCIL CH 1.00 X 0 0 0 MARILYN A BOWCUTT BOARD MEMBER 1.00 50.00 X 0 659973 16704 BRUCE MARSHALL EXECUTIVE DIRECTOR THRU MARCH 2016 40.00 X 106341 0 6468 PAM KAUFFMAN CURRENT EXECUTIVE DIRECTOR 40.00 X 154451 0 19743 CHERYL TAYLOR EMPLOYEE 40.00 X 126667 0 13073 KATHY MARKS EMPLOYEE 40.00 X 106067 0 9509 AMBER COOPER EMPLOYEE 40.00 X 109904 0 18449 603430 2231194 403011 5 0 1 0 HEAVENER CONSTRUCTION CO 1530 CRESENT CT AUGUSTA GA 30909 CONSTRUCTION 2075379 US FOOD SERVICEINC 120 LONGS POND RD LEXINGTON SC 29072 FOOD SUPPLIER 1014795 AEGIS THERAPIES INC PO BOX 8103 FT SMITH AR 72902 STAFFING 318362 BRIAR WOOD GROUP INC PO BOX 16423 AUGUSTA GA 30919 LANDSCAPING 316467 ON CALL STAFFING LLC 4236 COLUMBIA RD MARTINEZ GA 30907 STAFFING 199118 10 132749 132749 PATIENT CARE SERVICES 623000 13699807 13699807 ENTRANCE FEES 623000 3905487 3905487 MEALS 623000 615682 615682 OTHER PROGRAM SERVICE 623000 499472 229729 269743 MEDICAL SUPPLIES 623000 175411 175411 18895859 438268 438268 28162 17437 10725 10725 10725 301796 0 21165 301796 -21165 280631 -21165 301796 19758232 17989269 0 1636214 260792 217944 42848 6020419 5031264 989155 196240 163998 32242 751364 627915 123449 449980 376048 73932 3751 3135 616 29015 24248 4767 45390 37932 7458 114418 95619 18799 999756 835496 164260 32656 27291 5365 278572 232803 45769 2302929 1924558 378371 501942 419473 82469 SUPPLIES 1525330 1274718 250612 MISCELLANEOUS 1168910 976858 192052 REPAIRS AND MAINTENANCE 834928 697749 137179 CONTRACT LABOR AND EXPE 346297 289400 56897 15862689 13256449 2606240 0 6804498 2856657 1442550 1494232 89213 87435 878655 2333405 88715308 41445024 45712890 47270284 22759952 27443798 77687758 81485811 17971826 18349672 27739630 28078369 10963043 9219725 56674499 55647766 X 21013259 25838045 21013259 25838045 77687758 81485811 3895543 1013091 -83848 0 X X 0 1 X 1 0 X 1092493 853850 132749 2079092 14682945 16680911 17801044 19048381 18895859 87109140 15775438 16680911 18654894 19048381 19028608 89188232 0 0 0 89188232 83512 425127 1360940 438268 2307847 83512 425127 1360940 438268 2307847 15858950 17106038 20015834 19048381 19466876 91496079 0.97480 0.97800 0.02520 0.02200 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8851067 8851067 67663552 32541069 35122483 12200689 8903955 3296734 47270284 STATE STREET INVESTMENTS 27443798 C 27443798 DEPOSITS 763606 DUE TO UHI 8308330 DUE TO UHS 147058 DUE TO UEC 731 9219725 X X 0 0 0 0 0 1 0 0 0 JAMES R DAVIS BOARD MEMBER 0 701188 0 202708 0 61950 0 290011 0 14196 0 1270053 0 0 DAVE BELKOSKI BOARD MEMBER 0 408205 0 117635 0 79535 0 1357 0 13501 0 620233 0 0 MARILYN A BOWCUTT BOARD MEMBER 0 423429 0 124180 0 112364 0 7516 0 9188 0 676677 0 0 PAM KAUFFMAN CURRENT EXECUTIVE DIRECTOR 154451 0 0 0 0 0 4953 0 14790 0 174194 0 0 0 PART I, LINE 6 YEARLY INCENTIVE PLAN IS APPROVED BY THE BOARD EARLY IN THE YEAR. IN THE CALCULATION OF THE AWARD, 20% OF THE AWARD IS BASED ON THE NET INCOME VARIANCE. THOMAS DOZIER BOARD CHAIRMAN 31518 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 11572 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 17833 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 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 XII, LINE 2C THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AUDITED AS PART OF A CONSOLIDATED GROUP. THE ORGANIZATION DOES NOT HAVE A SEPARATE COMMITTEE TO OVERSEE THE AUDIT PROCESS, AS ALL AUDIT RELATED FUNCTIONS ARE HANDLED BY THE MAIN ENTITY OF THE CONSOLIDATED GROUP, UNIVERSITY HEALTH, INC. UNIVERSITY HEALTH INC 1350 WALTON WAY AUGUSTA GA 30901 581581102 CONSOLIDATING PARENT GA 501(C)(3) LINE 10 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 413388 COST UNIVERSITY HEALTH INC E 8308330 BOOK VALUE UNIVERSITY HEALTH SERVICES P 2102031 COST UNIVERSITY HEALTH SERVICES E 147058 BOOK VALUE