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GOVERNMENT COPY

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14001028 792811 71018 2018.04030 UNIVERSITY MCDUFFIE COUNT 71018__1

University McDuffie County Regional Medical Center, Inc. 1350 Walton Way Augusta, GA 30901

Enclosed are the original and one copy of the 2018 Exempt Organization return, as follows...

2018 Form 990

Electronic filing authorization forms should be signed and returned to us as soon as possible according to the enclosed filing instructions after reviewing returns for completeness and accuracy. Also, see enclosed filing instructions for any payments due which should be paid by the due date noted. We cannot electronically transmit your returns until we receive the signed authorization forms.

Please review the return for completeness and accuracy.

We prepared the return from information you furnished us without verification. Upon examination of the return by tax authorities, requests may be made for underlying data. We therefore recommend that you preserve all records which you may be called upon to produce in connection with such possible examinations.

We sincerely appreciate the opportunity to serve you. Please contact us if you have any questions concerning the tax return.

Elliott Davis, LLC/PLLC

TAX RETURN FILING INSTRUCTIONSFORM 990

FOR THE YEAR ENDINGDecember 31, 2018

Prepared For:

University McDuffie County RegionalMedical Center, Inc.1350 Walton WayAugusta, GA 30901

Prepared By:

Elliott Davis, LLC/PLLCOne 10th Street, Suite 400Augusta, GA 30901

Amount Due or Refund:

Not applicable

Make Check Payable To:

Not applicable

Mail Tax Return and Check (if applicable) To:

Not applicable

Return Must be Mailed On or Before:

Not applicable

Special Instructions:

This copy of the return is provided for state filing purposes.

This return has qualified for electronic filing. After you have reviewed the return for completeness and accuracy, please sign, date and return Form 8879-EO to our office. We will transmit the return electronically to the IRS and no further action is required. Return Form 8879-EO to us as soon as possible

OMB No. 1545-1878

Form

For calendar year 2018, or fiscal year beginning , 2018, and ending , 20

Department of the TreasuryInternal Revenue Service

823051 10-26-18

Employer identification number

Enter five numbers, butdo not enter all zeros

ERO firm name

Do not enter all zeros

| Do not send to the IRS. Keep for your records.

| Go to www.irs.gov/Form8879EO for the latest information.

1a, 2a, 3a, 4a, 5a, 1b, 2b, 3b, 4b, 5b,Do not

1a

2a

3a

4a

5a

| b Total revenue, 1b

2b

3b

4b

5b

| b Total revenue,

| b Total tax

| b Tax based on investment income

| b Balance Due

(a) (b) (c)

Officer's PIN: check one box only

ERO's EFIN/PIN.

Pub. 4163,

For Paperwork Reduction Act Notice, see instructions.

e-file

Name of exempt organization

Name and title of officer

~~~

~~~~~~~~~~~~~~~~~~~~

Officer's signature | Date |

ERO's signature | Date |

Form (2018)

(Whole Dollars Only)

Check the box for the return for which you are using this Form 8879-EO and enter the applicable amount, if any, from the return. If you check the boxon line or below, and the amount on that line for the return being filed with this form was blank, then leave line orwhichever is applicable, blank (do not enter -0-). But, if you entered -0- on the return, then enter -0- on the applicable line below. complete morethan one line in Part I.

Form 990 check here

Form 990-EZ check here

Form 1120-POL check here

if any (Form 990, Part VIII, column (A), line 12) ~~~~~~~

if any (Form 990-EZ, line 9) ~~~~~~~~~~~~~~

(Form 1120-POL, line 22) ~~~~~~~~~~~~~~~~

Form 990-PF check here

Form 8868 check here

(Form 990-PF, Part VI, line 5)

(Form 8868, line 3c)

Under penalties of perjury, I declare that I am an officer of the above organization and that I have examined a copy of the organization's 2018electronic return and accompanying schedules and statements and to the best of my knowledge and belief, they are true, correct, and complete. Ifurther declare that the amount in Part I above is the amount shown on the copy of the organization's electronic return. I consent to allow myintermediate service provider, transmitter, or electronic return originator (ERO) to send the organization's return to the IRS and to receive from the IRS

an acknowledgement of receipt or reason for rejection of the transmission, the reason for any delay in processing the return or refund, and the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (directdebit) entry to the financial institution account indicated in the tax preparation software for payment of the organization's federal taxes owed on thisreturn, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at1-888-353-4537 no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in theprocessing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to thepayment. I have selected a personal identification number (PIN) as my signature for the organization's electronic return and, if applicable, theorganization's consent to electronic funds withdrawal.

I authorize to enter my PIN

as my signature on the organization's tax year 2018 electronically filed return. If I have indicated within this return that a copy of the returnis being filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned ERO toenter my PIN on the return's disclosure consent screen.

As an officer of the organization, I will enter my PIN as my signature on the organization's tax year 2018 electronically filed return. If I haveindicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS Fed/Stateprogram, I will enter my PIN on the return's disclosure consent screen.

Enter your six-digit electronic filing identification

number (EFIN) followed by your five-digit self-selected PIN.

I certify that the above numeric entry is my PIN, which is my signature on the 2018 electronically filed return for the organization indicated above. Iconfirm that I am submitting this return in accordance with the requirements of Modernized e-File (MeF) Information for Authorized IRS

Providers for Business Returns.

LHA

Part I Type of Return and Return Information

Part II Declaration and Signature Authorization of Officer

Part III Certification and Authentication

ERO Must Retain This Form - See InstructionsDo Not Submit This Form to the IRS Unless Requested To Do So

8879-EO

IRS e-file Signature Authorizationfor an Exempt Organization8879-EO

2018

UNIVERSITY MCDUFFIE COUNTY REGIONALMEDICAL CENTER, INC. 45-4166209

26,786,655.X

X ELLIOTT DAVIS, LLC/PLLC

***** THIS IS NOT A FILEABLE COPY *****

81606

CFO

***** THIS IS NOT A FILEABLE COPY ***

67579630901

10/28/19

DAVID BELKOSKI


Checkifself-employed

OMB No. 1545-0047


Check ifapplicable:

Addresschange

NamechangeInitialreturn

Finalreturn/termin-ated Gross receipts $

AmendedreturnApplica-tionpending

Are all subordinates included?

832001 12-31-18

Beginning of Current Year

Paid

Preparer

Use Only

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)

| Do not enter social security numbers on this form as it may be made public. Open to Public Inspection| Go to www.irs.gov/Form990 for instructions and the latest information.

A For the 2018 calendar year, or tax year beginning and ending

B C D Employer identification number

E

G

H(a)

H(b)

H(c)

F Yes No

Yes No

I

J

K

Website: |

L M

1

2

3

4

5

6

7

3

4

5

6

7a

7b

a

b

Ac

tivi

tie

s &

Go

vern

an

ce

Prior Year Current Year

8

9

10

11

12

13

14

15

16

17

18

19

Re

ven

ue

a

b

Exp

en

se

s

End of Year

20

21

22

Sign

Here

Yes No

For Paperwork Reduction Act Notice, see the separate instructions.

(or P.O. box if mail is not delivered to street address) Room/suite

)501(c)(3) 501(c) ( (insert no.) 4947(a)(1) or 527

|Corporation Trust Association OtherForm of organization: Year of formation: State of legal domicile:

|

|

Net

Ass

ets

orFu

nd B

alan

ces

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is

true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Signature of officer Date

Type or print name and title

Date PTINPrint/Type preparer's name Preparer's signature

Firm's name Firm's EIN

Firm's address

Phone no.

Form

Name of organization

Doing business as

Number and street Telephone number

City or town, state or province, country, and ZIP or foreign postal code

Is this a group return

for subordinates?Name and address of principal officer: ~~

If "No," attach a list. (see instructions)

Group exemption number |

Tax-exempt status:

Briefly describe the organization's mission or most significant activities:

Check this box if the organization discontinued its operations or disposed of more than 25% of its net assets.

Number of voting members of the governing body (Part VI, line 1a)

Number of independent voting members of the governing body (Part VI, line 1b)

Total number of individuals employed in calendar year 2018 (Part V, line 2a)

~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~

Total number of volunteers (estimate if necessary)

Total unrelated business revenue from Part VIII, column (C), line 12

Net unrelated business taxable income from Form 990-T, line 38

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~

��

Contributions and grants (Part VIII, line 1h) ~~~~~~~~~~~~~~~~~~~~~

Program service revenue (Part VIII, line 2g) ~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~Investment income (Part VIII, column (A), lines 3, 4, and 7d)

Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) ~~~~~~~~

Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12) ��

Grants and similar amounts paid (Part IX, column (A), lines 1-3)

Benefits paid to or for members (Part IX, column (A), line 4)

Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)

~~~~~~~~~~~

~~~~~~~~~~~~~

~~~

Professional fundraising fees (Part IX, column (A), line 11e)

Total fundraising expenses (Part IX, column (D), line 25)

~~~~~~~~~~~~~~

Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e)

Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25)

Revenue less expenses. Subtract line 18 from line 12

~~~~~~~~~~~~~

~~~~~~~

��

Total assets (Part X, line 16)

Total liabilities (Part X, line 26)

Net assets or fund balances. Subtract line 21 from line 20

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~

��

May the IRS discuss this return with the preparer shown above? (see instructions) ��

LHA Form (2018)

Part I Summary

Signature BlockPart II

990

Return of Organization Exempt From Income Tax990 2018

§

==

999

EXTENDED TO NOVEMBER 15, 2019

UNIVERSITY MCDUFFIE COUNTY REGIONALMEDICAL CENTER, INC.

45-4166209

(706) 828-24061350 WALTON WAY26,786,655.

AUGUSTA, GA 30901XJAMES R. DAVIS

UNIVERSITY HOSPITAL MCDUFFIE

WWW.MRMC.ORGX 2012 GA

THE MISSION OF THE UNIVERSITY

52

191260.0.

0.26,172,064.

1,789.612,802.

24,867,782. 26,786,655.0.0.

7,067,671.0.

0.17,222,620.

23,386,831. 24,290,291.1,480,951. 2,496,364.

37,321,734. 39,804,125.30,692,251. 30,678,278.6,629,483. 9,125,847.

DAVID BELKOSKI, CFO

P01276209JESSICA C. CAIN57-0381582ELLIOTT DAVIS, LLC/PLLC

ONE 10TH STREET, SUITE 400AUGUSTA, GA 30901 (706) 722-9090

X

1350 WALTON WAY, AUGUSTA, GA 30901

MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC. IS TO PROVIDE HEALTH

SEE SCHEDULE O FOR ORGANIZATION MISSION STATEMENT CONTINUATION

X

0.24,842,101.

6,399.19,282.

0.0.

7,364,633.0.

16,022,198.

10/28/19

Code: Expenses $ including grants of $ Revenue $



Expenses $ including grants of $ Revenue $

832002 12-31-18

1

2

3

4

Yes No

Yes No

4a

4b

4c

4d

4e

Form 990 (2018) Page

Check if Schedule O contains a response or note to any line in this Part III ��

Briefly describe the organization's mission:

Did the organization undertake any significant program services during the year which were not listed on the

prior Form 990 or 990-EZ?

If "Yes," describe these new services on Schedule O.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization cease conducting, or make significant changes in how it conducts, any program services?

If "Yes," describe these changes on Schedule O.

~~~~~~

Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses.

Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and

revenue, if any, for each program service reported.

( ) ( ) ( )

( ) ( ) ( )

( ) ( ) ( )

Other program services (Describe in Schedule O.)

( ) ( )

Total program service expenses |

Form (2018)

2Statement of Program Service AccomplishmentsPart III

990

THE MISSION OF THE UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER,

X

X

INC. IS TO PROVIDE HEALTH CARE SERVICES WITH THE HELP OF OUR

22,951,522. 26,784,866.

FACILITY, CARRIED OUT MEDICAL-RELATED SERVICES TO THE COMMUNITY AND

MEDICAL CENTER, INC. 45-4166209UNIVERSITY MCDUFFIE COUNTY REGIONAL

COMMUNITIES AND PARTNERS, AND ENRICH THE LIVES WE TOUCH BY PROVIDINGCOMPASSIONATE QUALITY CARE IN A COST EFFECTIVE MANNER. WE STRIVE TO BE

UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER (UHM), A 25 BED

CONDUCTED HEALTH EDUCATION COURSES AND HEALTH FAIRS, PROVIDED EDUCATIONLITERATURE AND SPONSORED ILLNESS SUPPORT GROUPS. STAFF MEMBERS SERVEON A VARIETY OF BOARDS AND ARE INVOLVED IN CIVIC ENDEAVORS THAT PROMOTEHEALTH AND WELLNESS. UHM PROVIDED MEDICATION AND TRANSPORTATION TO ANDFROM THE HOSPITAL FOR THOSE WHO ARE UNABLE TO PAY. UNCOMPENSATED CAREWAS PROVIDED AS WELL AS IN INDIGENT AND CHARITY CARE. A HOSPITALBASEDPROGRAM ASSISTANCE COUNSELOR IS PROVIDED AT THE HOSPITAL'S EXPENSE INORDER TO ASSIST PATIENTS WITH QUALIFYING FOR MEDICARE DISABILITY,MEDICAID, SSI OR OTHER GOVERNMENT FINANCIAL ASSISTANCE PROGRAMS.

22,951,522.

X

SEE SCHEDULE O FOR CONTINUATION(S)2


832003 12-31-18

Yes No

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

1

2

3

4

5

6

7

8

9

10

Section 501(c)(3) organizations.

a

b

c

d

e

f

a

b

11a

11b

11c

11d

11e

11f

12a

12b

13

14a

14b

15

16

17

18

19

20a

20b

21

a

b

20

21

a

b

If "Yes," complete Schedule A

Schedule B, Schedule of Contributors

If "Yes," complete Schedule C, Part I

If "Yes," complete Schedule C, Part II

If "Yes," complete Schedule C, Part III

If "Yes," complete Schedule D, Part I

If "Yes," complete Schedule D, Part II

If "Yes," complete

Schedule D, Part III

If "Yes," complete Schedule D, Part IV

If "Yes," complete Schedule D, Part V

If "Yes," complete Schedule D,

Part VI

If "Yes," complete Schedule D, Part VII

If "Yes," complete Schedule D, Part VIII

If "Yes," complete Schedule D, Part IX

If "Yes," complete Schedule D, Part X

If "Yes," complete Schedule D, Part X

If "Yes," complete

Schedule D, Parts XI and XII

If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optionalIf "Yes," complete Schedule E

If "Yes," complete Schedule F, Parts I and IV

If "Yes," complete Schedule F, Parts II and IV

If "Yes," complete Schedule F, Parts III and IV

If "Yes," complete Schedule G, Part I

If "Yes," complete Schedule G, Part II

If "Yes,"

complete Schedule G, Part III

If "Yes," complete Schedule H

If "Yes," complete Schedule I, Parts I and II


Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Is the organization required to complete ?

Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for

public office?

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization engage in lobbying activities, or have a section 501(h) election in effect

during the tax year?

Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or

similar amounts as defined in Revenue Procedure 98-19?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~

Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to

provide advice on the distribution or investment of amounts in such funds or accounts?

Did the organization receive or hold a conservation easement, including easements to preserve open space,

the environment, historic land areas, or historic structures?

Did the organization maintain collections of works of art, historical treasures, or other similar assets?

~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization report an amount in Part X, line 21, for escrow or custodial account liability, serve as a custodian for

amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services?

Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent

endowments, or quasi-endowments?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~

If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X

as applicable.

Did the organization report an amount for land, buildings, and equipment in Part X, line 10?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization report an amount for investments - other securities in Part X, line 12 that is 5% or more of its total

assets reported in Part X, line 16?

Did the organization report an amount for investments - program related in Part X, line 13 that is 5% or more of its total

assets reported in Part X, line 16?

~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in

Part X, line 16?

Did the organization report an amount for other liabilities in Part X, line 25?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~

Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses

the organization's liability for uncertain tax positions under FIN 48 (ASC 740)?

Did the organization obtain separate, independent audited financial statements for the tax year?

~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Was the organization included in consolidated, independent audited financial statements for the tax year?

~~~~~

Is the organization a school described in section 170(b)(1)(A)(ii)?

Did the organization maintain an office, employees, or agents outside of the United States?

~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~

Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business,

investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000

or more? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any

foreign organization?

Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to

or for foreign individuals?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX,

column (A), lines 6 and 11e? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines

1c and 8a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization operate one or more hospital facilities? ~~~~~~~~~~~~~~~~

If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? ~~~~~~~~~~

Did the organization report more than $5,000 of grants or other assistance to any domestic organization or

domestic government on Part IX, column (A), line 1? ~~~~~~~~~~~~~~��

Form (2018)

3Part IV Checklist of Required Schedules

990

X

X

X

X

X

X

X

X

X

X

X

X

X

XX

X

X

X

X

X

X

UNIVERSITY MCDUFFIE COUNTY REGIONAL

XX

X

X

X

XX

X

MEDICAL CENTER, INC. 45-4166209

3 14001028 792811 71018 2018.04030 UNIVERSITY MCDUFFIE COUNT 71018__1

832004 12-31-18

Yes No

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

22

23

24a

24b

24c

24d

25a

25b

26

27

28a

28b

28c

29

30

31

32

33

34

35a

35b

36

37

38

a

b

c

d

a

b

Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations.

a

b

c

a

b


Note.

Yes No

1a

b

c

1a

1b

1c

(continued)

If "Yes," complete Schedule I, Parts I and III

If "Yes," complete

Schedule J

If "Yes," answer lines 24b through 24d and complete

Schedule K. If "No," go to line 25a

If "Yes," complete Schedule L, Part I

If "Yes," complete

Schedule L, Part I

If "Yes,"

complete Schedule L, Part II

If "Yes," complete Schedule L, Part III

If "Yes," complete Schedule L, Part IV



If "Yes," complete Schedule M

If "Yes," complete Schedule M

If "Yes," complete Schedule N, Part I

If "Yes," complete

Schedule N, Part II

If "Yes," complete Schedule R, Part I

If "Yes," complete Schedule R, Part II, III, or IV, and

Part V, line 1

If "Yes," complete Schedule R, Part V, line 2

If "Yes," complete Schedule R, Part V, line 2

If "Yes," complete Schedule R, Part VI


Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on

Part IX, column (A), line 2? ~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current

and former officers, directors, trustees, key employees, and highest compensated employees?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the

last day of the year, that was issued after December 31, 2002?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?

Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease

any tax-exempt bonds?

Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?

~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~

Did the organization engage in an excess benefit

transaction with a disqualified person during the year?

Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and

that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ?

~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or

former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial

contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member

of any of these persons? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV

instructions for applicable filing thresholds, conditions, and exceptions):

A current or former officer, director, trustee, or key employee? ~~~~~~~~~~~

A family member of a current or former officer, director, trustee, or key employee?

An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer,

director, trustee, or direct or indirect owner?

~~

~~~~~~~~~~~~~~~~~~~~~

Did the organization receive more than $25,000 in non-cash contributions?

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation

contributions?

~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization liquidate, terminate, or dissolve and cease operations?

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization own 100% of an entity disregarded as separate from the organization under Regulations

sections 301.7701-2 and 301.7701-3?

Was the organization related to any tax-exempt or taxable entity?

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity

within the meaning of section 512(b)(13)?

~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~

Did the organization make any transfers to an exempt non-charitable related organization?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization conduct more than 5% of its activities through an entity that is not a related organization

and that is treated as a partnership for federal income tax purposes? ~~~~~~~~

Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19?

All Form 990 filers are required to complete Schedule O ��

Check if Schedule O contains a response or note to any line in this Part V ��

Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ~~~~~~~~~~~

Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable ~~~~~~~~~~

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming

(gambling) winnings to prize winners? ��

Form (2018)

4Part IV Checklist of Required Schedules

Part V Statements Regarding Other IRS Filings and Tax Compliance

990

X

XX

XX

X

X

X

X

X

X

X


290

X

X

X

X

X

X

X

X


832005 12-31-18

Yes No

2

3

4

5

6

7

a

b

2a

Note.

2b

3a

3b

4a

5a

5b

5c

6a

6b

7a

7b

7c

7e

7f

7g

7h

8

9a

9b

a

b

a

b

a

b

c

a

b

Organizations that may receive deductible contributions under section 170(c).

a

b

c

d

e

f

g

h

7d

8

9

10

11

12

13

14

15

16

Sponsoring organizations maintaining donor advised funds.

Sponsoring organizations maintaining donor advised funds.

a

b


a

b

10a

10b


a

b

11a

11b

a

b

Section 4947(a)(1) non-exempt charitable trusts. 12a

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

Note.

a

b

c

a

b

13a

13b

13c

14a

14b

15

16

(continued)

e-file

If "No" to line 3b, provide an explanation in Schedule O

If "No," provide an explanation in Schedule O

Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?

Form (2018)


Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements,

filed for the calendar year ending with or within the year covered by this return ~~~~~~~~~~

If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

If the sum of lines 1a and 2a is greater than 250, you may be required to (see instructions)

~~~~~~~~~~

~~~~~~~~~~~

Did the organization have unrelated business gross income of $1,000 or more during the year?

If "Yes," has it filed a Form 990-T for this year?

~~~~~~~~~~~~~~

~~~~~~~~~~~

At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a

financial account in a foreign country (such as a bank account, securities account, or other financial account)? ~~~~~~~

If "Yes," enter the name of the foreign country:

See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

~~~~~~~~~~~~

~~~~~~~~~

If "Yes" to line 5a or 5b, did the organization file Form 8886-T? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit

any contributions that were not tax deductible as charitable contributions?

If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts

were not tax deductible?

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If "Yes," did the organization notify the donor of the value of the goods or services provided?

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required

to file Form 8282?

~~~~~~~~~~~~~~~

��

If "Yes," indicate the number of Forms 8282 filed during the year

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

~~~~~~~~~~~~~~~~

~~~~~~~

~~~~~~~~~Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?

~

Did a donor advised fund maintained by the

sponsoring organization have excess business holdings at any time during the year? ~~~~~~~~~~~~~~~~~~~

Did the sponsoring organization make any taxable distributions under section 4966?

Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?

~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~

Enter:

Initiation fees and capital contributions included on Part VIII, line 12

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

~~~~~~~~~~~~~~~

~~~~~~

Enter:

Gross income from members or shareholders

Gross income from other sources (Do not net amounts due or paid to other sources against

amounts due or received from them.)

~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Is the organization filing Form 990 in lieu of Form 1041?

If "Yes," enter the amount of tax-exempt interest received or accrued during the year ��

Is the organization licensed to issue qualified health plans in more than one state?

See the instructions for additional information the organization must report on Schedule O.

~~~~~~~~~~~~~~~~~~~~~

Enter the amount of reserves the organization is required to maintain by the states in which the

organization is licensed to issue qualified health plans

Enter the amount of reserves on hand

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization receive any payments for indoor tanning services during the tax year?

If "Yes," has it filed a Form 720 to report these payments?

~~~~~~~~~~~~~~~~

~~~~~~~~~~

Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or

excess parachute payment(s) during the year?

If "Yes," see instructions and file Form 4720, Schedule N.

Is the organization an educational institution subject to the section 4968 excise tax on net investment income?

If "Yes," complete Form 4720, Schedule O.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~

5Part V Statements Regarding Other IRS Filings and Tax Compliance

990

J

X

X

X

X

XX

X

X

X

XX

X

191


X


832006 12-31-18

Yes No

1a

1b

1

2

3

4

5

6

7

8

9

a

b

2

3

4

5

6

7a

7b

8a

8b

9

a

b

a

b

Yes No

10

11

a

b

10a

10b

11a

12a

12b

12c

13

14

15a

15b

16a

16b

a

b

12a

b

c

13

14

15

a

b

16a

b

17

18

19

20

For each "Yes" response to lines 2 through 7b below, and for a "No" responseto line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.

If "Yes," provide the names and addresses in Schedule O

(This Section B requests information about policies not required by the Internal Revenue Code.)

If "No," go to line 13

If "Yes," describe

in Schedule O how this was done

(explain in Schedule O)

If there are material differences in voting rights among members of the governing body, or if the governing

body delegated broad authority to an executive committee or similar committee, explain in Schedule O.

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts?

Form (2018)


Check if Schedule O contains a response or note to any line in this Part VI ��

Enter the number of voting members of the governing body at the end of the tax year

Enter the number of voting members included in line 1a, above, who are independent

~~~~~~

~~~~~~

Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other

officer, director, trustee, or key employee? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization delegate control over management duties customarily performed by or under the direct supervision

of officers, directors, or trustees, or key employees to a management company or other person? ~~~~~~~~~~~~~~

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?

Did the organization become aware during the year of a significant diversion of the organization's assets?

Did the organization have members or stockholders?

~~~~~

~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or

more members of the governing body?

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or

persons other than the governing body?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The governing body?

Each committee with authority to act on behalf of the governing body?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the

organization's mailing address? ��

Did the organization have local chapters, branches, or affiliates?

If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates,

and branches to ensure their operations are consistent with the organization's exempt purposes?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~

Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?

Describe in Schedule O the process, if any, used by the organization to review this Form 990.

Did the organization have a written conflict of interest policy? ~~~~~~~~~~~~~~~~~~~~

~~~~~~

Did the organization regularly and consistently monitor and enforce compliance with the policy?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization have a written whistleblower policy?

Did the organization have a written document retention and destruction policy?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~

Did the process for determining compensation of the following persons include a review and approval by independent

persons, comparability data, and contemporaneous substantiation of the deliberation and decision?

The organization's CEO, Executive Director, or top management official

Other officers or key employees of the organization

If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).

~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a

taxable entity during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation

in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's

exempt status with respect to such arrangements? ��

List the states with which a copy of this Form 990 is required to be filed

Section 6104 requires an organization to make its Forms 1023 (1024 or 1024-A if applicable), 990, and 990-T (Section 501(c)(3)s only) available

for public inspection. Indicate how you made these available. Check all that apply.

Own website Another's website Upon request Other

Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial

statements available to the public during the tax year.

State the name, address, and telephone number of the person who possesses the organization's books and records |

6Part VI Governance, Management, and Disclosure

Section A. Governing Body and Management

Section B. Policies

Section C. Disclosure

990

J

5

2

XX

X

XX

XX

XXX

XX

X

XXXX

X

X

X

X

DAVID A. BELKOSKI, CFO - 706-828-24061350 WALTON WAY, AUGUSTA, GA 30901

X


X

GA

X


Indi

vidu

al tr

uste

e or

dire

ctor

Inst

itutio

nal t

rust

ee

Offi

cer

Key

empl

oyee

Hig

hest

com

pens

ated

empl

oyee

Form

er

(do not check more than onebox, unless person is both anofficer and a director/trustee)

832007 12-31-18

current

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees

1a

current

current

former

former directors or trustees

(A) (B) (C) (D) (E) (F)


Check if Schedule O contains a response or note to any line in this Part VII ��

Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year.

¥ List all of the organization's officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation.Enter -0- in columns (D), (E), and (F) if no compensation was paid.

¥ List all of the organization's key employees, if any. See instructions for definition of "key employee."¥ List the organization's five highest compensated employees (other than an officer, director, trustee, or key employee) who received report-

able compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations.

¥ List all of the organization's officers, key employees, and highest compensated employees who received more than $100,000 ofreportable compensation from the organization and any related organizations.

¥ List all of the organization's that received, in the capacity as a former director or trustee of the organization,more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees; and former such persons.

Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.

PositionName and Title Average hours per

week (list any

hours forrelated

organizationsbelowline)

Reportablecompensation

from the

organization(W-2/1099-MISC)

Reportablecompensationfrom related

organizations(W-2/1099-MISC)

Estimatedamount of

othercompensation

from theorganizationand related

organizations

Form (2018)

7Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated

Employees, and Independent Contractors

990

(1) WILLIAM P. DOUPECHAIRMAN(2) ROBIN S. DUDLEY

(3) JOHN BIELTZ, D.O.

(4) JAMES R. DAVIS

(5) EDWARD L. BURR

(6) DAVID A. BELKOSKI

(7) WILLIAM L FARR JR

(8) MARILYN A BOWCUTT

(9) ROBERT J. KEPSHIRE

(10) DANITA T KISER

(11) MARCIA V RODGERS

DIRECTOR

DIRECTOR

UHCS CEO

LEGAL ADVISOR

UHCS & UHM CFO

CMO

PRESIDENT UNIVERSITY HOSPI

ADMINISTRATIVE CNO

NURSE DIRECTOR MED/SERG ED

PHARMACY MANAGER

2.00

2.00

2.00

2.00

2.00

2.00

50.00

50.00

40.00

50.00

50.00

X

X

X

X

X

X

X

X

X

X

X

0.

0.

63,000.

0.

0.

0.

0.

0.

0.

118,270.

119,549.

0.

0.

0.

979,349.

545,817.

665,756.

545,056.

451,708.

192,009.

0.

0.

0.

0.

0.

307,362.

19,183.

15,779.

25,671.

12,155.

5,451.

17,814.

13,371.


X

50.00

50.00

50.00


Form

er

Indi

vidu

al tr

uste

e or

dire

ctor

Inst

itutio

nal t

rust

ee

Offi

cer

Hig

hest

com

pens

ated

empl

oyee

Key

empl

oyee

(do not check more than onebox, unless person is both anofficer and a director/trustee)

832008 12-31-18

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees

(B) (C)(A) (D) (E) (F)

1b

c

d

Sub-total

Total from continuation sheets to Part VII, Section A

Total (add lines 1b and 1c)

2

Yes No

3

4

5

former

3

4

5

Section B. Independent Contractors

1

(A) (B) (C)

2

(continued)

If "Yes," complete Schedule J for such individual

If "Yes," complete Schedule J for such individual

If "Yes," complete Schedule J for such person

Page Form 990 (2018)

PositionAverage hours per

week(list any

hours forrelated

organizationsbelowline)

Name and title Reportablecompensation

from the

organization(W-2/1099-MISC)

Reportablecompensationfrom related

organizations(W-2/1099-MISC)

Estimatedamount of

othercompensation

from theorganizationand related

organizations

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |

~~~~~~~~~~ |

�� |

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable

compensation from the organization |

Did the organization list any officer, director, or trustee, key employee, or highest compensated employee on

line 1a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization

and related organizations greater than $150,000? ~~~~~~~~~~~~~

Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services

rendered to the organization? ��

Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from

the organization. Report compensation for the calendar year ending with or within the organization's tax year.

Name and business address Description of services Compensation

Total number of independent contractors (including but not limited to those listed above) who received more than

$100,000 of compensation from the organization |

Form (2018)

8Part VII

990

300,819. 3,379,695. 416,786.0. 0. 0.

CENTER DRIVE, CHICAGO, IL 60693

PO BOX 8103, FORT SMITH, AR 72902

1350 WALTON WAY, AUGUSTA, GA 30901

2

3

300,819. 3,379,695. 416,786.

X

MEDICAL CENTER, INC.

X

X

45-4166209

CROTHALL HEALTHCARE, 13028 COLLECTION


AEGIS THERAPIES

MORRISON'S MANAGEMENT HEALTHCARE INC

PLANT OPERATIONSEVS SERVICES AND

THERAPY SERVICES

FOOD SERVICES

679,614.

542,143.

225,575.


Noncash contributions included in lines 1a-1f: $

832009 12-31-18

Total revenue.

(A) (B) (C) (D)

1 a

b

c

d

e

f

g

h

1

1

1

1

1

1

a

b

c

d

e

f

Co

ntr

ibu

tio

ns,

Gif

ts,

Gra

nts

an

d O

the

r S

imila

r A

mo

un

ts

Total.

Business Code

a

b

c

d

e

f

g

2

Pro

gra

m S

erv

ice

Re

ven

ue

Total.

3

4

5

6 a

b

c

d

a

b

c

d

7

a

b

c

8

a

b

9 a

b

c

a

b

10 a

b

c

a

b

Business Code

11 a

b

c

d

e Total.

Oth

er

Re

ven

ue

12

Revenue excludedfrom tax under

sections512 - 514

All other contributions, gifts, grants, and

similar amounts not included above

See instructions

Form (2018)

Page Form 990 (2018)

Check if Schedule O contains a response or note to any line in this Part VIII ��

Total revenue Related orexempt function

revenue

Unrelatedbusinessrevenue

Federated campaigns

Membership dues

~~~~~~

~~~~~~~~

Fundraising events

Related organizations

~~~~~~~~

~~~~~~

Government grants (contributions)

~~

Add lines 1a-1f �� |

All other program service revenue ~~~~~

Add lines 2a-2f �� |

Investment income (including dividends, interest, and

other similar amounts)

Income from investment of tax-exempt bond proceeds

~~~~~~~~~~~~~~~~~ |

|

Royalties �� |

(i) Real (ii) Personal

Gross rents

Less: rental expenses

Rental income or (loss)

Net rental income or (loss)

~~~~~~~

~~~

~~

�� |

Gross amount from sales of

assets other than inventory

(i) Securities (ii) Other

Less: cost or other basis

and sales expenses

Gain or (loss)

~~~

~~~~~~~

Net gain or (loss) �� |

Gross income from fundraising events (not

including $ of

contributions reported on line 1c). See

Part IV, line 18 ~~~~~~~~~~~~~

Less: direct expenses ~~~~~~~~~~

Net income or (loss) from fundraising events �� |

Gross income from gaming activities. See

Part IV, line 19 ~~~~~~~~~~~~~

Less: direct expenses

Net income or (loss) from gaming activities

~~~~~~~~~

�� |

Gross sales of inventory, less returns

and allowances ~~~~~~~~~~~~~

Less: cost of goods sold

Net income or (loss) from sales of inventory

~~~~~~~~

�� |

Miscellaneous Revenue

All other revenue ~~~~~~~~~~~~~

Add lines 11a-11d ~~~~~~~~~~~~~~~ |

|��

9Part VIII Statement of Revenue

990

26,172,064.

MISCELLANEOUS 900099

26,172,064.


612,802.

26,786,655. 26,784,866. 0. 1,789.

45-4166209UNIVERSITY MCDUFFIE COUNTY REGIONAL

PATIENT SERVICE REVENUE 621990 26,172,064.

1,789.

0.1,789.

1,789. 1,789.

612,802.

612,802.


Check here if following SOP 98-2 (ASC 958-720)

832010 12-31-18

Total functional expenses.

Joint costs.

(A) (B) (C) (D)

1

2

3

4

5

6

7

8

9

10

11

a

b

c

d

e

f

g

12

13

14

15

16

17

18

19

20

21

22

23

24

a

b

c

d

e

25

26

Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).

Grants and other assistance to domestic organizations

and domestic governments. See Part IV, line 21

Compensation not included above, to disqualified

persons (as defined under section 4958(f)(1)) and

persons described in section 4958(c)(3)(B)

Pension plan accruals and contributions (include

section 401(k) and 403(b) employer contributions)

Professional fundraising services. See Part IV, line 17

(If line 11g amount exceeds 10% of line 25,

column (A) amount, list line 11g expenses on Sch O.)

Other expenses. Itemize expenses not covered above. (List miscellaneous expenses in line 24e. If line24e amount exceeds 10% of line 25, column (A)amount, list line 24e expenses on Schedule O.)

Add lines 1 through 24e

Complete this line only if the organization

reported in column (B) joint costs from a combined

educational campaign and fundraising solicitation.


Check if Schedule O contains a response or note to any line in this Part IX ��

Total expenses Program serviceexpenses

Management andgeneral expenses

Fundraisingexpenses

~

Grants and other assistance to domestic

individuals. See Part IV, line 22 ~~~~~~~

Grants and other assistance to foreign

organizations, foreign governments, and foreign

individuals. See Part IV, lines 15 and 16 ~~~

Benefits paid to or for members ~~~~~~~

Compensation of current officers, directors,

trustees, and key employees ~~~~~~~~

~~~

Other salaries and wages ~~~~~~~~~~

Other employee benefits ~~~~~~~~~~

Payroll taxes ~~~~~~~~~~~~~~~~

Fees for services (non-employees):

Management

Legal

Accounting

Lobbying

~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~

Investment management fees

Other.

~~~~~~~~

Advertising and promotion

Office expenses

Information technology

Royalties

~~~~~~~~~

~~~~~~~~~~~~~~~

~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~

Occupancy ~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~Travel

Payments of travel or entertainment expenses

for any federal, state, or local public officials ~

Conferences, conventions, and meetings ~~

Interest

Payments to affiliates

~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~

Depreciation, depletion, and amortization

Insurance

~~

~~~~~~~~~~~~~~~~~

All other expenses

|

Form (2018)

Do not include amounts reported on lines 6b,7b, 8b, 9b, and 10b of Part VIII.

10Statement of Functional ExpensesPart IX

990

5,059,597.

93,261.1,519,657.395,156.

2,261,205.14,669.

6,839.

2,965,352.16,438.4,861.

173,484.

353,403.5,114.

807,231.

1,920,996.180,495.

4,930,595.2,325,682.725,550.251,525.279,181.

24,290,291.

4,970,042. 89,555.

91,610. 1,651.1,492,759. 26,898.388,162. 6,994.

2,261,205.14,669.

6,839.

2,912,865. 52,487.16,438.

4,775. 86.170,413. 3,071.

347,148. 6,255.5,023. 91.

807,231.

1,886,994. 34,002.177,300. 3,195.

4,930,595.2,325,682.712,708. 12,842.

251,525.274,241. 4,940.

22,951,522. 1,338,769. 0.

BAD DEBTMED/SURG SUPPLIESREPAIRS & MAINTENANCETAXES


X


832011 12-31-18

(A) (B)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

1

2

3

4

5

6

7

8

9

10c

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

a

b

10a

10b

Asse

ts

Total assets.

Lia

bili

tie

s

Total liabilities.

Organizations that follow SFAS 117 (ASC 958), check here and

complete lines 27 through 29, and lines 33 and 34.

27

28

29

Organizations that do not follow SFAS 117 (ASC 958), check here

and complete lines 30 through 34.

30

31

32

33

34

Ne

t A

sse

ts o

r F

un

d B

ala

nc

es


Check if Schedule O contains a response or note to any line in this Part X ��

Beginning of year End of year

Cash - non-interest-bearing

Savings and temporary cash investments

Pledges and grants receivable, net

~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~

Accounts receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~~

Loans and other receivables from current and former officers, directors,

trustees, key employees, and highest compensated employees. Complete

Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Loans and other receivables from other disqualified persons (as defined under

section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing

employers and sponsoring organizations of section 501(c)(9) voluntary

employees' beneficiary organizations (see instr). Complete Part II of Sch L ~~

Notes and loans receivable, net

Inventories for sale or use

Prepaid expenses and deferred charges

~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~

Land, buildings, and equipment: cost or other

basis. Complete Part VI of Schedule D

Less: accumulated depreciation

~~~

~~~~~~

Investments - publicly traded securities

Investments - other securities. See Part IV, line 11

Investments - program-related. See Part IV, line 11

Intangible assets

~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~

~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Other assets. See Part IV, line 11 ~~~~~~~~~~~~~~~~~~~~~~

Add lines 1 through 15 (must equal line 34) ��

Accounts payable and accrued expenses

Grants payable

Deferred revenue

~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Tax-exempt bond liabilities

Escrow or custodial account liability. Complete Part IV of Schedule D

~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~

Loans and other payables to current and former officers, directors, trustees,

key employees, highest compensated employees, and disqualified persons.

Complete Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~

Secured mortgages and notes payable to unrelated third parties ~~~~~~

Unsecured notes and loans payable to unrelated third parties ~~~~~~~~

Other liabilities (including federal income tax, payables to related third

parties, and other liabilities not included on lines 17-24). Complete Part X of

Schedule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Add lines 17 through 25 ��

|

Unrestricted net assets

Temporarily restricted net assets

Permanently restricted net assets

~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~

|

Capital stock or trust principal, or current funds

Paid-in or capital surplus, or land, building, or equipment fund

Retained earnings, endowment, accumulated income, or other funds

~~~~~~~~~~~~~~~

~~~~~~~~

~~~~

Total net assets or fund balances ~~~~~~~~~~~~~~~~~~~~~~

Total liabilities and net assets/fund balances ��

Form (2018)

11Balance SheetPart X

990

3,537,644. 3,470,492.

3,833,537. 4,195,039.

21,442. 742.500,313. 452,578.241,159. 196,645.

37,826,846.10,135,659. 29,114,789. 27,691,187.

72,850. 3,797,442.37,321,734. 39,804,125.2,450,437. 2,799,378.

700,262. 1,357,405.30,692,251. 30,678,278.

X

6,629,483. 9,125,847.

6,629,483. 9,125,847.37,321,734. 39,804,125.

45-4166209MEDICAL CENTER, INC.UNIVERSITY MCDUFFIE COUNTY REGIONAL

27,541,552. 26,521,495.


832012 12-31-18

1

2

3

4

5

6

7

8

9

10

1

2

3

4

5

6

7

8

9

10

Yes No

1

2

3

a

b

c

2a

2b

2c

a

b

3a

3b


Check if Schedule O contains a response or note to any line in this Part XI ��

Total revenue (must equal Part VIII, column (A), line 12)

Total expenses (must equal Part IX, column (A), line 25)

Revenue less expenses. Subtract line 2 from line 1

Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A))

~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~

Net unrealized gains (losses) on investments

Donated services and use of facilities

Investment expenses

Prior period adjustments

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Other changes in net assets or fund balances (explain in Schedule O)

Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33,

column (B))

~~~~~~~~~~~~~~~~~~~

��

Check if Schedule O contains a response or note to any line in this Part XII ��

Accounting method used to prepare the Form 990: Cash Accrual Other

If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O.

Were the organization's financial statements compiled or reviewed by an independent accountant? ~~~~~~~~~~~~

If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a

separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis

Were the organization's financial statements audited by an independent accountant? ~~~~~~~~~~~~~~~~~~~

If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis,

consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis

If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit,

review, or compilation of its financial statements and selection of an independent accountant? ~~~~~~~~~~~~~~~

If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.

As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit

Act and OMB Circular A-133? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit

or audits, explain why in Schedule O and describe any steps taken to undergo such audits ��

Form (2018)

12Part XI Reconciliation of Net Assets

Part XII Financial Statements and Reporting

990

X


26,786,655.24,290,291.2,496,364.6,629,483.

0.

9,125,847.

X

X

X

X

X

X


(iv) Is the organization listedin your governing document?

OMB No. 1545-0047


832021 10-11-18

(i) (iii) (v) (vi)(ii) Name of supported

organization

Type of organization (described on lines 1-10 above (see instructions))

Amount of monetary

support (see instructions)

Amount of other

support (see instructions)

EIN

(Form 990 or 990-EZ)Complete if the organization is a section 501(c)(3) organization or a section

4947(a)(1) nonexempt charitable trust.| Attach to Form 990 or Form 990-EZ.

| Go to www.irs.gov/Form990 for instructions and the latest information.

Open to PublicInspection

Name of the organization Employer identification number

1

2

3

4

5

6

7

8

9

10

11

12

section 170(b)(1)(A)(i).

section 170(b)(1)(A)(ii).

section 170(b)(1)(A)(iii).

section 170(b)(1)(A)(iii).

section 170(b)(1)(A)(iv).

section 170(b)(1)(A)(v).

section 170(b)(1)(A)(vi).

section 170(b)(1)(A)(vi).

section 170(b)(1)(A)(ix)

section 509(a)(2).

section 509(a)(4).

section 509(a)(1) section 509(a)(2) section 509(a)(3).

a

b

c

d

e

f

g

Type I.

You must complete Part IV, Sections A and B.

Type II.

You must complete Part IV, Sections A and C.

Type III functionally integrated.

You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated.

You must complete Part IV, Sections A and D, and Part V.

Yes No

Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule A (Form 990 or 990-EZ) 2018

(All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in

A school described in (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in

A medical research organization operated in conjunction with a hospital described in Enter the hospital's name,

city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

(Complete Part II.)

A federal, state, or local government or governmental unit described in

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

(Complete Part II.)

A community trust described in (Complete Part II.)

An agricultural research organization described in operated in conjunction with a land-grant college

or university or a non-land-grant college of agriculture (see instructions). Enter the name, city, and state of the college or

university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from

activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment

income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975.

See (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or

more publicly supported organizations described in or . See Check the box in

lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving

the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting

organization.

A supporting organization supervised or controlled in connection with its supported organization(s), by having

control or management of the supporting organization vested in the same persons that control or manage the supported

organization(s).

A supporting organization operated in connection with, and functionally integrated with,

its supported organization(s) (see instructions).

A supporting organization operated in connection with its supported organization(s)

that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness

requirement (see instructions).

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III

functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Provide the following information about the supported organization(s).

LHA

SCHEDULE A

Part I Reason for Public Charity Status

Public Charity Status and Public Support2018

X

UNIVERSITY MCDUFFIE COUNTY REGIONAL45-4166209MEDICAL CENTER, INC.


Subtract line 5 from line 4.

832022 10-11-18

Calendar year (or fiscal year beginning in)

Calendar year (or fiscal year beginning in) |

2

(a) (b) (c) (d) (e) (f)

1

2

3

4

5

Total.

6 Public support.

(a) (b) (c) (d) (e) (f)

7

8

9

10

11

12

13

Total support.

12

First five years.

stop here

14

15

14

15

16

17

18

a

b

a

b

33 1/3% support test - 2018.

stop here.

33 1/3% support test - 2017.

stop here.

10% -facts-and-circumstances test - 2018.

stop here.

10% -facts-and-circumstances test - 2017.

stop here.

Private foundation.

Schedule A (Form 990 or 990-EZ) 2018

|

Add lines 7 through 10

Schedule A (Form 990 or 990-EZ) 2018 Page

(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization

fails to qualify under the tests listed below, please complete Part III.)

2014 2015 2016 2017 2018 Total

Gifts, grants, contributions, and

membership fees received. (Do not

include any "unusual grants.") ~~

Tax revenues levied for the organ-

ization's benefit and either paid to

or expended on its behalf ~~~~

The value of services or facilities

furnished by a governmental unit to

the organization without charge ~

Add lines 1 through 3 ~~~

The portion of total contributions

by each person (other than a

governmental unit or publicly

supported organization) included

on line 1 that exceeds 2% of the

amount shown on line 11,

column (f) ~~~~~~~~~~~~

2014 2015 2016 2017 2018 Total

Amounts from line 4 ~~~~~~~

Gross income from interest,

dividends, payments received on

securities loans, rents, royalties,

and income from similar sources ~

Net income from unrelated business

activities, whether or not the

business is regularly carried on ~

Other income. Do not include gain

or loss from the sale of capital

assets (Explain in Part VI.) ~~~~

Gross receipts from related activities, etc. (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~

If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3)

organization, check this box and �� |

~~~~~~~~~~~~Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f))

Public support percentage from 2017 Schedule A, Part II, line 14

%

%~~~~~~~~~~~~~~~~~~~~~

If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and

The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |

If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box

and The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |

If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more,

and if the organization meets the "facts-and-circumstances" test, check this box and Explain in Part VI how the organization

meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~ |

If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or

more, and if the organization meets the "facts-and-circumstances" test, check this box and Explain in Part VI how the

organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~ |

If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions �� |

Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)

Section A. Public Support

Section B. Total Support

Section C. Computation of Public Support Percentage



(Subtract line 7c from line 6.)

Amounts included on lines 2 and 3 received

from other than disqualified persons that

exceed the greater of $5,000 or 1% of the

amount on line 13 for the year

(Add lines 9, 10c, 11, and 12.)

832023 10-11-18



Total support.

3

(a) (b) (c) (d) (e) (f)

1

2

3

4

5

6

7

Total.

a

b

c

8 Public support.

(a) (b) (c) (d) (e) (f)

9

10a

b

c11

12

13

14 First five years.

stop here

15

16

15

16

17

18

19

20

2018

2017

17

18

a

b

33 1/3% support tests - 2018.

stop here.

33 1/3% support tests - 2017.

stop here.

Private foundation.


Unrelated business taxable income

(less section 511 taxes) from businesses

acquired after June 30, 1975


(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to

qualify under the tests listed below, please complete Part II.)

2014 2015 2016 2017 2018 Total

Gifts, grants, contributions, and

membership fees received. (Do not

include any "unusual grants.") ~~

Gross receipts from admissions,merchandise sold or services per-formed, or facilities furnished inany activity that is related to theorganization's tax-exempt purpose

Gross receipts from activities that

are not an unrelated trade or bus-

iness under section 513 ~~~~~

Tax revenues levied for the organ-

ization's benefit and either paid to

or expended on its behalf ~~~~

The value of services or facilities

furnished by a governmental unit to

the organization without charge ~

~~~ Add lines 1 through 5

Amounts included on lines 1, 2, and

3 received from disqualified persons

~~~~~~

Add lines 7a and 7b ~~~~~~~

2014 2015 2016 2017 2018 Total

Amounts from line 6 ~~~~~~~

Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources ~

~~~~

Add lines 10a and 10b ~~~~~~Net income from unrelated businessactivities not included in line 10b, whether or not the business is regularly carried on ~~~~~~~Other income. Do not include gainor loss from the sale of capitalassets (Explain in Part VI.) ~~~~

If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,

check this box and �� |

Public support percentage for 2018 (line 8, column (f), divided by line 13, column (f))

Public support percentage from 2017 Schedule A, Part III, line 15

~~~~~~~~~~~ %

%��

Investment income percentage for (line 10c, column (f), divided by line 13, column (f))

Investment income percentage from Schedule A, Part III, line 17

~~~~~~~~ %

%~~~~~~~~~~~~~~~~~~

If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not

more than 33 1/3%, check this box and The organization qualifies as a publicly supported organization ~~~~~~~~~~ |

If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and

line 18 is not more than 33 1/3%, check this box and The organization qualifies as a publicly supported organization ~~~~ |

If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions �� |

Part III Support Schedule for Organizations Described in Section 509(a)(2)

Section A. Public Support

Section B. Total Support

Section C. Computation of Public Support Percentage

Section D. Computation of Investment Income Percentage



832024 10-11-18

4

Yes No

1

2

3

4

5

6

7

8

9

10

Part VI

1

2

3a

3b

3c

4a

4b

4c

5a

5b

5c

6

7

8

9a

9b

9c

10a

10b

Part VI

a

b

c

a

b

c

a

b

c

a

b

c

a

b

Part VI

Part VI

Part VI

Part VI

Part VI,

Type I or Type II only.

Substitutions only.

Part VI.

Part VI.

Part VI.

Part VI.


If "No," describe in how the supported organizations are designated. If designated by

class or purpose, describe the designation. If historic and continuing relationship, explain.

If "Yes," explain in how the organization determined that the supported

organization was described in section 509(a)(1) or (2).

If "Yes," answer

(b) and (c) below.

If "Yes," describe in when and how the

organization made the determination.

If "Yes," explain in what controls the organization put in place to ensure such use.

If

"Yes," and if you checked 12a or 12b in Part I, answer (b) and (c) below.

If "Yes," describe in how the organization had such control and discretion

despite being controlled or supervised by or in connection with its supported organizations.

If "Yes," explain in what controls the organization used

to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B)

purposes.

If "Yes,"

answer (b) and (c) below (if applicable). Also, provide detail in including (i) the names and EIN

numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action;

(iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action

was accomplished (such as by amendment to the organizing document).

If "Yes," provide detail in

If "Yes," complete Part I of Schedule L (Form 990 or 990-EZ).

If "Yes," complete Part I of Schedule L (Form 990 or 990-EZ).




If "Yes," answer 10b below.

(Use Schedule C, Form 4720, to

determine whether the organization had excess business holdings.)


(Complete only if you checked a box in line 12 on Part I. If you checked 12a of Part I, complete Sections A

and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete

Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Are all of the organization's supported organizations listed by name in the organization's governing

documents?

Did the organization have any supported organization that does not have an IRS determination of status

under section 509(a)(1) or (2)?

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)?

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and

satisfied the public support tests under section 509(a)(2)?

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B)

purposes?

Was any supported organization not organized in the United States ("foreign supported organization")?

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign

supported organization?

Did the organization support any foreign supported organization that does not have an IRS determination

under sections 501(c)(3) and 509(a)(1) or (2)?

Did the organization add, substitute, or remove any supported organizations during the tax year?

Was any added or substituted supported organization part of a class already

designated in the organization's organizing document?

Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to

anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class

benefited by one or more of its supported organizations, or (iii) other supporting organizations that also

support or benefit one or more of the filing organization's supported organizations?

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor

(as defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with

regard to a substantial contributor?

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7?

Was the organization controlled directly or indirectly at any time during the tax year by one or more

disqualified persons as defined in section 4946 (other than foundation managers and organizations described

in section 509(a)(1) or (2))?

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which

the supporting organization had an interest?

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit

from, assets in which the supporting organization also had an interest?

Was the organization subject to the excess business holdings rules of section 4943 because of section

4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated

supporting organizations)?

Did the organization have any excess business holdings in the tax year?

Part IV Supporting Organizations

Section A. All Supporting Organizations



832025 10-11-18

5

Yes No

11

a

b

c

11a

11b

11cPart VI.

Yes No

1

2

Part VI

1

2

Part VI

Yes No

1

Part VI

1

Yes No

1

2

3

1

2

3

Part VI

Part VI

1

2

3

(see instructions).

a

b

c

line 2

line 3

Part VI

Answer (a) and (b) below. Yes No

a

b

a

b

Part VI identify

those supported organizations and explain

2a

2b

3a

3b

Part VI

Answer (a) and (b) below.

Part VI.

Part VI


If "Yes" to a, b, or c, provide detail in

If "No," describe in how the supported organization(s) effectively operated, supervised, or

controlled the organization's activities. If the organization had more than one supported organization,

describe how the powers to appoint and/or remove directors or trustees were allocated among the supported

organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

If "Yes," explain in

how providing such benefit carried out the purposes of the supported organization(s) that operated,

supervised, or controlled the supporting organization.

If "No," describe in how control

or management of the supporting organization was vested in the same persons that controlled or managed

the supported organization(s).

If "No," explain in how

the organization maintained a close and continuous working relationship with the supported organization(s).

If "Yes," describe in the role the organization's

supported organizations played in this regard.

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year

Complete below.

Complete below.

Describe in how you supported a government entity (see instructions).

If "Yes," then in

how these activities directly furthered their exempt purposes,

how the organization was responsive to those supported organizations, and how the organization determined

that these activities constituted substantially all of its activities.

If "Yes," explain in the

reasons for the organization's position that its supported organization(s) would have engaged in these

activities but for the organization's involvement.

Provide details in

If "Yes," describe in the role played by the organization in this regard.


Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c)

below, the governing body of a supported organization?

A family member of a person described in (a) above?

A 35% controlled entity of a person described in (a) or (b) above?

Did the directors, trustees, or membership of one or more supported organizations have the power to

regularly appoint or elect at least a majority of the organization's directors or trustees at all times during the

tax year?

Did the organization operate for the benefit of any supported organization other than the supported

organization(s) that operated, supervised, or controlled the supporting organization?

Were a majority of the organization's directors or trustees during the tax year also a majority of the directors

or trustees of each of the organization's supported organization(s)?

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the

organization's tax year, (i) a written notice describing the type and amount of support provided during the prior tax

year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the

organization's governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization's officers, directors, or trustees either (i) appointed or elected by the supported

organization(s) or (ii) serving on the governing body of a supported organization?

By reason of the relationship described in (2), did the organization's supported organizations have a

significant voice in the organization's investment policies and in directing the use of the organization's

income or assets at all times during the tax year?

The organization satisfied the Activities Test.

The organization is the parent of each of its supported organizations.

The organization supported a governmental entity.

Activities Test.

Did substantially all of the organization's activities during the tax year directly further the exempt purposes of

the supported organization(s) to which the organization was responsive?

Did the activities described in (a) constitute activities that, but for the organization's involvement, one or more

of the organization's supported organization(s) would have been engaged in?

Parent of Supported Organizations.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or

trustees of each of the supported organizations?

Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each

of its supported organizations?

(continued)Part IV Supporting Organizations

Section B. Type I Supporting Organizations

Section C. Type II Supporting Organizations

Section D. All Type III Supporting Organizations

Section E. Type III Functionally Integrated Supporting Organizations



832026 10-11-18

6

1 See instructions.

Section A - Adjusted Net Income

1

2

3

4

5

6

7

8

1

2

3

4

5

6

7

8Adjusted Net Income

Section B - Minimum Asset Amount

1

2

3

4

5

6

7

8

a

b

c

d

e

1a

1b

1c

1d

2

3

4

5

6

7

8

Total

Discount

Part VI

Minimum Asset Amount

Section C - Distributable Amount

1

2

3

4

5

6

7

1

2

3

4

5

6

Distributable Amount.



Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI.) All

other Type III non-functionally integrated supporting organizations must complete Sections A through E.

(B) Current Year(optional)(A) Prior Year

Net short-term capital gain

Recoveries of prior-year distributions

Other gross income (see instructions)

Add lines 1 through 3

Depreciation and depletion

Portion of operating expenses paid or incurred for production or

collection of gross income or for management, conservation, or

maintenance of property held for production of income (see instructions)

Other expenses (see instructions)

(subtract lines 5, 6, and 7 from line 4)

(B) Current Year(optional)(A) Prior Year

Aggregate fair market value of all non-exempt-use assets (see

instructions for short tax year or assets held for part of year):

Average monthly value of securities

Average monthly cash balances

Fair market value of other non-exempt-use assets

(add lines 1a, 1b, and 1c)

claimed for blockage or other

factors (explain in detail in ):

Acquisition indebtedness applicable to non-exempt-use assets

Subtract line 2 from line 1d

Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount,

see instructions)

Net value of non-exempt-use assets (subtract line 4 from line 3)

Multiply line 5 by .035

Recoveries of prior-year distributions

(add line 7 to line 6)

Current Year

Adjusted net income for prior year (from Section A, line 8, Column A)

Enter 85% of line 1

Minimum asset amount for prior year (from Section B, line 8, Column A)

Enter greater of line 2 or line 3

Income tax imposed in prior year

Subtract line 5 from line 4, unless subject to

emergency temporary reduction (see instructions)

Check here if the current year is the organization's first as a non-functionally integrated Type III supporting organization (see

instructions).

Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations



832027 10-11-18

7

Section D - Distributions Current Year

1

2

3

4

5

6

7

8

9

10

Part VI

Total annual distributions.

Part VI

(i)

Excess Distributions

(ii)Underdistributions

Pre-2018

(iii)Distributable

Amount for 2018Section E - Distribution Allocations

1

2

3

4

5

6

7

8

Part VI

a

b

c

d

e

f

g

h

i

j

Total

a

b

c

Part VI.

Part VI

Excess distributions carryover to 2019.

a

b

c

d

e



Amounts paid to supported organizations to accomplish exempt purposes

Amounts paid to perform activity that directly furthers exempt purposes of supported

organizations, in excess of income from activity

Administrative expenses paid to accomplish exempt purposes of supported organizations

Amounts paid to acquire exempt-use assets

Qualified set-aside amounts (prior IRS approval required)

Other distributions (describe in ). See instructions.

Add lines 1 through 6.

Distributions to attentive supported organizations to which the organization is responsive

(provide details in ). See instructions.

Distributable amount for 2018 from Section C, line 6

Line 8 amount divided by line 9 amount

(see instructions)

Distributable amount for 2018 from Section C, line 6

Underdistributions, if any, for years prior to 2018 (reason-

able cause required- explain in ). See instructions.

Excess distributions carryover, if any, to 2018

From 2013

From 2014

From 2015

From 2016

From 2017

of lines 3a through e

Applied to underdistributions of prior years

Applied to 2018 distributable amount

Carryover from 2013 not applied (see instructions)

Remainder. Subtract lines 3g, 3h, and 3i from 3f.

Distributions for 2018 from Section D,

line 7: $

Applied to underdistributions of prior years

Applied to 2018 distributable amount

Remainder. Subtract lines 4a and 4b from 4.

Remaining underdistributions for years prior to 2018, if

any. Subtract lines 3g and 4a from line 2. For result greater

than zero, explain in See instructions.

Remaining underdistributions for 2018. Subtract lines 3h

and 4b from line 1. For result greater than zero, explain in

. See instructions.

Add lines 3j

and 4c.

Breakdown of line 7:

Excess from 2014

Excess from 2015

Excess from 2016

Excess from 2017

Excess from 2018

(continued) Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations



832028 10-11-18

8



Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12;Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C,line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a, and 3b; Part V, line 1; Part V, Section B, line 1e; Part V,Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information.(See instructions.)

Part VI Supplemental Information.



OMB No. 1545-0047


832041 11-08-18

(Form 990 or 990-EZ)For Organizations Exempt From Income Tax Under section 501(c) and section 527


Complete if the organization is described below. Attach to Form 990 or Form 990-EZ.

| Go to www.irs.gov/Form990 for instructions and the latest information.

If the organization answered "Yes," on Form 990, Part IV, line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then

If the organization answered "Yes," on Form 990, Part IV, line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then

If the organization answered "Yes," on Form 990, Part IV, line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (ProxyTax) (see separate instructions), then


1

2

3

1

2

3

4

Yes No

a

b

Yes No

1

2

3

4

5

Form 1120-POL Yes No

(a) (b) (c) (d) (e)

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule C (Form 990 or 990-EZ) 2018

¥ Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.

¥ Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.

¥ Section 527 organizations: Complete Part I-A only.

¥ Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.

¥ Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.

¥ Section 501(c)(4), (5), or (6) organizations: Complete Part III.Name of organization

Provide a description of the organization's direct and indirect political campaign activities in Part IV.

Political campaign activity expenditures

Volunteer hours for political campaign activities

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter the amount of any excise tax incurred by the organization under section 4955

Enter the amount of any excise tax incurred by organization managers under section 4955

If the organization incurred a section 4955 tax, did it file Form 4720 for this year?

~~~~~~~~~~~~~ $

~~~~~~~~~~ $

~~~~~~~~~~~~~~~~~~~

Was a correction made?

If "Yes," describe in Part IV.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter the amount directly expended by the filing organization for section 527 exempt function activities

Enter the amount of the filing organization's funds contributed to other organizations for section 527

exempt function activities

~~~~ $

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL,

line 17b

Did the filing organization file for this year?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ $

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing organization

made payments. For each organization listed, enter the amount paid from the filing organization's funds. Also enter the amount of political

contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a

political action committee (PAC). If additional space is needed, provide information in Part IV.

Name Address EIN Amount paid fromfiling organization's

funds. If none, enter -0-.

Amount of politicalcontributions received and

promptly and directlydelivered to a separatepolitical organization.

If none, enter -0-.

LHA

SCHEDULE C

Part I-A Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Part I-B Complete if the organization is exempt under section 501(c)(3).

Part I-C Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Political Campaign and Lobbying Activities

2018J J

J

JJ

J

J

J



832042 11-08-18

If the amount on line 1e, column (a) or (b) is:

2

A

B

Limits on Lobbying Expenditures(The term "expenditures" means amounts paid or incurred.)

(a) (b)

1a

b

c

d

e

f

The lobbying nontaxable amount is:

g

h

i

j

Yes No

4-Year Averaging Period Under Section 501(h)(Some organizations that made a section 501(h) election do not have to complete all of the five columns below.

See the separate instructions for lines 2a through 2f.)

Lobbying Expenditures During 4-Year Averaging Period

(a) (b) (c) (d) (e)

2a

b

c

d

e

f

Schedule C (Form 990 or 990-EZ) 2018

Schedule C (Form 990 or 990-EZ) 2018 Page

Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN,

expenses, and share of excess lobbying expenditures).

Check if the filing organization checked box A and "limited control" provisions apply.

Filingorganization's

totals

Affiliated grouptotals

Total lobbying expenditures to influence public opinion (grass roots lobbying)

Total lobbying expenditures to influence a legislative body (direct lobbying)

~~~~~~~~~~

~~~~~~~~~~~

Total lobbying expenditures (add lines 1a and 1b)

Other exempt purpose expenditures

~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Total exempt purpose expenditures (add lines 1c and 1d)

Lobbying nontaxable amount. Enter the amount from the following table in both columns.

~~~~~~~~~~~~~~~~~~~~

Not over $500,000

Over $500,000 but not over $1,000,000

Over $1,000,000 but not over $1,500,000

Over $1,500,000 but not over $17,000,000

Over $17,000,000

20% of the amount on line 1e.

$100,000 plus 15% of the excess over $500,000.

$175,000 plus 10% of the excess over $1,000,000.

$225,000 plus 5% of the excess over $1,500,000.

$1,000,000.

Grassroots nontaxable amount (enter 25% of line 1f)

Subtract line 1g from line 1a. If zero or less, enter -0-

Subtract line 1f from line 1c. If zero or less, enter -0-

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~

If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720

reporting section 4911 tax for this year? ��

Calendar year (or fiscal year beginning in)

2015 2016 2017 2018 Total

Lobbying nontaxable amount

Lobbying ceiling amount

(150% of line 2a, column(e))

Total lobbying expenditures

Grassroots nontaxable amount

Grassroots ceiling amount

(150% of line 2d, column (e))

Grassroots lobbying expenditures

Part II-A Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election undersection 501(h)).

J

J



832043 11-08-18

3

(a) (b)

Yes No Amount

1

a

b

c

d

e

f

g

h

i

j

a

b

c

d

2

Yes No

1

2

3

1

2

3

1

2

3

4

5

(do not include amounts of political

expenses for which the section 527(f) tax was paid).

1

2a

2b

2c

3

4

5

a

b

c

Schedule C (Form 990 or 990-EZ) 2018

For each "Yes," response on lines 1a through 1i below, provide in Part IV a detailed description

of the lobbying activity.

Schedule C (Form 990 or 990-EZ) 2018 Page

During the year, did the filing organization attempt to influence foreign, national, state, or

local legislation, including any attempt to influence public opinion on a legislative matter

or referendum, through the use of:

Volunteers?

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)?

Media advertisements?

Mailings to members, legislators, or the public?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~

Publications, or published or broadcast statements?

Grants to other organizations for lobbying purposes?

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~

Direct contact with legislators, their staffs, government officials, or a legislative body?

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means?

Other activities?

~~~~~~

~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Total. Add lines 1c through 1i

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)?

If "Yes," enter the amount of any tax incurred under section 4912

If "Yes," enter the amount of any tax incurred by organization managers under section 4912

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~

~~~~~~~~~~~~~~~~

~~~

��

Were substantially all (90% or more) dues received nondeductible by members?

Did the organization make only in-house lobbying expenditures of $2,000 or less?

Did the organization agree to carry over lobbying and political campaign activity expenditures from the prior year?

~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~

Dues, assessments and similar amounts from members

Section 162(e) nondeductible lobbying and political expenditures

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Current year

Carryover from last year

Total

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess

does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political

expenditure next year?

~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Taxable amount of lobbying and political expenditures (see instructions) ��

Provide the descriptions required for Part I-A, line 1; Part I-B, line 4; Part I-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see

instructions); and Part II-B, line 1. Also, complete this part for any additional information.

Part II-B Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768(election under section 501(h)).

Part III-A Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Part III-B Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No," OR (b) Part III-A, line 3, isanswered "Yes."

Part IV Supplemental Information

DESCRIPTION OF LOBBYING ACTIVITY

A PART OF VARIOUS ASSOCIATION DUES INCLUDE A PERCENTAGE ALLOCATION FOR

EXPENDITURES ON LOBBYING ACTIVITIES. DUES PAID TO THE GEORGIA ALLIANCE

OF COMMUNITY HOSPITALS AND THE AMERICAN HOSPITAL ASSOCIATION HAVE A

LOBBY COMPONENT. FOR 2018 THESE FEES AMOUNTED TO $6,839.

6,839.6,839.

X

XXXXXXXX

X

PART II-B, LINE 1, LOBBYING ACTIVITIES:



OMB No. 1545-0047


832051 10-29-18

Held at the End of the Tax Year

(Form 990) | Complete if the organization answered "Yes" on Form 990,Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.

| Attach to Form 990.|Go to www.irs.gov/Form990 for instructions and the latest information.



(a) (b)

1

2

3

4

5

6

Yes No

Yes No

1

2

3

4

5

6

7

8

9

a

b

c

d

2a

2b

2c

2d

Yes No

Yes No

1

2

a

b

(i)

(ii)

a

b

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule D (Form 990) 2018

Complete if the

organization answered "Yes" on Form 990, Part IV, line 6.

Donor advised funds Funds and other accounts

Total number at end of year

Aggregate value of contributions to (during year)

Aggregate value of grants from (during year)

Aggregate value at end of year

~~~~~~~~~~~~~~~

~~~~

~~~~~~

~~~~~~~~~~~~~

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds

are the organization's property, subject to the organization's exclusive legal control? ~~~~~~~~~~~~~~~~~~

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only

for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring

impermissible private benefit? ��

Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education)

Protection of natural habitat

Preservation of open space

Preservation of a historically important land area

Preservation of a certified historic structure

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last

day of the tax year.

Total number of conservation easements

Total acreage restricted by conservation easements

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

Number of conservation easements on a certified historic structure included in (a)

Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure

listed in the National Register

~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax

year |

Number of states where property subject to conservation easement is located |

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of

violations, and enforcement of the conservation easements it holds? ~~~~~~~~~~~~~~~~~~~~~~~~~

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year

|

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year

| $

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i)

and section 170(h)(4)(B)(ii)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and

include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for

conservation easements.


If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art,

historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII,

the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical

treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts

relating to these items:

Revenue included on Form 990, Part VIII, line 1

Assets included in Form 990, Part X

~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $

$~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide

the following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1

Assets included in Form 990, Part X

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $

$�� |

LHA

Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.

Part II Conservation Easements.

Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.

SCHEDULE D Supplemental Financial Statements2018



832052 10-29-18

3

4

5

a

b

c

d

e

Yes No

1

2

a

b

c

d

e

f

a

b

Yes No

1c

1d

1e

1f

Yes No

(a) (b) (c) (d) (e)

1

2

3

4

a

b

c

d

e

f

g

a

b

c

a

b

Yes No

(i)

(ii)

3a(i)

3a(ii)

3b

(a) (b) (c) (d)

1a

b

c

d

e

Total.

Schedule D (Form 990) 2018

(continued)

(Column (d) must equal Form 990, Part X, column (B), line 10c.)

Two years back Three years back Four years back

Schedule D (Form 990) 2018 Page

Using the organization's acquisition, accession, and other records, check any of the following that are a significant use of its collection items

(check all that apply):

Public exhibition

Scholarly research

Preservation for future generations

Loan or exchange programs

Other

Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets

to be sold to raise funds rather than to be maintained as part of the organization's collection? ��

Complete if the organization answered "Yes" on Form 990, Part IV, line 9, orreported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included

on Form 990, Part X?

If "Yes," explain the arrangement in Part XIII and complete the following table:

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Amount

Beginning balance

Additions during the year

Distributions during the year

Ending balance

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided on Part XIII

~~~~~

��


Current year Prior year

Beginning of year balance

Contributions

Net investment earnings, gains, and losses

Grants or scholarships

~~~~~~~

~~~~~~~~~~~~~~

~~~~~~~~~

Other expenditures for facilities

and programs

Administrative expenses

End of year balance

~~~~~~~~~~~~~

~~~~~~~~

~~~~~~~~~~

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment

Permanent endowment

Temporarily restricted endowment

The percentages on lines 2a, 2b, and 2c should equal 100%.

| %

| %

| %

Are there endowment funds not in the possession of the organization that are held and administered for the organization

by:

unrelated organizations

related organizations

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If "Yes" on line 3a(ii), are the related organizations listed as required on Schedule R?

Describe in Part XIII the intended uses of the organization's endowment funds.

~~~~~~~~~~~~~~~~~~~~

Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property Cost or otherbasis (investment)

Cost or otherbasis (other)

Accumulateddepreciation

Book value

Land

Buildings

Leasehold improvements

~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~

~~~~~~~~~~

Equipment

Other

~~~~~~~~~~~~~~~~~

��

Add lines 1a through 1e. |��

2Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets

Part IV Escrow and Custodial Arrangements.

Part V Endowment Funds.

Part VI Land, Buildings, and Equipment.

1,446,149.25,474,113.

474,994.10,194,541.

237,049.

2,550,194.327,257.

7,258,208.

1,446,149.22,923,919.

147,737.2,936,333.237,049.

27,691,187.



(including name of security)

832053 10-29-18

Total.

Total.

(a) (b) (c)

(1)

(2)

(3)

(a) (b) (c)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(a) (b)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

Total.

(a) (b) 1.

Total.

2.


(Column (b) must equal Form 990, Part X, col. (B) line 15.)

(Column (b) must equal Form 990, Part X, col. (B) line 25.)

Description of security or category

(Col. (b) must equal Form 990, Part X, col. (B) line 12.) |

(Col. (b) must equal Form 990, Part X, col. (B) line 13.) |


Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

Book value Method of valuation: Cost or end-of-year market value

Financial derivatives

Closely-held equity interests

Other

~~~~~~~~~~~~~~~

~~~~~~~~~~~

(A)

(B)

(C)

(D)

(E)

(F)

(G)

(H)

Complete if the organization answered "Yes" on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.Description of investment Book value Method of valuation: Cost or end-of-year market value

Complete if the organization answered "Yes" on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

Description Book value

�� |

Complete if the organization answered "Yes" on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

Description of liability Book value

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

Federal income taxes

�� |

Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the

organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

3Part VII Investments - Other Securities.

Part VIII Investments - Program Related.

Part IX Other Assets.

Part X Other Liabilities.


PHYSICIAN GUARANTEE ASSETDUE FROM UECDUE FROM UHS

LONG-TERM CAPITAL LEASE OBLIGATIONDUE TO UNIVERSITY MEDICAL GROUPMISC/HOLDING ACCOUNT - DSH/UPLPHYSICAN GUARANTEE LIABILITY

45-4166209

102,951.10,620.

3,683,871.

3,797,442.

67,690.877,640.401,591.10,484.

1,357,405.


X


832054 10-29-18

1

2

3

4

5

1

a

b

c

d

e

2a

2b

2c

2d

2a 2d 2e

32e 1

a

b

c

4a

4b

4a 4b

3 4c.

4c

5

1

2

3

4

5

1

a

b

c

d

e

2a

2b

2c

2d

2a 2d

2e 1

2e

3

a

b

c

4a

4b

4a 4b

3 4c.

4c

5


(This must equal Form 990, Part I, line 12.)

(This must equal Form 990, Part I, line 18.)


Complete if the organization answered "Yes" on Form 990, Part IV, line 12a.

Total revenue, gains, and other support per audited financial statements

Amounts included on line 1 but not on Form 990, Part VIII, line 12:

~~~~~~~~~~~~~~~~~~~

Net unrealized gains (losses) on investments


Recoveries of prior year grants

Other (Describe in Part XIII.)

~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

Add lines through ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Subtract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Amounts included on Form 990, Part VIII, line 12, but not on line 1:

Investment expenses not included on Form 990, Part VIII, line 7b


~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

Add lines and

Total revenue. Add lines and

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

��

Complete if the organization answered "Yes" on Form 990, Part IV, line 12a.

Total expenses and losses per audited financial statements

Amounts included on line 1 but not on Form 990, Part IX, line 25:

~~~~~~~~~~~~~~~~~~~~~~~~~~


Prior year adjustments

Other losses


~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

Add lines through

Subtract line from line

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Amounts included on Form 990, Part IX, line 25, but not on line 1:

Investment expenses not included on Form 990, Part VIII, line 7b


~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~

Add lines and

Total expenses. Add lines and

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

��

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI,

lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

4Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return.

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return.

Part XIII Supplemental Information.

FIN 48 FOOTNOTE

ACCOUNTING FOR INCOME TAXES-

UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, 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 ACCOMPANYING FINANCIAL STATEMENTS DO NOT REFLECT A

PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. UNIVERSITY

PART X, LINE 2:


MCDUFFIE COUNTY REGIONAL MEDICAL CENTER, INC. HAS EVALUATED THEIR TAX

POSITION AND DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED

TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2018.


832055 10-29-18

5


(continued)Schedule D (Form 990) 2018 Page Part XIII Supplemental Information



OMB No. 1545-0047


If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospitalfacilities during the tax year.

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the"medically indigent"?

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Number ofactivities or

programs (optional)

Personsserved

(optional)

Total communitybenefit expense

Direct offsettingrevenue

Net communitybenefit expense

Percentof total

expense

Financial Assistance and

Means-Tested Government Programs

832091 11-09-18

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.


Attach to Form 990. | Go to www.irs.gov/Form990 for instructions and the latest information.


Yes No

1

2

3

a

b

1a

1b

3a

3b

4

5a

5b

5c

6a

6b

a

b

c

4

5

6

7

a

b

c

a

b

(a) (b) (c) (d) (e) (f) Financial Assistance and

Means-Tested Government Programs

a

b

c

d Total.

Other Benefits

e

f

g

h

i

j

k

Total.

Total.

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule H (Form 990) 2018

free

discounted

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year?

|

|

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a

If "Yes," was it a written policy?

~~~~~~~~~~~

��

Applied uniformly to all hospital facilities

Generally tailored to individual hospital facilities

Applied uniformly to most hospital facilities

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care: ~~~~~~~~~~~~~

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing care? If "Yes," indicate which

of the following was the family income limit for eligibility for discounted care: ~~~~~~~~~~~~~~~~~~~~~~~~

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determiningeligibility for free or discounted care. Include in the description whether the organization used an asset test or otherthreshold, regardless of income, as a factor in determining eligibility for free or discounted care.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted

care to a patient who was eligible for free or discounted care?

~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the organization prepare a community benefit report during the tax year?

If "Yes," did the organization make it available to the public?

~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance at cost (from

Worksheet 1)

Medicaid (from Worksheet 3,

column a)

~~~~~~~~~~

~~~~~~~~~~~

Costs of other means-tested

government programs (from

Worksheet 3, column b) ~~~~~

��

Community health

improvement services and

community benefit operations

(from Worksheet 4) ~~~~~~~

Health professions education


Subsidized health services


Research (from Worksheet 7)

Cash and in-kind contributions

for community benefit (from

Worksheet 8)

~~

~~~~~~~~~

Other Benefits

Add lines 7d and 7j

~~~~~~

��

LHA

SCHEDULE H(Form 990)

Part I Financial Assistance and Certain Other Community Benefits at Cost

Hospitals2018

UNIVERSITY MCDUFFIE COUNTY REGIONAL45-4166209

XX

X

X

XXX

XX

X

X

1738004.

3034769.

4772773.

951,378.

951,378.5724151.

437,397.

1820582.

2257979.

188,307.

188,307.2446286.

1300607.

1214187.

2514794.

763,071.

763,071.3277865.

6.72%

6.27%

12.99%

3.94%

3.94%16.93%



Number ofactivities or programs

(optional)

Personsserved (optional)

Total community

building expense

Directoffsetting revenue

Net community

building expense

Percent of

total expense

(owned 10% or more by officers, directors, trustees, key employees, and physicians - see instructions)

832092 11-09-18

2

(a) (b) (c) (d) (e) (f)

1

2

3

4

5

6

7

8

9

10 Total

Yes NoSection A. Bad Debt Expense

1

2

3

4

1

2

3

Section B. Medicare

5

6

7

8

5

6

7

Section C. Collection Practices

9a

b

9a

9b

(a) (b) (c) (d) (e)

Schedule H (Form 990) 2018

Physical improvements and housing

If "Yes," did the organization's collection policy that applied to the largest number of its patients during the tax year contain provisions on the

collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI

Schedule H (Form 990) 2018 Page

Complete this table if the organization conducted any community building activities during the

tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

Economic development

Community support

Environmental improvements

Leadership development and

training for community members

Coalition building

Community health improvement

advocacy

Workforce development

Other

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association

Statement No. 15? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Enter the amount of the organization's bad debt expense. Explain in Part VI the

methodology used by the organization to estimate this amount

Enter the estimated amount of the organization's bad debt expense attributable to

patients eligible under the organization's financial assistance policy. Explain in Part VI the

methodology used by the organization to estimate this amount and the rationale, if any,

for including this portion of bad debt as community benefit

~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt

expense or the page number on which this footnote is contained in the attached financial statements.

Enter total revenue received from Medicare (including DSH and IME)

Enter Medicare allowable costs of care relating to payments on line 5

Subtract line 6 from line 5. This is the surplus (or shortfall)

~~~~~~~~~~~~

~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.

Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.

Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Did the organization have a written debt collection policy during the tax year? ~~~~~~~~~~~~~~~~~~~~~~~

��

Name of entity Description of primaryactivity of entity

Organization'sprofit % or stock

ownership %

Officers, direct-ors, trustees, orkey employees'profit % or stock

ownership %

Physicians'profit % or

stockownership %

Part II Community Building Activities

Part III Bad Debt, Medicare, & Collection Practices

Part IV Management Companies and Joint Ventures

4,930,595.

493,060.

4,229,690.4,566,618.-336,928.

X

X

X

X



Facility

reporting

group

832093 11-09-18

3

Section A. Hospital Facilities


Gen

. med

ical

& s

urgi

cal


(list in order of size, from largest to smallest)

How many hospital facilities did the organization operateduring the tax year?

Name, address, primary website address, and state license number(and if a group return, the name and EIN of the subordinate hospitalorganization that operates the hospital facility)

Lic

en

sed

ho

spital

Ch

ildre

n's

ho

spital

Teach

ing

ho

spital

Critical a

ccess

ho

spital

Rese

arc

h f

acili

ty

ER

-24

ho

urs

ER

-oth

er

Other (describe)

Part V Facility Information

1 UNIVERSITY MCDUFFIE REGIONAL MEDICAL C

097-107 WWW.MRMC.ORG

2460 WASHINGTON ROAD, NE THOMSON, GA 30824


11/15/15X X

SWING-BED CERTIFIEDBY MEDICARE

X

1


832094 11-09-18

4

Section B. Facility Policies and Practices

Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital

facilities in a facility reporting group (from Part V, Section A):

Yes No

Community Health Needs Assessment

1

2

3

1

2

3

a

b

c

d

e

f

g

h

i

j

4

5

6

7

5

6a

6b

7

a

b

a

b

c

d

8

9

10

11

12

8

10

10b

a

b

a

b

c

12a

12b

$


(continued)Schedule H (Form 990) 2018 Page

(complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the

current tax year or the immediately preceding tax year?

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or

the immediately preceding tax year? If "Yes," provide details of the acquisition in Section C

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a

community health needs assessment (CHNA)? If "No," skip to line 12

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs

of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority

groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community's interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad

interests of the community served by the hospital facility, including those with special knowledge of or expertise in public

health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the

community, and identify the persons the hospital facility consulted ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Was the hospital facility's CHNA conducted with one or more other hospital facilities? If "Yes," list the other

hospital facilities in Section C ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Was the hospital facility's CHNA conducted with one or more organizations other than hospital facilities? If "Yes,"

list the other organizations in Section C ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Did the hospital facility make its CHNA report widely available to the public?

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

~~~~~~~~~~~~~~~~~~~~~~~~

Hospital facility's website (list url):

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility


Did the hospital facility adopt an implementation strategy to meet the significant community health needs

identified through its most recently conducted CHNA? If "No," skip to line 11 ~~~~~~~~~~~~~~~~~~~~~~~~

Indicate the tax year the hospital facility last adopted an implementation strategy: 20

Is the hospital facility's most recently adopted implementation strategy posted on a website? ~~~~~~~~~~~~~~~~

If "Yes," (list url):

If "No," is the hospital facility's most recently adopted implementation strategy attached to this return? ~~~~~~~~~~~

Describe in Section C how the hospital facility is addressing the significant needs identified in its mostrecently conducted CHNA and any such needs that are not being addressed together with the reasons whysuch needs are not being addressed.

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct aCHNA as required by section 501(r)(3)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ~~~~~~~~~~~~~~~~

If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720

for all of its hospital facilities?


X

XXX

XXX


XXX

16

X

X

X

X

X

16X

WWW.UNIVERSITYHEALTH.ORGX

UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDI

X

WWW.UNIVERSITYHEALTH.ORG

X

X

X

X

1


832095 11-09-18

5

Financial Assistance Policy (FAP)


Yes No

13 13

a

b

c

d

e

f

g

h

14

15

14

15

a

b

c

d

e

16 16

a

b

c

d

e

f

g

h

i

j



Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

If "Yes," indicate the eligibility criteria explained in the FAP:

~~~~~

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of

and FPG family income limit for eligibility for discounted care of

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

%

%

Underinsurance status

Residency


Explained the basis for calculating amounts charged to patients?

Explained the method for applying for financial assistance?

If "Yes," indicate how the hospital facility's FAP or FAP application form (including accompanying instructions)

explained the method for applying for financial assistance (check all that apply):

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his

or her application

Provided the contact information of hospital facility staff who can provide an individual with information

about the FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources

of assistance with FAP applications


Was widely publicized within the community served by the hospital facility?

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

~~~~~~~~~~~~~~~~~~~~~~~~

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital

facility and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in

the hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP,

by receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public

displays or other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)

spoken by Limited English Proficiency (LEP) populations


(continued)Part V Facility Information


400

X

X

SEE SCHEDULE H SUPPLEMENTAL INFOSEE SCHEDULE H SUPPLEMENTAL INFO

XXXXX

X

X

X

XXXX

X


X

X

X

X

SEE PART V, PAGE 8

X

200

X

X


832096 11-09-18

6

Billing and Collections


Yes No

17

18

19

17

19

a

b

c

d

e

f

a

b

c

d

e

20

a

b

c

d

e

f

Policy Relating to Emergency Medical Care

21

21

a

b

c

d



Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial

assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon

nonpayment? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the

tax year before making reasonable efforts to determine the individual's eligibility under the facility's FAP:

Reporting to credit agency(ies)

Selling an individual's debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a

previous bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making

reasonable efforts to determine the individual's eligibility under the facility's FAP?

If "Yes," check all actions in which the hospital facility or a third party engaged:

~~~~~~~~~~~~~~~~~~~~~~

Reporting to credit agency(ies)

Selling an individual's debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a

previous bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or

not checked) in line 19 (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the

FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)


None of these efforts were made

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care

that required the hospital facility to provide, without discrimination, care for emergency medical conditions to

individuals regardless of their eligibility under the hospital facility's financial assistance policy? ~~~~~~~~~~~~~~~

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility's policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)



X


X

X

XXX

X

X


X


832097 11-09-18

7

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)


Yes No

22

a

b

c

d

23

24

23

24



Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligibleindividuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior

12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private

health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination

with Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior

12-month period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided

emergency or other medically necessary services more than the amounts generally billed to individuals who had

insurance covering such care? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any

service provided to that individual?

If "Yes," explain in Section C.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


X



X

X


832098 11-09-18

8

Section C. Supplemental Information for Part V, Section B.



Provide descriptions required for Part V, Section B, lines2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provideseparate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letterand hospital facility line number from Part V, Section A ("A, 1," "A, 4," "B, 2," "B, 3," etc.) and name of hospital facility.


UNIVERSITY MCDUFFIE COUNTY REGIONAL MEDICAL CENTER:

PART V, SECTION B, LINE 5: SEE PAGE 39 AND PAGE 11 OF THE 2016 COMMUNITY

HEALTH NEEDS ASSESSMENT

MCDUFFIE COUNTY INPUT WAS OBTAINED FROM ONE OF THE LEADING INDUSTRIES IN

THE COUNTY, DENTIST, COUNTY EXTENSION SERVICES, LOCAL FAMILY CONNECTION

COLLABORATIVE ORGANIZATION, NURSE AT THE HOSPITAL, DISTRICT HEALTH

DEPARTMENT AND THE LOCAL SCHOOL INSTRUCTOR. IN ADDITION A PROVIDER SURVEY

WAS SENT TO LOCAL PHYSICIANS, MENTAL HEALTH PROVIDERS AND PHARMACISTS;

ASKING THEM TO TELL US A RESOURCE THAT YOU WISH WERE MORE ACCESSIBLE TO

YOUR PATIENTS THAT WOULD HELP THEM ADDRESS THEIR HEALTH NEEDS.


PART V, SECTION B, LINE 7D: CHNA MADE AVAILABLE UPON REQUEST


PART V, SECTION B, LINE 11: THERE ARE OTHER ORGANIZATONS THAT WERE/ARE


PROVIDING SOME OF THE SERVICES IDENTIFIED. THESE INCLUDE THE FOLLOWING

ORGANIZATIONS: THOMSON ROTARY CLUB, THOMSON YMCA, MCDUFFIE PUBLIC HEALTH,

MCDUFFIE COUNTY PARTNERSHIP FOR SUCCESS, AND MCDUFFIE COUNTY MENTAL HEALTH

DEPT.

PAGE 6 OF IMPLEMENTATION STRATEGY LISTS STEPS UNIVERSITY HOSPITAL MCDUFFIE

IS TAKING TO ADDRESS THE CHNA. THESE INCLUDE THE FOLLOWING: COORDINATE


832098 11-09-18

8

Section C. Supplemental Information for Part V, Section B.



Provide descriptions required for Part V, Section B, lines2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provideseparate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letterand hospital facility line number from Part V, Section A ("A, 1," "A, 4," "B, 2," "B, 3," etc.) and name of hospital facility.


WITH LOCAL COMMUNITY EVENTS AND BUSINESSES TO ARRANGE SCREENS, HOSTING

DIABETES WEBINAR PER QUARTER, HOSTING AT LEAST 2 COMMUNITY HEALTH FAIRS IN

MCDUFFIE COUNTY, PLAN PRIMARY CARE PROVIDER DIABETES EDUCATION, LABS

PROVIDED FOR HEALTH DEPARTMENT CARDIOVASCULAR SCREENING PROGRAMS, AND

SUPPORT THE EDUCATION CLASSES UNIVERSTIY HOSPITAL OFFERS.


PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:

SEE SCHEDULE H SUPPLEMENTAL INFO


PART V, SECTION B, LINE 16J: WWW.UNIVERSITYHEALTH.ORG/OUR-LOCATIONS/UNIVERS

ITY-HOSPITAL-MCDUFFIE/PATIENT-INFORMATION/INDEGENT-AND-CHARITY-CARE


PART V, SECTION B, LINE 21D: FAP INCLUDED ER MEDICAL CARE CONDITIONS. IN

ADDITION, UHM FOLLOWS EMTALA REGULATIONS.


PART V, LINE 16A, FAP WEBSITE:

HTTPS://WWW.UNIVERSITYHEALTH.ORG/OUR-LOCATIONS/UNIVERSITY-HOSPITAL-MCDUF

FIE/PATIENT-INFORMATION/INDIGENT-CHARITY-CARE


832099 11-09-18

9

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility



(list in order of size, from largest to smallest)

How many non-hospital health care facilities did the organization operate during the tax year?

Name and address Type of Facility (describe)



0


832100 11-09-18

10

1

2

3

4

5

6

7

Required descriptions.

Needs assessment.

Patient education of eligibility for assistance.

Community information.

Promotion of community health.

Affiliated health care system.

State filing of community benefit report.



Provide the following information.

Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and

9b.

Describe how the organization assesses the health care needs of the communities it serves, in addition to any

CHNAs reported in Part V, Section B.

Describe how the organization informs and educates patients and persons who may be billed

for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization's financial

assistance policy.

Describe the community the organization serves, taking into account the geographic area and demographic

constituents it serves.

Provide any other information important to describing how the organization's hospital facilities or other health

care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus

funds, etc.).

If the organization is part of an affiliated health care system, describe the respective roles of the organization

and its affiliates in promoting the health of the communities served.

If applicable, identify all states with which the organization, or a related organization, files a

community benefit report.

Part VI Supplemental Information

PART I, LINE 7:

EXPLANATION OF COSTING METHODOLOGY

USED COST TO CHARGE RATIO CALCULATED USING WORKSHEET 2 --THE OPTIONAL

WORKSHEETS PROVIDED TO ASSIST IN PREPARATION OF SCHEDULE H.

PART II, COMMUNITY BUILDING ACTIVITIES:

THE COMMUNITY BUILDING ACTIVITIES REPORTED ARE SUPPORT FOR THE VARIOUS

CHAMBERS OF COMMERCE FOR THE COMMUNITIES THAT UHM SERVES. IN SUPPORTING

THESE ORGANIZATIONS, UHM CAN SUPPORT THE DEVELOPMENT OF OUR COMMUNITY BY

BRINGING IN NEW INDUSTRIES, AND JOBS, INCREASING THE AVERAGE HOUSEHOLD

INCOME, IMPROVING LIVING CONDITIONS, AND IMPACTING OVERALL GENERAL HEALTH.

PART III, LINE 2:

FOR RECEIVABLES ASSOCIATED WITH SELFPAY 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),

UH RECORDS PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS

OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR



832271 04-01-18

10

Schedule H (Form 990)

Schedule H (Form 990) Page

(Continuation)Part VI Supplemental Information

UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY

RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED

RATES) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION

EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR

DOUBTFUL ACCOUNTS. RECOVERIES OF ACCOUNTS PREVIOUSLY WRITTEN OFF ARE

RECORDED AS A REDUCTION TO THE PROVISION FOR BAD DEBT EXPENSE WHEN

RECEIVED.

PART III, LINE 3:

BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT SINCE THE SERVICES THAT

INCUR BAD DEBT ARE PROVIDED BY THE HOSPITAL TO PROMOTE THE WELL-BEING OF

THE COMMUNITY. THESE SERVICES ARE RENDERED IN CONJUNCTION WITH THE

HOSPITAL'S CHARITABLE TAX-EXEMPT PURPOSES. THERE IS NO LOCAL SUPPORT FOR

UNINSURED PATIENTS; THEREFORE, THE SERVICES PROVIDED BY THE HOSPITAL

RELIEVE THE HEALTH CARE BURDENS OF THE LOCAL GOVERNMENTS.

PART III, LINE 4:

BAD DEBT EXPENSE

PAGE 8-9 OF THE AUDITED CONSOLIDATED FINANCIAL STATEMENT FOR UNIVERSITY

HEALTH, INC.


PART III, LINE 8:

EXPLANATION OF SHORTFALL AS COMMUNITY BENEFIT

THE SERVICES PROVIDED TO THE MEDICARE BENEFICIARIES ARE TO PROMOTE THE

WELL-BEING OF THE COMMUNITY WHICH IS PART OF THE HOSPITAL'S CHARITABLE

TAX-EXEMPT PURPOSE. THE MEDICARE DIFFERENCE BETWEEN COST AND MEDICARE

REIMBURSEMENT SHOULD BE ALLOWED AS COMMUNITY BENEFIT SINCE PROVIDERS

CANNOT NEGOTIATE RATES WITH CENTERS FOR MEDICARE/MEDICAID SERVICES (CMS).


832271 04-01-18

10




CMS REGULATES THAT THE REIMBURSEMENT BE FEDERAL BUDGET NEUTRAL THUS

PLACING THE COST OF THE CARING FOR MEDICARE BENEFICIARIES AS A COST TO THE

HOSPITALS.

PART III, LINE 9B:

PROVISIONS ON COLLECTION PRACTICES FOR QUALIFIED PATIENTS

AS OUTSTANDING BALANCES AGE, STATEMENT MESSAGES, COLLECTION LETTERS AND/OR

TELEPHONE CALLS MAY BE USED AT APPROPRIATE INTERVALS DETERMINED BY THE

PATIENT ACCOUNTING/COLLECTION DEPARTMENT. THE PATIENT

ACCOUNTING/COLLECTION DEPARTMENT RECOGNIZES THAT THERE ARE OCCASIONS WHEN

A PATIENT IS NOT FINANCIALLY ABLE TO PAY HIS OR HER MEDICAL BILL IN FULL

AND/OR THE PATIENT IS EXPERIENCING FINANCIAL HARDSHIP. THE HOSPITAL HAS

ESTABLISHED A CATASTROPHIC POLICY WHICH ALLOWS FOR THE COLLECTION

DEPARTMENT TO APPLY THE INDIGENT CRITERIA AND WRITE-OFF AS MEDICALLY

INDIGENT. AND AT ANY POINT DURING THE COLLECTION PROCESS IF A PATIENT

STATES OR PATIENT ACCOUNTING/COLLECTIONS BELIEVES THAT THE PATIENT CANNOT

AFFORD TO PAY, THEN AN INDIGENT/CHARITY CARE APPLICATION IS BEGUN BY THE

COLLECTION DEPARTMENT WHERE DISCOUNTS MAY BE GIVEN.

PART VI, LINE 2:


NEEDS ASSESSMENT

UHM WORKS WITH ER PERSONNEL AND AREA HEALTH DEPARTMENT DIRECTOR TO

IDENTIFY NEEDS BASED ON PATIENTS SEEKING HELP THROUGH THE EMERGENCY ROOM

AND HEALTH DEPARTMENT.

PART VI, LINE 3:

PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE

REGISTRARS INFORM PATIENT OF FINANCIAL ASSISTANCE PROGRAMS. ALSO, THERE


832271 04-01-18

10




ARE SIGNS POSTED IN ER AND REGISTRATION AREAS WHICH DENOTE THE

AVAILABILITY OF ASSISTANCE WITH HOSPITAL BILLS. IN ADDITION, UHM UTILIZES

THE SERVICES OF RCA (RESOURCE CENTER OF AMERICA) WHICH AIDS PATIENTS IN

GETTING CERTIFIED FOR SSI AND MEDICAID.

PART VI, LINE 4:

SEE COMMUNITY NEEDS ASSESSMENT PAGES 5-10

MCDUFFIE COUNTY IS A COUNTY LOCATED IN THE U.S. STATE OF GEORGIA. AS OF

THE 2014 CENSUS, THE POPULATION WAS 21,400.[1] THE COUNTY SEAT IS

THOMSON.[2] THE COUNTY WAS CREATED ON OCTOBER 18, 1870[3] AND NAMED AFTER

THE SOUTH CAROLINA GOVERNOR AND SENATOR GEORGE MCDUFFIE.

MCDUFFIE COUNTY IS PART OF THE AUGUSTA-RICHMOND COUNTY, GA-SC METROPOLITAN

STATISTICAL AREA. ALSO MCDUFFIE IS IN THE CMS -CORE BUSINESS STATISTICAL

AREA FOR WAGE INDEX CALCULATIONS.

THE % OF POPULATION THAT IS UNDER 18 YEARS IS 25.8%; AGE 18-64 IS 59.4%;

OVER 65 IS 14.8%. FEMALES MAKE UP 53.2% OF THE POPULATION. THE

RACE/ETHNICITY IS MADE UP OF 40.3% BLACK; 55.3% WHITE AND HISPANIC IS


2.5%. ONLY 1% OF POPULATION IS NOT PROFICIENT IN ENGLISH.

PART VI, LINE 5:

COLLABORATION WITH/SUPPORT OF COMMUNITY ORGANIZATIONS THROUGH SEVERAL

SURROUNDING CHAMBERS OF COMMERCE. - SEE PART II ABOVE.

SEE PAGE 39 OF THE CHNA FOR THE LIST OF AGENCIES THAT UNIVERSITY MCDUFFIE

COUNTY REGIONAL MEDICAL CENTER, INC. WORKS WITH TO SUPPORT AND PROMOTE


832271 04-01-18

10




HEALTH IN OUR COMMUNITY.

PART VI, LINE 6:

UHM GOVERNING BOARD MEMBERS ARE COMPRISED OF CITZENS WHO RESIDE IN THE

UHM'S PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES NOR CONTRACTORS OF

UHM. UHM BOARD MEMBERS ARE ACTIVE IN THE COMMUNITY AND ARE EAGER TO

IMPROVE THE HEALTH AND WELFARE OF THE COMMUNITY. UHM EXTENDS MEDICAL STAFF

PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN OUR COMMUNITY FOR ALL OF THE UH

DEPARTMENTS. UHM AND UHS COLLABORATE ON HEALTH FAIRS AND SCREENINGS



OMB No. 1545-0047


832111 10-26-18

For certain Officers, Directors, Trustees, Key Employees, and HighestCompensated Employees

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.Open to Public

InspectionAttach to Form 990.

| Go to www.irs.gov/Form990 for instructions and the latest information.Employer identification number

Yes No

1a

b

1b

2

2

3

4

a

b

c

4a

4b

4c

Only section 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

5

5a

5b

6a

6b

7

8

9

a

b

6

a

b

7

8

9

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule J (Form 990) 2018

||

Name of the organization

Check the appropriate box(es) if the organization provided any of the following to or for a person listed on Form 990,

Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel

Travel for companions

Housing allowance or residence for personal use

Payments for business use of personal residence

Tax indemnification and gross-up payments

Discretionary spending account

Health or social club dues or initiation fees

Personal services (such as maid, chauffeur, chef)

If any of the boxes on line 1a are checked, did the organization follow a written policy regarding payment or

reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain ~~~~~~~~~~~

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all directors,

trustees, and officers, including the CEO/Executive Director, regarding the items checked on line 1a? ~~~~~~~~~~~~

Indicate which, if any, of the following the filing organization used to establish the compensation of the organization's

CEO/Executive Director. Check all that apply. Do not check any boxes for methods used by a related organization to

establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee

Independent compensation consultant

Form 990 of other organizations

Written employment contract

Compensation survey or study

Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing

organization or a related organization:

Receive a severance payment or change-of-control payment?

Participate in, or receive payment from, a supplemental nonqualified retirement plan?

Participate in, or receive payment from, an equity-based compensation arrangement?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation

contingent on the revenues of:

The organization?

Any related organization?

If "Yes" on line 5a or 5b, describe in Part III.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation

contingent on the net earnings of:

The organization?

Any related organization?

If "Yes" on line 6a or 6b, describe in Part III.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed payments

not described on lines 5 and 6? If "Yes," describe in Part III

Were any amounts reported on Form 990, Part VII, paid or accrued pursuant to a contract that was subject to the

initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe in Part III

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in

Regulations section 53.4958-6(c)? ��

LHA

SCHEDULE J(Form 990)

Part I Questions Regarding Compensation

Compensation Information

2018

UNIVERSITY MCDUFFIE COUNTY REGIONAL45-4166209

X

X

X

XX

XXX

XX

X

X

XX

X

X

X



832112 10-26-18

2

Part II Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees.

Note:

(B) (C) (D) (E) (F)

(i) (ii) (iii) (A)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

(i)

(ii)

Schedule J (Form 990) 2018

Schedule J (Form 990) 2018 Page

Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the instructions, on row (ii).Do not list any individuals that aren't listed on Form 990, Part VII.

The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

Breakdown of W-2 and/or 1099-MISC compensation Retirement andother deferredcompensation

Nontaxablebenefits

Total of columns(B)(i)-(D)

Compensationin column (B)

reported as deferredon prior Form 990

Basecompensation

Bonus &incentive

compensation

Otherreportable

compensation

Name and Title


0. 0. 0. 0. 0. 0. 0.UHCS CEO 752,167. 200,156. 27,026. 298,718. 8,644. 1,286,711. 0.

0. 0. 0. 0. 0. 0. 0.LEGAL ADVISOR 397,173. 104,344. 44,300. 9,343. 9,840. 565,000. 0.

0. 0. 0. 0. 0. 0. 0.UHCS & UHM CFO 460,144. 115,117. 90,495. 1,248. 14,531. 681,535. 0.

0. 0. 0. 0. 0. 0. 0.CMO 399,812. 100,742. 44,502. 9,336. 16,335. 570,727. 0.

0. 0. 0. 0. 0. 0. 0.PRESIDENT UNIVERSITY HOSPI 207,820. 130,259. 113,629. 6,053. 6,102. 463,863. 0.

0. 0. 0. 0. 0. 0. 0.ADMINISTRATIVE CNO 172,320. 17,499. 2,190. 5,149. 302. 197,460. 0.

45-4166209

(1) JAMES R. DAVIS

(2) EDWARD L. BURR

(3) DAVID A. BELKOSKI

(4) WILLIAM L FARR JR

(5) MARILYN A BOWCUTT

(6) ROBERT J. KEPSHIRE

45

832113 10-26-18

3

Part III Supplemental Information



Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

PART I, LINE 1A:

SOCIAL CLUB DUES-

THE RELATED ORGANIZATION PAYS MEMBERSHIP FEES FOR THE CEO (JAMES DAVIS) TO

THE ORGANIZATION CAN HAVE ACCESS TO THE MEETING FACILITIES AND CATERING

ANY PERSONAL USE, RELATED TO THESE MEMBERSHIPS, IS INCLUDED IN THE WAGES OF

SAGE VALLEY AND THE AUGUSTA COUNTRY CLUB. THESE MEMBERSHIP FEES ARE PAID SO

SERVICES THESE ORGANIZATIONS PROVIDE FOR MEETINGS THAT ARE HELD OFF CAMPUS.

THE CEO.

PART I, LINE 4B:

JAMES R. DAVIS - SERP - $290,468

DAVID BELKOSKI - ROTH IUL - $58,839

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 AND HAVE BEEN INCLUDED IN THE INDIVIDUALS' W-2, WITH THE

EXCEPTION OF THE SERP FOR JAMES R. DAVIS.

PART I, LINE 6:


46

832113 10-26-18

3





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

2018 STRATEGIC INITIATIVES

WEIGHT QUALITY

THESE INITIATIVES WERE WEIGHTED AS DISPLAYED IN THE FOLLOWING SCHEDULE:

UNIVERSITY HEALTH SERVICES, INC

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 AND COLUMBIA COUNTIES OVER 2017

LEVELS

SAFETY


47

832113 10-26-18

3





15% MINIMIZE THE NUMBER OF HOSPITAL ACQUIRED CONDITIONS PER 1000

DISCHARGES AS MEASURED BY MIDAS SYSTEM

15% ACHIEVE RN TURNOVER RATE FOR UHS

AFFORDABILITY

PEOPLE

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 PAYOUT OUT

OF A POSSIBLE 100% BASED ON A THRESHOLD LEVEL, TARGET LEVEL, OR AN EXCEED

LEVEL.


48

OMB No. 1545-0047


832211 10-10-18

Complete to provide information for responses to specific questions onForm 990 or 990-EZ or to provide any additional information.

| Attach to Form 990 or 990-EZ.| Go to www.irs.gov/Form990 for the latest information.

(Form 990 or 990-EZ)



For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule O (Form 990 or 990-EZ) (2018)


LHA

SCHEDULE O Supplemental Information to Form 990 or 990-EZ2018

FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:

CARE SERVICES WITH THE HELP OF OUR COMMUNITIES AND PARTNERS, AND ENRICH

THE LIVES WE TOUCH BY PROVIDING COMPASSIONATE QUALITY CARE IN A COST

EFFECTIVE MANNER. WE STRIVE TO BE UTILIZED AS THE HEALTHCARE PARTNER OF

CHOICE FOR THE COMMUNITIES WE SERVE.

FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:

UTILIZED AS THE HEALTHCARE PARTNER OF CHOICE FOR THE COMMUNITIES WE

SERVE.

FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS:

FOR 2018, THE HOSPITAL HAD A TOTAL OF 1,917 PATIENT DAYS. 171 OF THESE

PATIENT DAYS WERE FOR INDIGENT PATIENTS. SWING BEDS WERE 3,458.

OBSERVATION STAYS WERE 435 DAYS. OUTPATIENT VISITS WERE 33,833. OF

THE TOTAL OUTPATIENT VISITS, 19,144 WERE FOR EMERGENCY CARE. WITHIN

THESE INDICATORS ARE THE EFFORTS OF UNIVERSITY HOSPITAL MCDUFFIE TO

SERVICE THE NEEDS OF THE COMMUNITY, WHICH INCLUDE THE INDIGENT. IN

2018 THE COST OF INDIGENT AND CHARITY CARE PROVIDED ALONG WITH MEDICAID

SHORTFALLS WAS $2,952,191. UHM RECEIVED DISPROPORTIONATE SHARE (DSH)

FUNDS OF $830,618 AND UPPER PAYMENT LIMIT (UPL) FUNDS OF $101,088 TO

HELP OFFSET THESE COSTS.

FORM 990, PART VI, SECTION B, LINE 11B:

FORM 990 REVIEW PROCESS

A COPY OF THE FORM 990 AND ALL RELATED SCHEDULES WAS PROVIDED TO THE

GOVERNING BOARD BEFORE FILING IN ELECTRONIC FORM. AN EMAIL WAS SENT TO ALL



832212 10-10-18

2


Schedule O (Form 990 or 990-EZ) (2018)

Schedule O (Form 990 or 990-EZ) (2018) Page


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:

EXPLANATION OF MONITORING AND ENFORCEMENT CONFLICTS

DUTY TO DISCLOSE:

IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN

INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND

BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS

AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING

THE PROPOSED TRANSACTION ARRANGEMENT.

DETERMINING WHETHER A CONFLICT EXISTS:

AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND

AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, THE INTERESTED PERSON WILL

LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE GOVERNING BOARD OR

COMMITTEE DISCUSSES AND VOTES ON A DETERMINATION OF WHETHER A CONFLICT OF

INTEREST EXISTS. THE REMAINING BOARD OR COMMITTEE MEMBERS WILL DECIDE IF A

CONFLICT OF INTEREST EXISTS.

PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST:

AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR


COMMITTEE MEETING BUT, AFTER THE PRESENTATION, SUCH INTERESTED PERSON WILL

LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE


832212 10-10-18

2





TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST.

THE CHAIRPERSON OR THE GOVERNING BOARD OR COMMITTEE WILL, IF APPROPRIATE,

APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO

THE PROPOSED TRANSACTION OR ARRANGEMENT.

AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE WILL

DETERMINE WHETHER THE CORPORATION CAN OBTAIN WITH REASONABLE EFFORTS A MORE

ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD

NOT GIVE RISE TO A CONFLICT OF INTEREST.

IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY

POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE

GOVERNING BOARD OR COMMITTEE WILL DETERMINE BY A MAJORITY VOTE OF THE

DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE

CORPORATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IS IT FAIR

AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, IT WILL MAKE

ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT.

VIOLATION OF THE CONFLICT OF INTEREST POLICY:

IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A

MEMBER OF SUCH BOARD OR COMMITTEE HAS FAILED TO DISCLOSE AN ACTUAL OR

POSSIBLE CONFLICT OF INTEREST, IT WILL INFORM THE MEMBER OF THE BASIS FOR

SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED

FAILURE TO DISCLOSE.


IF, AFTER HEARING THE MEMBER'S RESPONSE AND MAKING FURTHER INVESTIGATIONS


832212 10-10-18

2





AS WARRANTED BY THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE

DETERMINES THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT

OF INTEREST, IT WILL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION.

FORM 990, PART VI, SECTION B, LINE 15:

COMPENSATION REVIEW & APPROVAL PROCESS - OFFICERS & KEY EMPLOYEES

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 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

COMMITTEE ARE RECORDED. THE COMPENSATION COMMITTEE REPORTS TO THE UHS BOARD

EXECUTIVE COMMITTEE.

FORM 990, PART VI, SECTION C, LINE 19:

OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE

THE IRS FORM 990 IS ALSO AVAILABLE ON WWW.GUIDESTAR.ORG

FORM 990, PART VII: COMPENSATION EXPLAINED

JAMES R. DAVIS


COMPENSATION PAID BY UNIVERSITY HEALTH SERVICES, INC. (58-1581103)

DAVID A. BELKOSKI


832212 10-10-18

2






MARILYN A. BOWCUTT


WILLIAM L. FARR JR.


EDWARD L. BURR


FORM 990, PART IX, LINE 11G, OTHER FEES:

PHYSICIAN:

PROGRAM SERVICE EXPENSES 664,583.

MANAGEMENT AND GENERAL EXPENSES 11,975.

FUNDRAISING EXPENSES 0.

TOTAL EXPENSES 676,558.

PHYSICIANS-ON CALL:


MANAGEMENT AND GENERAL EXPENSES 956.



BANKING FEES:






CONSULTING FEES:


832212 10-10-18

2









PURCHASED SERVICES:

PROGRAM SERVICE EXPENSES 2,055,753.



TOTAL EXPENSES 2,092,795.

PURCHASED SERVICES - OTHER:





DUES & MEMBERSHIPS:





MISCELLANEOUS:







832212 10-10-18

2





TOTAL OTHER FEES ON FORM 990, PART IX, LINE 11G, COL A 2,965,352.

FORM 990, PART XII, LINE 2C:

THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR



OMB No. 1545-0047


Section 512(b)(13)

controlled

entity?

832161 10-02-18

SCHEDULE R(Form 990) Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.

Attach to Form 990. Open to PublicInspection| Go to www.irs.gov/Form990 for instructions and the latest information.


Part I Identification of Disregarded Entities.

(a) (b) (c) (d) (e) (f)

Identification of Related Tax-Exempt Organizations. Part II

(a) (b) (c) (d) (e) (f) (g)

Yes No

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule R (Form 990) 2018

|

|



Name, address, and EIN (if applicable)of disregarded entity

Primary activity Legal domicile (state or

foreign country)

Total income End-of-year assets Direct controllingentity

Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related tax-exemptorganizations during the tax year.

Name, address, and EINof related organization


foreign country)

Exempt Codesection

Public charitystatus (if section

501(c)(3))

Direct controllingentity

LHA

Related Organizations and Unrelated Partnerships

2018


RICHMOND COUNTY HOSPITAL AUTHORITY -

UNIVERSITY HEALTH SERVICES, INC. -

UNIVERSITY HEALTH CARE FOUNDATION -

UNIVERSITY HEALTH, INC. - 58-1581102

30901

30901

AUGUSTA, GA 30904

58-6001901, 1350 WALTON WAY, AUGUSTA, GA


58-1343550, 2100 CENTRAL AVENUE, SUITE D-1,

1350 WALTON WAYAUGUSTA, GA 30901

LEASED FACILITIES

HOSPITAL

PHILANTHROPY

CONSOLIDATING PARENT

GEORGIA

GEORGIA

GEORGIA

GEORGIA

N/A

UNIVERSITY HEALTH

45-4166209

INC.

UNIVERSITY HEALTHINC.

N/A

501(C)(3) LINE 3

501(C)(3) LINE 3

501(C)(3) LINE 7

501(C)(3) LINE 11

X

X

X

X

56

Section 512(b)(13)

controlled

organization?

83222204-01-18

Part II Continuation of Identification of Related Tax-Exempt Organizations

(a) (b) (c) (d) (e) (f) (g)

Yes No

Schedule R (Form 990)



foreign country)

Exempt Codesection

Public charitystatus (if section

501(c)(3))

Direct controllingentity

AUGUSTA RESOURCE CENTER ON AGING INC - NONPROFIT LIFE CARE UNIVERSITY HEALTH58-1728812, 4275 OWENS RD, EVANS, GA 30809 COMMUNITY GEORGIA 501(C)(1) LINE 11 INC.UNIVERSITY EXTENDED CARE INC. - 58-15811051350 WALTON WAY UNIVERSITY HEALTHAUGUSTA, GA 30901 SKILLED NURSING HOME GEORGIA 501(C)(3) LINE 3 INC.


X

X

57

Disproportionate

allocations?

Legaldomicile(state orforeigncountry)

General ormanagingpartner?

Section512(b)(13)controlled

entity?

Legal domicile(state orforeigncountry)

832162 10-02-18

2

Identification of Related Organizations Taxable as a Partnership. Part III

(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k)

Yes No Yes No

Identification of Related Organizations Taxable as a Corporation or Trust. Part IV

(a) (b) (c) (d) (e) (f) (g) (h) (i)

Yes No

Schedule R (Form 990) 2018

Predominant income(related, unrelated,

excluded from tax undersections 512-514)

Schedule R (Form 990) 2018 Page

Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more relatedorganizations treated as a partnership during the tax year.


Primary activity Direct controllingentity

Share of totalincome

Share ofend-of-year

assets

Code V-UBIamount in box20 of ScheduleK-1 (Form 1065)

Percentageownership

Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more relatedorganizations treated as a corporation or trust during the tax year.


Primary activity Direct controllingentity

Type of entity(C corp, S corp,

or trust)

Share of totalincome

Share ofend-of-year

assets

Percentageownership

UNIVERSITY HEALTH RESOURCES, I - 58-1601372

UNIVERSITY HOSPITAL OF AIKEN, INC -

1350 WALTON WAY


GA

SC

C CORP

C CORP

AUGUSTA, GA 30901

30901

SVCS TO PHY

HOSPITAL

UNIVERSITYHEALTH, INC.

UNIVERSITYHEALTH, INC.


X

X

58

832163 10-02-18

3

Part V Transactions With Related Organizations.

Note: Yes No

1

a

b

c

d

e

f

g

h

i

j

k

l

m

n

o

p

q

r

s

(i) (ii) (iii) (iv) 1a

1b

1c

1d

1e

1f

1g

1h

1i

1j

1k

1l

1m

1n

1o

1p

1q

1r

1s

2

(a) (b) (c) (d)

(1)

(2)

(3)

(4)

(5)

(6)



Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

During the tax year, did the organization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

Receipt of interest, annuities, royalties, or rent from a controlled entity ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Gift, grant, or capital contribution to related organization(s)

Gift, grant, or capital contribution from related organization(s)

Loans or loan guarantees to or for related organization(s)

Loans or loan guarantees by related organization(s)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Dividends from related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Sale of assets to related organization(s)

Purchase of assets from related organization(s)

Exchange of assets with related organization(s)

Lease of facilities, equipment, or other assets to related organization(s)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Lease of facilities, equipment, or other assets from related organization(s)

Performance of services or membership or fundraising solicitations for related organization(s)

Performance of services or membership or fundraising solicitations by related organization(s)

Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

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832164 10-02-18

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8868 Application for Automatic Extension of Time To File anExempt Organization Return

2018


DAVID A. BELKOSKI, CFO

X

0.

0.

0.

706-828-2406

1350 WALTON WAY

AUGUSTA, GA 30901

45-4166209

NOVEMBER 15, 2019

1350 WALTON WAY - AUGUSTA, GA 30901

0 1


Electronic Filing PDF Attachment


University Health, Inc.

Consolidated Financial Statements and Other Financial Information

Years Ended December 31, 2018 and 2017


Table of Contents

Independent Auditors' Report .................................................................................................................. 1

Consolidated Financial Statements:

Consolidated Balance Sheets ............................................................................................................. 3

Consolidated Statements of Operations.............................................................................................. 5

Consolidated Statements of Changes in Net Assets .......................................................................... 6

Consolidated Statements of Cash Flows ............................................................................................ 7

Notes to Consolidated Financial Statements ...................................................................................... 8

Independent Auditors' Report on Supplementary Information ............................................................ 35

Supplementary Information:

Consolidating Balance Sheet Information (2018) ................................................................................ 36

Consolidating Statement of Operations Information (2018) ................................................................ 38

Consolidating Statement of Changes in Net Assets Information (2018) ............................................. 39

Consolidating Balance Sheet Information (2017) ................................................................................ 40

Consolidating Statement of Operations Information (2017) ................................................................ 42

Consolidating Statement of Changes in Net Assets Information (2017) ............................................. 43

1

Independent Auditors’ Report

The Board of Trustees University Health, Inc.

We have audited the accompanying consolidated financial statements of University Health, Inc. (the Corporation), which comprise the consolidated balance sheets as of December 31, 2018 and 2017, and the related consolidated statements of operations, changes in net assets, and cash flows for the years then ended, and the related notes to the consolidated financial statements.

Management’s Responsibility for the Financial Statements Management is responsible for the preparation and fair presentation of these consolidated financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of consolidated financial statements that are free from material misstatement, whether due to fraud or error.

Auditors’ Responsibility Our responsibility is to express an opinion on these consolidated financial statements based on our audits. We did not audit the financial statements of Walton Way Indemnity, SPC (WWI), a wholly owned subsidiary, which statements reflect approximately $23,746,000 and $21,206,000 of consolidated total assets as of December 31, 2018 and 2017, respectively. Those statements were audited by other auditors whose report has been furnished to us, and our opinion, insofar as it relates to the amounts included for WWI, is based solely on the report of the other auditors. We conducted our audits in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the consolidated financial statements are free from material misstatement.

An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the consolidated financial statements. The procedures selected depend on the auditors’ judgment, including the assessment of the risks of material misstatement of the consolidated financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the Corporation’s preparation and fair presentation of the consolidated financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Corporation’s internal control. Accordingly, we express no such opinion. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements.

We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion.

2

Change in Accounting Principle As discussed in Note 1 to the consolidated financial statements, the Corporation adopted Financial Accounting Standards Board Accounting Standards Update (“ASU”) 2016-14, Not-for-Profit Entities (Topic 958): Presentation of Financial Statements of Not-for-Profit Entities and ASU 2014-09 Revenue from Contracts with Customers (Topic 606) in 2018. Our opinion is not modified with respect to these matters.

Opinion In our opinion, based on our audits and the report of the other auditors, the consolidated financial statements referred to above present fairly, in all material respects, the consolidated financial position of University Health, Inc. at December 31, 2018 and 2017, and the consolidated results of their operations, changes in net assets, and cash flows for the years then ended in accordance with accounting principles generally accepted in the United States of America.

Charlotte, North Carolina April 30, 2019

2018 2017(As Adjusted)

AssetsCurrent assets:

Cash and cash equivalents 44,016,161$ 28,720,394$ Short-term investments - 2,787,655 Patient accounts receivable, less allowances for

uncollectible accounts of $49,981,000 in 2017 98,160,510 100,182,168 Other receivables 13,596,267 12,256,630 Inventories 12,720,067 12,316,911 Prepaid expenses 9,872,752 9,379,482

Total current assets 178,365,757 165,643,240

Property and equipment, net 329,477,701 365,903,160

Other assets:Assets limited as to use 74,200,652 93,068,001 Investments 447,869,879 463,979,202 Other 9,604,434 10,322,262

Total assets $ 1,039,518,423 $ 1,098,915,865

December 31, 2018 and 2017

Consolidated Balance Sheets


December 31

See accompanying notes. 3


Liabilities and net assetsCurrent liabilities:

Accounts payable and accrued expenses 29,477,134$ 33,235,734$ Accrued compensation, benefits, and withholdings 31,928,250 31,988,987 Other current liabilities 3,080,460 21,154,963 Estimated third-party payor settlements 16,534,012 13,621,102 Current maturities of long-term debt 42,569,786 39,864,974 Current portion of capital lease obligations 2,091,323 2,022,686 Short-term accrued postretirement benefit cost 1,747,058 1,785,608

Total current liabilities 127,428,023 143,674,054

Long-term debt, less current maturities 202,190,651 232,392,900 Long-term capital lease obligations, less current portion 2,689,269 3,996,085 Other long-term obligations 3,815,456 31,078,443 Reserve for contingent losses 17,055,599 15,270,816 Accrued postretirement benefit cost, less short-term obligation 30,399,341 35,267,615 Total liabilities 383,578,339 461,679,913

Net assets:Without donor restrictions 618,837,090 593,473,095 With donor restrictions 37,102,994 43,762,857

Total net assets 655,940,084 637,235,952 Total liabilities and net assets 1,039,518,423$ 1,098,915,865$

December 31, 2018 and 2017Consolidated Balance Sheets, continuedUniversity Health, Inc.

December 31



Unrestricted revenues and other support:Patient service revenue (net of contractual

allowances and discounts) 660,969,355$ Provision for bad debts (38,045,319)

Net patient service revenue 649,732,922 622,924,036

Other operating revenues 16,319,400 19,735,558 Net assets released from restriction 8,193,369 2,361,683

Total unrestricted revenues and other support 674,245,691 645,021,277

Operating expenses:Salaries and benefits 333,705,699 324,101,504 Other operating expenses 279,906,965 255,100,744 Depreciation 48,065,676 44,180,322 Interest 7,991,943 7,915,024

Total operating expenses 669,670,283 631,297,594

Income from operations 4,575,408 13,723,683

Nonoperating (loss) income:Investment (loss) income (29,175,260) 56,612,940 Gain on sale of assets 46,652,315 - Other components of net benefit cost (1,953,016) (1,505,491)

Total nonoperating income 15,524,039 55,107,449

Excess of revenues, other support, and gainsover expenses and losses 20,099,447 68,831,132

Change in postretirement plan funded status 5,709,690 (4,258,043) Other 86,093 (27,176) Transfer (to) from net assets with donor restrictions (531,235) 654,727 Increase in net assets without donor restrictions 25,363,995$ 65,200,640$

Years Ended December 31, 2018 and 2017Consolidated Statements of OperationsUniversity Health, Inc.

Year Ended December 31



Net assets without donor restrictions:Excess of revenues, other support, and gains

over expenses and losses 20,099,447$ 68,831,132$ Change in postretirement plan funded status 5,709,690 (4,258,043) Other 86,093 (27,176) Transfer (to) from net assets with donor restrictions (531,235) 654,727

Increase in net assets without donor restrictions: 25,363,995 65,200,640

Net assts with donor restrictionsContributions and other 2,435,768 3,205,308 Investment (loss) income (1,433,497) 4,703,970 Net assets released from restriction (8,193,369) (2,361,683) Transfer from (to) assets without donor restrictions 531,235 (654,727)

(Decrease) increase in net assets with donor restrictions (6,659,863) 4,892,868

Increase in net assets 18,704,132 70,093,508

Net assets at beginning of year 637,235,952 567,142,444 Net assets at end of year 655,940,084$ 637,235,952$



Years EndedDecember 31, 2018 and 2017

Consolidated Statements of Changes in Net Assets



Operating activities:Change in net assets 18,704,132$ 70,093,508$ Adjustments to reconcile change in net assets to net cash

provided by operating activities:Change in postretirement plans funded status (5,709,690) 4,258,043 Depreciation 48,065,676 44,180,322 Provision for bad debts – 38,045,319 Gain on sale of assets (46,652,315) Other (959,664) (881,746) Changes in operating assets and liabilities:

Patient accounts receivable 2,021,658 (51,329,448) Other receivables 1,031,556 (453,322) Inventories (449,327) (1,923,423) Prepaid expenses (531,912) 140,422 Investments and assets limited as to use classified as trading 37,450,427 (45,734,709) Other assets 717,828 275,202 Accounts payable and accrued expenses (3,758,600) 4,330,210 Accrued compensation, benefits, and withholdings 73,641 969,697 Other current liabilities (2,288,999) (2,023,171) Other long-term obligations (1,236,718) 616,709 Estimated third-party payor settlements 2,912,910 (8,783,813) Reserve for contingent losses 1,784,783 (457,058) Accrued pension and postretirement benefit cost 1,299,908 194,051

Net cash provided by operating activities 52,475,294 51,516,793

Investing activities:Proceeds from sale of assets 45,580,973 - Purchases of property and equipment, net (54,041,809) (70,173,305)

Net cash used in investing activities (8,460,836) (70,173,305)

Financing activities:Debt issuance costs used in refunding – (109,435) Proceeds from bank term loans 14,893,029 61,550,298 Scheduled principal payments on long-term debt (41,516,895) (37,333,904) Principal payments on capital lease obligations (2,094,825) (1,930,709)

Net cash (used in) provided by financing activities (28,718,691) 22,176,250 Net increase in cash and cash equivalents 15,295,767 3,519,738 Cash and cash equivalents at beginning of year 28,720,394 25,200,656 Cash and cash equivalents at end of year 44,016,161$ 28,720,394$

Supplemental schedule of cash flow information:Cash paid for interest 8,848,377$ 6,902,864$ Noncash investing and financing activities:

Property leased under capital lease obligations 856,646$ 1,611,335$



Years Ended December 31, 2018 and 2017

Consolidated Statements of Cash Flows


University Health, Inc. Notes to Consolidated Financial Statements

8

Notes to Consolidated Financial Statements

1. Organization and Significant Accounting Policies

The significant accounting policies adopted by University Health, Inc. (the Parent or Corporation) are set forth below.

Reporting Entity and Corporate Reorganization

As part of a corporate reorganization during 1984, University Health, Inc., a not-for-profit corporation, was formed to conduct long-range health planning, public health education, and resource allocation for University Health Services, Inc. and other affiliated corporations. Effective December 31, 1984, Richmond County Hospital Authority (the Authority) approved the restructuring of the Hospital, whereby it was leased to University Health Services, Inc., an affiliate of University Health, Inc., for two lease terms of 30 years each expiring on February 1, 2045.

Principles of Consolidation

The consolidated financial statements include the accounts of University Health, Inc., University Health Services, Inc. (UHS), University Health Care Foundation, Inc. (the Foundation), Walton Way Indemnity, SPC (WWI), University Extended Care, Inc. (UEC), University Health Resources, Inc. (UHR), University Healthcare Physicians, LLC (UHCP), University McDuffie County Regional Medical Center (McDuffie), and Augusta Resource Center on Aging, Inc. (ARCOA). ARCOA does business as “Brandon Wilde”, a continuing care retirement community. During the year, ARCOA sold Brandon Wilde. All significant intercompany accounts and transactions have been eliminated.

Use of Estimates

The preparation of the consolidated financial statements in conformity with accounting principles generally accepted in the United States of America (GAAP) requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, and disclosures of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.

Cash Equivalents

The Corporation considers all highly liquid investments with a maturity of three months or less when purchased to be cash equivalents. Deposits with banks are generally federally insured in limited amounts.

Patient Accounts Receivable

Patient accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Corporation analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor 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 Corporation analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary.


9

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 Corporation records a provision for bad debts 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) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Recoveries of accounts previously written off are recorded as a reduction to the provision for bad debt expense when received.

Allowance for Uncollectible Accounts

For the year ended December 31, 2017, the allowance for uncollectible accounts was based upon management's assessment of historical and expected net collections, considering business and economic conditions, trends in health care coverage, and other collection indicators. Periodically, management assessed the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payor category. The results of this review were then used to make any modifications to the provision for bad debts to establish an appropriate allowance for uncollectible accounts. The Corporation’s allowance for doubtful accounts was 77% of self-pay accounts receivable and patient liability portion of other accounts at December 31, 2017.

Investments

Investments in other enterprises whereby the Parent does not have control but does exert significant influence are accounted for under the equity method of accounting. The Parent has equity investments in the following enterprises:

• Phoenix Health Care Management Services, Inc. • Surgery Center of Columbia County, LLC • Evans Imaging Center • Orthopedics Associates Surgery Center • Augusta Back Properties, LLC

Investments in marketable securities are measured at fair market value. The Corporation's investment portfolio is classified as trading. As such, all investment income or loss (including realized and unrealized gains and losses on investments, interest, and dividends) is included in the excess of revenues, other support, and gains over expenses and losses.

Inventories

Inventories (primarily pharmaceuticals and medical supplies) are stated at the lower of cost (first-in, first-out and average cost methods) or net realizable value.

Assets Limited as to Use

Assets limited as to use consist of Foundation investments limited as to use by donors and UHS investments limited as to use by other third parties in accordance with debt agreements (see Note 4) and are measured at fair value.


10

Property and Equipment

Property and equipment are stated at cost. Major renewals and betterments are charged to the property accounts while maintenance and repairs which do not improve or extend the life of the respective assets are charged to operations. Upon disposal of properties, the related costs and accumulated depreciation are removed from the respective accounts. Any resulting gain or loss is reflected as other operating revenue or expenses.

The Corporation follows the policy of providing for depreciation by charging against operations amounts sufficient to amortize the cost of properties over their estimated useful lives principally using the straight-line method. Principal lives used are: 20 to 50 years for buildings and improvements; 5 to 20 years for fixed equipment; and 3 to 10 years for major moveable equipment. Equipment under capital lease obligations is amortized on the straight-line method over the useful life of the asset or the lease term, whichever is less. Amortization of assets recorded under capital lease obligations is included in depreciation expense.

Vacation and Sick Pay

The Corporation accrues vacation and sick pay as earned by the employees.

Deferred Revenues from Entrance Fees

Deferred revenues from entrance fees relate to amounts paid by residents but not yet earned related to the continuing care retirement community (see Note 5). An advance fee is classified as deferred revenue when a continuing care retirement community has a resident contract that provides for payment of the refundable advance fee upon re-occupancy by a subsequent resident, which is limited to the proceeds of re-occupancy. Refundable advance fees that are contingent upon re-occupancy by a subsequent resident but are not limited to the proceeds of re-occupancy are accounted for and reported as a liability.

UHI’s Residency Agreement does not explicitly limit the amount of the refund to the amount of proceeds collected from re-occupancy. As such, the refundable portion of the entrance fees is recorded as a liability.

Asset Retirement Obligation

A conditional asset retirement obligation is an unconditional legal obligation to perform an asset retirement activity in which the timing and (or) method of settlement are conditional on a future event that may or may not be within the control of the entity. The Corporation recognizes a liability for the fair value of a conditional asset retirement obligation if the fair value of the liability can be reasonably estimated. The Corporation has determined that conditional legal obligations exist for its facilities related primarily to asbestos materials. The Corporation has recorded a liability of approximately $3,318,000 and $3,408,000 for the estimated present value for the conditional asset retirement obligation at December 31, 2018 and 2017, respectively. A related amount is recorded in property and equipment of approximately $251,000 and $268,000, representing the remaining un-depreciated cost of the asset retirement obligation at December 31, 2018 and 2017, respectively.

Post-Retirement Health Care Benefits

The Corporation sponsors a post-retirement health care plan. The Corporation recognizes the underfunded status of postretirement plans in its consolidated balance sheets. Changes in the funded status are recorded in the year in which the changes occurred through changes in net assets without restrictions. Benefit obligations are measured as of the date of the fiscal year-end balance sheet.

Adoption of New Accounting Standards Updates

During the year ended December 31, 2018, the Corporation adopted Accounting Standards Update (“ASU”) No. 2016-14 – Not-for-Profit Entities (Topic 958): Presentation of Financial Statements of Not-for-Profit Entities. The ASU addresses the complexity and understandability of net asset classification, deficiencies in information about liquidity of available resources, and the lack of consistency in the type of information provided about expenses and investment return. The fiscal year 2017 financial statements have been adjusted to reflect retrospective


11

application of the new accounting guidance, except for the disclosures around liquidity and availability of resources and analysis of expenses by functional and natural categories. These disclosures have been presented for 2018 as allowed by ASU No. 2016-14. The retrospective application resulted in temporarily restricted net assets of $22,228,763 and permanently restricted net assets of $21,534,094 being reported as net assets with donor restrictions totaling $43,762,857 and net assets without restrictions of $593,473,095 being reported as net assets without donor restrictions as of December 31, 2017.

During the year ended December 31, 2018, the Corporation adopted ASU 2014-09, Revenue from Contracts with Customers (Topic 606) and ASU 2015-14, Revenue from Contracts with Customers (Topic 606): Deferral of the Effective Date, using the modified retrospective method (ASC 606). The information in the prior year comparative period has not been restated and continues to be reported under the accounting standards in effect for that period. The overall impact of adoption was not material to the consolidated financial statements, with the primary changes related to presentation of certain information, as described below, and expanded disclosures in this note related to revenue recognition principles, disaggregation of revenues, and other matters.

As a result of the adoption of ASC 606, estimated uncollectible amounts from patients that was previously presented as the provision for bad debts in the consolidated statement of operations is now considered implicit price concessions (as defined in ASC 606) and therefore included in net patient service revenues in 2018. Such implicit price concessions reflected in net patient service revenue for the year ended December 31, 2018 were $31,492,177. Prior to January 1, 2018, the provision for bad debts has been presented consistent with the previous revenue recognition standards separately as a component of patient service revenue. Upon adoption of ASC 606, the allowance for doubtful accounts of $38,045,319 at January 1, 2018, was reclassified as a direct reduction of accounts receivable. Such implicit price concessions continue to be presented as a direct reduction of the accounts receivable.

Management has determined that the Corporation has an unconditional right to payment only subject to the passage of time for services provided to date based on just the need to either finalize billing for such services (i.e. charge lag) or to discharge the patient and bill for such services for patients who are still receiving inpatient care in our facilities at the balance sheet date. Accordingly, the Corporation accrues revenues and the related accounts receivable for services performed but not yet billed at the balance sheet date for in-house patients. Thus, management has determined that they do not have any amounts that should be reflected separately as contract assets.

As part of the adoption of ASC 606, the Corporation elected certain available practical expedients under the standard. First, the Corporation has elected the practical expedient allowed under FASB ASC 606-10-18 and does not adjust the promised amount of consideration from patients and third-party payors for the effects of a significant financing component due to the Corporation’s expectation that the period between the time the service is provided to a patient and the time that the patient or a third-party payor pays for that service will be one year or less. However, the Corporation does, in certain instances, enter into payment agreements with patients that allow payments in excess of one year. For those cases, the financing component is not deemed to be significant to the contract. Additionally, the Corporation has applied the practical expedient provided by FASB ASC 340-40-25-4 and all incremental customer contract acquisition costs are expenses as they are incurred, as the amortization period of the asset that the Corporation otherwise would have recognized is one year or less in duration.


12

Net Patient Service Revenue

Net patient service revenue is reported at the amount that reflects the consideration to which the Corporation expects to be entitled in exchange for providing patient care. These amounts are due from patients, third-party payors (including health insurer and government programs) and others. This also includes variable consideration for retroactive revenue adjustments due to settlement of audit, reviews and investigations by third-party payors. Net patient service revenue increased approximately $3,622,000 and $7,429,000 in 2018 and 2017, respectively, due to changes in amounts previously estimated as a result of final settlements, growth of patient revenues due to physician practice acquisitions and changes in estimates. Generally, the Corporation bills the patients and third-party payors several days after the services are performed or the patient is discharged from the facility. Revenue is recognized as performance obligations are satisfied.

Performance obligations are determined based on the nature of the services provided by the Corporation. Revenue for performance obligations satisfied over time is recognized based on actual charges incurred in relation to total expected charges. The Corporation believes that this method provides a faithful depiction of the transfer of services over the term of the performance obligation based on the inputs needed to satisfy the obligations. Generally, performance obligations satisfied over time relate to patients in our hospitals receiving inpatient acute care services. The Corporation measures the performance obligation from admission in to the hospital to the point when it is no longer required to provide services to that patient, which is generally the time of discharge. Revenue for performance obligations satisfied at a point in time generally relate to patients receiving outpatient services or patients and customers in a retail setting (for example, pharmaceuticals and medical equipment) and the Corporation does not believe it is required to provide additional goods or services.

Because all of its performance obligations relate to contracts with a duration of less than one year, the Corporation has elected to apply the optional exemption provided in FASB ASC 606-10-50-14(a) and, therefore, is not required to disclose the aggregate amount of the transaction price allocated to performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period. The unsatisfied or partially unsatisfied performance obligations referred to above are primarily related to inpatient acute care services at the end of the reporting period. The performance obligations for these contracts are generally completed when patients are discharged, which generally occurs within days or weeks of the end of the reporting period.

The Corporation determines the transaction price based on standard charges for goods and services provided, reduced by contractual adjustments provided to third-party payors, discounts provided to uninsured patients in accordance with the Corporation’s policy and implicit price concessions provided to uninsured patients. The Corporation determines its estimates of explicit price concessions for contractual adjustments based on contractual agreements, or discount policies and historical experience. The Corporation determines its estimate of implicit price concessions based on its historical collection experience with this class of patients using a portfolio approach as a practical expedient to account for patient contracts as collective groups rather than individually. Management believes that the financial effects of using this practical expedient are not materially different from an individual contract approach.

The Corporation has agreements with third-party payors that provide for payments to the Corporation at amounts different from its established rates. A significant portion of the Corporation’s net patient service revenues are derived from the third-party payor programs. Revenues received under third-party arrangements are subject to audit and retroactive adjustment.

The Medicare program pays prospectively determined rates for inpatient and outpatient operating and capital related services. These rates vary according to a patient classification system that is based on clinical, diagnostic, and other factors. Revenue for services rendered under Medicare third-party payor programs has been recorded at estimated settlement amounts. Final determination of the settlement amounts is subject to review by appropriate authorities or their agents and to the extent that ultimate settlement amounts differ from amounts previously estimated, related adjustments are reflected in the financial statements in the period of final settlement. Final settlement has been reached through the fiscal year ended December 31, 2009, for Medicare services. Revenues from Medicare were


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approximately 46% and 45% of total net patient service revenues for the years ended December 31, 2018 and 2017, respectively.

The Medicaid program pays prospectively determined rates for inpatient operations and capital related services. These rates vary according to a patient classification system that is based on clinical, diagnostic, and other factors. Outpatient services are paid on a cost reimbursement basis. Final settlement has been reached through the fiscal year ended December 31, 2015, for Georgia Medicaid services. Revenues from Medicaid were approximately 11% of total net patient service revenues for the years ended December 31, 2018 and 2017.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 created the Recovery Audit Contractors (RAC) program to detect and correct improper payments in the Medicare program. The RAC reviews began in late 2009 and continued in 2018. Although management believes its billing policies do not result in overpayments, the RAC reviews could materially affect the operations of the Corporation.

Laws and regulations governing Medicare and Medicaid programs are complex and subject to interpretation. As a result, there is a reasonable possibility that recorded estimates may change by a material amount in the near term. The Corporation believes that it is in compliance with all applicable laws and regulations. The Corporation is not aware of any pending or threatened investigations involving allegations of potential wrongdoing that would have a material effect on the Corporation's consolidated financial statements. Compliance with such laws and regulations can be subject to future government review and interpretation. Non-compliance can result in significant regulatory action including fines, penalties, and exclusion from the Medicare and Medicaid programs.

The Corporation also has entered into payment agreements with certain commercial insurance carriers, health maintenance organizations, and preferred provider organizations. The basis for payment to the Corporation under these agreements includes prospectively determined rates per discharge, discounts from established charges, and prospectively determined daily rates. Revenue is recognized as services are provided for these payors. Revenues from nongovernmental payors were approximately 41% and 42% of total net patient service revenues for the years ended December 31, 2018 and 2017, respectively.

Consistent with the Corporation’s mission, care is provided to patients regardless of their ability to pay. Therefore, the Corporation has determined it has provided implicit price concessions to uninsured patients and patients with other uninsured balances (for example, copays and deductibles). The implicit price concessions included in estimating the transaction price represent the difference between amounts billed to patients and the amounts the Corporation expects to collect based on its collection history with those patients.

The Corporation has determined that the nature, amount, timing and uncertainty of revenue and cash flows are affected by the following factors: payors, geography, service lines, method of reimbursement and timing of when revenue is recognized.

The Corporation’s revenues from third-party payors and others (including uninsured patients) for the years ended December 31, 2018 and 2017, and by primary hospitals and all other facilities are summarized in the following tables:

2018 Total All UHS UEC UHM Others Total Ratio Medicare $244,046,804 $ 10,333,618 $ 8,527,245 $ 36,188,924 $299,096,591 46% Medicaid 46,311,418 19,809,950 2,212,224 2,322,090 70,655,682 11% Indigent/ Self Pay 5,717,976 3,332,824 1,839,554 1,981,616 12,871,970 2% Other 223,198,784 1,052,371 8,662,446 34,195,078 267,108,679 41% Revenues $519,274,982 $ 34,528,763 $ 21,241,469 $ 74,687,708 $649,732,922 100%


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2017 Total All UHS UEC UHM Others Total Ratio Medicare $226,663,485 $ 10,841,570 $ 6,968,407 $ 33,643,119 278,116,581 45% Medicaid 44,373,515 18,770,366 2,000,168 1,815,659 66,959,708 11% Indigent/ Self Pay 11,757,540 3,464,773 1,545,600 1,727,815 18,495,728 3% Other 211,803,089 949,770 10,066,223 36,532,937 259,352,019 41% Revenues $494,597,629 $ 34,026,479 $20,580,398 $ 73,719,530 $622,924,036 100% Revenue from patient’s deductibles and coinsurance are included in the categories presented above based on the primary payor.

Charity Care

UHS and McDuffie provide care to patients who meet certain criteria under its charity care policy without charge or for payments less than its established rates. Because UHS and McDuffie do not expect collection of amounts determined as charity care, they are not reported as net patient service revenue. Gross charges forgone based on established rates for charity care services rendered were approximately $114,423,000 and $94,384,000 for the years ended December 31, 2018 and 2017, respectively.

The costs to provide charity services were approximately $33,947,000 and $27,911,000 for the years ended December 31, 2018 and 2017, respectively. These costs are estimated based on UHS’ cost to charge ratio for each respective fiscal year.

HITECH Incentive Funding for Meaningful Use of Electronic Health Records

The American Recovery and Reinvestment Act of 2009 (ARRA) established incentive payments under the Medicare and Medicaid programs for certain healthcare providers that use certified electronic health records (EHR) technology. The program is commonly referred to as the Health Information Technology for Economic and Clinical Health (HITECH) Act. To qualify for incentives under the HITECH Act, healthcare providers must meet designated EHR meaningful use criteria as defined by the Centers for Medicare and Medicaid Services (CMS). Incentive payments are awarded to healthcare providers who have attested to CMS that applicable meaningful use criteria have been met. Compliance with meaningful use criteria is subject to audit by the federal government or its designee and incentive payments are subject to adjustment in a future period.

The Corporation recognizes revenue for EHR incentive payments in the period in which it has attested that it is in compliance with the applicable EHR meaningful use requirements. Accordingly, the Corporation recognized other operating revenues of approximately $0 and $887,000 in the consolidated statements of operations for the years ended December 31, 2018 and 2017, respectively.

Excess (Deficiency) of Revenues, Other Support, and Gains Over Expenses and Losses

The consolidated statements of operations include excess (deficiency) of revenues, other support, and gains over expenses and losses. Changes in net assets without restrictions which are excluded from excess (deficiency) of revenues, other support, and gains over expenses and losses, consistent with industry practice, include changes in unfunded postretirement liability, permanent transfers of assets for other than goods and services, and contributions of long-lived assets (including assets acquired using contributions which by donor restriction were to be used for the purposes of acquiring such assets).


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Accounting for Income Taxes

The Parent, UHS, the Foundation, ARCOA, McDuffie, and University Extended Care, Inc. are 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. University Health Resources, Inc. is a taxable entity and files a corporate tax return. UHCP is organized under Georgia law and the Internal Revenue Code as a limited liability company (LLC). The members of an LLC report taxable income or loss on their corporate or individual tax returns.

With respect to its for-profit entities, as well as any unrelated business income generated by the tax-exempt entities, the Parent records income taxes using the liability method under which deferred tax assets and liabilities are determined based on the differences between the financial accounting and tax bases of assets and liabilities. Deferred tax assets or liabilities at the end of each period are determined using the currently enacted tax rate expected to apply to taxable income in the period that the deferred tax asset or liability is expected to be realized or settled.

There is presently no taxation imposed by the government of the Cayman Islands on income or premiums of WWI. As a result, no tax liability or expense has been recorded.

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.

Donor-Restricted Gifts

Unconditional promises to give cash and other assets to the Corporation are reported at fair value at the date the promise is received. The gifts are reported as net assets with donor restrictions if they are received with donor stipulations that limit the use of the donated assets. When a donor restriction expires, that is, when a stipulated time restriction ends or purpose restriction is accomplished, net assets with donor restrictions are reclassified as net assets without donor restrictions and reported in the consolidated statement of operations as net assets released from restrictions. Donor-restricted contributions whose restrictions are met within the same year as received are reported as unrestricted contributions in the accompanying consolidated financial statements.

Fair Value of Financial Instruments

Fair value as defined under GAAP is an exit price, representing the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. GAAP establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value. These tiers include:

• Level 1: Observable inputs such as quoted prices in active markets. • Level 2: Inputs other than quoted prices in active markets that are either directly or indirectly observable. • Level 3: Unobservable inputs about which little or no market data exists, therefore requiring an entity to

develop its own assumptions.

Commitment On October 1, 2017, the Corporation entered into a five-year agreement with Novant Health, Inc. (Novant Health) for certain contracted services. A base annual fee of $5,265,968 is paid in quarterly installments, increasing on each anniversary of the effective date of the agreement by 1.5%.

Sale of Assets ARCOA sold its continuing care retirement community, which operated under the name of Brandon Wilde, on August 17, 2018. The gain on the sale of approximately $46,650,000 is reported as nonoperating income on the Consolidated Statements of Operations.


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Subsequent Events

The Corporation evaluated the effect subsequent events would have on the consolidated financial statements from January 1, 2019 through April 30, 2019 which is the date the consolidated financial statements were issued.

In February 2016, FASB issued ASU 2016-02 Leases (Topic 842). ASU 2016-02 generally requires all leases to be capitalized and recognized on the consolidated balance sheet. ASU 2016-02 will be effective for fiscal year ending December 31, 2019. Management is currently assessing the effects ASU 2016-02 will have on the consolidated financial statements.

2. Investments

Short-Term Investments

The composition of short-term investments at December 31, 2018 and 2017, is set forth in the following table:

2018 2017 Cash and cash equivalents $ - $ 2,787,655

Assets Limited as to Use

The composition of assets limited as to use at December 31, 2018 and 2017, is set forth in the following table:

2018 2017 Cash and cash equivalents $ 4,635,595 $ 3,360,464 Equities 21,909,527 24,748,805 Limited partnerships - 3,128,437 Fixed income securities 8,400,744 13,914,883 Alternative investments 36,576,226 47,915,412 Other 2,678,560 - $ 74,200,652 $ 93,068,001 Long-Term Investments

The composition of long-term investments at December 31, 2018 and 2017, is set forth in the following table:

2018 2017 Cash and cash equivalents $ 11,297,151 $ 7,276,675 Equities 120,125,705 112,477,437 Limited partnerships - 14,773,354 Fixed income securities 56,929,115 69,459,287 Alternative investments 239,529,327 256,597,159 Other 19,988,581 3,395,290 $ 447 869 879 $ 463,979,202


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Investment income, gains, and losses for short-term investments, assets limited as to use, long-term investments, and cash and cash equivalents are comprised of the following for the years ended December 31, 2018 and 2017:

2018 2017 Interest and dividend income $ 12,297,364 $ 8,781,542 Net realized gains on investments 5,276,128 8,395,980 Change in net unrealized (losses)/gains on investments, trading securities (48,182,249) 44,139,388 $ (30 608 757) $ 61,316,910

3. Property and Equipment

Property and equipment consist of the following: 2018 2017 Land $ 21,961,420 $ 28,102,777 Land improvements 5,167,596 8,626,535 Buildings and improvements 385,217,210 428,930,365 Major moveable equipment 377,457,364 365,418,486 Fixed equipment 18,963,448 19,005,716 808,767,038 850,083,879 Less accumulated depreciation (491,092,769) (498,126,041) 317,674,269 351,957,838 Construction in progress 11,803,432 13,945,322 $ 329 477 701 $ 365,903,160 Equipment under capital lease obligations is included in major movable equipment and accumulated depreciation. The carrying value and related accumulated depreciation at December 31, 2018 are approximately $10,448,000 and $5,818,000, and at December 31, 2017 are approximately $10,298,000 and $4,425,000, respectively.

Estimated cost to complete existing construction in progress under contract, which relates primarily to facility renovation and expansion projects, is approximately $24,120,000 at December 31, 2018.


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4. Long-Term Debt

Long-term debt is summarized as follows:

2018 2017 Revenue Anticipation Certificates, Series 2016 $ 127,965,000 $ 130,965,000 Bank Loans (Bank of America, TD Bank and GA Bank and Trust) 101,767,656 125,391,522 Total 229,732,656 256,356,522 Less current maturities (42,569,786) (39,864,974) Plus unamortized bond issue premium 16,608,283 17,585,240 Less unamortized bond issuance costs (1,580,502) (1,683,888) $ 202,190,651 $ 232,392,900 On October 1, 2016, the Authority issued $135,745,000 of tax-exempt Series 2016 revenue anticipation certificates (the 2016 Certificates) for the purpose of advance refunding the Series 2009 revenue anticipation certificates, in order to refinance the costs of acquiring, constructing, and equipping of hospital and health care facilities. The 2016 Certificates consist of Serial Certificates payable annually in varying principal amounts ranging from $3,000,000 to $10,465,000 through 2036 and bear interest at fixed rates ranging from 2.00% to 5.00%, payable annually.

The gross revenue and property of the Obligated Group are pledged as security for the 2016 Certificates. The Obligated Group consists of UHS, UHI, and UEC and affiliates of these corporations. The related loan agreements and master trust indenture contain certain covenants on the part of the Obligated Group, including limitations on the incurrence of additional indebtedness, transfers of assets, maintenance of certain amounts of insurance, and certain other financial covenants.

Beginning March 27, 2013, UHS entered into a financing agreement in the amount of approximately $63,266,000 with Banc of America Leasing & Capital, LLC. to retroactively finance the Epic system conversion and other capital equipment. These funds were borrowed over the course of the year and each note schedule consists of a term of seven years with interest rates varying from 2.20% to 2.67%. The Note is secured by equipment purchased with the funds. In 2014, funds of approximately $23,356,000 were borrowed from Banc of America to finance additional capital equipment. In 2015, funds of approximately $20,955,000 were borrowed from Banc of America to finance additional capital equipment. Each note schedule related to 2014 and 2015 borrowings consists of a term of five years with interest rates varying from 2.36% to 2.43%. On February 3, 2017, $16,550,298 was borrowed from Banc of America Leasing & Capital, LLC. to finance additional capital equipment. The additional debt has a term of five years with an interest rate of 2.86%. On May 24, 2017, $10,000,000 was borrowed to finance additional capital equipment with a term of seven years with an interest rate of 3.09%. On June 7, 2018, $14,893,029 was borrowed to finance additional capital equipment with a term of 5 years with an interest rate of 3.7%.

On May 22, 2015, UHS entered into a promissory note in the amount of $36,000,000 with Banc of America Leasing & Capital, LLC (the “Note”) related to financing the termination of the pension plan. The Note is payable in sixty consecutive monthly installments of principal and interest at a fixed annual interest rate of 2.26%. The Note is secured by certain financial instruments. Under the terms of the agreement, these certain financial instruments must maintain a minimum market value that is greater than 125% of the then outstanding principal amount under the agreement which are classified as assets limited as to use in the accompanying balance sheets. The Note also has certain financial and other covenants for which UHS must comply.

On July 11, 2017, UHS entered into a promissory note in the amount of $25,000,000 with TD Bank N.A. related to financing the purchase of certain assets of Trinity Hospital. The Note is payable in eighty-four consecutive monthly installments of principal and interest at a fixed annual interest rate of 2.63%. The Note is secured by certain financial instruments. Under the terms of the agreement, these certain financial instruments must maintain a minimum market


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value that is at least 100% of the then outstanding principal amount under the agreement which are classified as assets limited as to use in the accompanying balance sheets. The Note also has certain financial and other covenants for which UHS must comply.

On July 28, 2017, UHS entered into a promissory note in the amount of $10,000,000 with Banc of America Leasing & Capital, LLC (the “Note”). The Note is payable in eighty-four consecutive monthly installments of principal and interest at a fixed annual interest rate of 2.99%. The Note is secured by certain financial instruments. Under the terms of the agreement, these certain financial instruments must maintain a minimum market value that is greater than 125% of the then outstanding principal amount under the agreement which are classified as assets limited as to use in the accompanying balance sheets. The Note also has certain financial and other covenants for which UHS must comply.

For the year ended December 31, 2018, UHS violated the minimum debt service coverage ratio requirement of 1.2 as required under the Banc of America Leasing & Capital, LLC agreements. The violation constitutes an event of default which gives the lender the ability to accelerate the debt among other remedies. Subsequent to year-end, UHS obtained a waiver from the bank related to its covenant violations at December 31, 2018. Because the bank has waived its right to accelerate the debt related to this covenant violation, the debt is reported as noncurrent liabilities within long-term debt, net of current maturities, in the accompanying consolidated balance sheets. The waiver is limited to the violation of the debt service coverage covenant. Should any other events of default occur, the bank may exercise any and all remedies available to it under the relevant agreements.

Scheduled principal payments on all long-term debt obligations are as follows (excluding premium): Fiscal Year Total 2019 $ 42,569,786 2020 29,892,009 2021 16,096,376 2022 15,680,858 2023 14,314,703 Thereafter 111,178,924 Total $ 229,732,656

5. Entrance Fees

Entrance fees were amounts paid by residents to ARCOA for admission to the continuing care retirement community, for future services to be rendered to the resident, and for use of the facility as specified in the contract. The refundable portion of entrance fees would be refunded to the resident or their estate upon the re-occupancy of the resident unit. These amounts were included in other current liabilities.

Nonrefundable entrance fees were included in other long-term obligations in the consolidated balance sheets as of December 31, 2017. The Continuing Care Retirement Community, DBA Brandon Wilde, was sold on August 17, 2018, as such, there are no refundable entrance fees as of December 31, 2018.


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Nonrefundable and refundable entrance fees are summarized as follows:

2018 2017 Nonrefundable entrance fees $ - $ 50,657,588 Less accumulated amortization - (22,987,059) $ - $ 27,670,529 Refundable entrance fee liability $ - $ 14,455,015

The nonrefundable fees were amortized over the life expectancy of each specific resident based on actuarially determined life expectancies as of the date when the resident takes occupancy.

6. Reserve for Contingent Losses

WWI, a wholly owned subsidiary of UHS, was incorporated as an exempted segregated portfolio company on August 23, 2002, under the laws of the Cayman Islands, B.W.I., to provide professional and general liability coverage for UHS and its sister corporations effective July 1, 2002. WWI provides prior acts professional liability coverage for UHI, UHS, UEC, UHR, UHM and the administratively employed physicians for claims incurred but not reported from January 1, 1992 through July 1, 2002; and for claims incurred and reported from July 1, 2002 to the end of the current policy period, January 1, 2019.

WWI currently insures the Corporation, UHS, UHR and UHM for professional and general liabilities under a $25 million policy on a claims made basis. WWI is directly responsible for up to $5 million per claim with a policy aggregate of $14 million. The $20 million excess coverage is ceded in two tiers of $10 million each to “A” rated outside insurance providers with WWI remaining liable for $150,000 each and every claim, in the excess layer.

WWI currently insures UEC and ARCOA with a separate claims made policy of $2 million per claim with a $4 million annual aggregate, retroactive to January 1, 1992 for professional and general liability claims. In 2016, 100% of the professional exposure for the full time employed physicians was placed with a commercial carrier without any self-insured liability retained by UHS.

In 2012, the captive, under approval of the Cayman Island Monetary Authority, expanded coverage to address the workers compensation claims of University Health Services, Inc. WWI has a SIR of $400,000/claim for workers compensation with excess coverage of $2M provided by a commercial carrier. By 2016, all Georgia based employees were insured under the Walton Way workers compensation policy. All South Carolina based employees remain covered by a commercial policy.

The estimated liability and expenses related to the professional, general liability and workers compensation risks insured by WWI are evaluated annually by an actuarial analysis performed by Willis Towers Watson. The analysis is based on incurred losses, expenses, expected future losses and expenses which include the individual case reserves for identified and reported claims as well as aggregate liability for incurred but not reported losses.

UHI is subject to certain claims and regulatory reviews that arise in the ordinary course of business. Further, like other healthcare providers, UHI’s operations are subject to a variety of federal, state, and local regulatory risks, including without limitation, the federal Anti-Kickback statute. It is also not possible at the present time to estimate the ultimate legal and financial liability, if any, with respect to certain claims or regulatory reviews. In the opinion of management, the eventual outcome of claims and regulatory reviews is not expected to have a material adverse effect on the UHI’s financial position. However, depending on the amounts and timing of such resolution, an unfavorable outcome could materially affect the results of operations or cash flows in a particular period.


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7. Concentrations of Credit Risk

UHS grants credit without collateral to its patients, most of who are local residents of Augusta, Georgia, and the surrounding region and are insured under various third-party payor agreements. The mix of receivables from patients and third-party payors at December 31, 2018 and 2017, was as follows:

2018 2017 Medicare 38% 42% Medicaid 6% 6% Other third-party payor 39% 37% Patients 17% 15% 100% 100%

8. Retirement Benefits

UHS sponsors a defined benefit health care plan that provides postretirement medical benefits to full-time employees hired prior to January 1, 2005, who have worked ten years and attained age 55 while in service with UHS. Effective January 1, 2011, the plan requires the employee to work twenty years and attain the age of 60. Effective January 1, 2010, the plan no longer provides a dental supplement to the participants. The plan is contributory with retiree contributions adjusted annually, and contains other cost-sharing features such as deductibles and coinsurance. The accounting for the plan anticipates future cost-sharing changes to the plan that are consistent with UHS' expressed intent to increase the retiree contribution rate annually for the expected increases in the health trend rates. UHS' policy is to fund benefits as they are actually submitted for payment by plan participants, rather than build a segregated reserve to finance future benefit payments.

Net periodic postretirement benefit cost includes the following components:

2018 2017 Service cost $ 635,458 $ 578,985 Interest cost 1,262,256 1,215,446 Amortization of prior service cost (1,010,881) (1,010,881) Amortization of actuarial loss 1,701,641 1,300,926 $ 2,588,474 $ 2,084,476

The components of net periodic postretirement benefit cost other than the service cost component are included in the line item other components of net benefit cost in the accompanying consolidated statements of operations.


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The following table presents a reconciliation of the beginning and ending balances of the plan's accumulated postretirement benefit obligation, and the funded status of the plan:

2018 2017 Change in benefit obligation: Accumulated postretirement benefit obligation, beginning of year $ 37,053,223 $ 32,601,129 Service cost 635,458 578,985 Interest cost 1,262,256 1,215,446 Actuarial loss (gain) (5,018,930) 4,548,088 Net claims paid (1,785,608) (1,890,425) Accumulated postretirement benefit obligation, end of year $ 32,146,399 $ 37,053,223 Plan assets, end of year $ - $ - Funded status of the plan recognized in the consolidated balance sheets $ (32,146,399) $ (37,053,223) Amounts recognized in the consolidated balance sheets at December 31 consist of: 2018 2017 Current liabilities $ (1,747,058) $ (1,785,608) Noncurrent liabilities (30,399,341) (35,267,615) Net amount recognized $ (32 146 399) $ (37,053,223)

Amounts recognized in net assets without donor restrictions at December 31 consist of:

2018 2017 Net actuarial loss $ (12,639,851) $ (19,360,422) Prior service credit 1,435,453 2,446,334 $ (11 204 398) $ (16,914,088)

The gain (loss) in net assets without donor restrictions during the year is attributable to:

2018 2017 Amortization of prior service credit $ (1,010,881) $ (1,010,881) Amortization of loss 1,701,641 1,300,926 Net gain (loss) during the year 5,018,930 (4,548,088) $ 5,709,690 $ (4,258,043) The net actuarial loss and prior service credit included in net assets without donor restrictions and expected to be recognized in net periodic postretirement benefit cost during the fiscal year ending December 31, 2019, are $1,073,486 and ($1,010,881), respectively.


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The discount rates used to determine net periodic postretirement benefit cost for the plan for the years ended December 31, 2018 and 2017 were as follows:

2018 2017 Discount rate 3.80% 4.54% The discount rate used to determine benefit obligations for the plan as of December 31, 2018 and 2017 were as follows:

2018 2017 Discount rate 4.47% 3.80% The initial and health care trend rates for determining benefit obligations at year-end are shown below. The initial rate decreases gradually to the ultimate trend rate. 2018 2017 Medical benefits: Initial trend rate 6.20%/6.20% 6.50%/6.50% Ultimate trend rate 4.40%/4.50% 4.40%/4.50% Year ultimate rate reached 2038 2038 The health care cost trend rate assumption has a significant effect on the amounts reported. For example, increasing the assumed health care cost trend rate by one percentage point in each year would increase the accumulated postretirement benefit obligation as of December 31, 2018 by approximately $5,237,000 and the aggregate of the service and interest cost components of net periodic postretirement benefit cost by approximately $396,000 for 2018. A one percentage point decrease in each year would decrease the accumulated postretirement benefit obligation as of December 31, 2018, by approximately $4,189,000 and the aggregate of the service cost and interest cost components of net periodic postretirement benefit cost by approximately $306,000 for 2018.

Based on current data and assumptions, the following benefit payments are expected to be paid over the next ten years:

Year ending: 2019 $1,747,058 2020 1,538,143 2021 1,399,650 2022 1,327,980 2023 1,365,084 2024-2028 7,938,823 The measurement dates used are December 31, 2018 and 2017.

UHS has a defined contribution retirement plan for all eligible employees. The plan is a tax-deferred annuity plan which allows employee and employer matching contributions upon employment. Employer contributions are made at fixed rates of participants' compensation and contributions to the plan. UHS incurred $4,830,944 and $4,859,433 of expenses related to the plan during the years ended December 31, 2018 and 2017, respectively.


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9. Endowment and Other Donor Restricted Funds

The Corporation has 117 donor restricted endowment funds and 79 other donor restricted funds established for a variety of purposes. As required by GAAP, net assets associated with endowment funds, and other donor restricted funds, are classified and reported based on the existence or absence of donor-imposed restrictions.

Interpretation of Relevant Law

The State Prudent Management of Institutional Funds Act (SPMIFA) requires the preservation of the fair value of the original gift as of the gift date of the donor restricted endowment funds absent explicit donor stipulations to the contrary. As such, the Corporation classifies donor restricted endowment funds as net assets with restrictions (a) at the original value of gifts donated to the permanent endowment, (b) at the original value of subsequent gifts to the permanent endowment, and (c) through accumulations to the permanent endowment made in accordance with the direction of the applicable donor gift instrument at the time the accumulation is added to the fund.

In accordance with SPMIFA, the Corporation considers the following factors in making a determination to appropriate or accumulate donor restricted endowment funds:

1. The duration and preservation of the fund 2. The purpose of the Corporation and the donor restricted endowment fund 3. General economic conditions 4. The possible effect of inflation and deflation 5. The expected total return from income and the appreciation of investments 6. Other resources of the organization 7. The investment policies of the organization

The composition of donor restricted endowment funds and other donor restricted funds by type and restriction as of December 31, 2018, is summarized as follows:

Donor restricted endowment funds $ 31,157,817 Other donor restricted funds 5,945,177 Total donor restricted funds $ 37,102,994 The composition of donor restricted endowment funds and other donor restricted funds by type and restriction as of December 31, 2017, is summarized as follows:

Donor restricted endowment funds $ 37,298,900 Other donor restricted funds 6,463,957 Total donor restricted funds $ 43,762,857


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The changes in donor restricted funds for the year ended December 31, 2018 are summarized as follows: Donor restricted funds, beginning of year $ 43,762,857 Investment gain: Investment income 947,424 Net appreciation (realized and unrealized) (2,380,921) Total investment loss (1,433,497) New gifts 2,435,768 Appropriation of endowment assets for expenditure (8,193,369) Transfers 531,235 Donor restricted funds, end of year $ 37,102,994 The changes in donor restricted funds for the year ended December 31, 2017 are summarized as follows: Donor restricted funds, beginning of year $ 38,869,989 Investment gain: Investment income 786,550 Net appreciation (realized and unrealized) 3,917,420 Total investment gain 4,703,970 New gifts 3,205,308 Appropriation of endowment assets for expenditure (2,361,683) Transfers (654,727) Donor restricted funds, end of year $ 43,762,857

Funds with Deficiencies

From time to time, the fair value of assets associated with individual donor restricted endowment funds may fall below the level that the donor or SPMIFA requires the Corporation to retain as a fund of perpetual duration. There were no significant deficiencies as of December 31, 2018 and 2017.

Return Objectives and Risk Parameters

The Corporation has adopted investment and spending policies for endowment assets that attempt to provide a predictable stream of funding to programs supported by its endowment while seeking to maintain the purchasing power of the endowment assets. Endowment assets include those assets of donor-restricted funds that the organization must hold in perpetuity or for a donor-specified period(s). The Corporation expects its endowment funds, over time, to provide an average rate of return of approximately 8 percent annually. Actual returns in any given year may vary from this amount.


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Strategies Employed for Achieving Objectives

To satisfy its long-term rate-of-return objectives, the Corporation relies on a total return strategy in which investment returns are achieved through both capital appreciation (realized and unrealized) and current yield (interest and dividends). The Corporation targets a diversified asset allocation that places a greater emphasis on equity-based investments to achieve its long-term return objectives within prudent risk constraints.

Spending Policy and How the Investment Objectives Relate to Spending Policy

During 2009, the Corporation adopted a policy of appropriating for distribution each year 4 percent of its endowment fund’s three year moving average as of September 30 preceding the fiscal year in which the distribution is planned. In establishing this policy, the Corporation considered the long-term expected return on its endowment. Accordingly, over the long term, the Corporation expects the current spending policy to allow its endowment to grow at an average of 4 percent annually. This is consistent with the Corporation’s objective to maintain the purchasing power of the endowment assets held in perpetuity or for a specified term as well as to provide additional real growth through new gifts and investment return.

10. Income Taxes

Deferred income taxes, which as of December 31, 2018 and 2017, have no net carrying value, reflect the net tax effect of temporary differences between the carrying amounts of assets and liabilities for financial reporting and the amounts used for income tax purposes. As of December 31, 2018 and 2017, the Corporation had deferred tax assets of approximately $7,602,000 and $11,608,000, respectively, relating principally to net operating loss carryovers of UHR. GAAP requires a valuation allowance to reduce the deferred tax assets reported if, based on the weight of the evidence, it is more likely than not that some portion or all of the deferred tax assets will not be realized. After consideration of all the evidence, both positive and negative, management determined that a $7,602,000 and $11,608,000 allowance at December 31, 2018 and 2017, respectively, was necessary to reduce the deferred tax assets to the amount that would more likely than not be realized to zero. At December 31, 2018, the Corporation has available net operating loss carryforwards of approximately $29,534,000, which began expiring during the 2006 tax year.

11. Leases

The Corporation leases office space and equipment from various parties. Future minimum payments, by year and in the aggregate, at December 31, 2018, are as follows:

Capital Operating Leases Leases 2019 $ 2,119,466 $ 5,483,144 2020 1,858,178 4,762,776 2021 589,308 4,445,274 2022 238,538 4,303,560 2023 5,649 3,398,190 Thereafter - 10,922,704 Total minimum lease payments 4,811,139 33,315,648 Less amounts representing interest 183,719 - Present value of net minimum lease payments (including current portion of $2,091,323) $ 4,627,420 $ 33,315,648

Rental expense incurred for 2018 and 2017 amounted to approximately $8,585,000 and $7,612,000, respectively.


27

12. Functional Expenses

The Corporation provides inpatient, outpatient, emergency care services, and long-term care primarily for residents of the Augusta, Georgia area. Expenses related to providing these services for the years ended December 31, 2018 are approximately:

Healthcare General & Services Administrative Total Salaries and benefits $ 317,053,785 $ 16,651,914 $ 333,705,699 Other operating expenses 265,738,720 14,168,245 279,906,965 Depreciation 45,667,199 2,398,477 48,065,676 Interest 7,593,145 398,798 7,991,943 Total operating expenses $ 636,052,849 $ 33,617,434 $ 669,670,283 Expenses related to providing these services for the years ended December 31, 2017 are approximately:

Healthcare General & Services Administrative Total Salaries and benefits $ 309,516,936 $ 14,584,568 $ 324,101,504 Other operating expenses 243,621,211 11,479,533 255,100,744 Depreciation 42,192,208 1,988,114 44,180,322 Interest 7,558,848 356,176 7,915,024 Total operating expenses $ 602,889,203 $ 28,408,391 $ 631,297,594

13. Fair Values of Financial Instruments

Assets and liabilities are classified in their entirety based on the lowest level of input that is significant to the fair value measurement. The Corporation’s assessment of the significance of a particular input to the fair value measurement requires judgment and may affect the valuation of fair value assets and liabilities and their placement within the fair value hierarchy levels. There were no changes in valuation techniques during the current year.

When quoted prices are available in active markets for identical instruments, investment securities are classified within Level 1 of the fair value hierarchy. Level 1 investments include common stocks and certain equity mutual funds.

Level 2 investment securities include money market funds, corporate bonds, U.S. government backed securities, mortgage-backed securities, certain equity mutual funds, and non-publicly traded common stocks for which quoted prices are not available in active markets for identical instruments. The Corporation utilizes a third party pricing service to determine the fair value of each of these investment securities. Because quoted prices in active markets for identical assets are not available, these prices are determined using observable market information such as quotes from less active markets and/or quoted prices of securities with similar characteristics.


28

The following table set forth by level within the fair value hierarchy the Corporation’s assets accounted for at fair value on a recurring basis at December 31, 2018: Level 1 Level 2 Total Assets limited as to use Cash and cash equivalents: Money Market Fund $ - $ 1,915,405 $ 1,915,405 STIF-type instrument - 2,720,190 2,720,190 Total cash and cash equivalents - 4,635,595 4,635,595 Equities: Common stocks 1,754,226 - 1,754,226 Mutual Funds: Domestic 6,864,826 - 6,864,826 International 12,991,326 - 12,991,326 Commodity 200,547 - 200,547 Preferred stocks 74,820 - 74,820 REIT 23,782 - 23,782 Total equities 21,909,527 - 21,909,527 Fixed Income securities: Corporate bonds - 899,036 899,036 Mutual funds 7,051,767 - 7,051,767 U.S. government backed and other securities - 449,941 449,941 Total fixed income securities 7,051,767 1,348,977 8,400,744 Total assets limited as to use in the fair value hierarchy $ 28,961,294 $ 5,984,572 34,945,866 Total assets limited as to use measured at net asset value (a) 36,576,226 Total assets limited as to use, not considered financial instruments 2,678,560 Total assets limited as to use $ 74,200,652

(a) In accordance with Topic 820, certain investments that were measured at NAV per share (or its equivalent) have not been classified in the fair value hierarchy. The fair value amounts presented in this table are intended to permit reconciliation of the fair value hierarchy to the line items presented in the consolidated balance sheets.


29

Level 1 Level 2 Total Long-term investments

Cash and cash equivalents: Money Market Funds $ - $ - $ - STIF-type instrument - 11,297,151 11,297,151 Total cash and cash equivalents - 11,297,151 11,297,151 Equities: Common stocks 26,478 - 26,478 Mutual funds: Domestic 40,859,619 - 40,859,619 International 79,239,608 - 79,239,608 Total equities 120,125,705 - 120,125,705 Fixed income securities: Corporate bonds - 3,736,215 3,736,215 Mutual funds 50,409,253 - 50,409,253 U.S. government backed and other securities - 2,783,647 2,783,647 Total fixed income securities 50,409,253 6,519,862 56,929,115 Total long-term investments $170,534,958 $ 17,817,013 188,351,971 Total long-term investments measured at net asset value (a) 239,529,327 Total long-term investments, not considered financial instruments 16,448,500 Cost and equity investments, not considered financial instruments 3,540,081 Total long-term investments $ 447,869,879



30

The following table set forth by level within the fair value hierarchy the Corporation’s assets accounted for at fair value on a recurring basis at December 31, 2017:

Level 1 Level 2 Total Short-term investments Cash and cash equivalents: Money market funds $ - $ 2,787,655 $ 2,787,655 Assets limited as to use Cash and cash equivalents: Money Market Fund $ - $ 1,346,347 $ 1,346,347 STIF-type instrument - 2,014,117 2,014,117 Total Cash and cash equivalents - 3,360,464 3,360,464 Equities: Common stocks 5,007,035 - 5,007,035 Mutual Funds: Domestic 3,297,200 - 3,297,200 International 13,999,992 1,765,146 15,765,138 Commodity 213,622 - 213,622 Preferred stocks 182,589 - 182,589 REIT 283,221 - 283,221 Total equities 22,983,659 1,765,146 24,748,805 Limited partnerships 3,128,437 - 3,128,437 Fixed Income securities: Corporate bonds - 2,842,739 2,842,739 Mutual funds 10,882,950 - 10,882,950 U.S. government backed and other securities - 189,194 189,194 Total fixed income securities 10,882,950 3,031,933 13,914,883 Total assets limited as to use in the fair value hierarchy $ 36,995,046 $ 8,157,543 45,152,589 Total assets limited as to use measured at net asset value (a) 47,915,412 Total assets limited as to use $ 93,068,001



31

Level 1 Level 2 Total Long-term investments

Cash and cash equivalents: Money Market Funds $ - $ 2,749,845 $ 2,749,845 STIF-type instrument - 4,526,830 4,526,830 Total Cash and cash equivalents - 7,276,675 7,276,675 Equities: Common stocks 21,457,233 - 21,457,233 Mutual funds: Domestic 10,672,931 - 10,672,931 International 70,034,693 8,998,355 79,033,048 REIT 1,314,225 - 1,314,225 Total equities 103,479,082 8,998,355 112,477,437 Limited partnerships 14,773,354 - 14,773,354 Fixed income securities: Corporate bonds - 13,015,760 13,015,760 Mutual funds 55,479,056 - 55,479,056 U.S. government backed and other securities - 964,471 964,471 Total fixed income securities 55,479,056 13,980,231 69,459,287 Total long-term investments $173,731,492 $ 30,255,261 203,986,753 Total long-term investments measured at net asset value (a) 256,597,159 Cost and equity investments, not considered financial instruments 3,395,290 Total long-term investments $ 463,979,202



32

The carrying values of cash, accounts receivable and accounts payable are reasonable estimates of their fair value due to the short-term nature of these financial instruments. Fair values of UHI’s revenue certificates are based on currently traded values. The carrying amounts and fair values of UHI’s long-term debt at December 31, are as follows:

2018 2017 Carrying Carrying Amount Fair Value Amount Fair Value Long-term debt $246,340,940 $256,354,558 $273,941,763 $288,516,977 Investment securities are exposed to various risks such as interest rate, market and credit risks. Due to the level of risk associated with certain investment securities, the possibility is reasonable that changes in the values of investment securities will occur in the near term and that these changes could materially affect the amounts reported in the consolidated balance sheets.

UHI invests in alternative investments that are defined as venture capital, international and domestic private equity investments, and absolute return (hedge) funds. Long-term investments are alternative investment funds, primarily comprised of real estate funds that require seven to ten year fund terms before the investments can be liquidated.

The recorded market price for alternative investments is estimated by the individual investment manager taking into account such factors as the financial condition of each investee, economic and market conditions affecting their operations, any changes in management, the length of time since the initial investment, recent transactions involving the securities of the investee, the value of similar securities issued by companies in the same or similar businesses, and limited marketability of the portfolio. Valuations provided by the general partners and investment managers are evaluated by management through accounting and financial reporting processes to review and monitor existence and valuation assertions. Due to the inherent uncertainty of valuation of alternative investments, the fair values estimated by the individual investment manager, in the absence of readily ascertainable market values, may not necessarily represent the amounts that could be realized from sales or other dispositions of investments, and the differences may be material.

UHI’s alternative investments are measured at net asset value as a practical expedient for fair value and are accordingly excluded from the fair value hierarchy. The table below sets forth a summary of the alternative investments including a description of the investments and any unfunded commitments or restrictions associated with the investments.


33

Fair Value Fair Value Other Redemption At at Unfunded Redemption Notice 12/31/2018 12/31/2017 Commitments Restrictions Period (v) Included in assets Limited as to use: Energy funds (i) $ 1,410,923 $ 1,107,318 $ 932,379 Not permitted - Real estate investment funds (ii) 3,515,783 4,371,964 521,574 Not permitted - Master funds and fund of funds (iii) 3,274,287 4,104,591 - No Restrictions 90 day written notice, monthly Private funds (iv) 28,375,233 38,331,539 1,604,931 Some Not 0-90 day Permitted written notice, $ 36,576,226 $ 47,915,412 monthly Included in long-term investments: Energy funds (i) $ 8,728,952 $ 5,644,879 $ 8,810,178 Not Permitted - Real estate investment funds (ii) 21,751,087 22,287,378 4,928,426 Not Permitted - Master funds and fund of funds (iii) 20,257,022 20,924,368 - No Restrictions 90 day written notice, monthly Private funds (iv) 188,792,266 207,740,534 15,165,205 Some not 0-90 day permitted written notice, $239,529,327 $256,597,159 monthly

i. The objective of these investments is to capitalize on investment opportunities in the energy industry. These investments include but are not limited to energy-related assets, securities or instruments, including loans, participations in loans, loan assignments and other forms of debt secured by energy-related assets.

ii. The objective of these investments is to achieve long-term growth of capital by investing in a wide range of real estate investments. These investments include portfolio companies, portfolio investments, and real estate assets.

iii. The objective of these investments is to achieve long-term growth of capital by investing in various funds that focus on a wide range of investments. These investments include but are not limited to equity securities.

iv. The objective of these investments is to achieve long-term growth of capital by investing in a wide range of investments. These investments include but are not limited to debt, equities, derivatives, assets that carry exposure to insurance risk, and real estate.


34

v. If the aggregate amount requested by investors to be redeemed on any redemption date is greater than 25% of the net asset value of the total fund, the Fund Board may reduce the amount of shares to be redeemed pro rata among investors so that the aggregate amount to be withdrawn equals 25% of the net asset value of the fund.

14. Liquidity and Availability of Resources

Financial assets available for general expenditure, without donor or other restrictions limiting their use, within one year of the balance sheet date are reflected in the balance sheets as current assets and include the following balances at December 31, 2018:

Cash and cash equivalents $ 44,016,161 Accounts receivable 98,160,510 Other receivables 13,596,267 Total $155,772,938 The Corporation funds its operations primarily through services charged to patients.

15. Net Assets with Donor Restrictions

Net assets with donor restrictions are restricted for the following purposes or periods:

2018 2017 Subject to expenditure for specified purpose: Hospital operational support $ 5,070,710 $ 5,529,318 Patience assistance 5,366,096 6,769,790 Education 8,337,662 9,399,428 Employee assistance 357,872 530,227 Held in perpetuity: Hospital operational support 3,875,536 3,835,591 Patient assistance 5,458,694 8,052,861 Education 7,222,708 8,325,892 Employee assistance 1,413,716 1,319,750 Total net assets with donor restrictions $ 37 102 994 $ 43,762,857

Supplementary Information

35

Independent Auditors’ Report on Supplementary Information

The Board of Trustees University Health, Inc.

We have audited the consolidated financial statements of University Health, Inc. as of and for the years ended December 31, 2018 and 2017 and have issued our separate report thereon dated April 30, 2019, which contained an unmodified opinion on the consolidated financial statements. Our audits were performed for the purpose of forming an opinion on the consolidated financial statements as a whole. The consolidating information in the accompanying schedules is presented for the purpose of additional analysis of the consolidated financial statements rather than to present the financial position and results of operations of the individual affiliates and is not a required part of the consolidated financial statements. Such information is the responsibility of management and was derived from and relates directly to the underlying accounting and other records used to prepare the consolidated financial statements. The information has been subjected to the auditing procedures applied in the audits of the consolidated financial statements and certain additional procedures, including comparing and reconciling such information directly to the underlying accounting and other records used to prepare the consolidated financial statements or to the consolidated financial statements themselves, and other additional procedures in accordance with auditing standards generally accepted in the United States of America. In our opinion, which insofar as it relates to Walton Way Indemnity, SPC (WWI) is based on the report of other auditors, the information is fairly stated in all material respects in relation to the consolidated financial statements as a whole.

Charlotte, North Carolina April 30, 2019

University Augusta University University University University Health Resource Health Care McDuffie County

Health Extended Resources, University Center on Physicians, University Regional Medical Services, Inc. Care, Inc. Inc. Health, Inc. Aging, Inc. Physicians, Hospice, Inc. Medical Center, Eliminations Consolidated

AssetsCash and cash equivalents 30,553,528$ 3,067,691$ 490,656$ -$ 1,976,745$ 4,457,049$ -$ 3,470,492$ -$ 44,016,161$ Short-term investments - - - - - - - - - - Patient accounts receivable 88,028,834 2,174,037 - - 1,797 3,760,803 - 4,195,039 - 98,160,510 Other receivables 10,774,171 3,436 888,947 - 1,925,629 1,023,399 - 742 (1,020,057) 13,596,267 Inventories 12,267,489 - - - - - - 452,578 - 12,720,067 Prepaid expenses 8,938,743 39,357 - - - 698,007 - 196,645 - 9,872,752 Total current assets 150,562,765 5,284,521 1,379,603 - 3,904,171 9,939,258 - 8,315,496 (1,020,057) 178,365,757

Property and equipment, net 278,016,527 2,894,892 7,418,211 - 2,709,710 10,747,174 - 27,691,187 - 329,477,701

Other assets:Amounts due from affiliates 28,499,882 14,029,279 - 30,439,166 8,661,093 877,640 - 3,694,491 (86,201,551) - Assets limited as to use 74,200,652 - - - - - - - - 74,200,652 Investments 343,878,137 35,255,063 567,925 91,912,017 67,106,877 - - - (90,850,140) 447,869,879 Other 9,292,340 206,944 - - - 2,199 - 102,951 - 9,604,434

884,450,303$ 57,670,699$ 9,365,739$ 122,351,183$ 82,381,851$ 21,566,271$ -$ 39,804,125$ (178,071,748)$ 1,039,518,423$

December 31, 2018

Consolidating Balance Sheet Information


See independent auditors' report on the supplementary information. 36


Health Extended Resources, University Center on Physicians, University Regional Medical Services, Inc. Care, Inc. Inc. Health, Inc. Aging, Inc. LLC. Hospice, Inc. Inc. Eliminations Consolidated


Accounts payable and accrued expenses 26,126,745$ 1,764,098$ 974$ -$ -$ 858,648$ -$ 726,669$ -$ 29,477,134$ Accrued compensation, benefits, -

and withholdings 23,522,692 832,535 - - - 7,062,898 - 510,125 - 31,928,250 Other current liabilities 2,642,408 - - - 25,977 - - 412,075 - 3,080,460 Estimated third-party payor settlements 14,422,520 634,392 - - - - - 1,477,100 - 16,534,012 Current maturities of long-term debt 40,462,584 - - 2,107,202 - - - 1,020,057 (1,020,057) 42,569,786 Current portion of capital lease obligations 2,005,839 - - - - - - 85,484 - 2,091,323 Short-term accrued postretirement benefit cost 1,747,058 - - - - - - - - 1,747,058

Total current liabilities 110,929,846 3,231,025 974 2,107,202 25,977 7,921,546 - 4,231,510 (1,020,057) 127,428,023

Long-term debt, less current maturities 200,019,704 - - 2,170,947 - - - 25,501,438 (25,501,438) 202,190,651 Long-term capital lease obligations,

less current portion 2,621,579 - - - - - - 67,690 - 2,689,269 Other long-term obligations 3,318,414 - - - - - - - - 3,318,414 Amounts due to affiliates 23,843,660 10,620 27,490,655 1,668,805 4,313,734 2,494,999 - 877,640 (60,700,113) - Reserve for contingent losses 17,055,599 - - - - - - - - 17,055,599 Accrued pension cost 497,042 - - - - - - - - 497,042 Accrued postretirement benefit cost,

less short-term obligation 30,399,341 - - - - - - - - 30,399,341 Total liabilities 388,685,185 3,241,645 27,491,629 5,946,954 4,339,711 10,416,545 - 30,678,278 (87,221,608) 383,578,339

Net assets:Without donor restrictions 458,662,124 54,429,054 - 116,404,229 78,042,140 - - 5,874,396 (94,574,853) 618,837,090 With donor restrictions 37,102,994 - - - - - - - - 37,102,994

Total net assets 495,765,118 54,429,054 - 116,404,229 78,042,140 - - 5,874,396 (94,574,853) 655,940,084 Contributed capital - - 50,484,022 - - 202,642,489 2,202,880 3,251,451 (258,580,842) - Retained (deficit) earnings - - (68 609 912) - - (191 492 763) (2 202 880) - 262 305 555 -

884 450 303$ 57 670 699$ 9 365 739$ 122 351 183$ 82 381 851$ 21 566 271$ -$ 39 804 125$ (178 071 748)$ 1 039 518 423$


December 31, 2018Consolidating Balance Sheet Information (continued)




Net patient service revenue 519,274,982$ 34,528,763$ -$ -$ 8,810,246$ 65,877,462$ -$ 21,241,469$ -$ 649,732,922$ Other operating revenues 12,452,848 24,154 4,903,327 - 4,030,598 13,823,338 - 612,802 (19,527,667) 16,319,400 Net assets released from restriction 8,193,369 - - - - - - - - 8,193,369

Total unrestricted revenues and other support 539,921,199 34,552,917 4,903,327 - 12,840,844 79,700,800 - 21,854,271 (19,527,667) 674,245,691

Operating expenses:Salaries and benefits 214,249,229 12,924,167 - - 4,462,297 88,332,114 - 7,024,384 6,713,508 333,705,699 Other operating expenses 253,503,278 15,341,901 3,186,812 28,507 4,185,936 19,492,060 - 9,607,085 (25,438,614) 279,906,965 Depreciation 40,258,922 587,388 1,318,237 - 1,673,364 2,306,769 - 1,920,996 - 48,065,676 Interest 7,826,067 - - 161,206 154,470 - - 807,231 (957,031) 7,991,943

Total operating expenses 515,837,496 28,853,456 4,505,049 189,713 10,476,067 110,130,943 - 19,359,696 (19,682,137) 669,670,283

Income (loss) from operations 24,083,703 5,699,461 398,278 (189,713) 2,364,777 (30,430,143) - 2,494,575 154,470 4,575,408

Nonoperating income (loss):Investment income (loss) (24,233,521) (1,347,794) 123,287 45,452,541 (3,765,550) - - 1,789 (45,406,012) (29,175,260) Gain on sale of assets - - - - 46,652,315 - - - - 46,652,315 Other components of net benefit cost (1,953,016) - - - - - - - - (1,953,016)

Total nonoperating income (loss) (26,186,537) (1,347,794) 123,287 45,452,541 42,886,765 - - 1,789 (45,406,012) 15,524,039

Excess (deficiency) of revenues, othersupport, and gains over expenses and losses (2,102,834) 4,351,667 521,565 45,262,828 45,251,542 (30,430,143) - 2,496,364 (45,251,542) 20,099,447

Change in pension andpostretirement plans funded status 5,709,690 - - - - - - - - 5,709,690

Other 86,093 - - - - - - - - 86,093 Transfer (to) from affiliate (29,993,289) - - - - 29,993,289 - - - - Transfer (to) from net assets with

donor restrictions (531,235) - - - - - - - - (531,235) Increase (decrease) in net assets without

donor restrictions (26 831 575)$ 4 351 667$ 521 565$ 45 262 828$ 45 251 542$ (436 854)$ -$ 2 496 364$ (45 251 542)$ $ 25 363 995


Year Ended December 31, 2018

Consolidating Statement of Operations Information




Net assets without donor restrictionsExcess (deficiency) of revenues, other

support, and gains over expenses and losses (2,102,834)$ 4,351,667$ 521,565$ 45,262,828$ (1,400,773)$ (30,430,143)$ -$ 2,496,364$ (45,251,542)$ (26,552,868)$ Change in pension and

postretirement plans funded status 5,709,690 - - - - - - - - 5,709,690 Other 86,093 - - - 46,652,315 - - - - 46,738,408 Transfer (to) from affiliate (29,993,289) - - - - 29,993,289 - - - - Transfer (to) from net assets with

donor restrictions (531,235) - - - - - - - - (531,235) Increase (decrease) in net assets without

donor restrictions (26,831,575) 4,351,667 521,565 45,262,828 45,251,542 (436,854) - 2,496,364 (45,251,542) 25,363,995

Net assets with donor restrictionsContributions and other 2,435,768 - - - - - - - - 2,435,768 Investment income (loss) (1,433,497) - - - - - - - - (1,433,497) Net assets released from restriction (8,193,369) - - - - - - - - (8,193,369) Transfer to net assets without donor restrictions 531,235 - - - - - - - - 531,235 Increase in net assets with donor restrictions (6,659,863) - - - - - - - - (6,659,863)

Increase (decrease) in net assets (33,491,438) 4,351,667 521,565 45,262,828 45,251,542 (436,854) - 2,496,364 (45,251,542) 18,704,132 Net assets at beginning of year 529,256,556 50,077,387 (18,647,455) 71,141,401 32,790,598 11,586,580 - 6,629,483 (45,598,598) 637,235,952 Net assets at end of year 495,765,118$ 54,429,054$ (18,125,890)$ 116,404,229$ 78,042,140$ 11,149,726$ -$ 9,125,847$ (90,850,140)$ 655,940,084$

Year Ended December 31, 2018

Consolidating Statement of Changes in Net Assets Information





AssetsCash and cash equivalents 12,462,491$ 4,482,837$ 1,574,538$ -$ 3,962,040$ 2,700,844$ -$ 3,537,644$ -$ 28,720,394$ Short-term investments - - - - 2,787,655 - - - - 2,787,655 Patient accounts receivable, net 88,412,394 2,738,332 - - 1,485,142 3,712,763 - 3,833,537 - 100,182,168 Other receivables 12,249,115 6,273 631,602 - 35,431 332,824 - 21,442 (1,020,057) 12,256,630 Inventories 11,765,652 - - - 50,946 - - 500,313 - 12,316,911 Prepaid expenses 8,355,566 153,189 12,968 - 42,950 573,650 - 241,159 - 9,379,482 Total current assets 133,245,218 7,380,631 2,219,108 - 8,364,164 7,320,081 - 8,134,095 (1,020,057) 165,643,240

Property and equipment, net 267,864,522 3,250,815 8,151,936 - 46,480,490 11,040,608 - 29,114,789 - 365,903,160

Other assets:Amounts due from affiliates 31,869,248 5,475,319 - 32,484,352 - 286,837 - 10,505 (70,126,261) - Assets limited as to use 93,068,001 - - - - - - - - 93,068,001 Investments 394,862,273 36,603,144 554,084 46,649,190 30,909,109 - - - (45,598,598) 463,979,202 Other 9,513,406 223,611 - - - 522,900 - 62,345 - 10,322,262

930 422 668$ 52 933 520$ 10 925 128$ 79 133 542$ 85 753 763$ 19 170 426$ -$ 37 321 734$ (116 744 916)$ 1 098 915 865$

University Health, Inc.Consolidating Balance Sheet InformationDecember 31, 2017





Accounts payable and accrued expenses 29,531,985$ 1,771,330$ 969$ -$ 130,617$ 1,217,573$ -$ 583,260$ -$ 33,235,734$ Accrued compensation, benefits, -

and withholdings 24,173,481 711,326 - - 318,580 6,366,273 - 419,327 - 31,988,987 Other current liabilities 2,640,492 - - - 18,328,045 - - 186,426 - 21,154,963 Estimated third-party payor settlements 11,907,761 360,365 - - - - - 1,352,976 - 13,621,102 Current maturities of long-term debt 37,819,788 - - 2,045,186 - - - 1,020,057 (1,020,057) 39,864,974 Current portion of capital lease obligations 1,927,812 - - - - - - 94,874 - 2,022,686 Short-term accrued postretirement benefit cost 1,785,608 - - - - - - - - 1,785,608

Total current liabilities 109,786,927 2,843,021 969 2,045,186 18,777,242 7,583,846 - 3,656,920 (1,020,057) 143,674,054

Long-term debt, less current maturities 228,114,750 - - 4,278,150 - - - 26,521,495 (26,521,495) 232,392,900 Long-term capital lease obligations,

less current portion 3,842,911 - - - - - - 153,174 - 3,996,085 Other long-term obligations 3,407,914 - - - 27,670,529 - - - - 31,078,443 Amounts due to affiliates 5,475,179 13,112 29,571,614 1,668,805 6,515,394 - - 360,662 (43,604,766) - Reserve for contingent losses 15,270,816 - - - - - - - - 15,270,816 Accrued pension cost - - - - - - - - - - Accrued postretirement benefit cost,

less short-term obligation 35,267,615 - - - - - - - - 35,267,615 Total liabilities 401,166,112 2,856,133 29,572,583 7,992,141 52,963,165 7,583,846 - 30,692,251 (71,146,318) 461,679,913

Net assets:Without donor restrictions 485,493,699 50,077,387 - 71,141,401 32,790,598 - - 3,378,032 (49,408,022) 593,473,095 With donor restrictions 43,762,857 - - - - - - - - 43,762,857

Total net assets 529,256,556 50,077,387 - 71,141,401 32,790,598 - - 3,378,032 (49,408,022) 637,235,952 Contributed capital - - 50,484,022 - - 172,649,200 2,202,880 3,251,451 (228,587,553) - Retained (deficit) earnings - - (69 131 477) - - (161 062 620) (2 202 880) - 232 396 977 -

930 422 668$ 52 933 520$ 10 925 128$ 79 133 542$ 85 753 763$ 19 170 426$ -$ 37 321 734$ (116 744 916)$ 1 098 915 865$

University Health, Inc.Consolidating Balance Sheet Information (continued)December 31, 2017




Unrestricted revenues and other support:Patient service revenue (net of contractual

allowances and discounts) 527,331,594$ 35,076,130$ -$ -$ 13,707,366$ 60,012,164$ -$ 24,842,101$ -$ 660,969,355$ Provision for bad debts (32,733,965) (1,049,651) - - - - - (4,261,703) - (38,045,319) Net patient service revenue 494,597,629 34,026,479 - - 13,707,366 60,012,164 - 20,580,398 - 622,924,036

Other operating revenues 15,737,573 22,576 4,751,133 94,532 5,640,964 12,749,204 - 19,282 (19,279,706) 19,735,558 Net assets released from restriction 2,361,683 - - - - - - - - 2,361,683

Total unrestricted revenues and other support 512,696,885 34,049,055 4,751,133 94,532 19,348,330 72,761,368 - 20,599,680 (19,279,706) 645,021,277

Operating expenses:Salaries and benefits 209,128,640 13,239,423 - - 6,702,362 81,535,659 - 7,341,300 6,154,120 324,101,504 Other operating expenses 228,668,428 15,332,521 3,515,695 27,101 6,394,060 16,814,621 - 8,949,859 (24,601,541) 255,100,744 Depreciation 35,350,220 557,767 1,412,138 - 2,569,660 2,295,674 - 1,994,863 - 44,180,322 Interest 7,686,806 - - 221,397 219,283 - - 839,106 (1,051,568) 7,915,024

Total operating expenses 480,834,094 29,129,711 4,927,833 248,498 15,885,365 100,645,954 - 19,125,128 (19,498,989) 631,297,594

Income (loss) from operations 31,862,791 4,919,344 (176,700) (153,966) 3,462,965 (27,884,586) - 1,474,552 219,283 13,723,683

Nonoperating income (loss):Investment income (loss) 48,971,031 4,103,849 25,551 7,188,358 3,489,588 - - 6,399 (7,171,836) 56,612,940 Loss on early extinguishment of debt - - - - - - - - - - Other components of net benefit cost (1,505,491) - - - - - - - - (1,505,491)

Total nonoperating income (loss) 47,465,540 4,103,849 25,551 7,188,358 3,489,588 - - 6,399 (7,171,836) 55,107,449

Excess (deficiency) of revenues, othersupport, and gains over expenses and losses 79,328,331 9,023,193 (151,149) 7,034,392 6,952,553 (27,884,586) - 1,480,951 (6,952,553) 68,831,132

Change in pension andpostretirement plans funded status (4,258,043) - - - - - - - - (4,258,043)

Other (27,176) - - - - - - - - (27,176) Transfer (to) from affiliate (25,874,625) - - - - 25,874,625 - - - - Transfer (to) from net assets with

donor restrictions 654,727 - - - - - - - - 654,727 Increase (decrease) in net assets without

donor restrictions 49 823 214$ 9 023 193$ (151 149)$ 7 034 392$ 6 952 553$ (2 009 961)$ -$ 1 480 951$ (6 952 553)$ $ 65 200 640

University Health, Inc.Consolidating Statement of Operations InformationYear Ended December 31, 2017




Net assets without donor restrictions:Excess (deficiency) of revenues, other

support, and gains over expenses and losses 79,328,331$ 9,023,193$ (151,149)$ 7,034,392$ 6,952,553$ (27,884,586)$ -$ 1,480,951$ (6,952,553)$ 68,831,132$ Change in pension and

postretirement plans funded status (4,258,043) - - - - - - - - (4,258,043) Other (27,176) - - - - - - - - (27,176) Transfer (to) from affiliate (25,874,625) - - - - 25,874,625 - - - - Transfer (to) from net assets with

donor restrictions 654,727 - - - - - - - - 654,727 Increase (decrease) in net assets without

donor restrictions 49,823,214 9,023,193 (151,149) 7,034,392 6,952,553 (2,009,961) - 1,480,951 (6,952,553) 65,200,640

Net assets with donor restrictions:Contributions and other 3,205,308 - - - - - - - - 3,205,308 Investment income (loss) 4,703,970 - - - - - - - - 4,703,970 Net assets released from restriction (2,361,683) - - - - - - - - (2,361,683) Transfer to net assets without donor restrictions (654,727) - - - - - - - - (654,727) Increase in net assets with donor restrictions 4,892,868 - - - - - - - - 4,892,868

Increase (decrease) in net assets 54,716,082 9,023,193 (151,149) 7,034,392 6,952,553 (2,009,961) - 1,480,951 (6,952,553) 70,093,508 Net assets at beginning of year 474,540,474 41,054,194 (18,496,306) 64,107,009 25,838,045 13,596,541 - 5,148,532 (38,646,045) 567,142,444 Net assets at end of year 529 256 556$ 50 077 387$ (18 647 455)$ 71 141 401$ 32 790 598$ 11 586 580$ -$ 6 629 483$ (45 598 598)$ 637 235 952$

University Health, Inc.Consolidating Statement of Changes in Net Assets InformationYear Ended December 31, 2017


2016COMMUNITY HEALTH NEEDS ASSESSMENT

COMMUNITY HEALTH NEEDS ASSESSMENT 2016

Table of Contents

Introduction .................................................................................................................................................. 3

Executive Summary .................................................................................................................................. 3

University Health Care System’s Mission, Vision, and Values ............................................................... 3

Process & Methodology ........................................................................................................................... 4

Defining and describing the community we serve ....................................................................................... 5

Community definition ............................................................................................................................... 5

Community description ............................................................................................................................ 6

Demographics ....................................................................................................................................... 6

Population ............................................................................................................................................. 7

Age ........................................................................................................................................................ 8

Race and ethnic origins ........................................................................................................................ 9

Other demographics ........................................................................................................................... 10

Existing health care facilities and resources .......................................................................................... 10

Summary ................................................................................................................................................. 10

Analysis of public health data ..................................................................................................................... 11

Eight topics of health ............................................................................................................................. 11

Topic 1. Access to health care........................................................................................................... 12

Health insurance ................................................................................................................................. 12

Primary care access ............................................................................................................................ 13

Mental health provider access ............................................................................................................ 14

Topic 2. Health status of the population .......................................................................................... 15

Leading causes of death ...................................................................................................................... 15

Treatment rates of chronic conditions ............................................................................................... 17

Cancer ................................................................................................................................................. 19

Diabetes .............................................................................................................................................. 23

Topic 3. Behaviors and conditions related to the top 10 causes of death ........................................ 25

Adult physical inactivity ..................................................................................................................... 25

Obesity ................................................................................................................................................ 26

Smoking .............................................................................................................................................. 27


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Teen pregnancy .................................................................................................................................. 28

Topic 4. Child health ......................................................................................................................... 29

Low birth weight ................................................................................................................................ 29

Topic 5. Infectious diseases............................................................................................................... 30

Disease prevalence and trends............................................................................................................ 30

Topic 6. Natural environment .......................................................................................................... 32

Air quality ........................................................................................................................................... 32

Topic 7. Social environment ............................................................................................................. 32

Violent crime rate ............................................................................................................................... 32

Child abuse rate .................................................................................................................................. 33

Inadequate social support ................................................................................................................... 34

Seniors living alone ............................................................................................................................ 35

Topic 8. Mental health ...................................................................................................................... 36

Poor mental health days ..................................................................................................................... 36

Mental health conditions: Medicare population ................................................................................ 37

Summary and discussion ........................................................................................................................ 38

Community feedback .................................................................................................................................. 39

McDuffie County Listening Session ...................................................................................................... 39

Feedback on the 2013 University Hospital McDuffie Community Health Needs Assessment and Implementation Strategy ....................................................................................................................... 43

Provider survey .......................................................................................................................................... 44

Prioritization of health needs ..................................................................................................................... 45

The process for identifying and prioritizing health needs and services ................................................ 45

Results .................................................................................................................................................... 45

Appendix A. Public health data sources .............................................................................................. 46

Appendix B. Actions taken since conducting our 2013 implementation strategy guide ................... 49

Chronic Disease Prevalence ................................................................................................................... 49

Prevention and screening ....................................................................................................................... 53

Access to Care ......................................................................................................................................... 58


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Introduction

Executive Summary University Hospital McDuffie’s 2016 Community Health Needs Assessment (CHNA) was created with the help of a number of people and organizations that research community demographics, socio-economic factors and health service utilization trends. Using the CHNA process outlined in this report, University Hospital McDuffie was able to narrow its assessment scope to the following issues: diabetes, cancer, heart disease and stroke, and health literacy. The CHNA Implementation Plan addresses how University Hospital McDuffie can collaborate with local organizations and agencies to improve our community’s health and illustrates how University Hospital McDuffie is meeting its obligation to deliver efficient health care services.

University Hospital McDuffie does not have adequate resources to solve all the problems identified during this assessment process. Some issues are beyond its mission and are best addressed by other organizations, some of which have been identified through this process. We view this as a plan for how we, along with other organizations and agencies, can collaborate to bring the best each has to offer to address the health needs of the community we serve.

University Hospital McDuffie will use this assessment as a guide for strengthening, creating, and implementing programs that address the identified health needs of our community.

University Health Care System’s Mission, Vision, and Values The mission of University Health Care System is to improve the health of those we serve.

The vision of University Health Care System is patients will insist on University, employees will be proud to be part of University, and physicians will prefer University because we set the standard for high-quality, safe care and exceptional service.

The values of University Health Care System are Quality, Safety, Service, People, Growth, and Affordability.


Page | 4

Process & Methodology Our process was guided by the Catholic Health Association’s guidebook on performing a health needs assessment, Assessing and Addressing Community Health Needs. We also used the Health Communities Institute’s services and coaching, and feedback written by Georgia Watch on the 2013 health needs assessments done by hospitals in Georgia. We made every effort to adhere to the final IRS rules issued on Dec. 31, 2014 regarding health needs assessments. We formed an internal team, led by the director of the Systems Engineering department.

Our first step was to define our community using data from our medial record system. We compared the numbers of patients who visited our emergency department from different counties. Having defined our community, we sought to understand their health needs by listening to narratives from three sources: public health data, community leaders, and providers.

The first source of information we used is public health data. With the data we sought to answer several questions with regard to each of eight health topics outlined by the Catholic Health Association’s guidebook. First, what do the data say about which health needs are impacting the greatest number of people in our community and in the greatest ways? Second, how does McDuffie County compare to peer counties and, when the data are available, to Georgia and the United States in general? We have tried to restrict comments on the data to brief objective observations. This section begins on page 6. The public health data sources are listed and described in Appendix A.

The second source of information we used is the feedback of community leaders. This data supplements the information gap of the primary and chronic disease needs and health issues of uninsured persons, low-income persons, and minority groups. We solicited leaders of the community to provide feedback on our 2013 CHNA and ISG and we invited them to listening sessions in which a moderator posed several questions about the health needs, social determinants of health, and obstacles to care. We have described the format of the listening sessions, the leaders, and the feedback they provided, both regarding the community’s current needs and regarding our 2013 CHNA and ISG, beginning on page 39.

The third source of information we used is the feedback of providers in our community. We designed a survey with one question, “Please tell us about a resource you wish was more accessible to your patients that would help them address their health needs.” Responses to this question were categorized by our steering committee. Details about the survey method and results are provided on page 44.

Equipped through these three sources of information, our steering committee prioritized the health needs of our community. Their process and the results are described on page 45.

Our 2013 ISG listed actions to be taken to address needs we identified. Appendix B lists the actions actually taken and an evaluation of their impact.

These findings were presented to our board of trustees on December, 12, 2016. At that meeting, the board adopted the prioritization of health needs done by our steering committee, as well as our implementation strategy guide.


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Defining and describing the community we serve

Community definition In 2013 we defined the community served by University Hospital McDuffie as McDuffie County. We maintain this definition in our 2016 assessment. Internal data from our medical record system indicate that 57% of patients served are from McDuffie County. Additionally, University Hospital McDuffie is a newer part of University Health Care System and so emphasis on the nearer community is valuable as relationships with the community are strengthened.

Figure 1 The Community We Serve McDuffie County


Page | 6

Community description

Demographics Figure 2 shows demographics in McDuffie County, according to the CDC’s Community Health Status Indicators website. McDuffie County is matched to a set of peer counties based on similar demographics. The peer counties are listed in Table 1, along with county seats.

Figure 2 – Demographics


Page | 7

Lowndes County, AL (Haneville) Franklin County, AR (Ozark) Gadsden County, FL (Quincy) Burke County, GA (Waynesboro) De Soto Parish, LA (Mansfield) East Feliciana Parish, LA (Jackson) Iberville Parish, LA (Plaquemine) St. Helena Parish, LA (Greensburg) Copiah County, MS (Hazlehurst) Simpson County, MS (Mendenhall) Fairfield County, SC (Winnsboro) Union County, TN (Maynardville) Scott County, VA (Gate City) Bristol, VA (Independent city) Clay County, WV (Clay) Lincoln County, WV (Hamlin) Table 1 – Peer counties and county seats

Population Table 2 shows a slight decline in the population of McDuffie County. The data in this table and in subsequent sections may differ slightly from that represented in Figure 2, due to the dates and sources of data.

People US GA McDuffie County

Population, 2014 est (000's) 318,857.1 10,097.3 21.4 Population change 2010 to 2014 4% 4% 2%

Table 2 – Population and population growth

Data source: www.census.gov/quickfacts

Data period: 2010 census data and 2014 census estimates


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Age Figure 3 shows the ages of the residents of McDuffie County. It has a higher percentage of persons 65 years and older than Georgia or the United States.

Figure 3 – Population by age



6.2% 6.6% 6.2%

16.9% 18.1% 19.0%

62.4% 62.9% 58.9%

14.5% 12.4% 15.9%

US GA McDuffie County

Population by age

Persons 65 years and over

Persons 18 to 64 years

Persons 5 to 17 years

Persons under 5 years


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Race and ethnic origins Figure 4 shows the race and ethnic origins of the residents of McDuffie County compared to residents in Georgia and the rest of the United States. Over 97% of the residents of McDuffie County are either black or white. The percentage of Hispanic or Latino residents, Asian residents, and residents of other races is lower than the national and the GA average.

Figure 4 – Population by race and origin




Two or More Races 2.5% 2.0% 1.5%

Some other single race 1.4% 0.6% 0.5%

Asian alone 5.4% 3.8% 0.5%

White alone, Hispanic or Latino 15.4% 7.8% 0.0%

Black or African American alone 13.2% 31.5% 40.7%

White alone, not Hispanic or Latino 62.1% 54.3% 56.8%

0%

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50%

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Population by race and ethnic origin


Page | 10

Other demographics Table 3 shows other demographics. McDuffie County has fewer foreign born persons and speakers of a language other than English at home than Georgia or the rest of the nation. It has fewer college graduates and a higher rate of poverty, but a similar level of home ownership.

Other (2009-2013) US GA McDuffie County

Foreign born persons 12.9% 9.7% 1.2% Language other than English spoken at home, pct age 5+ 20.7% 13.3% 2.7%

High school graduate or higher of persons age 25+ 86.0% 84.7% 74.6% Bachelor's degree or higher of persons age 25+ 28.8% 28.0% 13.7%

Homeownership rate 64.9% 65.1% 66.0% Per capita income in past 12 months (2013 dollars) $28,155 $25,182 $17,922

Median household income $53,046 $49,179 $37,487

Persons below poverty level 15.4% 18.2% 22.2% Table 3 – Other demographic data



Existing health care facilities and resources

Within our community many organizations share our mission, to improve the health of those we serve. Larger hospitals in the Augusta area are Doctors Hospital of Augusta, Augusta University Medical Center, and University Hospital. Each feature specialties, services, clinics, and programs for different types of health needs (e.g., children’s health, burn recovery, trauma care, digestive health services, bariatric health services, etc). Other hospitals in nearby rural areas are Wills Memorial Hospital, Washington County Regional Medical Center, and Jefferson Hospital.

While hospitals provide acute care, primary care providers and specialists can help patients manage chronic conditions. There are 85 providers and 60 organizations listed in our community, according to Medicare’s National Plan and Provider Enumeration System. These include assisted living facilities, dental practices, mental health counselors, and others.

A few other organizations that address social determinants of health are the YMCA, McDuffie County Mental Health Department, McDuffie County Partnership for Success, and McDuffie County District of the East Central District Department of Public Health.

Summary In summary, McDuffie County is a small community in which almost all residents are either black or white. More people in McDuffie County live below the poverty line than is typically found in Georgia and the United States and fewer people have a bachelor’s degree. McDuffie County is similar to many other counties in the rural south. Health data from these counties will be compared to health data from McDuffie County in many of the following sections.


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Analysis of public health data

Eight topics of health The Catholic Health Association’s guidelines were used to select topics that summarize the state of health and quality of life in the community. Mental health has been added to the list of topics. These are as follows:

1. Access to health care 2. Health status of the population 3. Behaviors and conditions related to the top 10 causes of death 4. Child health 5. Infectious diseases 6. Natural environment 7. Social environment 8. Mental health

For each of these topics we have presented several indicators that describe our community.


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Topic 1. Access to health care

Health insurance Figure 5 shows the percentage of people under age 65 who do not have insurance (those over 65 are eligible for Medicare). McDuffie County is roughly in the middle of its peers and similar to the median county in the United States.

Figure 5 – People under 65 without insurance

Data source: The US Census Bureau's Small Area Health Insurance Estimates (SAHIE), via the CDC’s Community Health Status Indicators website

Technical details: This measure represents the estimated percent of the population under age 65 that has no health insurance coverage. The US Census Bureau's Small Area Health Insurance Estimates (SAHIE) program produces estimates of health insurance coverage for all states and counties. For estimation, SAHIE uses statistical models that combine survey data from the American Community Survey (ACS) with administrative records data and Census 2010 data. The models are "area-level" models because they use survey estimates and administrative data at certain levels of aggregation, rather than individual survey and administrative records.

Data period: 2011


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Table 4 shows this percentage over the years since 2011. The percentage of people without insurance has been slowly increasing.

Year Percent of the population without health insurance

in McDuffie County 2011 19.9% 2012 20.1% 2013 20.7% 2014 21.1%

Table 4 – Trends in insurance rates

Source: American Community Survey, maintained by Healthy Communities Institute

Data period: 2011-2014

Primary care access Figure 6 shows the number primary care physicians (PCP) per 100,000 people. McDuffie County has more PCP’s per 100,000 people than any of its peer counties and more than the median US county.

Figure 6 – Population per primary care physician

Data source: Health Resources and Services Administration. Area Health Resources Files, via the CDC’s Community Health Status Indicators website

Technical details: The Health Resources and Services Administration compiles physician data from the American Medical Association Master File and from the Census Population Estimates program to report primary care provider data at the county level. Primary care physicians are those who identify as practicing general practice, internal medicine, obstetrics and gynecology, or pediatrics.

Data period: 2011


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Mental health provider access Figure 7 shows the number of people per mental health provider. (Note that the numerator and denominator of the data are switched compared to the previous section; here a higher number indicates less access). The number of people per provider is much higher in McDuffie County than in Georgia and in the United States. There were only ten mental health providers in McDuffie County.

Figure 7 – Population per mental health provider

Data source: CMS, National provider identification file, maintained by County Health Rankings

Data period: 2014

529

914

2157


Population per mental health provider


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Topic 2. Health status of the population

Leading causes of death Figure 8 and Figure 9 show the leading causes of death in the USA, in Georgia, and in McDuffie County. The causes are sorted in the order of the leading causes in the United States.

Several observations are noteworthy. First, the death rates from cancer and from diabetes are higher relative to those in Georgia and in the United States. Second, the gap between Georgia and McDuffie County is larger for the crude death rate than it is for the age-adjusted death rate, which can be explained by the fact that a higher percentage of residents in McDuffie County are over the age of 65. Third, as is true for Georgia and the United States, as many people die from heart disease and from cancer as do from the remaining eight reasons combined.

Figure 8 – Death rates

192 162 191

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Suicide

Kidney diseases

Influenza and pneumonia

Diabetes

Alzheimers

Accidents

Stroke

Chronic lower resp disease

Cancer

Heart disease


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Figure 9 – Age adjusted death rates

Data source: The Health Indicators Warehouse at healthindicators.gov


171 180 174

166 169 206

42 45 45 39

39 40 37

42 37

24 27

30 21

23

69

15 17

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Age-adjusted death rates (per 100,000 people)

Suicide

Kidney diseases

Influenza and pneumonia

Diabetes

Alzheimers

Stroke

Accidents

Chronic lower respdiseaseCancer

Heart disease


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Treatment rates of chronic conditions Figure 10 shows treatment rates of chronic conditions among Medicare beneficiaries. Several observations are noteworthy. First, treatment rates of many conditions are higher than they are in Georgia and in the United States. This could mean that there are higher incidence rates of disease, or it could mean that people with disease are more likely to be treated. Second, the treatment rates for cancer are lower than they are in Georgia and in the United States. This is surprising, given the high death rates for cancer shown in Figure 8 and Figure 9. Third, many people were treated for stroke. Given that the death rates for stroke were not unusual, this is also surprising.


Figure 10 – Treatment of chronic conditions among Medicare beneficiaries

Data source: CMS Chronic Conditions Data

Technical details and data period: All data are from 2014. The definitions of treatment, the settings of treatment, and the period in which treatment may have occurred can be found at https://www.ccwdata.org/web/guest/condition-categories

0

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Chronic cardiovascular conditions Chronic respiratoryconditions

Other chronic conditions

Treatment of chronic conditions among Medicare beneficiaries



Cancer The three types of cancer with the highest death rates nationally are lung and bronchus cancer, breast cancer, and colon and rectal cancer. For each of these types, we present age-adjusted death rates and age-adjusted incidence rates for each geographical area. For lung and bronchus cancer, these data are presented alongside smoking rates. For breast cancer, they are presented alongside the percentage of surveyed women (50-74 years old) who responded that they have not had a mammogram in the past two years. For colon and rectal cancer, they are presented alongside the percentage of surveyed adults (50+ years old) who responded that they have never had a colorectal endoscopy. The incidence rates and the behavioral data come from different sources. The causal relationship between the death rates and incidence rates and between the incidence rates and behaviors are commonly accepted and established in medical literature. But in each case, the behaviors may portend a future increase in death rates, rather than explain the past. The behavioral data comes from small samples of surveyed residents and has wide margins of error. But there may be some value in presented these data side by side.


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Lung and bronchus cancer Figure 11 shows lung and bronchus cancer death and incidence rates alongside the percentage of adults who smoke. McDuffie County has a higher death rate, higher incidence rate, and a marginally higher prevalence of smoking.

Figure 11 – Lung and bronchus cancer death and incidence rates alongside a behavioral measure

Data source: State Cancer Profiles Web Site

Technical details and data period: Data are 5 year averages (2008-12). Survey responses come from the CDC’s behavioral risk factors surveillance system (BRFSS). Persons are consider smokers if they reported smoking every day or some days to the question, "Do you now smoke cigarettes every day, some days, or not at all?"

45 48

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US GA McDuffie

Lung and bronchus cancer

Age-adjusted death rate (per 100,000 people)

Age-adjusted incidence rate (per 100,000 people)

Percentage of adults who smoke


Page | 21

Breast cancer Figure 12 shows breast cancer death and incidence rates alongside the percentage of surveyed women aged 50-74 who reported that they had not had a mammogram in the past two years. McDuffie County has a similar incidence rate and a similar death rate, but a higher lack of screening.

Figure 12 – Breast cancer death and incidence rates alongside a screening measure


Technical details and data period: Data are 5 year averages (2008-12). Survey responses come from the CDC’s behavioral risk factors surveillance system (BRFSS).

21 22 22

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Percent of surveyed women (age 50-74) who have not had a mammogram in the past two years


Page | 22

Colorectal cancer Figure 13 shows colorectal cancer death and incidence rates alongside the percentage of adults age 50 and over who reported that they had never had a colorectal endoscopy (colonoscopy or sigmoidoscopy). McDuffie County has a higher death rate and a higher incidence rate of colorectal cancer. It also has a higher percentage of residents who have never had a colorectal endoscopy.

Figure 13 – Colo rectal cancer death and incidence rates alongside a screening measure


Technical details and data period: Data are 5 year averages (2008-12). Survey responses come from the CDC’s behavioral risk factors surveillance system (BRFSS).

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Percent of adults (50+) who have never had a colorectal endoscopy


Page | 23

Diabetes Figure 14 shows the self-reported incidence rate of diabetes for McDuffie County compared to its peer counties. McDuffie County residents report the disease at a much higher rate than the median US county and at a higher rate than any of its peer counties.

Figure 14 – Self reported rates of diabetes diagnoses among adults

Data source: CDC's Behavioral Risk Factor Surveillance System (BRFSS), via the CDC’s Community Health Status Indicators website

Technical details: The prevalence of diagnosed diabetes was estimated for adults age 20 and over, using data from CDC's Behavioral Risk Factor Surveillance System (BRFSS), and data from the U.S. Census Bureau’s Population Estimates Program. Respondents were considered to have diabetes if they responded "yes" to the question, "Has a doctor ever told you that you have diabetes?"


Figure 15 shows the percentage of diabetic Medicare patients who had a blood sugar test in the prior year. McDuffie County has a higher treatment rate among Medicare beneficiaries. A similar percentage of Medicare beneficiaries had a blood sugar test done.


Page | 24

Figure 15 – Diabetes incidence and blood sugar monitoring rates

Data source: Centers for Medicare and Medicaid Services, maintained by Healthy Communities Institute

Data period: 2012

85% 84%

0%

20%

40%

60%

80%

100%

Median US County McDuffie

Percentage of diabetic Medicare patients who had a blood sugar test in the past year


Page | 25

Topic 3. Behaviors and conditions related to the top 10 causes of death

Adult physical inactivity Figure 16 shows the percentage of adults who report no time spent exercising in the past month. Physical inactivity in McDuffie County is around the same as that of the median US county and lower than that of most of the peer counties.

Figure 16 – Self reported rates of physical inactivity

Data source: Community Health Status Indicators

Technical details: From the CDC’s Behavioral Risk Factor Surveillance System. The percentage of respondents who said 'no' in the Behavioral Risk Factor Surveillance System survey: "During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?"



Page | 26

Obesity Figure 17 shows rates of obesity among adults in McDuffie County. The percentage is lower than that of the median US county and all other peer counties.

Figure 17 – Self reported rates of adult obesity

Data source: Community Health Status Indicators

Technical note: Based on the Behavioral Risk Factor Surveillance System survey. Calculated from self-reported weights and heights.



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Smoking Figure 12 showed that lung cancer rates are higher in McDuffie County than in Georgia and in the United States in general. Figure 18 shows, however, that a similar percentage of respondents in McDuffie County report smoking as those in the median US county. It should be noted that, while this data is the best available on smoking rates, because of the sample size, margin of error is around 8%.

Figure 18 – Smoking rates

Data source: Community Health Status Indicators, Based on the Behavioral Risk Factor Surveillance System survey.

Technical note: Persons are considered smokers if they reported smoking every day or some days to the question, "Do you now smoke cigarettes every day, some days, or not at all?"



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Teen pregnancy Figure 19 compares teen birth and pregnancy rates in McDuffie County to those in the median Georgia county. McDuffie County has a lower rate of teen births and pregnancies among females 15-17 years of age but has a higher rate of pregnancies among females 15-19 years of age. From this data we can deduce that the birth rate among females age 18-19 is much higher than it is in the median Georgia county.

Figure 19 – Teen births and pregnancies

Data sources: Pregnancy data: The Online Analytical Statistical Information System for the Georgia Department of Public Health; Birth data: Community Health Status Indicators

Technical details: Reported pregnancies include live births + abortions + fetal deaths

Data period: 2013

22.8 19.5

42.1

65.5

Median GA county McDuffie County

Teen births and pregnancies

Pregnancies per 1,000females 15-17 years ofage

Births per 1,000 females15-19 years of age


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Topic 4. Child health

Low birth weight Figure 20 shows the rate of babies born with a very low birth weight. This statistic is higher for McDuffie County than for the rest of Georgia.

Figure 20 – Child health indicators

Data sources: The Online Analytical Statistical Information System (OASIS) of the Georgia Department of Public Health

Technical details: “Very low birth weight” is defined as a live birth weight less than 3lbs 5oz.

Data period: 2014

18

21

GA McDuffie County

Babies born with very low birth weight / 1000 live births


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Topic 5. Infectious diseases

Disease prevalence and trends Figure 21 shows the prevalence of Chlamydia and Gonorrhea in 2012. McDuffie County residents had higher rates of both. Data on HIV and AIDS are unavailable.

Figure 21 – Sexually transmitted infection prevalence in 2012

Data sources: The CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) atlas.

Data period: 2012

While it is helpful to compare incidence rates in our community to state and national reference points, reflection on trends in diagnoses are valuable. Figure 22 shows these trends. Chlamydia diagnoses has been increasing.

453 528

803

107 155

226


Sexually transmitted infections per 100,000 residents

Chlamydia Gonorrhea


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Figure 22 – Chlamydia diagnosis trend

Data sources: The CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) atlas.


0

100

200

300

400

500

600

700

800

900

2008 2009 2010 2011 2012 2013

STI infection trends per 100,000 residents

Chlamydia diagnosesper 100,000 residents

Gonorrhea diagnosesper 100,000 residents


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Topic 6. Natural environment

Air quality The American Lung Association (ALA) assigns grades to each county in the US based on the annual number of high ozone days. However, in McDuffie County, data were not collected.

Topic 7. Social environment

Violent crime rate Figure 23 shows violent crimes per 100,000 residents. McDuffie County has a lower rate than the median US county and most of its peer counties.

Figure 23 – Violent crime rate

Data source: Uniform crime reporting statistics of the US Department of Justice, compared with US Census data.

Technical details: Violent crimes include murder, rape, robbery, and aggravated assault.

Data period: 2010


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Child abuse rate Figure 24 shows the incidents of child abuse per 100,000 residents. McDuffie County has a higher rate of child abuse than the average in Georgia, by around 15%.

Figure 24 – Rates of abuse or neglect among children

Data source: Kids Count Data Center

Technical details: Multiple incidents of abuse to the same child are counted once.

Data period: 2014

10.2

11.7

GA McDuffie County

Rates (per 1,000 children) of abuse or neglect among children under 18 years of age


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Inadequate social support Figure 25 shows the percentage of adults reporting inadequate social support. McDuffie County is similar to the median US county, but better than most of its peer counties.

Figure 25 – Adults reporting inadequate social support

Data source: Community Health Status Indicators, Based on the Behavioral Risk Factor Surveillance System survey.

Technical details: Survey question: "How often do you get the social and emotional support you need?" Persons were considered to be receiving sufficient emotional/social support if they reported getting social/emotional support all or most of the time.



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Seniors living alone Figure 26 shows the percentage of seniors living alone in each county. Around one in every four seniors lives alone, similar to the median US county.

Figure 26 – Seniors living alone

Source: American Community Survey, maintained by Healthy Communities Institute


27.3 25.6

0

20

40

60

80

100

Median US county McDuffie County

Percentage of people aged 65 years and over who live alone


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Topic 8. Mental health

Poor mental health days Figure 27 shows the average number of reported mentally unhealthy days per month. The average from McDuffie County respondents is similar to that of US and Georgia respondents.

Figure 27 – Mentally unhealthy days

Data source: Based on the Behavioral Risk Factor Surveillance System survey, maintained by County Health Rankings.


3.4 3.3 3.6


Average number of reported mentally unhealthy days per month


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Mental health conditions: Medicare population Where Figure 10 showed the percentage of Medicare beneficiaries treated for various chronic physical conditions, Figure 28 shows similar data for mental conditions. The rates of beneficiaries treated for these conditions are lower than most of those for physical conditions. The treatment rate in McDuffie County is lower than it is for the rest of Georgia and the United States. While this could be the result of a lower incidence of mental health conditions, it may also be a product of the low number of mental health providers in McDuffie County.

Figure 28 – Treatment of mental health conditions

Data source: CMS Chronic Conditions Data Warehouse.

Technical details: The definitions of treatment, the settings of treatment, and the period in which treatment may have occurred can be found at https://www.ccwdata.org/web/guest/condition-categories.

Data period: 2014

16.2

3.8

15.4

3.4

9.2

2.3

0

20

40

60

80

100

Depression Schizophrenia/ Other Psychotic Disorders

Treatment of mental health conditions among Medicare beneficiaries



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Summary and discussion The data presented here attempt to draw two sets of comparisons: between the prevalence and severity of different health needs and between the states of the three counties in our community. These data have some limitations, however. Some of the differences in averages may be due to reality or they may be due to random chance. Factors like the billing and coding practices of different physicians, practices, and hospitals concentrated in different counties may also play a role. While these kinds of issues should be remembered, the data still have some value in making objective comparisons. The following are several noteworthy observations from the data:

• The percentage of adults without insurance has slowly been increasing.

• While the number of primary care providers is high, the number of mental health providers is very low.

• Death rates due to cancer in general are relatively high in McDuffie County, and particularly so for colorectal and lung cancer.

• Several indicators point to a significant problem with diabetes. McDuffie County has a high death rate due to diabetes, and a higher incident rate than any of its peer counties. However, obesity rates and physical inactivity rates are lower than those of almost all of the peer counties. One possible explanation is a prevalence of people with a genetic disposition to diabetes rather than a prevalence of behaviors that lead to diabetes.

• Chlamydia has been increasing, but the incidence rate is low relative to the rate of other non-sexually transmitted diseases.

• While the percentage of people reporting inadequate social support and the percentage of seniors living alone are not larger than comparison areas, the numbers are still high and are other barriers to access to care.


Community feedback

McDuffie County Listening Session The McDuffie CHNA listening session was held in the University Hospital McDuffie Board Room on March 22, 2016. Thirteen individuals from various health and social service agencies were invited to attend, and eight participated in the session.

Those who were invited but did not attend were from the following organizations: YMCA, McDuffie County Mental Health Department, McDuffie County High School and one family care practice in Thomson. Representatives from these organizations were sent an email with the list of questions from the listening session and invited to provide feedback.

Listening Session: McDuffie County Name Title Organization Special knowledge/expertise in

public health Miriam Smith Coordinator McDuffie County

Partnership for Success McDuffie County Partnership for Success is the local Family Connection Collaborative Organization, whose goals include healthy children, school readiness, self-sufficient families and strong communities.

Teresa Nelson Occupational Health Nurse

Shaw Industries Ms. Nelson offers occupational health services, screenings and programs to employees of Shaw Industries, one of McDuffie County’s top five employers.

Dr. Curtis Pickard, D.M.D.

Dentist Thomson Dental Wellness

Dr. Pickard is a local dentist who has practicing in Thomson for many years. He accepts Medicaid patients.

Dot Cofer Retired McDuffie County Extension Service

Ms. Cofer was a long-time employee of the McDuffie County Extension Service, whose mission is to educate Georgia citizens in agriculture, the environment, communities and youth and families. She continues her service through the coordination of the county health fair and membership in various other community projects and boards.

Robin Dudley Registered Nurse University Hospital McDuffie; University Hospital McDuffie Board of Trustees

As a registered nurse working at University Hospital McDuffie, a long-time resident of McDuffie County and an active member in her community, Ms. Dudley has special knowledge of the community’s health needs.

Kathy Nurse Manager / McDuffie County As part of the Georgia Department


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Linebarger Practitioner District of the East Central District Department of Public Health

of Public Health, the East Central Health District exists to promote and protect the health and safety of Central Savannah River Area (CSRA) and surrounding county residents. A source of health information, the organization also exists to prevent disease by managing health risks in the community.

Caroline Richardson

Agent McDuffie County Extension Service

McDuffie County Extension Service’s mission is to educate Georgia citizens in agriculture, the environment, communities and youth and families.

Dr. Lynn Cato Director of Curriculum and Instruction

McDuffie County Schools

Dr. Cato’s understanding of the barriers between McDuffie County students and educational achievement qualify her as having specialized knowledge of community health needs.

Laurie Ott, Vice President of Human Resources and Community Services and President of University Health Care Foundation facilitated the listening session, following questions and guidelines provided by the CHNA Steering Committee. In an attempt to enlist someone with specific experience in guiding health-related listening sessions, a representative from the East Central District of the Georgia Department of Public Health was initially approached to facilitate but was unavailable. The guidelines followed for conducting a listening session and the questions that were asked were taken from the North Carolina Department of Health and Human Services, North Carolina Division of Public Health’s Community Health Assessment Guide, revised June 2014.

Taking notes for the session were Jonathon Turner, University Health Care System Director of Systems Engineering/2016 CHNA Committee Chair, and Leila Lawson, University Health Care System Community Relations Specialist. Bob Kepshire, Administrator and Chief Nursing Officer for University Hospital McDuffie, observed.

Session length was one and one-half hours. The following chart is a close representation of the questions and the feedback received. Questions and answers may have been combined or changed slightly to accommodate repeated and/or similar responses or themes. The order of feedback as it appears in the chart is not significant.


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Listening Session: McDuffie County Question Answers What do people in this community do to stay healthy?

• Participate in annual county health fair • Utilize multiple walking tracks • Use exercise facilities provided by YMCA and churches • Participate in YMCA after-school wellness program (partnership with

school) • Youth participate in screenings as part of school sports • Adults screened through work programs (Shaw) • Participation in educational programs provided by the Extension Service

What are the major health problems in McDuffie County?

• Heart disease • Undiagnosed conditions • Diabetes • Rise of juvenile and early onset diabetes • Mental health problems • Increase in dental problems

What are the causes of these problems? Also: What keeps people from people from being healthy?

• Adults and youth without primary care physicians • Lack of insurance • Poor diet • Lack of understanding the importance of preventative care/people do not

see a physician until there is a problem • Increase of poverty every year • Lack of resources to educate parents living in poverty • Low number of providers in area • Physicians unwilling to accept Medicaid patients causes a backlog of

patients waiting to be seen; long waiting period to see physician • Transportation/Access to care • Grandparents are often heads of household and they have a different

view of healthcare – not inclined to go to the doctor • Cost of services • Fear among illegal immigrants to seek care • Language and environment of healthcare intimidating/confusing • Illiteracy/health literature written above appropriate reading level

What are the underlying reasons for poor eating habits?

• Learned behavior from caretakers • Large number of unhealthy restaurant/fast food options compared to

low number of healthy options • Parents working different/long shifts rely on quick, inexpensive meals

What are the issues surrounding this community’s mental health problem?

• Rise in frequency and severity among the student population • Diminished mental health resources; nowhere to refer patients for care;

patients bounce between emergency departments and jail • Difficulty accessing mental health resources for those without

transportation to neighboring Augusta What are the underlying causes of mental health problems?

• Genetic factors • Alcohol/drug use by parents • Environment


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What can be done to solve these problems?

• Educational resources, e.g., Diabetes Empowerment & Education Program (DEEP); Partners for Success

• Encourage wellness in the workplace • Reach beyond this group and engage other community members and

partners • Hospital should partner with groups who are working to solve social and

economic barriers to health • Create health literature that is written at a third grade level • Keep lines of communication open between local and rural health

providers and hospital staff • Early intervention for children • Recreation Department has transportation services • Soup kitchen has worked well in the past (no longer running) • Communicate and make health needs a priority • Establish a central community health calendar so all agencies are aware

of current activities and services • Nutrition education at every level of school • Go to MANNA (Meeting Area Needs Now and Always) and post

nutritional information on the board What groups are not receiving enough health care?

• High poverty population • Seniors • The very young • Teens


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Feedback on the 2013 University Hospital McDuffie Community Health Needs Assessment and Implementation Strategy To gain feedback from the community on the 2013 CHNA and Implementation Strategy, each invitation to the listening session included a survey asking for feedback on both reports. Invitees were asked to mail back the survey or bring it with them to the listening session. Of the 13 surveys that were mailed, four were returned. For each question, participants were asked if they were very satisfied, satisfied or dissatisfied. An opportunity for optional comments was provided with each question. Representatives from the organizations that did not participate were invited to participate in this survey via email.

Survey Results on 2013 UH McDuffie CHNA and Implementation Strategy Question Answers 1. (Regarding the assessment.) Pages 23 through

25 describe the community leaders we included and the process that was used to solicit feedback. How satisfied are you that the community was well represented?

• Optional comment question: Should any additional leaders have been included? Were any subgroups of the population underrepresented in our process?

• Satisfied – 3 • Very satisfied – 1 • Dissatisfied - 0 • No optional comments provided

2. (Regarding the assessment.) How satisfied are

you that the data and community feedback accurately represented the community’s health needs?

• Optional comment question: Should any additional health needs be addressed?

• Satisfied – 2 • Very Satisfied – 2 • Dissatisfied – 0 • No optional comments provided

3. (Regarding the implementation strategy.)

How satisfied are you that the goals, strategies and action steps listed were appropriate for addressing the health needs listed?

• Optional comment question: Please share any ways in which the goals, strategies or action steps could have been improved.

• Satisfied – 3 • Very satisfied – 1 • Dissatisfied – 0 • No optional comments provided


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Provider survey We invited providers in our community to, “Please tell us about a resource you wish was more accessible to your patients that would help them address their health needs.” The survey was made accessible by an online survey vendor. We accessed the name, address, and type of providers in our community through the Centers for Medicare and Medicaid Services’ National Plan and Provider Enumeration System (NPPES). We restricted the survey to physicians, mental health providers, and pharmacists. We then mailed an invitation to each provider which included the web address of the survey and the promise of a gift to a randomly selected respondent.

Figure 29 – Survey invitation

We sent the survey to 42 providers whose addresses in the NPPES were a city in McDuffie County. We received three responses. The needs identified were

• Continuity/coordination of care among hospitalists at University Hospital McDuffie

• Diabetic education services

• A user friendly patient portal where patients can access their records


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Prioritization of health needs

The process for identifying and prioritizing health needs and services Equipped with this data, our prioritization steering committee attempted to answer the question, “What are the greatest health needs of the people of Richmond County, Aiken County, and Columbia County?” First, we agreed upon criteria we would use to prioritize health needs, selecting prevalence (e.g., how many people in our community are affected by it?) and severity (e.g., what are the implications of neglecting it?). We then identified a list of needs, beginning with the 42 topics and objectives of Healthy People 2020. We pared the list down to 26, excluding topics that weren’t consistent with the standard definition of a health need. For example, “Global Health” is a topic area but not a health need. To the 26 we added two health needs of our own: health literacy and transportation. Each of the members of our steering committee subgroup independently scored each need on the prevalence and severity criteria. To rank health needs by prevalence, the members were encouraged to examine incidence, prevalence, treatment rates, and death rates of some of the diseases and population cohorts in the health needs assessment. We then reviewed the results and through discussion and clarification made some minor adjustments to our overall rankings. We also identified which needs are consistent with the scope of the care we currently provide to people in the community, with the understanding that highly ranked health needs outside our scope may require us to identify resources to address those health needs. We invited members of the East Central Health District of the Georgia Department of Public Health to participate in the prioritization process but they were unable.

Results Although many health needs were acknowledged, the steering committee identified four priorities: diabetes, cancer, heart disease and stroke, and health literacy. Our Implementation Strategy Guide addresses the actions to be taken to address the prioritized health needs of the community and those other organizations that can better address needs like health literacy.


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Appendix A. Public health data sources The following public health data sources were to describe the health needs of our community. Descriptions were taken from the sources’ web sites.

• American Community Survey o The US Census Bureau conducts this survey, but unlike the every-10-year census, it

continues all year, every year. It randomly samples addresses in every state, the District of Columbia, and Puerto Rico and includes questions regarding housing, health insurance, and other topics.

o Can be found at https://www.census.gov/programs-surveys/acs/

• American Lung Association’s www.stateoftheair.org o For 16 years, the American Lung Association has analyzed data from official air quality

monitors to compile the State of the Air report. o Can be found at www.stateoftheair.org

• Census QuickFacts o QuickFacts is an easy to use application that shows tables, maps, and charts of

frequently requested statistics from more than ten Census Bureau censuses, surveys, and programs. Profiles are available for the nation, all 50 states plus the District of Columbia and Puerto Rico, and all counties. Cities and towns with a population of 5,000 or more are also included.

o Can be found at http://www.census.gov/quickfacts/

• The Center for Disease Services’ Behavioral Risk Factor Surveillance System o The Behavioral Risk Factor Surveillance System (BRFSS) is the nation's premier system

of health-related telephone surveys that collect state data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services. Established in 1984 with 15 states, BRFSS now collects data in all 50 states as well as the District of Columbia and three U.S. territories. BRFSS completes more than 400,000 adult interviews each year, making it the largest continuously conducted health survey system in the world.

o Can be found at http://www.cdc.gov/brfss/

• The Center for Disease Services’ Community Health Status Indicators web application o CHSI 2015 is an interactive web application that produces health profiles for all 3,143

counties in the United States. Each profile includes key indicators of health outcomes, which describe the population health status of a county and factors that have the potential to influence health outcomes, such as health care access and quality, health behaviors, social factors and the physical environment.

o Can be found at http://wwwn.cdc.gov/communityhealth

• The Centers for Medicare and Medicaid Services’ Chronic Conditions Data Warehouse o The Centers for Medicare and Medicaid Services’ Chronic Conditions Data Warehouse

provides researchers with Medicare and Medicaid beneficiary, claims, and assessment data linked by beneficiary across the continuum of care.

o Can be found at https://www.ccwdata.org/web/guest/home

• County Health Rankings


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o The annual County Health Rankings measure vital health factors, including high school graduation rates, obesity, smoking, unemployment, access to healthy foods, the quality of air and water, income, and teen births in nearly every county in America. The annual Rankings provide a revealing snapshot of how health is influenced by where we live, learn, work and play.

o Can be found at http://www.countyhealthrankings.org/

• Healthy People 2020, of the Healthy Communities Institute o Healthy People 2020 includes over 1,200 objectives to monitor and improve the health

of all Americans over the decade. The objectives are organized into 42 Topic Areas, each representing an important public health area. To determine the success of Healthy People, it is important to track and measure progress for the objectives over the decade.

o Can be found at https://www.healthypeople.gov/

• Kids Count Data Center o A project of the Annie E. Casey Foundation, KIDS COUNT is the premier source for

data on child and family well-being in the United States. In addition to including data from the most trusted national resources, the KIDS COUNT Data Center draws from more than 50 KIDS COUNT state organizations that provide state and local data, as well publications providing insights into trends affecting child and family well-being.

o Can be found at http://datacenter.kidscount.org/

• The Online Analytical Statistical Information System (OASIS) of the Georgia Department of Public Health

o OASIS is a suite of interactive tools used to access the Georgia Department of Public Health's standardized health data repository. The standardized health data repository used by OASIS is currently populated with Vital Statistics (births, deaths, fetal deaths, induced terminations, pregnancies), Hospital Discharge, Emergency Room Visit, Arboviral Surveillance, Youth Risk Behavior Survey (YRBS), Behavioral Risk Factor Surveillance Survey (BRFSS), STD, Motor Vehicle Crash, and Population data.

o Can be found at https://oasis.state.ga.us/

• State Cancer Profiles Web Site o The objective of the State Cancer Profiles Web site is to provide a system to

characterize the cancer burden in a standardized manner in order to motivate action, integrate surveillance into cancer control planning, characterize areas and demographic groups, and expose health disparities. The Profiles Web site brings together data that are collected from public health surveillance systems by using either their published reports or public use files. The data may appear dated but it is the most recent that has completed the national data synthesis and quality assurance processes. Many states provide Web sites with just their state's data. This data may be more recent or in more detail than can be provided nationally.

o Can be found at http://statecancerprofiles.cancer.gov/index.html

• Uniform crime reporting statistics of the US Department of Justice, compared with US Census data

o The FBI’s Uniform Crime Reporting (UCR) Program is a nationwide, cooperative statistical effort of nearly 18,000 city, university and college, county, state, tribal, and federal law enforcement agencies voluntarily reporting data on crimes brought to their


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attention. Since 1930, the FBI has administered the UCR Program and continued to assess and monitor the nature and type of crime in the Nation. The program’s primary objective is to generate reliable information for use in law enforcement administration, operation, and management; however, its data have over the years become one of the country’s leading social indicators.

o Can be found at http://www.ucrdatatool.gov/


Appendix B. Actions taken since conducting our 2013 implementation strategy guide Our 2013 assessment prioritized several health needs: chronic disease prevalence; prevention and screening; and financial access to care. For each of these, we wrote goals, strategies, and action steps in our 2013 Implementation Strategy Guide, which accompanied the assessment. In this section we report on whether the action steps we listed were taken.

Chronic Disease Prevalence

Topic Area Overview:

Chronic Diseases are the leading causes of death and disability in the U.S., with 7 out of 10 deaths among Americans each year from chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year, while diabetes continues to be the leading cause of kidney failure, non-traumatic lower extremity amputations, and blindness among adults, aged 20-74. Four modifiable health risk behaviors - lack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumption - are responsible for much of the illness, suffering, and early death related to chronic disease. - CDC

Specific Needs Identified in CHNA:

McDuffie County ranks as one of the highest in the U.S. for deaths related to cancer and diabetes. It is also in the highest percentile for incidents of breast cancer. The average number of age adjusted death rates due to cancer in all U.S. counties is 184 per 100,000. McDuffie County reflects a rate much higher than the average - 229 deaths per 100,000. This is 70 more deaths per 100,000 than neighboring Columbia County. This is significant because a majority of preventable deaths and illnesses in the United States are directly caused by human behaviors such as smoking and unhealthful diets.

Goals: Reduce the incidence, as well as the economic and emotional burden, of chronic conditions while also addressing health risk behaviors associated with chronic disease.


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Strategy: Provide lab work needed for Cardiovascular Screening Program, a partnership with the McDuffie County Health Department - linked with Access to Care - Uninsured

Lead Organizational Entity: University Hospital McDuffie Laboratory Department

Action Step Desired Outcome Notes

The McDuffie County Health Department currently provides a Cardiovascular Screening Program by offering assessments and education to the residents of surrounding communities. Annual lab work provided by University Hospital McDuffie will be linked with the McDuffie County Health Department to support prevention and screening.

Provide opportunities for early detection of cardiovascular disease for residents within the community.

We continue fulfilling this action step by partnering with the County Health Department regarding lab work.

Strategy: Support University Hospital education classes and events

Lead Organizational Entity: University Hospital McDuffie facility wide


University Hospital McDuffie will support the education initiatives of University Hospital, which offer a wide range of ongoing education and support opportunities geared towards improving chronic disease prevalence. University Hospital will provide no less than five ongoing classes/groups, and no less than five annual education/outreach events related to chronic diseases such as Diabetes, Cancer and Obesity. All community classes are free, and are open to residents of McDuffie County. Healthy U Calendars will be provided to the McDuffie County Health Department and community

Improved access to education and support related to chronic diseases.

University Hospital provided many different classes and support groups. Some examples are an Insulin Pump Support Group, Sweet Success (nutrition education for people with diabetes), Breast Self Exam classes, Fresh Start smoking cessation classes, health fairs, etc. Healthy U Calendars were sent to the McDuffie County Health Department at various time throughout 2014 and 2015.


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Strategy: Support University Hospital screening events, such as lung cancer/lung disease and skin cancer - linked with Chronic Disease Prevalence and Prevention and Screening

Lead Organizational Entities: Cancer Services, Community Relations/Corporate Communications


Support University Hospital's annual lung cancer education and screening event. This is a physician-lead event that includes free pulmonary function and Alpha-1 Antitrypsin Deficiency tests, along with smoking cessation information. This free community event is open to the residents of McDuffie County. Healthy U Calendars will be provided to the McDuffie County Health Department and the community.

Improved access to free pulmonary function screenings.

2014: 29 people screened; number of abnormal results: 0 2015: Screening cancelled due to vendor not reporting results 2016: No screening due to lack of interest

Support University Hospital's annual skin cancer screening. University Hospital and local dermatologists team up every May to provide free skin cancer screenings to the community, which may help identify cancer at an early stage. This screening is open to the residents of McDuffie County. Healthy U Calendars will be provided to the McDuffie County Health department and the community.

Promote opportunities for free skin cancer screenings.

2014: number screened: 58 • 14 - biopsy recommended • 3 - had biopsy (negative) • 1 - had biopsy (positive - basal cell carcinoma) • 2 - saw primary care physician who did not recommend biopsy • 7 - did not respond to request for follow-up 2015: 37 people screened • 10 - biopsy recommended • 2 - saw dermatologist cryosurgery; 1 had cauterization) • 4 - saw primary care physician who did not recommend biopsy • 4 - did not respond to request for follow-up 2016: Cancelled due to physician unavailability


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Strategy: Support University Hospital initiatives to provide or participate in health fairs and/or screenings - linked with Access to Care-Uninsured and Prevention-Screening



University Hospital McDuffie will support the health fair initiatives of University Hospital. Healthy U Calendars will be provided to the McDuffie County Health Department and community. These events are opportunities to screen and educate off campus on a variety of health-related concerns related to chronic diseases. Screenings include blood sugar, cholesterol and blood sugar checks; and carotid artery ultrasounds which identify early signs of plaque build up. Education is made available through the participation of multiple hospital service lines and includes information cardiovascular health and prevention, nutrition and weight management, cancer, diabetes and more. Health fairs are partnerships with community churches, local media and business and industry. All community health fairs are open to residents of McDuffie county, and University Hospital will host, or participate in, no less than two health fairs per year located in McDuffie County.

Improve access to information and screenings related to chronic disease.

2013: We were not able to provide screenings in 2013 at the McDuffie County Health Fair due to a prior commitment on the same date to provide them at another event. We did send a representative out from Heart & Vascular to provide education. We also participated in the McCorkle Nursery health fair in Dearing, GA. In 2013, we served at total of 359 persons at a various events in McDuffie County, or the surrounding area. Events were considered to be “McDuffie County” events if their locations were closer to UHM than to UH. 2014: We provided screenings at both the McDuffie County Health Fair and at McCorkle Nurseries in Dearing, GA. We served a total of 380 persons at various events in McDuffie County, or the surrounding areas. 2015: We provided screenings at both the McDuffie County Health Fair and at McCorkle Nurseries in Dearing, GA. We served a total of 585 persons in McDuffie County, or the surrounding areas.


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Prevention and screening


Preventive services such as routine disease screenings and scheduled immunizations are key to reducing death and disability and improving overall health. These services both prevent and detect illnesses and diseases—from flu to cancer—in their earlier, more treatable stages, significantly reducing the risk of illness, disability, early death, and medical care costs. In addition, wellness and education initiatives empower the community to make healthy lifestyle choices by creating environments that nourish all dimensions of personal health. These initiatives aim to keep the community informed of services available, as well as how to access them.

Specific Needs Identified in CHNA:

McDuffie County residents demonstrate a higher breast cancer incidence rate when compared to surrounding counties. Providing education and outreach to McDuffie County residents in collaboration with the McDuffie County Health Department will help them to make lifestyle choices that lead to longer, healthier lives.

Goals: Increase community health literacy and awareness through outreach programs with a focus on wellness and healthy behavior initiatives to empower individual personal health.


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Strategy: Provide access to mammograms in collaboration with the McDuffie County Health Department - linked with Access to Care - Uninsured

Lead Organizational Entity: University Hospital McDuffie Radiology Department


Continue to provide and coordinate screening diagnostics, mammography or sonography, to eligible targeted women that are not getting regular health care or mammograms because cost is a barrier. Reports of each client's results for the purpose of follow up and documentation will be sent to the respective health department. The patient will receive a "lay letter" indicating either normal results, or a directive to contact their local health department.

Provide opportunities for early detection of breast cancer to residents.

Letters have been and continue to be sent to patients and to the medical director of the health department.


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University Hospital McDuffie will support the health fair initiatives of University Hospital. Healthy U Calendars will be provided to the McDuffie County Health Department and community. These events are opportunities to screen and educate off campus on a variety of health-related concerns related to chronic diseases. Screenings include blood sugar, cholesterol and blood sugar checks; and carotid artery ultrasounds which identify early signs of plaque buildup. Education is made available through the participation of multiple hospital service lines and includes information cardiovascular health and prevention, nutrition and weight management, cancer, diabetes and more. Health fairs are partnerships with community churches, local media and business and industry. All community health fairs are open to residents of McDuffie county, and University Hospital will host, or participate in, no less than two health fairs per year located in McDuffie County.




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Strategy: Provide free Heart Attack and Stroke Prevention classes



University Hospital will continue to provide Heart Attack and Stroke Prevention classes, which are open to residents of McDuffie County. Classes are held four times per month. This class explains some of the causes of vascular disease as well as early warning signs. Information is provided about how changes can be made immediately to prevent heart attack and stroke.

Improved access to education about vascular disease and prevention.

All Heart Attack & Stroke Prevention Orientation classes hosted by UH were open to the residents of McDuffie County. They were offered between two and four times a month. 2013: 39 Orientation classes, 196 persons served 2014: 39 Orientation classes, 183 persons served 2015: 44 Orientation classes, 158 persons served


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Access to Care


“A person’s ability to access health services has a profound effect on every aspect of his or her health, yet at the start of the decade, almost 1 in 4 Americans do not have a primary care provider (PCP) or health center where they can receive regular medical services. Approximately 1 in 5 Americans (children and adults under age 65) do not have medical insurance. People without medical insurance are more likely to lack a usual source of medical care, such as a PCP, and are more likely to skip routine medical care due to costs, increasing their risk for serious and disabling health conditions. When they do access health services, they are often burdened with large medical bills and out-of-pocket expenses.” - HP2020

Specific Needs Identified in CHNA: McDuffie County has over 51% of its residents living 200% above the federal poverty level.

Goals: Increase access to medical services and screenings for uninsured persons.


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Strategy: Provide access to mammograms in collaboration with the McDuffie County Health Department - linked with Access to Care - Uninsured

Lead Organizational Entity: University Hospital McDuffie Radiology Department


Continue to provide and coordinate screening diagnostics, mammography or sonography, to eligible targeted women that are not getting regular health care or mammograms because cost is a barrier. Reports of each client's results for the purpose of follow up and documentation will be sent to the respective health department. The patient will receive a "lay letter" indicating either normal results, or a directive to contact their local health department.

Provide opportunities for early detection of breast cancer to residents.

Letters have been and continue to be sent to patients and to the medical director of the health department.

Strategy: Provide lab work needed for Cardiovascular Screening Program, a partnership with the McDuffie County Health Department - linked with Access to Care - Uninsured

Lead Organizational Entity: University Hospital McDuffie Laboratory Department




We continue fulfilling this action step by partnering with the County Health Department regarding lab work.


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University Hospital McDuffie will support the health fair initiatives of University Hospital. Healthy U Calendars will be provided to the McDuffie County Health Department and community. These events are opportunities to screen and educate off campus on a variety of health-related concerns related to chronic diseases. Screenings include blood sugar, cholesterol and blood sugar checks; and carotid artery ultrasounds which identify early signs of plaque buildup. Education is made available through the participation of multiple hospital service lines and includes information cardiovascular health and prevention, nutrition and weight management, cancer, diabetes and more. Health fairs are partnerships with community churches, local media and business and industry. All community health fairs are open to residents of McDuffie county, and University Hospital will host, or participate in, no less than two health fairs per year located in McDuffie County.




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2016COMMUNITY HEALTH NEEDS ASSESSMENT

IMPLEMENTATION STRATEGY

IMPLEMENTATION STRATEGY GUIDE 2016

Table of Contents

Introduction .................................................................................................................................................. 2

Executive summary .................................................................................................................................. 2

University Health Care System’s mission, vision, and values ................................................................. 2

Description of the health needs for which we are adopting action plans .................................................... 3

Diabetes (from Healthy People 2020) ...................................................................................................... 3

Cancer (from Healthy People 2020) ......................................................................................................... 3

Heart Disease and Stroke (from Healthy People 2020) ........................................................................... 4

Health literacy (from health.gov) ............................................................................................................. 4

Action steps in response to the adopted health needs ................................................................................. 6


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Introduction

Executive summary University Hospital McDuffie’s 2016 Implementation Strategy Guide (ISG) accompanies its 2016 Community Health Needs Assessment (CHNA). The CHNA identifies McDuffie County (GA) as the community University Hospital McDuffie serves. The CHNA lists four health needs as priorities in that community: diabetes, cancer, heart disease and stroke, and health literacy. This ISG describes the actions the hospital intends to take to address the health need and the anticipated impact of these actions. It also identifies the resources the hospital plans to commit to address the health need and describes any planned collaboration between the hospital and other organizations in addressing the health need.

University Health Care System’s mission, vision, and values The mission of University Health Care System is to improve the health of those we serve.

The vision of University Health Care System is patients will insist on University, employees will be proud to be part of University, and physicians will prefer University because we set the standard for high-quality, safe care and exceptional service.

The values of University Health Care System are Quality, Safety, Service, People, Growth, and Affordability.


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Description of the health needs for which we are adopting action plans

Diabetes (from Healthy People 2020) Diabetes Melltus (DM) affects an estimated 23.6 million people in the United States and is the 7th leading cause of death. DM:

• Lowers life expectancy by up to 15 years.

• Increases the risk of heart disease by 2 to 4 times.

• Is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness.

In addition to these human costs, the estimated total financial cost of DM in the United States in 2007 was $174 billion, which includes the costs of medical care, disability, and premature death.

The rate of DM continues to increase both in the United States5, 6 and throughout the world.7 Due to the steady rise in the number of persons with DM, and possibly earlier onset of type 2 DM, there is growing concern about:

• The possibility of substantial increases in diabetes-related complications

• The possibility that the increase in the number of persons with DM and the complexity of their care might overwhelm existing health care systems

• The need to take advantage of recent discoveries on the individual and societal benefits of improved diabetes management and prevention by bringing life-saving discoveries into wider practice

• The clear need to complement improved diabetes management strategies with efforts in primary prevention among those at risk for developing DM

Cancer (from Healthy People 2020) Continued advances in cancer research, detection, and treatment have resulted in a decline in both incidence and death rates for all cancers. Among people who develop cancer, more than half will be alive in 5 years, yet cancer remains a leading cause of death in the United States, second only to heart disease. The cancer objectives for Healthy People 2020 support monitoring trends in cancer incidence, mortality, and survival to better assess the progress made toward decreasing the burden of cancer in the United States. The objectives reflect the importance of promoting evidence-based screening for cervical, colorectal, and breast cancer by measuring the use of screening tests identified in the U.S. Preventive Services Task Force (USPSTF) recommendations. The objectives for 2020 also highlight the importance of monitoring the incidence of invasive cancer (cervical and colorectal) and late-stage breast cancer, which are intermediate markers of cancer screening success.

In an era of patient-centered care, effective communication between clinicians and their patients and family members fosters shared knowledge and understanding and leads to medical decisions that align with patient values. The objectives assess whether people understand and remember the information they receive about cancer screening. Research shows that a recommendation from a health care provider is the most important reason patients cite for having cancer screening tests.


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Heart Disease and Stroke (from Healthy People 2020) Heart disease is the leading cause of death in the United States. Stroke is the third leading cause of death in the United States. Together, heart disease and stroke are among the most widespread and costly health problems facing the Nation today, accounting for more than $500 billion in health care expenditures and related expenses in 2010 alone. Fortunately, they are also among the most preventable.

The leading modifiable (controllable) risk factors for heart disease and stroke are:

• High blood pressure

• High cholesterol

• Cigarette smoking

• Diabetes

• Poor diet and physical inactivity

• Overweight and obesity

Over time, these risk factors cause changes in the heart and blood vessels that can lead to heart attacks, heart failure, and strokes. It is critical to address risk factors early in life to prevent the potentially devastating complications of chronic cardiovascular disease.

Controlling risk factors for heart disease and stroke remains a challenge. High blood pressure and cholesterol are still major contributors to the national epidemic of cardiovascular disease. High blood pressure affects approximately 1 in 3 adults in the United States, and more than half of Americans with high blood pressure do not have it under control. High sodium intake is a known risk factor for high blood pressure and heart disease, yet about 90 percent of American adults exceed their recommendation for sodium intake.

The risk of Americans developing and dying from cardiovascular disease would be substantially reduced if major improvements were made across the U.S. population in diet and physical activity, control of high blood pressure and cholesterol, smoking cessation, and appropriate aspirin use.

Health literacy (from health.gov) Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.1

Health literacy is dependent on individual and systemic factors:

• Communication skills of lay persons and professionals

• Lay and professional knowledge of health topics

• Culture

• Demands of the healthcare and public health systems

• Demands of the situation/context

Health literacy affects people's ability to:


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• Navigate the healthcare system, including filling out complex forms and locating providers and services

• Share personal information, such as health history, with providers

• Engage in self-care and chronic-disease management

• Understand mathematical concepts such as probability and risk

Health literacy includes numeracy skills. For example, calculating cholesterol and blood sugar levels, measuring medications, and understanding nutrition labels all require math skills. Choosing between health plans or comparing prescription drug coverage requires calculating premiums, copays, and deductibles.

In addition to basic literacy skills, health literacy requires knowledge of health topics. People with limited health literacy often lack knowledge or have misinformation about the body as well as the nature and causes of disease. Without this knowledge, they may not understand the relationship between lifestyle factors such as diet and exercise and various health outcomes.

Health information can overwhelm even persons with advanced literacy skills. Medical science progresses rapidly. What people may have learned about health or biology during their school years often becomes outdated or forgotten, or it is incomplete. Moreover, health information provided in a stressful or unfamiliar situation is unlikely to be retained.


Action steps in response to the adopted health needs This section includes a list of action steps we are taking to address the adopted health needs. Some action steps address several needs simultaneously.

Action Anticipated impact

Metric for future evaluation

Resources planning to commit

Any planned collaboration with other facilities or organizations

Health needs addressed

Continue to coordinate with local community events and businesses to arrange for community screening opportunities. The University Breast Health Center’s Digital Mobile Mammography Unit reaches women unable to come to University's onsite center. With a mobile mammography unit, the center is able to take breast health care to underserved populations; to working women at business and industrial sites; and to community and church groups throughout the area. Letters to the health department. Any additional breast cancer diagnostic service where cost is a barrier will be performed.

Increase access to mammography. Improve the rate of early diagnosis of breast cancer.

Number of mammograms performed on the mobile unit in McDuffie County

University Hospital has a dedicated staff for the Mobile Mammography Unit. The staff performs mammograms and handles patient appointments, registration and follow-up letters.

University Health Care Foundation covers expenses related to reading mammograms and vehicle maintenance. Pays for diagnostic mammographies for indigent patients. Cancer

Host one diabetes webinar per quarter. Classes will alternate between diabetes prevention and management of the disease. Webinar dates and access information will be shared with the McDuffie County Health Department and will be posted in University Hospital's online Healthy U Calendar with a link to the webinar appearing on the UHM page.

Improved access to diabetes prevention and management education

Participation rates in webinars

Support from diabetes program coordinator and from University Health Care's corporate communications department

University Health Care System diabetes education and corporate communication departments

Diabetes; Health literacy


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Host two community health fairs per year in McDuffie County. Events will feature as many service lines as possible and will include, at minimum, representation from Diabetes Services, Cancer Services and Heart Attack & Stroke Prevention. In addition to providing education and printed materials, carotid artery ultrasounds, lipid profiles, blood sugar checks and fecal occult blood test kits will be available at no charge. We will also provide information about lung cancer screening programs available at University Hospital (Augusta). Blood sugar results will be available immediately via finger stick. Lipid profiles will be processed through University Hospital Laboratory and mailed to participants within 10 business days of screening. Heart Attack and Stroke Prevention will follow up with all participants who indicate "critical' levels, as defined by a University Hospital physician. Information about health fairs will be shared with the McDuffie County Health Department and will be listed in University Hospital's online Healthy U Calendar and community calendars.

Improved access to screenings related to cancer and diabetes. Increase awareness of preventative behaviors. Number seen

Time investment from staff as well as financial resources needed to provide health fairs

In collaboration with University Hospital (Augusta).

Diabetes; Cancer; Heart disease and stroke; Health literacy


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Plan a diabetes education outreach event with primary care providers in McDuffie County.

Help the PCP's understand the diabetes education opportunities University Health Care System can make available through University Hospital McDuffie. Brainstorm with them to partner in new ways to help their diabetic patients manage diabetes.

PCP's in attendance

Evening event. Have an employed endocrinologist speak, along with a diabetes educator.

McDuffie County primary care physicians Diabetes



Labs processed Financial support for lab results

McDuffie County Health Department

Heart disease and stroke; Diabetes


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University Hospital McDuffie will support the education initiatives of University Hospital, which offer a wide range of ongoing education and support group opportunities. All support groups are free, and are open to residents of McDuffie County. Healthy U Calendars will be available online.

Improved access to education and support related to chronic diseases.

Support groups offered Any staff needs

University Hospital (Augusta)

Health literacy

University Hospital will continue to provide Heart Attack and Stroke Prevention classes, which are open to residents of McDuffie County. Classes are held four times per month. This class explains some of the causes of vascular disease as well as early warning signs. Information is provided about how changes can be made immediately to prevent heart attack and stroke.

Attendees will be able to reduce risk factors associated with heart attack and stroke

Classes held; total attendance (specific to McDuffie County if possible to obtain) Any staff needs

University Hospital (Augusta)

Heart disease and stroke


File by thedue date forfiling yourreturn. Seeinstructions.

823841 12-19-18

| File a separate application for each return.

| Go to www.irs.gov/Form8868 for the latest information.

Electronic filing (e-file).

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print

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3a

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Caution:

For Privacy Act and Paperwork Reduction Act Notice, see instructions. 8868

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Form

(Rev. January 2019)OMB No. 1545-1709

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2018


DAVID A. BELKOSKI, CFO

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706-828-2406

1350 WALTON WAY

AUGUSTA, GA 30901

45-4166209

NOVEMBER 15, 2019

1350 WALTON WAY - AUGUSTA, GA 30901

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