2023-11-07T09:24:38-06:00 2022-12-31 570381582 ELLIOTT DAVIS LLCPLLC 500 EAST MOREHEAD STREET SUITE 700 CHARLOTTE NC 28202 990 2022-01-01 586001901 RICHMOND COUNTY HOSPITAL AUTHORITY RICH 7068282406 1350 WALTON WAY AUGUSTA GA 30901 DAVID A BELKOSKI UHCS CFO 7068282406 2023-11-01 1 DAVID BELKOSKI 999009999 1 JANICE A RATICA P00358837 7043338881 2023-11-01 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z HUGH L HAMILTON 1350 WALTON WAY AUGUSTA GA 30901 27168405 0 X N/A X 1956 GA TO ESTABLISH UNIVERSITY HOSPITAL AND ITS RELATED INSTITUTIONS FOR THE PROVISION OF HEALTH SERVICES TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY AND TO PROVIDE CARE PURSUANT TO THE LEASE AGREEMENT FOR THE INDIGENT SICK OF RICHMOND COUNTY, GEORGIA AND OTHER COUNTIES. 9 7 0 7 0 0 0 0 24276028 23155163 0 0 0 0 24276028 23155163 0 0 0 0 0 0 0 0 0 24276028 23155163 24276028 23155163 0 0 49580 2893540 49580 2893540 0 0 TO ESTABLISH UNIVERSITY HOSPITAL AND ITS RELATED INSTITUTIONS FOR THE PROVISION OF HEALTH SERVICES TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY AND TO PROVIDE CARE PURSUANT TO THE LEASE AGREEMENT FOR THE INDIGENT SICK OF RICHMOND COUNTY, GEORGIA AND OTHER COUNTIES. 0 0 23155163 23155163 RECEIVED $23,155,163 IN DISPROPORTIONATE SHARE/UPL (DSH) PROGRAM REVENUE. THE REVENUE WAS TRANSFERRED TO UNIVERSITY HEALTH SERVICES, INC. (58-1581103) TO SUPPORT THE INDIGENT AND CHARITY CARE OF THE COMMUNITY. 23155163 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X DAVID A BELKOSKI 7067747710 1350 WALTON WAY AUGUSTA GA 30901 X SANFORD LOYD BOARD MEMBER 1.00 X 0 0 0 ALEXANDER H MACDONELL III MD BOARD MEMBER 1.00 39.00 X 0 713576 24618 ANNE D TROTTER BOARD MEMBER 1.00 X 0 0 0 RABBI DAVID SIRULL BOARD MEMBER 1.00 X 0 0 0 EDWARD TARVER BOARD MEMBER 1.00 X 0 0 0 BRANDON GARRETT BOARD MEMBER 1.00 X 0 0 0 EUGENE F MCMANUS BOARD MEMBER 1.00 X 0 0 0 MAC A BOWMAN MD VICE CHAIRMAN 1.00 39.00 X X 0 740815 21646 HUGH HAMILTON CHAIRMAN 1.00 X X 0 0 0 0 1454391 46264 0 0 1 0 0 DSH/UPL 623000 23155163 23155163 23155163 4013242 4013242 0 23155163 23155163 0 0 DSH/UPL TO UNIVERSITY H 23155163 23155163 23155163 23155163 0 0 49580 0 0 2893540 49580 2893540 49580 0 0 2893540 49580 2893540 X 0 0 0 0 0 0 0 0 49580 2893540 0 0 X X 0 1 X 1 0 X 0 DUE FROM DSH/UPL 2893540 2893540 X 27168405 4013242 4013242 23155163 0 23155163 27168405 4013242 4013242 23155163 0 23155163 PART X, LINE 2: THE AUTHORITY IS EXEMPT FROM FEDERAL INCOME TAX AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE AUTHORITY HAS EVALUATED ITS TAX POSITIONS AND DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2022. PART XI, LINE 2D - OTHER ADJUSTMENTS: LEASE REVENUE OFFSET BY INTEREST EXPENSE 4,013,242. PART XII, LINE 2D - OTHER ADJUSTMENTS: INTEREST EXPENSE OFFSET BY LEASE REVENUE 4,013,242. 0 0 0 0 0 0 0 0 0 MAC A BOWMAN MD VICE CHAIRMAN 0 636811 0 82500 0 21504 0 6100 0 15546 0 762461 0 0 ALEXANDER H MACDONELL III MD BOARD MEMBER 0 533293 0 155625 0 24658 0 8700 0 15918 0 738194 0 0 A THE RICHMOND COUNTY HOSPITAL AUTHORITY 0 0 0 A 0 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 ADDITIONAL INFORMATION RICHMOND COUNTY HOSPITAL AUTHORITY ISSUED THE RICHMOND COUNTY HOSPITAL AUTHORITY BOND, CUSIP #764603BV7, ON 10/25/2016 IN THE AMOUNT OF $154,488,348 FOR THE BENEFIT OF UNIVERSITY HEALTH SERVICES, INC. THE BOND LIABILITY AND INFORMATION IS REPORTED ON THE 990 AND SCHEDULE K OF UNIVERSITY HEALTH SERVICES, INC. (58-1581103). FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 FORM AND ALL RELATED SCHEDULES WAS PROVIDED TO THE GOVERNING BOARD BEFORE FILING IN ELECTRONIC FORM. AN EMAIL WAS SENT TO ALL 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 THE STEPS IN THE CONFLICT OF INTEREST POLICY ARE OUTLINED BELOW: 1. SENIOR MANAGEMENT (VICE PRESIDENTS AND ABOVE) SHALL COMPLETE A POTENTIAL CONFLICT OF INTEREST QUESTIONNAIRE PERIODICALLY. EACH SYSTEM ORGANIZATION'S CEO, COO, CFO AND WITHIN THEIR DIVISION'S VICE PRESIDENTS MAY REQUIRE ANY EMPLOYEE TO COMPLETE A POTENTIAL CONFLICT OF INTEREST QUESTIONNAIRE. 2. EACH EMPLOYEE IS EXPECTED TO REPORT A POTENTIAL CONFLICT OF INTEREST WHEN IT ARISES. 3.A. AN EMPLOYEE WILL REPORT A POTENTIAL CONFLICT OF INTEREST BY INITIATING A POTENTIAL CONFLICT OF INTEREST DISCLOSURE FORM AND DELIVERING IT TO HIS/HER VICE PRESIDENT. ALL EMPLOYEE POTENTIAL CONFLICTS WILL BE SCREENED BY TWO LEVELS OF SENIOR MANAGEMENT TO IDENTIFY CONFLICT OR DUALITY OF INTEREST SITUATIONS. (A DUALITY OF INTEREST EXISTS WHEN AN INDIVIDUAL HAS PERSONAL OR OUTSIDE INTERESTS THAT CAN BE AFFECTED BY DECISIONS OF THE SYSTEM. SUCH A DUALITY OR EVEN MULTIPLICITY OF INTEREST CAN BE BENEFICIAL TO AND CONSISTENT WITH THE PRIMARY GOALS OF THE INSTITUTIONS. DUALITY OF INTEREST CAN RAISE THE POTENTIAL FOR CONFLICT OF INTEREST WHEN THE PERSONAL INTERESTS OF INDIVIDUALS COME INTO CONFLICT WITH THE INTERESTS OF THE SYSTEM.) B. WHEN A DIVISION VICE PRESIDENT IS NOTIFIED OF A POTENTIAL CONFLICT/DUALITY OF INTEREST, THE VICE PRESIDENT SHALL INVESTIGATE THE SITUATION AND MAKE A REPORT OF HIS OR HER FINDINGS ALONG WITH A RECOMMENDATION TO THE EXECUTIVE VICE PRESIDENT (COO) OR CEO OF THE INVOLVED SYSTEM ORGANIZATION. C. THE EXECUTIVE VICE PRESIDENT OR CEO WHO RECEIVED THE 3.B REPORT SHALL MAKE A DECISION CONCERNING A POTENTIAL CONFLICT OF INTEREST AND ANY RESOLUTION MEASURES TO BE TAKEN. IN THE EVENT THE POTENTIAL CONFLICT OF INTEREST INVOLVES A VICE PRESIDENT, THE PRESIDENT OF UNIVERSITY HEALTH SHALL INVESTIGATE THE SITUATION AND MAKE A DECISION CENCERNING A POTENTIAL CONFLICT OF INTEREST AND ANY RESOLUTION MEASURES TO BE TAKEN. THIS INFORMATION SHALL BE COMMUNICATED DIRECTLY TO THE CONCERNED EMPLOYEE. D. THE EMPLOYEE MAY APPEAL THE CONFLICT OF INTEREST DETERMINATION TO THE PRESIDENT OF UNIVERSITY HEALTH. THE PRESIDENT'S DECISION ABOUT A POTENTIAL CONFLICT OF INTEREST AND ANY RESOLUTION MEASURES IS FINAL AND NOT COGNIZABLE UNDER THE EMPLOYEE GRIEVANCE POLICY A-30. E. IN THE EVENT THE POTENTIAL CONFLICT INVOLVES THE CEO OF A SYSTEM ORGANIZATION, THE MATTER SHALL BE REPORTED TO THE CHAIRMAN OF THE INVOLVED SYSTEM ORGANIZATION BOARD, WHO SHALL DETERMINE IF A CONFLICT EXISTS AND WHAT, IF ANY, RESOLUTION MEASURES ARE NECESSARY IN ACCORDANCE WITH THE CORPORATION'S CONFLICT OF INTEREST POLICY. 4. FILING OF FORMS A. CONFLICT OF INTEREST QUESTIONNAIRES OF THOSE WHO ARE REQUIRED BY THIS POLICY TO COMPLETE ONE PERIODICALLY SHALL BE FILED IN THE APPLICABLE CORPORATION'S CEO'S OFFICE AND RETAINED FOR NO LESS THAN SEVEN YEARS. OPTIONAL CONFLICT OF INTEREST QUESTIONNAIRES SHALL BE FILED IN THE OFFICE OF THE VICE PRESIDENT WHO REQUESTED COMPLETION OF THE FORM. B. COMPLETED POTENTIAL CONFLICT OF INTEREST DISCLOSURE FORMS SHALL BE FILED IN THE APPLICABLE CORPORATION'S CEO'S OFFICE FOR THE CEO, COO, AND VICE PRESIDENTS AND FOR ALL OTHERS IN THE APPROPRIATE VICE PRESIDENT'S OFFICE. THE FORMS SHOULD BE RETAINED FOR NO LESS THAN SEVEN YEARS. 5. THE VICE PRESIDENT FOR LEGAL AFFAIRS WILL BE AVAILABLE TO ADVISE ON POTENTIAL CONFLICT OF INTEREST MATTERS. BOARD MEMBERS: BOARD MEMBERS ARE ALSO REQUIRED TO COMPLETE A POTENTIAL CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY. THIS QUESTIONNAIRE ASKS FOR DISCLOSURES RELATED TO ANY FAMILY RELATIONSHIPS OR BUSINESS RELATIONSHIPS WITH OTHER BOARD MEMBERS, OR BUSINESS RELATIONSHIPS WITH THE ORGANIZATION. 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. ANNUALLY, A COMPENSATION COMMITTEE OF THE UNIVERSITY HEALTH SERVICES BOARD, 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 REVIEW INVOLVE THE ADVICE AND ASSISTANCE OF AN INDEPENDENT COMPENSATION CONSULTING FIRM. MINUTES OF THE COMPENSATION COMMITTEE ARE RECORDED. THE COMPENSATION COMMITTEE REPORTS TO THE UNIVERSITY HEALTH SERVICES BOARD EXECUTIVE COMMITTEE. ALL OF THE STAFF OF RICHMOND COUNTY HOSPITAL AUTHORITY ARE EMPLOYED AND THEREFORE PAID BY UNIVERSITY HEALTH SERVICES, INC. SINCE ALL STAFF MEMBERS ARE EMPLOYED BY UNIVERSITY HEALTH SERVICES, INC., RICHMOND COUNTY HOSPITAL AUTHORITY COMPLIES WITH THE ABOVE MENTIONED PROCEDURE. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS, AND INFORMATIONAL RETURNS ARE AVAILABLE UPON REQUEST AT THE ADMINISTRATIVE OFFICES. FORM 990, PART VII - COMPENSATION EXPLANATION: DR MAC A BOWMAN COMPENSATION PAID BY UNIVERSITY CARDIOLOGY ASSOCIATES, LLC (45-1437971) DR. ALEXANDER MACDONELL COMPENSATION PAID BY UNIVERSITY CARDIOLOGY ASSOCIATES, LLC (45-1437971) FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR FORM 990, PART X - PRIOR PERIOD ADJUSTMENT EXPLANATION: DURING 2022, THE AUTHORITY ADOPTED GOVERNMENTAL ACCOUNTING STANDARDS BOARD STATEMENT NO. 91 CONDUIT DEBT OBLIGATIONS (GASB 91). THIS STANDARD ESTABLISHES THAT A CONDUIT DEBT OBLIGATION SHOULD NOT BE RECOGNIZED AS A LIABILITY TO THE ISSUER. AS SUCH, THE 2021 FINANCIAL STATEMENTS HAVE BEEN RESTATED FOR THE ADOPTION OF GASB 91, AND THE CONDUIT DEBT AND RECEIVABLE FROM UNIVERSITY HEALTH SERVICES, INC. HAVE BEEN REMOVED. 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