2020 Home Health Survey

Part A : General Information

1. Identification UID:HHA024

Facility Name: Encompass Health Home Health County: Hart Street Address: 600 Chandler Street City: Hartwell Zip: 30643 Mailing Address: 6688 N. Central Expressway, Suite 1300 Mailing City: Dallas Mailing Zip: 75206 Medicaid Provider? Check the box to the right if the agency is a medicaid provider If you indicated yes above, please report the medicaid number below. 000814811Q

Medicare Provider? Check the box to the right if the agency is a medicare provider If you indicated yes above, please report the medicare number below. 11-7069

2. Report Period

Report Data for the full twelve month period, January 1,2020 - December 31, 2020 (365 days). Do not use a different report period.

Check the box to the right if your facility was not operational for the entire year. If your facility was not operational for the entire year, provide the dates the facility was operational.

Part B : Survey Contact Information

Person authorized to respond to inquiries about the responses to this survey.

Contact Name: Julie Jolley Contact Title: Executive Vice President of Home Health and Hospice Operations

Page 1 Phone: 214-239-6500 Fax: 214-239-6581 E-mail: [email protected]

Part C : Ownership, Operation and Management

1. Ownership, Operation and Management As of the last day of the report period, indicate the operation/management status of the facility and provide the effective date. Using the drop-down menus, select the organization type. If the category is not applicable, the form requires you only to enter Not Applicable in the legal name field. You must enter something for each category.

A. Agency Owner Full Legal Name (Or Not Applicable) Organization Type Effective Date CareSouth HHA Holdings of Washington, LLC For Profit 03/01/1998

B. Owner's Parent Organization Full Legal Name (Or Not Applicable) Organization Type Effective Date CareSouth Health Systems, Inc. For Profit 03/01/1998

C. Agency Operator Full Legal Name (Or Not Applicable) Organization Type Effective Date CareSouth HHA Holdings of Washington, LLC For Profit 03/01/1998

D. Operator's Parent Organization Full Legal Name (Or Not Applicable) Organization Type Effective Date CareSouth Health Systems, Inc. For Profit 03/01/1998

E. Management Contractor Full Legal Name (Or Not Applicable) Organization Type Effective Date Not Applicable Not Applicable

F. Management's Parent Organization Full Legal Name (Or Not Applicable) Organization Type Effective Date Not Applicable Not Applicable

2. Branch Offices If your agency has a branch office or branch offices please check the box to the right.

3. Branch Office Locations If your agency operates branch offices please provide the following information on branch locations.

Branch Office Street Address Street City County Date Est. Watkinsville 1551 Jennings Mill Rd, Suite 2100-AWatkinsville Oconee 03/01/1998

Page 2 Commerce 215 Mercer Place Commerce Jackson 10/23/2007 Augusta 4128 Madeline Drive, Suite A Augusta Richmond 03/01/1998 Eatonton 117 Harmony Crossing, Suite 7 Eatonton Putnam 03/01/1998 Sandersville 601 Ferncrest Drive, Building B Sandersville Washington 05/01/2010 Statesboro 118 Hill Pond Land Statesboro Bulloch 10/15/2012

Page 3 Part D : Agency Utilization and Patient Caseload Information

1. Health-Related Visits Please report the number of health-related visits (not units) during the report period by service/discipline. Also, please provide the per visit rate your agency charges for providing each of the services indicated. Use the blank lines to report other services/disciplines.

Service/Discipline Number of Visits Charge per Visit Skilled Nursing 45,813 200 Physical Therapy 45,232 250 Home Health Aide 1,685 125 Occupational Therapy 17,285 250 Medical Social Services 311 250 Speech Pathology 3,299 250 0 0 0 0 0 0

2. Agency Caseload Please report the total number of cases at the end of the business day on December 31,2020. 1043

4. Completed Medicare Episodes of Care Provide the total number of completed Medicare episodes of care during the report year. Include all completed episodes including Low Utilization Payment Adjustments (LUPA). 6975

5. Health-Related Patients by Race/Ethnicity Please report the number of health-related patients during the report period using the following race and ethnicity categories.

Race/Ethnicity Number of Patients American Indian/Alaska Native 4 Asian 24 Black/African American 1,490 Hispanic/Latino 22 Pacific Islander/Hawaiian 3 White 3,469 Multi-Racial 0

6. Health-Related Patients by Gender Report the number of health-related patients by gender served during the report period.

Gender Number of Patients Male 2,044 Female 2,968

7. Health-Related Visits by Payer Please report the number of Health-Related visits, unduplicated patients, and the gross and net

Page 4 patient revenue during the report period by each payer. Please note that gross and net patient revenue totals must balance to those reported in Part E.)

Payer Patients Visits Gross Revenue Net Revenue Medicare 3,275 76,728 14,721,565 14,710,276 Medicaid 50 1,030 0 0 Other Government Payers 0 0 0 0 Managed Care (HMO/PPO) 0 0 0 0 Other Third Party Insurers 1,669 35,561 6,038,440 6,014,456 Self Pay 2 88 13,790 13,735 Other Non Government 16 218 45,725 0

Page 5 Part E : Agency Financial Summary, Indigent and Charity Care Provided and Patient Point of Origin

1.Indigent and/or Charity Care Policy Check the box to the right if the agency had a formal written policy or written policies concerning the provision of indigent and/or charity care during 2020. If you indicated yes above, please indicate the effective date of the policy or policies. 11/01/1995

2. Person Responsible Please indicate the name and title or position held by the person most responsible for adherence to or interpretation of the policy or policies you will provide the department. Sarah Feldman, Senior Vice President Regional Operations

3. Charity Care Provision Check the box if the policy or policies included provision for the care that is defined as charity.

4. Financial Table Please complete the following financial table for the 2020 calendar year. Please note that Total Uncompensated Indigent and Charity Care Charges (automatically calculated by the database) should not exceed Gross Indigent and Charity Care Charges.

Revenue or Expense Amount Gross Patient Revenue 20,819,520 Medicare Contractual Adjustments 0 Medicaid & Peachcare Contractual Adjustments 0 Other Contractual Adjustments 0 Total Contractual Adjustments 0 Bad Debt 35,328 Indigent Care Gross Charges 45,725 Indigent Care Compensation 0 Uncompensated Indigent Care (Net) 45,725 Charity Care Gross Charges 0 Charity Care Compensation 0 Uncompensated Charity Care (Net) 0 Other Free Care 0 Total Net Patient Revenue 20,738,467 Adjusted Gross Patient Revenue 20,784,192 Other Revenue 0 Total Net Revenue 20,738,467 Total Expenses 18,809,074 Adjusted Gross Revenue 20,784,192 Total Uncompensated I/C Care 45,725 Percent Uncompensated Indigent/Charity Care 0.22%

5. Indigent or Charity Care Cases

Page 6 Report the number of home health care patients who were classified as being indigent or charity care cases and for which patient charges were written off to indigent or charity care accounts as reproted in Part E, Question 4 above. 16

6. Patient Point of Origin Report the number of home health care patients who were referred to your agency by each of the following healthcare points of origin

Point of Origin Number of Patients Referred Hospitals (via discharge planner) 1,968 Physicians 1,577 Other Home Health Agencies 35 All Other Healthcare Providers 1,432

7. Referral Hospitals Please provide the names of the hospitals above who referred patients during the report year.

Hospital Name Patients Referred Atrium Main - Charlotte 1 Augusta Medical Center 1 Augusta University Med Center (Geraldine) 87 Augusta University Med Center (Tanya) 638 Augusta University Surgery CM 5 Blake Medical Center 1 Burke Medical Center 1 Cancer Treatment Centers of America - Newnan 1 Candler Count Hsopital Swing Bed 26 Candler Hospital 8 Cartersville Medical Center 1 Doctors Hospital Augusta 283 East Georgia Regional Medical Center 230 Eastside Inpatient Rehab Center 1 Effingham Hospital 3 Eisenhower Medical Center 27 Elbert Memorial Hospital 104 Emory Medical Center 4 Emory Midtown Hospital 6 Emory Saint Joseph's Hospital 2 Emory St Joseph's Hospital 1 Emory University dba Emory Crawford Long Hospital 1 Emory University Hospital 25 St Marys Scared Heart Hospital 51 St Francis Hospital Columbus 1 St Mary Hospital 1

Page 7 St Marys Hospital 4 Stephens Country Hospital 5 Charlie Norwood VA Medical Center - Augusta 51 Coastal Carolina Hospital 1 Coliseum Medical Center 38 Coliseum Northside Hosptial 1 Collquitt Regional Medical Center 1 Dekalb Medical Center 2 Saint Joseph Hospital Savannah 9 Saint Josephs Hospital of Atlanta 1 Saint Marys Hospital - Athens 3 Select Specialty Augusta 10 Self Regional Healthcare 1 Shepherd Center 3 Sylvan Grove Hospital 1 The Emory Clinic 1 University Health Care System 216 University Hospital - Summerville 15 University Hospital - McDuffie 10 VA Medical Center - Downtown Augusta 3 VA Medical Center - Uptown Augusta 30 VAMC Augusta, GA 3 Washington County Regional Medical Center 35 Wayne Memorial Hospital 1 Wellstar Kenneston 2 Wellstar North Fulton Hospital 1 Wills Memorial 32 Atrium Health - Mercy 2 Aiken Regional Medical Center 2 Anderson Area Medical Center 23 Anmed Health 19 Atlanta VA Medical Center 18 Atlanta VA Medical Center - Decatur GA 1 Emanuel Medical Center 1 Emory Healthcare - Wesley Wood Rehab 1 Emory Healthcare - Wesley Woods Wound Center 1 Emory Hospital 10 Emory Hospital Midtown 2 Emory Johns Creek Hospital 2 Fairview Park Hospital 28 Grady Health System 1 Grady Hospital 1 Greenville Medical Center 1 Gwinett Medical Center 2

Page 8 Gwinnett Medical Center of LWR 2 Piedmont Hospital 1 Piedmont Newton Hospital 8 Prisma Health Baptist Parkridge Hospital 2 Prisma Health Greenville Memorial Hospital 1 Putnam General Hospital 68 Rockdale Healthcare Center 1 Landmark Hospital 5 Medical Center of Central Georgia 1 Memorial Health University Medical Center 40 Morgan Medical Center 10 Navicent Health 50 Navicent Health Baldwin 108 Northeast GA Medical Center - Braselton 11 Northeast Georgia Health Systems, Inc 68 Northeast Georgia Medical enter - Lumpkin 1 Northside Hospital - Atlanta 1 Northside Hospital - Forsyth 4 Northside Hospital of Atlanta 1 Gwinnett Medical Center - Duluth 1 Habersham Medical Center 1 Houston Healthcare Houston Medical Center 1 Jasper Memorial Hospital 14 Jefferson County Hospital of GA 38 Joseph M Still Burn Center 4 Oconee Medical Center of Seneca, SC 4 Optim Med Center Screven 11 Optim Medical Center Tattnall 6 Piedmont Athens Regional Medical Center 497 Piedmont Atlanta Hospital 27 Piedmont Atlanta Hospital Transplant Unit 4 Spalding Regional Hospital 1 Spartanburg Regional Medical Center 1 St Joseph Hospital of Atlanta 4 St Mary's Health Care System 11 St Marys Good Samaritan Hospital 48 St Marys Hospital 117 Total 3,278

Page 9 Part F : Agency Workforce Information

This information is being collected to support Georgia's healthcare workforce planning activities.

1. Budgeted FTE Please report the number of budgeted fulltime equivalents (FTEs) and the number of vacancies as of 12-31-2020.

Profession Budgeted FTEs Vacant Contract/Temporary Budgeted FTEs Staff FTEs Registered Nurses (RNs 28 8 1 Advanced Practice) Licensed Practical Nurses 14 0 0 (LPNs) Aides/Assistants 2 1 0 Allied Health/Therapists 45 10 0

Page 10 2. Filling Vacancies Please enter the average time needed during the past six months to fill each type of vacant position.

Type of Vacancy Average Time Needed to Fill Vacancies Registered Nurse 58 Days Licensed Practical Nurse 60 Days Aide/Assistant 25 Days Allied Health/Therapists 71 Days

Part G : Monthly Admissions, Readmissions and Utilization by Patient County

1. Monthly Admissions and Readmissions Provide the number of new admissions and readmissions in each of the months during the report year

Month New Admissions Re-Admissions January 254 238 February 224 208 March 230 173 April 179 160 May 226 188 June 239 211 July 213 179 August 231 173 September 269 212 October 246 177 November 234 136 December 205 159

2A. Patient Origin Part A. Patient Origin - Report the admissions, visits, and caseload by county for the report period. Caseload totals are for 1/1/2020. Admissions should capture all admissions during the report year. Visits should capture all visits during the report year. Report patients served for the four age cohort groups. The Total Patients column will be automatically calculated. You will not be able to enter data in that column. Also provide patients for ages 60 to 79 in the column provided.

County Beginning Admissions Total Patients I/C Patients Patients Patients Patients Total Caseload Visits 60-79 Patients Under 18 18-64 65-79 80 & Over by Age Bulloch 79 387 8,067 194 1 0 51 176 159 386

Burke 12 68 1,306 46 1 0 17 42 10 69

Clarke 129 458 12,152 170 0 0 42 152 269 463

Columbia 62 413 7,993 240 2 0 68 217 152 437

Elbert 73 419 9,336 159 3 0 51 140 175 366

Glascock 4 30 614 20 0 0 8 17 8 33

Greene 20 177 3,447 78 0 0 15 70 85 170

Hancock 33 128 2,833 67 1 0 36 56 46 138

Hart 78 347 10,491 159 0 0 41 146 147 334

Page 11 Jackson 76 268 6,745 132 0 0 21 123 143 287

Jasper 16 78 1,382 45 0 0 15 38 31 84

Jefferson 35 164 3,903 73 0 0 29 62 75 166

Jenkins 12 32 734 23 0 0 14 18 5 37

Lincoln 8 60 797 33 0 0 10 30 20 60

Madison 20 113 2,601 62 0 0 16 59 43 118

Morgan 7 62 1,275 33 1 0 5 30 31 66

Oconee 21 90 2,442 35 0 0 4 34 57 95

Oglethorpe 20 101 2,415 48 0 0 12 44 47 103

Putnam 62 330 6,893 169 2 0 45 147 137 329

Richmond 167 762 18,318 436 2 0 158 379 258 795

Screven 15 67 1,117 42 1 0 19 34 18 71

Taliaferro 1 28 452 16 1 0 5 13 8 26

Warren 8 39 1,150 19 0 0 9 16 14 39

Washington 47 228 5,043 114 0 0 56 96 74 226

Wilkes 16 115 2,119 63 1 0 29 55 30 114

Total by Age 0 0 0 0 0 0 776 2,194 2,042 5,012

2B. Patient Origin Part B. Please report the Gross Charges, Adjusted Gross Patient Revenue and Net Uncompensated Charges by County. The grand total of each of these must balance to the Gross Patient Revenue, Adjusted Gross Patient Revenue and Net Uncompensated Charges reported in Part E Question 4.

County Gross Charges Adjusted Gross Patient Revenue Net Uncompensated Charges Bulloch 1,489,953 1,487,425 1,200

Burke 248,692 248,270 1,400

Clarke 2,555,951 2,551,614 0

Columbia 1,523,862 1,521,277 11,125

Elbert 1,611,532 1,608,797 3,850

Glascock 98,166 98,000 0

Greene 601,810 600,788 0

Hancock 539,385 538,470 2,250

Hart 1,638,646 1,635,866 0

Jackson 1,191,443 1,189,421 0

Jasper 332,876 332,311 0

Jefferson 649,997 648,894 0

Jenkins 146,709 146,460 0

Lincoln 171,929 171,638 0

Madison 504,847 503,990 0

Morgan 326,117 325,564 2,300

Oconee 524,155 523,266 0

Oglethorpe 446,444 445,686 0

Putnam 1,188,234 1,186,218 16,250

Richmond 3,317,646 3,312,014 3,500

Page 12 Screven 238,202 237,798 1,400

Taliaferro 83,876 83,734 2,250

Warren 160,523 160,251 0

Washington 848,906 847,465 0

Wilkes 379,619 378,975 200

Total 20,819,520 20,784,192 45,725

Electronic Signature

Please note that the survey WILL NOT BE ACCEPTED without the authorized signature of the Chief Executive Officer or Executive Director (principal officer) of the facility. The signature can be completed only AFTER all survey data has been finalized. By law, the signatory is attesting under penalty of law that the information is accurate and complete.

I state, certify and attest that to the best of my knowledge upon conducting due diligence to assure the accuracy and completeness of all data, and based upon my affirmative review of the entire completed survey, this completed survey contains no untrue statement, or incaccurate data, nor omits requested material information or data. I further state, certify and attest that I have reviewed the entire contents of the completed survey with all appropriate staff of the facility. I further understand that inaccurate, incomplete or omitted data could lead to sanctions against me or my facility. I further understand that a typed version of my name is being accepted as my original signature pursuant to the Georgia Electronic Records and Signature Act.

Authorized Signature: Chris A. Walker Date: 03/02/2021 Title: Chief Financial Officer Comments: Per settlement agreement dated July 21, 2008, item 2: The indigent and charity care commitment shall be for the twelve counties CareSouth has been approved to service in SSDR7 (Hancock, Taliaferro, Wilkes, Lincoln, Burke, Columbia, Glascock, Jefferson, Jenkins, Richmond, Warren and Washington Counties). Based on our calculation the total indigent and charity care requirements for 2020 was $81,554 and $20,725 of uncompensated charges occurred resulting in a shortfall of $60,829.

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