Taylor Hospital

National Labor Relations Board - Board Decisions

Jun 27, 1995

317 N.L.R.B. 991 (N.L.R.B. 1995)

991
317 NLRB No. 143
TAYLOR HOSPITAL
1 The General Counsel’s motion to correct formal papers is grant-
ed.
2 The General Counsel’s motion to correct transcript is granted.
3 Based on admissions in the pleadings, I find that the Board has
jurisdiction and that the Union is a labor organization within the
meaning of Sec. 2(5) of the Act.
4 Hereinafter, all dates are in 1993 unless noted otherwise.
5 Census was defined by Neely simply as the number of patients
in the hospital on any given day.
6 The declining length of stay impacts the number of beds needed
and was therefore a factor in the decision to lay off.
Taylor Hospital and Pennsylvania Nurses Associa-
tion, PNA Local 723. Case 4–CA–22400
June 27, 1995
DECISION AND ORDER
BY MEMBERS BROWNING, COHEN, AND
TRUESDALE
On March 15, 1995, Administrative Law Judge Wil-
liam F. Jacobs issued the attached decision. The Re-
spondent filed exceptions and a supporting brief, the
General Counsel filed an answering brief, and the Re-
spondent filed a reply brief.
The National Labor Relations Board has delegated
its authority in this proceeding to a three-member
panel.
The Board had considered the decision and the
record in light of the exceptions and briefs and has de-
cided to affirm the judge’s rulings, findings, and con-
clusions and to adopt the recommended Order.
ORDER
The National Labor Relations Board adopts the rec-
ommended Order of the administrative law judge and
orders that the Respondent, Taylor Hospital, Ridley
Park, Pennsylvania, its officers, agents, successors, and
assigns, shall take the action set forth in the Order.
Mark E. Arbesfeld, Esq., for the General Counsel.
Lawrence B. Fine, Esq. (Morgan, Lewis & Bockius), of
Philadelphia, Pennsylvania, for the Respondent.
Jamie Zurasky, Esq., of Fort Washington, Pennsylvania, for
the Charging Party.
DECISION
STATEMENT OF THE CASE
WILLIAM F. JACOBS, Administrative Law Judge. This pro-
ceeding was tried before me on September 20, 1994, in
Philadelphia, Pennsylvania. The charge was filed on January
27, 1994,1 and amended on March 28, 1994, by Pennsyl-
vania Nurses Association, PNA Local 723 (the Union). The
complaint issued March 31, 1994, alleging that Taylor Hos-
pital (the Respondent or the Hospital) violated Section
8(a)(1) and (5) of the National Labor Relations Act by refus-
ing to furnish the Union with ‘‘budgetary information’’ and
copies of census and reimbursement records, information
necessary for, and relevant to, the Union’s performance of its
duties as the exclusive bargaining representative of the unit
of employees it represents. Respondent, in its answer, denies
the commission of any unfair labor practices.
All parties appeared at the hearing and were afforded full
opportunity to be heard and present evidence and argument.
The General Counsel and Respondent filed briefs. On the en-
tire record,2 my observation of the demeanor of the wit-
nesses, and after giving due consideration to the briefs, I
make the following
FINDINGS OF FACT3
Taylor Hospital is a not-for-profit community hospital lo-
cated in Ridley Park, Pennsylvania. Registered nurses at the
hospital are represented by the Union and number about 100.
They have been so represented since 1977, the most recent
collective-bargaining agreement being effective from June 1,
1992, to May 31, 1994. The parties have agreed to an exten-
sion of this agreement and it was in force at the time of the
hearing.
Meredith Neely is the senior vice president of human re-
sources and administrative services. Her responsibilities lie
within the collective-bargaining relationship between the
PNA and Respondent, and include contract negotiation and
interpretation and the arranging and holding of third-step
grievance meetings.
According to Neely, in 19934 the subject of health care re-
form was being discussed throughout the country. The drive
toward health care reform put a great deal of pressure on
hospitals to change their operations to conform to the re-
quirements resulting from these pressures.
On November 4, Neely met with representatives of the
Union to discuss the demand for health care reform, its effect
on the hospital, what had already been done, and what might
be done about it in the future. In attendance were officers of
both the Respondent and the Union. Although the date for
the meeting had been scheduled in advance, the Union had
not been advised as to its purpose and its officers were
caught off guard by the announcements made at the meeting.
At the meeting, Neely advised the union officers that in-
surers were tightening up their requirements and lowering re-
imbursements, that they were now questioning and denying
hospitalization, and whereas they had previously agreed to
the admittance of new patients, they were now looking for
alternative ways of treating them. Certain procedures that had
been done on an in-patient basis were now being done on
an out-patient basis; procedures that had been done on an
out-patient basis were now being done in doctors’ offices.
Neely explained how insurers had changed their method of
payments. Whereas, at one time the insurers would pay a
percentage of charges, they were now paying the way Medi-
care pays, by diagnosis or paying on a per diem rate, with
the result that reimbursements were declining.
Neely told those present that the various pressures from
the insurance companies had resulted in a declining census5
in hospitals—fewer admissions and shorter lengths of stay6
and that the resulting changes, in turn, had impacted on the
hospital’s environment. In other words, it was taking in less
money.
Aware that something had to be done, Neely explained, a
steering committee was formed to look into ways of rede-
signing methods of providing health care in the hospital
992 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
7 Misspelled Loughery on most documents in evidence.
which would permit Respondent to continue to meet its
budget and remain financially healthy.
The committee, according to Neely, came up with a sug-
gestion that the problems facing the hospital could best be
solved by changing the skill mix in the hospital, by having
registered nurses perform only those more demanding tasks
for which they had been awarded their title, leaving the less
demanding tasks, previously done in part by them, to less
highly trained individuals who would be paid less than reg-
istered nurses. Neely then offered some examples of how
units could be closed or combined with other units in such
a way as to implement the committee’s plan.
Finally, after providing the Union’s officials with the
above information, Neely advised them of the expected im-
pact on their membership. She told them that she estimated
that between 20 and 25 employees would be affected. Some
would be laid off, to be replaced by unlicensed personnel
and LPNs, but the situation might also be ameliorated
through attrition.
Neely pointed out that Respondent had never before used
the layoff provisions of the contract before and so wished to
discuss with the Union the procedure to be followed. The
parties did not, however, discuss the layoff procedure at
length at this meeting.
Neely credibly testified that although she made reference
to projected statistics for use in formulating a budget, such
as the number of admissions and the length of patients’ stay,
she did not, at any time, indicate that the hospital was expe-
riencing financial hardship. On the contrary, she was clear in
her representation that the hospital was financially sound and
that it was management’s obligation to take steps to ensure
that it remain in that condition.
Neely’s description of what was said at the November 4
meeting was not seriously challenged by the General Coun-
sel’s sole witness, Barbara Loughruy,7 the Union’s president,
who was in attendance at the meeting. Some skepticism was
voiced by Loughruy as the meeting broke up, however, when
she asked Neely if she could give any assurances that the
hospital was taking the action it was because it had to be
done, rather than because it simply wanted to make more
money.
On November 8, Loughruy met with Lisa Holgash, the
Union’s labor representative, who had been out of town and
had not attended the November 4 meeting. Loughruy in-
formed Holgash about the content of Neely’s address at the
November 4 meeting and about the impending layoff. They
discussed what steps should be taken to avoid the layoff in-
cluding making monetary concessions if, in fact, the hospital
was in need of concessions. Holgash then told Loughruy that
she was going to request financial information since Neely
had told the Union on November 4 that the hospital intended
to remain financially healthy. Loughruy testified that she had
input into precisely what information would be requested and
that she had discussed this subject with Holgash on Novem-
ber 8.
On November 8, Holgash sent the following letter to
Neely:
Dear Meredith:
During the meeting with PNA Representatives Bar-
bara Loughery, Elizabeth Pearsall, Janice Sara and
Kathleen Duffy Hewes on Thursday, November 4,
1993, you referred to budgetary information. PNA Rep-
resentatives requested a copy of the referenced material.
The PNA is again requesting a copy of any and all
relevant information.
Very truly yours,
Lisa A. Holgash
Labor Representative
With regard to the specific text of the November 8 letter,
Loughruy’s ‘‘input’’ was clearly limited to identifying those
who attended the November 4 meeting and possibly supply-
ing the term ‘‘budgetary information.’’ When examined at
the hearing concerning this term, Loughruy testified, contrary
to the letter, that the Union did not ask for ‘‘budgetary infor-
mation’’ nor anything else at the November 4 meeting. She
testified further that neither she nor anyone else from the
Union ever explained to hospital management what was
meant by the term ‘‘budgetary information’’ because no one
ever asked her to explain it.
Loughruy testified that the term ‘‘budgetary information,’’
as used in Holgash’s November 4 letter, referred to what part
of the budget was being allotted to nursing care prior to the
contemplated changes, what part of the budget was going to
be allotted to nursing care after the contemplated changes,
where the savings derived from the contemplated changes
were going to be spent and the amount of the expected sav-
ings. Loughruy denied that by the request for ‘‘budgetary in-
formation,’’ the Union was requesting the hospital to open
its books to the entire range of budgetary matters. According
to Neely, when she received Holgash’s November 8 letter,
she did not know precisely what the reference to budgetary
information might pertain. She testified that she assumed that
it was a request that the hospital open its books to show the
Union its financial situation.
Apparently Holgash and Loughruy spoke again after the
November 8 letter had been sent, because on November 10
a followup letter was sent in which Holgash requested Neely
to also send copies of the census and reimbursement records
in addition to the information requested earlier. By ‘‘census’’
Holgash was referring to the number of in-patients in the
hospital at a given time, a definition with which Neely was
in agreement. By reimbursement records Holgash was refer-
ring to information concerning the care of those patients,
whether it was being paid by an insurance company, by
Medicare, or by Medicaid.
More particularly, with regard to census records, Holgash
was seeking information regarding how many in-patients the
hospital had been treating in the past, how many in-patients
were being treated at the time, and how many in-patients the
hospital projected for treatment in the future and the length
of stay of patients already treated and under treatment. Since
Neely, on November 4, had mentioned reducing the number
of beds by 16, the Union was also interested in this subject.
Although Holgash and Loughruy knew precisely what infor-
mation they were seeking, the letter simply requested ‘‘cen-
sus and reimbursement records,’’ and nothing more.
993TAYLOR HOSPITAL
Loughruy testified that the Union requested the informa-
tion sought in its letters of November 8 and 10 because Re-
spondent had cited the low census and its desire to remain
financially healthy as the reasons for the forthcoming
changes in operations. The Union hoped that the information
could help it in three ways. First, the information would be
of value in determining whether or not grievances or poten-
tial grievances were meritorious. Second, it might enable the
Union to offer a concessions package to the Respondent
which, in turn, might enable some of the bargaining unit
members to retain their jobs. Third, it might be advantageous
in negotiating a severance package for the employees who
would be laid off.
Neely testified that when she received Holgash’s Novem-
ber 10 letter, she understood it to mean that the Union want-
ed information on Respondent’s contractual agreements with
insurance companies as to how they would be reimbursing
the hospital. She explained that the relationship between the
hospital and its insurance companies was by contract and
that each contract contained a confidentiality clause which
precluded her from divulging to the Union the information
requested.
On November 12, Neely replied to Holgash’s November
8 letter requesting ‘‘budgetary information.’’ In it she stated,
‘‘as there is no contractual obligation to provide documents
concerning the hospital’s financial condition, nor has the
Hospital asserted that it is in financial distress, there is no
obligation to produce financial or budgetary information as
requested.’’ The letter invited further discussion if Holgash
would pursue the matter.
On November 15, another meeting was held between Re-
spondent and the Union. Both parties were represented by
the same individuals who had attended the November 4
meeting except that Holgash joined the union contingent.
The meeting had been called to discuss the procedure to
be followed in the forthcoming layoff of requested nurses.
Neely noted that although the contract contained a layoff
provision, the parties had never had the opportunity to work
with it before so it was going to be a new experience. The
parties then discussed the various ways of using the provi-
sion’s language.
At some point during this meeting, Holgash asked Neely
about the requested budgetary information because she had
not yet received Neely’s November 12 response. Neely men-
tioned that she had already answered that request by letter
and that the answer had been no. She reiterated that the hos-
pital was not having any financial difficulty and was not in
any financial distress. She stated that since the hospital was
not claiming financial reasons for its decision to lay off the
nurses, it was not obligated to divulge to the Union, the
budgetary information it had requested. She explained that
due to pressures involving reimbursements and reform, the
Respondent was just trying to ensure that it could maintain
its financial viability on a prospective basis.
Despite Neely’s statement of position, Holgash insisted
that the Union was entitled to the information. At that point,
another member of the management team advised her that
she still was not going to get it. Holgash replied that the
Union would file an unfair labor practice charge. After No-
vember 15, the Union made no further requests for informa-
tion.
At no point during the discussion concerning the budg-
etary information did Respondent’s representatives ask the
Union’s representative to clarify their reasons for requesting
the information. Nor did the Union’s representatives ever
offer any explanation as to why they needed the information.
On November 16, Neely replied to Holgash’s November
10 letter. She stated once again that at no time had she
claimed that the hospital was experiencing financial hardship.
Therefore, since there was no contractual obligation to pro-
vide documents concerning the hospital’s financial condition,
there was no obligation to produce financial, census, or reim-
bursement records as requested. Neely invited Holgash to
contact her if she would like to discuss the matter further.
Holgash did not reply nor did the Union.
Sometime after the meeting of November 15, Respondent
undertook implementation of the new layoff and replacement
policy which eventually resulted in the layoff of 26 unit em-
ployees. This gave rise to the filing of at least six grievances
from November 16 through December 8. These grievances,
however, all concerned the manner in which the hospital im-
plemented the layoffs, according to Loughruy. The informa-
tion requested by the Union was not the specific subject of
any of the grievances but, she testified, was needed to deter-
mine whether or not to file additional grievances based on
the information received and may or may not have been rel-
evant to the grievances that were filed. The six grievances
were taken to arbitration and were lost.
About November 17, the financial department of the Re-
spondent and the Union were in contact discussing the num-
ber of layoffs, the bumping process, and who was involved.
Despite this contact, the Union did not take the opportunity
to clarify its information requests. The reason, according to
Loughruy, was that the Union was not asked to clarify its
information requests.
Conclusions
Condensation of the above findings of fact indicates that
on November 4, Respondent’s agent Neely advised the
Union that due to pressures for reform within the industry,
insurance reimbursements had dropped, and the number of
patients and their length of stay had decreased. She explained
that in order for the hospital to counteract the resulting de-
crease in revenues and remain financially healthy the number
of available beds would be decreased and a number of reg-
istered nurses, all unit members, would be laid off and their
places taken by less skilled personnel.
In order to protect the integrity of the unit and to deter-
mine if the purported reasons given for the layoffs were true,
the Union asked for budgetary information and copies of
census and reimbursement records. The budgetary informa-
tion sought concerned the savings achieved by the hospital
by laying off the registered nurses and replacing them with
lower-paid less skilled employees while the census and reim-
bursement records would support or fail to support the rea-
sons given by the hospital for the layoffs. With this informa-
tion, the Union would be able to tell whether or not the Re-
spondent was dealing with it in good faith and what steps
it should take in response to the layoffs, if any. Without the
requested information the Union had no way of determining
what response it should make, whether grievances should be
filed, concessions offered, or some other action taken.
994 DECISIONS OF THE NATIONAL LABOR RELATIONS BOARD
8 Postal Service, 307 NLRB 429 (1992), citing Electrical Workers
IUE v. NLRB, 648 F.2d 18 (D.C. Cir. 1980), and J. I. Case Co. v.
NLRB, 253 F.2d 149 (7th Cir. 1958).
9 Western Massachusetts Electric Co., 234 NLRB 118 (1978).
10 Citing AMF Bowling Co. v. NLRB, 977 F.2d 141 (4th Cir.
1992).
11 National Electrical Contractors Assn., Birmingham Chapter, 313
NLRB 770 (1994); Keauhou Beach Hotel, 298 NLRB 702 (1990).
12 301 NLRB 1104 (1991).
A union is entitled to relevant information during the term
of a collective-bargaining agreement to evaluate or process
grievances and to perform other duties or take other actions
necessary to administer the agreement.8 It is basic that a
union must, of necessity, have a continuing interest in mat-
ters which will affect the tenure of employees it represents.9
In the instant case, Respondent gave the Union a very spe-
cific reason why it found it necessary to lay off 26 members
of the unit and replace them with nonunion employees. It
claimed it was necessary in order to permit Respondent to
continue to meet its budget and remain financially healthy
because of a diminishing census and declining reimburse-
ments. If the Union were to accept Respondent’s claim with-
out requesting to see available verifying documentation, it
would not be properly representing its members. I find that
the Union is entitled to the information it requested because
the information is both relevant and necessary for the Union
to perform its representational duties.
Respondent offers several affirmative defenses. First, it
maintains that the General Counsel has not established the
relevancy of the requested information. In my view, Re-
spondent itself established the relevancy of the information
when it told the Union that there would be a layoff, that the
purpose of the layoff was to meet its budget and remain fi-
nancially healthy, and the reasons it was necessary was fewer
patients and diminished reimbursements. That established the
relevancy of the documentation which was the subject of the
Union’s request.
Second, Respondent argues that the Union is not entitled
to the information requested because Respondent did not
make a plea of poverty. The Union however has never re-
quested that Respondent open its books, nor has it exhibited
any interest in Respondent’s overall financial position. That
is irrelevant. The Union merely seeks information directly re-
lated to the economic layoff and the purported reasons for
it. The Respondent cannot refuse any and all requests for in-
formation on the sole ground that it has not pled poverty.
Third, Respondent posits that it has no obligation to pro-
vide the requested documentation because the Union failed
adequately to specify the information it was seeking and
where a union makes only a ‘‘general request’’ for records
or documentation and ‘‘fails to provide the employer with an
explanation as to why it is seeking the information, and fails
to identify the specific documents it is requesting, an em-
ployer is under no obligation to produce materials.’’10
The terminology used by the Union, however, in its re-
quests of November 8 and 10 is virtually identical to the ter-
minology used by Neely in her explanation to the Union dur-
ing her speech of November 4 when she advised the Union’s
officials of the forthcoming layoff. When she referred to re-
designing methods so as to permit Respondent to continue
‘‘to meet its budget and remain financially healthy,’’ she
knew what budgetary information had been used for this pur-
pose. She also knew what she meant when she discussed
census and reimbursement and what records were relied on
in determining the necessity for the layoff. The union offi-
cials did not. All they could do is ask for ‘‘all relevant infor-
mation,’’ namely, budgetary information, census, and reim-
bursement records, which they did on November 8 and 10.
If Neely did not understand that the Union was asking for
whatever she was talking about on November 4, i.e., docu-
mentation to support the decision to lay off the nurses, then
it was her duty to inquire, not to simply reject the request
out of hand.11 This she did not do.
Finally, Respondent claims that much of the requested in-
formation is highly confidential and therefore not subject to
disclosure to the Union without a specific finding of rel-
evancy. Relevancy however, I have already found to be obvi-
ous, and as stated in Pennsylvania Power Co.:12
It is clear . . . that in dealing with union requests for
relevant, but assertedly confidential information, the
Board is required to balance a union’s need for the in-
formation against any ‘‘legitimate and substantial’’ con-
fidentiality interests established by the employer. The
appropriate accommodation necessarily depends on the
particular circumstances of each case. The party assert-
ing confidentiality has the burden of proof. Legitimate
and substantial confidentiality and privacy claims will
be upheld but blanket claims of confidentiality will not.
Further, a party refusing to supply information on con-
fidentiality grounds has a duty to seek an accommoda-
tion. Thus, when a union is entitled to information con-
cerning which an employer can legitimately claim a
partial confidentiality interest, the employer must bar-
gain toward an accommodation between the union’s in-
formation needs and the employer’s justified interests.
In the instant case, Respondent merely announced that cer-
tain information was confidential and made no attempt to ac-
commodate the Union and its request for information. It
therefore failed to bargain in good faith as required by the
Act.
In conclusion, I find that Respondent has failed and re-
fused to furnish the Union with budgetary information and
census and reimbursement records, relevant information re-
quested by the Union which is necessary for it to fulfill its
statutory duties and responsibilities as the employees’ collec-
tive-bargaining representative. By doing so, Respondent vio-
lated Section 8(a)(1) and (5) of the Act.
CONCLUSIONS OF LAW
1. Respondent is an employer engaged in commerce within
the meaning of Section 2(2), (6), and (7) of the Act.
2. The Union is a labor organization within the meaning
of Section 2(5) of the Act.
3. The unit appropriate for collective bargaining within the
meaning of Section 9(b) of the Act, consists of:
All full-time and regular part-time registered and grad-
uate nurses in the employ of respondent, excluding any
other employees such as nurses in the Supply Process
and Distribution Section, or supervisors such as Head
Nurses, as defined in the Act.
995TAYLOR HOSPITAL
13 If no exceptions are filed as provided by Sec. 102.46 of the
Board’s Rules and Regulations, the findings, conclusions, and rec-
ommended Order shall, as provided in Sec. 102.48 of the Rules, be
adopted by the Board and all objections to them shall be deemed
waived for all purposes.
14 If this Order is enforced by a judgment of a United States court
of appeals, the words in the notice reading ‘‘Posted by Order of the
National Labor Relations Board’’ shall read ‘‘Posted Pursuant to a
Judgment of the United States Court of Appeals Enforcing an Order
of the National Labor Relations Board.’’
4. At all times material, the Union has been and continues
to be the exclusive representative of the employees in the ap-
propriate unit for purposes of collective bargaining within the
meaning of Section 9(a) of the Act.
5. By failing and refusing to furnish the Union with budg-
etary information and census and reimbursement records, Re-
spondent has engaged in, and is engaging in, unfair labor
practices affecting commerce within the meaning of Section
8(a)(5) and (1) and Section 2(6) and (7) of the Act.
REMEDY
Having found that the Respondent engaged in certain un-
fair labor practices, I shall recommend that it be required to
cease and desist therefrom and take affirmative action de-
signed to effectuate the policies of the Act including action
to make available to the Union the budgetary information
and census and reimbursement records, which date is rel-
evant and necessary to the Union’s obligation to represent
Respondent’s employees in the appropriate unit.
On these findings of fact and conclusions of law and on
the entire record, I issue the following recommended13
ORDER
The Respondent, Taylor Hospital, Ridley Park, Pennsyl-
vania, its officers, agents, successors, and assigns, shall
1. Cease and desist from
(a) Refusing to bargaining collectively with Pennsylvania
Nurses Association, PNA Local 723, as the exclusive bar-
gaining representative of its employees in the appropriate
bargaining unit described in paragraph 3 of the Conclusions
of Law section of this decision by refusing or failing to fur-
nish the Union or its agents, on request, with data concerning
budgetary information and census and reimbursement records
or other relevant data and information necessary to the ad-
ministration of its collective-bargaining agreement with the
Union.
(b) In any like or related manner interfering with, restrain-
ing, or coercing its employees in the exercise of the rights
guaranteed them by Section 7 of the Act.
2. Take the following affirmative action necessary to ef-
fectuate the policies of the Act.
(a) On request furnish or make available to the appropriate
agent of the Union the information described in paragraph
1(a) above.
(b) Post at its Ridley Park, Pennsylvania facility, copies of
the attached notice marked ‘‘Appendix.’’14 Copies of the no-
tice, on forms provided by the Regional Director for Region
4, after being signed by the Respondent’s authorized rep-
resentative, shall be posted by the Respondent immediately
upon receipt and maintained for 60 consecutive days in con-
spicuous places including all places where notices to employ-
ees are customarily posted. Reasonable steps shall be taken
by the Respondent to ensure that the notices are not altered,
defaced, or covered by any other material.
(c) Notify the Regional Director in writing within 20 days
from the date of this Order what steps the Respondent has
taken to comply.
APPENDIX
NOTICE TO EMPLOYEES
POSTED BY ORDER OF THE
NATIONAL LABOR RELATIONS BOARD
An Agency of the United States Government
The National Labor Relations Board has found that we vio-
lated the National Labor Relations Act and has ordered us
to post and abide by this notice.
Section 7 of the Act gives employees these rights.
To organize
To form, join, or assist any union
To bargain collectively through representatives of
their own choice
To act together for other mutual aid or protection
To choose not to engage in any of these protected
concerted activities.
WE WILL NOT refuse to furnish or make available to Penn-
sylvania Nurses Association, PNA Local 723 relevant data
and information necessary to the policing and administration
of our contract with the Union.
WE WILL NOT in any like or related manner interfere with,
restrain, or coerce you in the exercise of the rights guaran-
teed you by Section 7 of the Act.
WE WILL, on request, furnish to the Union or its agents
budgetary information and census and reimbursement records
and other relevant data and information necessary to the ad-
ministration of our collective-bargaining agreement with the
Union.
TAYLOR HOSPITAL