2023-06-09T16:24:14-05:00 2022-09-30 FORVIS LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2021-10-01 752717782 JPS Foundation % BECKY KUNDERT JPSF 8177027310 1350 S Main Street Suite 4000 Fort Worth TX 76104 SHARON CLARK SENIOR EVP/CFO TCHD 8177023869 2023-08-15 true Sharon Clark 999009999 Jeanette Verrelli P00742631 9727028262 3 2021 2023-04-26 12:10:37Z KAREN DUNCAN 1350 S MAIN STREET STE 4000 FORT WORTH TX 76104 2451581 false X WWW.JPSHEALTHNET.ORG/FOUNDATION X 1997 TX JPS FOUNDATION IS A NONPROFIT WHOSE PURPOSE IS TO PERFORM SERVICES ON BEHALF OF THE TARRANT COUNTY HOSPITAL DISTRICT, INCLUDING ... (CONTINUED ON SCHEDULE O) 4 4 0 4 0 0 2431366 2082653 67895 69350 81487 113895 0 37508 2580748 2303406 656614 667632 0 0 0 0 0 0 0 1474512 991293 2131126 1658925 449622 644481 7162271 7046352 182425 142343 6979846 6904009 JPS FOUNDATION IS A PUBLIC/PRIVATE COLLABORATION DEDICATED TO ACTS OF SERVICE AND SUPPORT TO IMPROVE THE HEALTH STATUS OF FAMILIES RECEIVING HEALTH CARE VIA JPS HEALTH NETWORK. IT IS THE FOUNDATION FOR JPS HEALTH NETWORK. false false 1595567 667632 106858 FOR THE YEAR ENDED SEPTEMBER 30, 2022, HEALTH AND HUMAN ASSISTANCE SERVICES WERE PROVIDED FOR PATIENTS AND EMPLOYEES OF THE TARRANT COUNTY HOSPITAL DISTRICT DBA JPS HEALTH NETWORK (TCHD) THROUGH PATIENT ASSISTANCE, DENTAL VOUCHERS, AND EMPLOYEE GIVING CAMPAIGN. JPS FOUNDATION ALSO PROVIDES SUPPORT FOR ACTIVITIES OF TCHD, THE SUPPORTED ORGANIZATION, INCLUDING CAPITAL PROJECTS AND OTHER PROGRAMS. 1595567 true true false false false true false false false true true false false false true false false true false false false false false false false false false true true true false false false false false false false false true false false false false true true true false false true 36 0 true 0 false false false false false false false false false false false false false false false X 4 4 false false false false false true false true true false false false true true true true true false false false X BECKY KUNDERT 8177023869 1350 S MAIN STREET STE 4000 FORT WORTH TX 76104 ROBERT EARLEY END 1221 PRESIDENT AND CEO TCHD 2.0 38.0 X 0 1259235 254948 KAREN DUNCAN START 0122 PRESIDENT AND CEO TCHD 2.0 38.0 X 0 835851 120876 JILL LABBE END 0821 SVP COMMUNITY AFFAIRS & DEVELO 28.0 12.0 X 0 172849 18414 TERESA YEARGINS DIRECTOR OF DEVELOPMENT 40.0 0.0 X 0 106234 37022 ONYINYE AKUJUO END 0522 GRANT DIRECTOR FOUNDATION 40.0 0.0 X 0 125600 9279 AMANDA ARIZOLA JPS BOARD OF MANAGERS LIAISON 1.0 0.0 X 0 0 0 JANE NOBER DIRECTOR END: 04/22 1.0 0.0 X 0 0 0 LARRY ANFIN DIRECTOR 1.0 0.0 X 0 0 0 LAURA WHEAT CHAIR 1.0 0.0 X X 0 0 0 LELAND C CLEMONS DIRECTOR END: 9/22 1.0 0.0 X 0 0 0 ROBERT STURNS DIRECTOR END: 4/22 1.0 0.0 X 0 0 0 CHERYL SUTTERFIELD JPSF PRESIDENT START: 03/22 40.0 0.0 X X 0 0 0 0 2499769 440539 0 false true false 0 471853 47509 1563291 127539 2082653 OTHER OPERATING REVENUE 624100 69350 69350 69350 120004 120004 0 0 0 0 0 142066 148175 -6109 -6109 -6109 0 0 0 0 0 0 0 0 0 RECOVERY OF BAD DEBT 900099 37508 37508 37508 2303406 106858 113895 X 127539 127539 540093 540093 0 0 0 0 0 0 0 0 0 0 0 0 0 26051 26051 293914 290016 3898 0 0 136142 126205 9937 0 0 24775 24181 594 2727 2727 0 2515 2515 0 0 10 10 0 EQUIPMENT EXPENSE 217556 217556 TRAINING 177793 175216 2577 COMMUNITY RELATIONS 60314 60314 - 0 49496 29205 20291 1658925 1595567 63358 0 0 0 2183420 2711663 5192 70000 14050 0 0 0 0 0 0 0 0 0 29699 29201 23829 23829 10 0 4848044 4217647 0 0 0 0 0 0 81856 17841 7162271 7046352 3148 20618 37508 0 0 0 0 0 0 0 0 0 0 0 0 0 141769 121725 182425 142343 X 3613331 4141930 3366515 2762079 6979846 6904009 7162271 7046352 644481 -720318 X X false true X false false X X 1 TARRANT COUNTY HOSPITAL DISTRICT 756000439 6 true 1595567 0 1 1595567 0 true false false false false false false false false false false false false false false true false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 400100 543143 false false 594430 5000 -83486 6615 509329 537531 10000 53510 6611 594430 512446 1025 30036 5976 537531 417876 62173 38333 5936 512446 405535 17711 5370 417876 0.77500 0.22500 false false 23829 23829 0 0 0 Due to affiliates 121725 121725 2252701 -720318 707121 -13197 2265898 37508 37508 2303406 2328538 707121 707121 1621417 37508 37508 1658925 SCHEDULE D, PART V, LINE 4 INTENDED USE OF ENDOWMENT FUNDS: THE PERMANENTLY RESTRICTED NET ASSETS OF JPS FOUNDATION REPRESENT FUNDS RESTRICTED BY THE DONOR TO ESTABLISH A PERMANENT ENDOWMENT. THE INCOME FROM THE ALCON OPHTHALMOLOGY ENDOWMENT IS FOR THE OPHTHALMOLOGY TEACHING PROGRAM AT JPS. THE INCOME FROM THE HEALING WINGS ENDOWMENT WAS ESTABLISHED FOR THE ONGOING PRESERVATION OF THE HEALING WINGS UNIT. THE MEDICAL LIBRARY ENDOWMENT MAY BE SPENT ON EQUIPMENT AND MATERIALS TO IMPROVE THE MEDICAL LIBRARY. THE INCOME FROM THE JPS HEALTH NETWORK ENDOWMENT FOR PODIATRIC RESIDENCY IS ALLOCATED 22.5% TO UNRESTRICTED FUNDS TO SUPPORT THE OVERALL MISSION OF THE FOUNDATION AND 77.5% TO SUPPORT THE JPS PODIATRIC RESIDENCY PROGRAM. SCHEDULE D, PART X, LINE 2 ASC 740 FOOTNOTE: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUES PER AUDITED FINANCIALS TO TAX RETURN: RECOVERY OF BAD DEBT $37,508 SCHEDULE D, PART XII, LINE 4B RECONCILIATION OF EXPENSES PER AUDITED FINANCIALS TO TAX RETURN: RECOVERY OF BAD DEBT $37,508 true Tarrant County Hospital District 1500 S Main Street Fort Worth TX 76104 756000439 501(C)(3) 127539 Improve Health Status of Community 1 PATIENT ASSISTANCE 533 54019 EMPLOYEE ASSISTANCE 8 3824 PATIENT TRANSPORTATION 1864 10397 ACA CONNECTION SUPPLEMENTAL TO INSURANCE 2480 471853 SCHEDULE I, PART I, LINE 2 MONITORING USE OF GRANT FUNDS IN THE UNITED STATES: PATIENT ASSISTANCE FOR MEDICAL TREATMENT, TRANSPORTATION, RENT PAYMENTS, ULITILIES, AND SUPPLIES - REQUESTS FOR DISTRIBUTIONS FROM THESE FUNDS ARE SUBMITTED FROM THE SOCIAL SERVICES DEPARTMENT TO THE JPS FOUNDATION. UPON RECEIPT, THE REQUESTS ARE REVIEWED AND APPROVED BY THE MANAGEMENT AT JPS FOUNDATION FOR CHECK DISBURSEMENT. A LOG OF GAS CARDS AND BUS PASSES IS REVIEWED MONTHLY. EMPLOYEE EMERGENCY ASSISTANCE - IN ORDER FOR A JPS EMPLOYEE TO SUBMIT AN APPLICATION FOR EMERGENCY ASSISTANCE, THEY MUST MEET THE CRITERIA OF (1) FULL TIME EMPLOYMENT AT JPS FOR AT LEAST SIX MONTHS OR PART TIME FOR ONE YEAR, (2) NO DISCIPLINARY ACTIONS WITHIN THE LAST TWELVE MONTHS OR CURRENTLY UNDER INVESTIGATION WITH ANY MAJOR AREA OF CONCERN, AND (3) SITUATION MUST BE A NATURALLY OCCURRING EMERGENCY OR CATASTROPHE (FIRE, FLOOD, TORNADO, ETC). APPLICATIONS FOR EMERGENCY ASSISTANCE ARE SUBMITTED TO THE JPS FOUNDATION AND FORWARDED TO A REVIEW COMMITTEE AND A MAJORITY DECISION VOTE IS MADE TO APPROVE OR REJECT THE APPLICATION. APPROVED APPLICATIONS ARE FORWARDED TO THE ACCOUNTANT FOR PAYMENT OF EMERGENCY EXPENSES FROM THE FUND. ASSISTANCE IS MADE BY PAYING BILLS DIRECTLY. IT IS INTENDED TO HELP WITH LIFE SUSTAINING OR ESSENTIAL EXPENSES. TYPICALLY, LIFE SUSTAINING OR ESSENTIAL INCLUDES: UTILITIES, CAR PAYMENT, HOUSE PAYMENT, APARTMENT RENT, TRAVEL (TO ATTEND FUNERAL OR REACH BEDSIDE OF TERMINALLY ILL FAMILY MEMBER), FOOD, ETC. DIRECT PAYMENTS TO THE EMPLOYEE TYPICALLY ARE NOT DONE. THE MAXIMUM AMOUNT OF ASSISTANCE PER EMPLOYEE IN AN EIGHTEEN MONTH PERIOD IS $500. WEEKLY, THE JPS HEALTH NETWORK WILL DONATE FUNDS TO THE FOUNDATION TO COVER ELIGIBLE PATIENT EXPENSES. THE NETWORK ESTABLISHED THE JPS CONNECTION PROGRAM TO ASSIST INDIVIDUALS WHO NEED MEDICAL ASSISTANCE BUT ARE WITHOUT THE FINANCIAL MEANS TO AFFORD NECESSARY MEDICAL SERVICES. THE NETWORK WILL IDENTIFY A PORTION OF THE NETWORK'S ELIGIBLE JPS CONNECTION POPULATION WHO ARE ELIGIBLE FOR ENROLLMENT AND/OR MAY ENROLL IN THE FUTURE IN A QUALIFIED HEALTH PLAN OR STAND ALONE DENTAL PLAN AND LACK THE FINANCIAL RESOURCES FOR PAYMENT OF THE REQUIRED INSURANCE PREMIUMS AND OTHER ELIGIBLE PATIENT EXPENSES. ONLY THE PATIENTS' NEED AND NOT THEIR HEALTH STATUS IS CONSIDERED. ASSISTANCE, WHERE APPLICABLE, MUST COVER THE ENTIRE POLICY YEAR, BE PROVIDED IN AMOUNTS THAT ARE CONSISTENT WITH APPLICABLE FAIR MARKET VALUE, AND BE CONSISTENT WITH APPLICABLE NETWORK POLICIES AND PROCEDURES. PAYMENTS ARE THEN WIRED WEEKLY FROM THE JPS FOUNDATION TO VARIOUS PHYSICIAN NETWORKS THAT PROVIDE SERVICES TO THESE PATIENTS. false false false false false false false false false ROBERT EARLEY END 1221 PRESIDENT AND CEO TCHD 0 840278 0 357451 0 61506 0 216270 0 38678 0 1514183 KAREN DUNCAN START 0122 PRESIDENT AND CEO TCHD 0 622922 0 154284 0 58645 0 111033 0 9843 0 956727 JILL LABBE END 0821 SVP COMMUNITY AFFAIRS & DEVELO 0 156842 0 0 0 16007 0 11907 0 6507 0 191263 SCHEDULE J, PART I, LINE 3 EXECUTIVE COMPENSATION: THE TARRANT COUNTY HOSPITAL DISTRICT, A RELATED ORGANIZATION, DETERMINES COMPENSATION OF THE FOUNDATION'S EXECUTIVE DIRECTOR THROUGH THE USE OF THE FOLLOWING: - COMPENSATION SURVEYS OR STUDIES - COMPENSATION CONSULTANTS - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE X 1000 FMV X 118826 FMV X 3 7000 FMV X 2 413 FMV X GIFT CARD 3 300 FMV false true false SCHEDULE M, PART I, COLUMN B NUMBER OF CONTRIBUTIONS OR ITEMS RECEIVED: THE AMOUNTS REPORTED IN THIS COLUMN ARE THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OR STOCKHOLDERS WHO CAN ELECT MEMBERS OF THE GOVERNING BODY: AT ALL TIMES THE JPS FOUNDATION BOARD WILL CONSIST OF MEMBERS OF THE TCHD BOARD, THE TCHD CEO AND PERSONS SELECTED BY THE TCHD CEO. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR, CONTROLLER AT TARRANT COUNTY HOSPITAL DISTRICT AND JPS FOUNDATION PRESIDENT PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: MEMBERS ARE ASKED TO DISCLOSE, ANNUALLY, ANY BUSINESS RELATIONSHIPS THAT POTENTIALLY GIVE RISE TO CONFLICTS. ANY CONFLICTS THAT ARISE ARE RESOLVED AT THE BOARD LEVEL. IN THE EVENT OF A CONFLICT, THE BOARD MEMBER ABSTAINS FROM VOTING AND DISCUSSION OF THE RELATED MATTER. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FINANCIAL STATEMENTS ARE ALSO AVAILABLE ON THE JPS HEALTH NETWORK WEBSITE. FORM 990, PART VI, SECTION B, LINE 15A REVIEW OF CEO OF TOP MGMT OFFICIAL COMPENSATION: NO COMPENSATION IS PAID BY JPS FOUNDATION. COMPENSATION IS PAID THROUGH TARRANT COUNTY HOSPITAL DISTRICT WHICH REVIEWS, APPROVES, AND SETS ALL SALARIES. FORM 990, PART I, LINE 1 ORGANIZATION'S MISSION: CONTINUED FROM FORM 990, PART I... ORGANIZING FUNDRAISING ACTIVITIES, PROVIDING PATIENT ASSISTANCE PROGRAMS, PARTICIPATING IN RECRUITING FUNCTIONS AND CONDUCTING ADMINISTRATIVE SERVICES. FORM 990, PART XII, LINE 2C: COMMITTEE RESPONSIBLE OVER THE AUDIT: TARRANT COUNTY HOSPITAL DISTRICT, A RELATED ORGANIZATION, ALONG WITH ITS BOARD OF MANAGERS, HAVE THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL SERVICES TOTAL FEES:179980 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:74734 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTATION FEES TOTAL FEES:21950 FORM 990 PART IX LINE 11G DESCRIPTION:OUTSIDE SERVICES TOTAL FEES:17250 TARRANT COUNTY HOSPITAL DISTRICT 1500 SOUTH MAIN STREET FORT WORTH TX 76104 756000439 HEALTHCARE TX 501(C)(3) 6 NA false ACCLAIM PHYSICIAN GROUP 200 W MAGNOLIA AVE SUITE 201 FORT WORTH TX 761047644 352526373 HEALTHCARE TX 501(C)(3) 3 TCHD true TCHD PUBLIC FACILITY CORPORATION 1500 SOUTH MAIN STREET FORT WORTH TX 76104 384224168 PUBLIC FACILITY TX TCHD C CORPORATION true false true true false false false false false false false false true false true true true true true false ACCLAIM PHYSICIAN GROUP B 343394 FMV