2023-11-15T15:49:09-06:00 2020-12-31 752570395 DURBIN & COMPANY LLP 1500 BROADWAY SUITE 1000 LUBBOCK TX 79401 990 2020-01-01 452750258 EL CAMPO MEMORIAL HOSPITAL ELCA 9795436251 303 SANDY CORNER RD EL CAMPO TX 77437 DAVID MAK CHIEF FINANCIAL OFFICER 9795436251 2023-11-15 DAVID MAK 999009999 TOMMY L DAVIS P03007276 8067911591 3 AAL1 IAL1 2020 2023-04-26 12:10:37Z DAVID MAK 303 SANDY CORNER RD EL CAMPO TX 77437 37715895 0 X WWW.ECMH.ORG X 2011 TX THE HOSPITAL PROVIDES EL CAMPO AND SURROUNDING AREAS WITH THE HIGHEST STANDARD OF CARE THROUGH A BROAD RANGE OF SERVICES: INPATIENT, SWING BED, EMERGENCY, SURGICAL, LABORATORY, IMAGING, RESPIRATORY, ETC. 7 7 423 0 0 0 308382 4616476 19263170 26195176 3984 9375 10099695 6894868 29675231 37715895 0 0 0 0 14380298 15924656 0 0 0 16828309 19468533 31208607 35393189 -1533376 2322706 8039520 18410138 4905797 10962191 3133723 7447947 THE HOSPITAL PROVIDES EL CAMPO AND SURROUNDING AREAS WITH THE HIGHEST STANDARD OF CARE THROUGH A BROAD RANGE OF SERVICES: INPATIENT, SWING BED, EMERGENCY, SURGICAL, LABORATORY, IMAGING, RESPIRATORY, ETC. 0 0 28314552 33090044 PROVIDE HEALTHCARE TO EL CAMPO AND SURROUNDING AREAS WITH A BROAD RANGE OF SERVICES: INPATIENT, SWING BED, EMERGENCY, SURGICAL, LABORATORY, IMAGING, RESPIRATORY, AND THERAPY. 28314552 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 120 0 1 423 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 0 0 X THE ORGANIZATION 9795436251 303 SANDY CORNER RD EL CAMPO TX 77437 MELISSA ERWIN DIRECTOR 1.00 X 0 0 0 THAI HUYNH DIRECTOR 1.00 X 0 0 0 CLAY HARRIS DIRECTOR 1.00 X 0 0 0 BILL JENKINS DIRECTOR 1.00 X 0 0 0 STEPHEN COOPER VICE - CHAIR 1.00 X 0 0 0 RANDY CLAPP CHAIR 1.00 X 0 0 0 RACHEL CUTRER SECRETARY 1.00 X 0 0 0 FRANCISCA LERMA CNO 40.00 X 144640 0 0 ANITA CRISP VP PHYSCIAN SERVICES 40.00 X 164229 0 0 ROBERT PASCASIO COO/CFO 40.00 X 127284 0 0 DAVID MAK CFO 40.00 X 375950 0 0 NATHAN TUDOR CEO 40.00 X 658650 0 0 ASHLEY KOUDELA PHYSICIAN ASSISTANT 40.00 X 110311 0 0 CLAY ZBORIL PHYSICIAN ASSISTANT 40.00 X 137314 0 0 SANDI BYSTREK OCCUPATIONAL THERAPIST 40.00 X 148558 0 0 ANNETTE LONG FNP 40.00 X 187641 0 0 ALEXIS MARTINEZ PHYSICIAN ASSISTANT 40.00 X 130201 0 0 MARJO MCLAUGHLIN PHYSICIAN ASSISTANT 40.00 X 123808 0 0 ANITA LEWIS PHYSICIAN ASSISTANT 40.00 X 118582 0 0 MEGAN RIHA PHYSICIAN ASSISTANT 40.00 X 134103 0 0 DEBRA HULSEY PHYSICIAN ASSISTANT 40.00 X 131427 0 0 2692698 0 0 14 0 1 0 CPSI PO BOX 850309 MOBILE AL 36685 EMR & PAYMENT CLAIMS PROCESSING 1528378 MCKESSON DRUG 3301 POLLOCK DRIVE CONROE TX 77303 PHARMACEUTICAL MEDICATIONS 1099987 CONCORD MEDICAL GROUP PLLC 1602 AVENUE Q LUBBOCK TX 79401 PROFESSIONAL MEDICAL STAFFING 717030 CONCORD MEDICAL GROUP OF TEXAS PLLC 1602 AVENUE Q LUBBOCK TX 79401 PROFESSIONAL MEDICAL STAFFING 694632 ALLIED BENEFITS SYSTEM 200 W ADAMS ST STE 500 CHICAGO IL 60606 EMPLOYEE BENEFITS 531484 5 4321015 295461 4616476 PROGRAM SERVICE REVENU 621990 26195176 26195176 26195176 9375 9375 INDIGENT SUPPORT 624100 6410933 6410933 OTHER 624100 225279 225279 DSRIP 624100 188495 188495 70161 70161 6894868 37715895 33090044 0 9375 1237616 990093 247523 13650297 10920238 2730059 343443 274754 68689 693300 554640 138660 11429061 9143249 2285812 2621341 2097073 524268 84216 67373 16843 4288 3430 858 MEDICAL SUPPLIES 3186682 2549346 637336 RENTAL EXPENSE 1464218 1171374 292844 MISCELLANEOUS 378522 302818 75704 REPAIRS & MAINTENANCE 147921 118337 29584 152284 121827 30457 35393189 28314552 7078637 0 337725 3671252 3680055 3223238 700991 1236529 881540 1185672 5714393 3712692 1619597 2001701 819612 7091746 8039520 18410138 4111060 4030400 3111037 44737 471954 750000 3348800 4905797 10962191 X 3133723 7447947 3133723 7447947 8039520 18410138 2322706 1991518 0 X 1 0 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 294218 294218 306680 306680 5113495 3712692 1400803 2001701 DUE TO/FROM MEDICARE 62765 A/R 1115 WAIVER 346513 DUE FROM WWCHD 1354322 INVESTMENT IN RECIPROCAL 76535 OTHER CURRENT ASSETS 5251611 7091746 X PART X, LINE 2: THE HOSPITAL IS NOT-FOR-PROFIT ORGANIZATION THAT IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL EVALUATES AND ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES (FORMERLY FASB INTERPRETATION 48 (FIN 48) ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THIS STANDARD REQUIRES CERTAIN DISCLOSURES ABOUT UNCERTAIN INCOME TAX POSITIONS. THE HOSPITAL EVALUATES ANY UNCERTAIN TAX POSITIONS USING THE PROVISIONS OF ASC 450, CONTINGENCIES. AS A RESULT, MANAGEMENT DOES NOT BELIEVE THAT ANY UNCERTAIN TAX POSITIONS CURRENTLY EXIST AND NO LOSS CONTINGENCY HAS BEEN RECOGNIZED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL HAS FILED ALL APPLICABLE TAX RETURNS. 1 1 1 X 1 X 1 1 0 0 855260 855260 0.02420 1039322 1554280 0 0.00000 1894582 1554280 855260 0.02420 1894582 1554280 855260 0.02420 1 0 2082794 11248218 7081149 4167069 X 1 1 1 1 EL CAMPO MEMORIAL HOSPITAL 303 SANDY CORNER RD EL CAMPO TX 77437 WWW.ECMH.ORG 000426 X X X X EL CAMPO MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X WWW.ECMH.ORG X 1 19 1 WWW.ECMH.ORG 0 1 X 150.000000000000 200.000000000000 X X X X X X 1 1 X 1 X X 1 X X 0 X 1 0 0 EL CAMPO MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR EL CAMPO MEMORIAL HOSPITAL INCLUDED INTERVIEWS/FOCUS GROUPS WITH REPRESENTATIVES OF THE HOSPITAL'S ADMINSTRATIVE STAFF AND BOARD OF DIRECTORS, TEXAS DEPARTMENT OF STATE HEALTH SERVICES, TEXANA CENTER, MEMORIAL HERMANN, KINDRED HOSPTIAL SUGAR LAND, SPJST, BETHANY HOME HEALTH SERVICES, NATIONAL CHURCH RESIDENCES, ANGMAR MEDICAL HOLDINGS, COURT APPOINTED SPECIAL ADVOCATE FOR CHILDREN, ALZHEIMER'S ASSOCIATION AND THE KNIGHTS OF COLUMBUS, AND LOCAL CITIZENS REPRESENTING SENIORS, LOW INCOME HOUSEHOLDS, HISPANIC/LATINOS AND AFRICAN AMERICANS. EL CAMPO MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J: EACH PATIENT APPLYING FOR CHARITY CARE WILL BE ASKED TO COMPLETE AN EL CAMPO MEMORIAL HOSPITAL APPLICATION FOR HEALTH CARE ASSISTANCE ("ASSISTANCE APPLICATION"). ASSISTANCE APPLICATIONS CAN BE REQUESTED FROM THE INDIGENT /CHARITY PROGRAM COORDINATOR AT EL CAMPO MEMORIAL HOSPITAL, 303 SANDY CORNER RD, EL CAMPO, TX 77437, (979) 543-6251 EXTENSION 262. ASSISTANCE APPLICATIONS CAN ALSO BE PICKED UP IN THE HOSPITAL BUSINESS OFFICE AND FROM A MID COAST MEDICAL CLINIC RECEPTIONIST. EL CAMPO MEMORIAL HOSPITAL STAFF MUST GIVE OR MAIL ASSISTANCE APPLICATIONS THE SAME DAY THEY ARE REQUESTED. A BRIEF EXPLANATION, IF POSSIBLE, SHOULD BE GIVEN TO THE APPLICANT EXPLAINING THE PROCESS AND THE APPLICANT'S RESPONSIBILITIES. ASSISTANCE IN COMPLETING THE ASSISTANCE APPLICATION WILL BE PROVIDED IF NEEDED. APPLICANTS SHALL BE INFORMED THAT THEY SHOULD CONTACT THE INDIGENT/CHARITY PROGRAM COORDINATOR AT EL CAMPO MEMORIAL HOSPITAL AT (979) 578-5194. PART I, LINE 3C: EL CAMPO MEMORIAL HOSPITAL SHALL REQUEST THAT THE APPLICANT VERIFY HIS OR HER GROSS ANNUAL HOUSEHOLD INCOME BY SUPPLYING THE FOLLOWING: TAX RETURN AND IRS FORM W-2, WAGE AND EARNINGS STATEMENT, PAY CHECK REMITTANCE, SOCIAL SECURITY, WORKERS COMPENSATION, UNEMPLOYMENT COMPENSATION OR GOVERNMENT PROGRAM DETERMINATION LETTERS, TELEPHONE VERIFICATION BY EMPLOYER OF THE APPLICANT'S ANNUAL GROSS INCOME, AND/OR BANK STATEMENTS. CURRENT ELIGIBILITY BEGINS ON THE FIRST CALENDAR DAY IN THE MONTH THAT AN IDENTIFIABLE APPLICATION IS FILED OR THE EARLIEST, SUBSEQUENT MONTH IN WHICH ALL ELIGIBILITY CRITERIA ARE MET. THE APPLICANT MAY BE RETROACTIVELY ELIGIBLE IN ANY OF THE THREE CALENDAR MONTHS BEFORE THE MONTH THE IDENTIFIABLE APPLICATION IS RECEIVED IF ALL ELIGIBILITY CRITERIA ARE MET. PART III, LINE 2: COST TO CHARGE RATIO PART III, LINE 3: COST TO CHARGE RATIO PART III, LINE 4: THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, CHARITY CARE IS EXCLUDED FROM NET PATIENT REVENUE.THE EVALUATION OF NECESSITY FOR MEDICAL TREATMENT OF ANY PATIENT WILL BE BASED UPON CLINICAL JUDGMENT REGARDLESS OF THE FINANCIAL STATUS OF THE PATIENT. THE CLINICAL JUDGMENT OF THE PATIENT'S PERSONAL PHYSICIAN OR THE EMERGENCY DEPARTMENT PHYSICIAN WILL BE THE SOLE DETERMINING CRITERION FOR A PATIENT'S ADMISSION TO EL CAMPO MEMORIAL HOSPITAL IN ACCORDANCE WITH THE MEDICAL STAFF BYLAWS. IN CASES WHERE A MEDICAL EMERGENCY CONDITION EXISTS, EL CAMPO MEMORIAL HOSPITAL'S EVALUATION OF POSSIBLE PAYMENT ALTERNATIVES WILL OCCUR ONLY AFTER URGENT MEDICAL CARE EVALUATION AND TREATMENT HAVE BEEN RENDERED IN ACCORDANCE WITH FEDERAL [EMTALA], STATE OR LOCAL LAW. PART III, LINE 8: THE HOSPITAL USES A COST TO CHARGE RATIO CALCULATED THROUGH THE ANNUAL MEDICARE/MEDICAID COST REPORT TO REPORT THE AMOUNT REPRESENTED ON LINE 7. PART III, LINE 9B: THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS FROM THOSE WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE. X 0 0 0 0 0 0 0 0 0 NATHAN TUDOR CEO 658650 0 0 0 0 0 0 0 0 0 658650 0 0 0 DAVID MAK CFO 375950 0 0 0 0 0 0 0 0 0 375950 0 0 0 ANNETTE LONG FNP 187641 0 0 0 0 0 0 0 0 0 187641 0 0 0 ANITA CRISP VP PHYSCIAN SERVICES 164229 0 0 0 0 0 0 0 0 0 164229 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE HOSPITAL HAS A THIRD-PARTY ACCOUNTING FIRM PREPARE FORM 990. ONCE THE 990 IS COMPLETED IT IS PRESENTED TO THE BOARD OF DIRECTORS IN DRAFT FORM. ANY QUESTIONS OR CONCERNS ARE THEN ADDRESSED, AND THE FINAL FORM 990 IS PREPARED WITH THE NECESSARY ADJUSTMENTS AND FILED. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR SHALL INDIVIDUALLY DISCLOSE TO EL CAMPO MEMORIAL HOSPITAL AND TO THE BOARD OF DIRECTORS AT THE TIME OF NOMINATION AND APPOINTMENT AND TO THE TEXAS STATE BOARD OF MEDICAL EXAMINERS AT THE TIMES OF INITIAL APPLICATION AND BENNIAL REPORT THE IDENTITY OF EACH FINANCIAL RELATIONSHIP KNOWN TO THE DIRECTOR, IF ANY, WHICH HE OR SHE HAS WITH ANY OTHER DIRECTOR OR ANY SUPPLIER OF THE ORGANIZATION, AND TO PROVIDE A CONCISE EXPLANATION OF THE NATURE OF EACH SUCH FINANCIAL RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 15A THE PROCESS FOR DETERMINING COMPENSATION FOR EL CAMPO MEMORIAL HOSPITAL'S CEO INCLUDES AN ANNUAL REVIEW AND APPROVAL BY THE BOARD OF DIRECTORS, COMPARABILITY DATA FOR SIMILAR HOSPITALS AND HOSPITAL ORGANIZATIONS IN NEARBY COMMUNITIES OR SIMILAR ECONOMIES OF SCALE, AND CONTEMPORANEOUS DOCUMENTATION OF THE DELIBERATION AND DISCUSSION BETWEEN THE HOSPITAL AND ITS ADMINISTRATOR. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. PALACIOS COMMUNITY MEDICAL CENTER 760698013 HOSPITAL TX 501(C)(3) 170(B)(A)(III) 0 MID COAST HEALTH SYSTEM 303 SANDY CORNERS EL CAMPO TX 77437 833174646 MANAGEMENT COMPANY TX 501(C)(3) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 PALACIOS COMMUNITY MEDCIAL CENTER N 7214856 FMV PALACIOS COMMUNITY MEDICAL CENTER O 7188915 FMV MID COAST HEALTH SYSTEM P 11066181 FMV PART V, LINE 2 ALL SHARED ITEMS IN TRANSACTION TYPES N AND O ARE ALLOCATED BETWEEN EL CAMPO 990 AND PALACIOS 990 ACCORDINGLY.