EL CAMPO MEMORIAL HOSPITAL: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- EL CAMPO MEMORIAL HOSPITAL (EIN 45-2750258)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2023-11-15
- IRS object ID
- 202343199349324104
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-11-15T15:56:32-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 752570395 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DURBIN & COMPANY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1500 BROADWAY SUITE 1000 | AddressLine1Txt |
| City | LUBBOCK | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 79401 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 452750258 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EL CAMPO MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ELCA | BusinessNameControlTxt |
| Phone | 9795436251 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 303 SANDY CORNER RD | AddressLine1Txt |
| City | EL CAMPO | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 77437 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID MAK | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 9795436251 | PhoneNum |
| Signature | 2023-11-15 | SignatureDt |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | DAVID | PersonFirstNm |
| Person Last | MAK | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TOMMY L DAVIS | PreparerPersonNm |
| PTIN | P03007273 | PTIN |
| Phone | 8067911591 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID MAK | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 303 SANDY CORNER RD | AddressLine1Txt |
| City | EL CAMPO | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 77437 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $48,451,547 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ECMH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2011 | FormationYr |
| Legal Domicile State | TX | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,616,476 | PYContributionsGrantsAmt |
| CY Contributions Grants | $10,114,481 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $26,195,176 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $33,986,128 | CYProgramServiceRevenueAmt |
| PY Investment Income | $9,375 | PYInvestmentIncomeAmt |
| CY Investment Income | $104,354 | CYInvestmentIncomeAmt |
| PY Other Revenue | $6,894,868 | PYOtherRevenueAmt |
| CY Other Revenue | $4,246,584 | CYOtherRevenueAmt |
| PY Total Revenue | $37,715,895 | PYTotalRevenueAmt |
| CY Total Revenue | $48,451,547 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $15,924,656 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,043,117 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $19,468,533 | PYOtherExpensesAmt |
| CY Other Expenses | $26,920,868 | CYOtherExpensesAmt |
| PY Total Expenses | $35,393,189 | PYTotalExpensesAmt |
| CY Total Expenses | $44,963,985 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,322,706 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,487,562 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $18,410,138 | TotalAssetsBOYAmt |
| Total Assets EOY | $18,750,012 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,962,191 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,814,504 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,447,947 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,935,508 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $36,837,906 | ExpenseAmt |
| Revenue | $38,337,066 | RevenueAmt |
| Desc | PROVIDE HEALTHCARE TO EL CAMPO AND SURROUNDING AREAS WITH A BROAD RANGE OF SERVICES: INPATIENT, SWING BED, EMERGENCY, SURGICAL, LABORATORY, IMAGING, RESPIRATORY, AND THERAPY. | Desc |
| Total Program Service Expenses | $36,837,906 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9795436251 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 303 SANDY CORNER RD | AddressLine1Txt |
| City | EL CAMPO | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 77437 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MELISSA ERWIN | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| THAI HUYNH | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CLAY HARRIS | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BILL JENKINS | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| MARY JOHNSON | ||||||||
| FORMER SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| STEPHEN COOPER | ||||||||
| VICE - CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RANDY CLAPP | ||||||||
| CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RACHEL CUTRER | ||||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ANITA CRISP | ||||||||
| VP PHYSICIAN SERVICES | 40.00 | $178,789 | $0 | $0 | Yes (X) | |||
| FRANCISCA LERMA | ||||||||
| CNO | 1.00 | $0 | $192,773 | $0 | Yes (X) | 40.00 | ||
| DAVID MAK | ||||||||
| CFO | 1.00 | $0 | $414,128 | $0 | Yes (X) | 40.00 | ||
| NATHAN TUDOR | ||||||||
| CEO | 1.00 | $0 | $633,468 | $0 | Yes (X) | 40.00 | ||
| CLAY ZBORIL | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $141,135 | $0 | $0 | Yes (X) | |||
| SANDI BYSTREK | ||||||||
| OCCUPATIONAL THERAPIST | 40.00 | $139,703 | $0 | $0 | Yes (X) | |||
| ANNETTE LONG | ||||||||
| FNP | 40.00 | $146,912 | $0 | $0 | Yes (X) | |||
| MEGAN RIHA | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $125,050 | $0 | $0 | Yes (X) | |||
| DEBRA HULSEY | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $166,850 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $898,439 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,240,369 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | CompensationCompensationAmt |
|---|---|---|---|---|
| EL CAMPO MOB LLC | ||||
| PO BOX 96255 | SOUTHLAKE | TX | 76092 | $680,853 |
| VALIANT LLC | ||||
| 3130 GRANTS LAKE BLVD 19998 | SUGARLAND | TX | 77496 | $240,000 |
| CARDIAC SERVICES MOBILE INC | ||||
| 1618 GRASSMERE PARK DR STE 17 | NASHVILLE | TN | 37211 | $200,000 |
| BAS MEA JOINT VENTURES LLC | ||||
| 222 TARROW STREET | COLLEGE STATION | TX | 77840 | $195,000 |
| MKH3 LLC | ||||
| PO BOX 366 | LLANO | TX | 78643 | $188,125 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $10,114,481 | AllOtherContributionsAmt |
| Total Contributions | $10,114,481 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PROGRAM SERVICE REVENU | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $33,986,128 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $33,986,128 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $33,986,128 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $104,319 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $104,319 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $35 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $35 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| GAIN ON FORGIVENESS OF | 624100 | $3,348,800 | $3,348,800 |
| OTHER OPERATING REVENU | 624100 | $897,784 | $897,784 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $4,246,584 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $48,451,547 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $38,337,066 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $898,439 | TotalAmt |
| Program Services | $718,751 | ProgramServicesAmt |
| Management And General | $179,688 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,573,842 | TotalAmt |
| Program Services | $13,259,074 | ProgramServicesAmt |
| Management And General | $3,314,768 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $570,836 | TotalAmt |
| Program Services | $456,669 | ProgramServicesAmt |
| Management And General | $114,167 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,586,539 | TotalAmt |
| Program Services | $7,669,232 | ProgramServicesAmt |
| Management And General | $1,917,307 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,608,360 | TotalAmt |
| Program Services | $3,917,106 | ProgramServicesAmt |
| Management And General | $691,254 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,282 | TotalAmt |
| Program Services | $75,040 | ProgramServicesAmt |
| Management And General | $13,242 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,876 | TotalAmt |
| Program Services | $88,295 | ProgramServicesAmt |
| Management And General | $15,581 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,088,591 | TotalAmt |
| Program Services | $1,775,302 | ProgramServicesAmt |
| Management And General | $313,289 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $598 | TotalAmt |
| Program Services | $508 | ProgramServicesAmt |
| Management And General | $90 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $6,915,449 | $5,878,132 | $1,037,317 |
| RENTAL EXPENSE | $2,749,633 | $2,337,188 | $412,445 |
| MISCELLANEOUS | $360,510 | $306,434 | $54,076 |
| TELEPHONE & UTILITIES | $224,185 | $190,557 | $33,628 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $194,845 | TotalAmt |
| Program Services | $165,618 | ProgramServicesAmt |
| Management And General | $29,227 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,963,985 | TotalAmt |
| Program Services | $36,837,906 | ProgramServicesAmt |
| Management And General | $8,126,079 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,671,252 | BOYAmt |
| EOY | $190,827 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,223,238 | BOYAmt |
| EOY | $3,978,159 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,236,529 | BOYAmt |
| EOY | $1,410,100 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,185,672 | BOYAmt |
| EOY | $787,545 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,731,751 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,801,281 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,001,701 | BOYAmt |
| EOY | $3,930,470 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,091,746 | BOYAmt |
| EOY | $8,452,911 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,410,138 | BOYAmt |
| EOY | $18,750,012 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,030,400 | BOYAmt |
| EOY | $3,650,987 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,111,037 | BOYAmt |
| EOY | $1,271,413 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $471,954 | BOYAmt |
| EOY | $829,127 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,348,800 | BOYAmt |
| EOY | $2,062,977 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,962,191 | BOYAmt |
| EOY | $7,814,504 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,447,947 | BOYAmt |
| EOY | $10,935,508 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,447,947 | BOYAmt |
| EOY | $10,935,508 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,410,138 | BOYAmt |
| EOY | $18,750,012 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,487,562 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $796,048 | OtherCostOrOtherBasisAmt |
| Book Value | $796,048 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,649,895 | OtherCostOrOtherBasisAmt |
| Book Value | $3,649,895 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,285,808 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,801,281 | DepreciationAmt |
| Book Value | -$515,473 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,930,470 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM WWCHD | $56,096 |
| INVESTMENT IN RECIPROCAL | $76,535 |
| OTHER CURRENT ASSETS | $8,320,280 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $8,452,911 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | NET REVENUE EARNED 01/01/19 TO 03/31/19 |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE EXPENSES INCURRED 01/01/19 TO 03/31/19 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,766,653 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,766,653 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03930 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,246,767 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,704,963 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $541,804 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01200 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,013,420 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,704,963 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,308,457 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05130 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,013,420 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,704,963 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,308,457 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05130 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense Attributable | $4,050,467 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,164,136 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,867,451 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $5,296,685 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EL CAMPO MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 303 SANDY CORNER RD | AddressLine1Txt |
| City | EL CAMPO | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 77437 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.ECMH.ORG | WebsiteAddressTxt |
| State License | 000426 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Emergency Room Other | Yes (X) | EmergencyRoomOtherInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EL CAMPO MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.ECMH.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.ECMH.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Permit Legal Judicial Process | Yes (X) | PermitLegalJudicialProcessInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NATHAN TUDOR | ||||||||||||||
| CEO | $0 | $633,468 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $633,468 | $0 | $0 |
| DAVID MAK | ||||||||||||||
| CFO | $0 | $414,128 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $414,128 | $0 | $0 |
| FRANCISCA LERMA | ||||||||||||||
| CNO | $0 | $192,773 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $192,773 | $0 | $0 |
| ANITA CRISP | ||||||||||||||
| VP PHYSICIAN SERVICES | $178,789 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $178,789 | $0 | $0 | $0 |
| DEBRA HULSEY | ||||||||||||||
| PHYSICIAN ASSISTANT | $166,850 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $166,850 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 3,917,106. MANAGEMENT AND GENERAL EXPENSES 691,254. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,608,360. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd |
|---|---|---|---|---|---|---|---|---|---|
| PALACIOS COMMUNITY MEDICAL CENTER | |||||||||
| 760698013 | HOSPITAL | TX | 501(C)(3) | 170(B)(A)(III) | 0 | ||||
| MID-COAST HALTHSYSTEM | |||||||||
| 833174646 | MANAGEMENT COMPANY | TX | 501(C)(3) | 0 | 303 SANDY CORNERS | EL CAMPO | TX | 77437 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| PALACIOS COMMUNITY MEDICAL CENTER | ||
| N | $6,427,067 | FMV |
| PALACIOS COMMUNITY MEDICAL CENTER | ||
| O | $10,395,925 | FMV |
| MID-COAST HEALTH SYSTEM | ||
| P | $9,848,512 | FMV |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART V, LINE 2 | FormAndLineReferenceDesc |
| Explanation | ALL SHARED ITEMS IN TRANSACTION TYPES N AND O ARE REFLECTED ON THE EL CAMPO MEMORIAL HOSPITAL, PALACIOS HOSPITAL, AND MID COAST CENTRAL - LLANO FORM 990'S. | ExplanationTxt |
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