2022-05-04T09:50:50-05:00 2021-06-30 ERNST & YOUNG US LLP 2323 VICTORY AVENUE SUITE 2000 DALLAS TX 75219 990 2020-07-01 751976930 Mother Frances Hospital - Jacksonville % LEE SONNE MOTH 9036065639 919 Hidden Ridge Irving TX 75038 ELIZABETH PULLIAM VP 9036065639 2022-04-28 true ELIZABETH PULLIAM 999009999 STEPHANIE LEW P01080011 2149698000 2022-04-14 2 2020 2022-09-23 18:48:47Z X See Schedule O ELIZABETH PULLIAM 1315 DOCTORS DRIVE TYLER TX 75701 72988542 false X www.christushealth.org/trinity/jacksonville X 2000 TX TO PROVIDE THE COMMUNITY WITH A FULL RANGE OF COMPREHENSIVE HEALTH CARE SERVICES WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. 15 12 0 2 0 0 40979 23585 63591481 71378984 7 -125 2664655 1586098 66297122 72988542 1581037 386 0 0 21627893 16788731 0 0 0 28636917 39588724 51845847 56377841 14451275 16610701 12900105 11589730 22584418 5283217 -9684313 6306513 X To provide the community with a full range of comprehensive health care services without regard to race, creed, sex, national origin, handicap, age, or ability to pay. false false 42594137 386 71378984 THE HOSPITAL'S OPERATING PLAN INCORPORATES PROVISIONS FOR INDIVIDUALS WHO DO NOT POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. OUR COMMITMENT TO OUR COMMUNITY EXTENDS TO FREE OR SUBSIDIZED INDIVIDUAL CARE, SUBSIDIZED EDUCATION OF HEALTHCARE PROFESSIONALS, DISCOUNTED FEES FOR PARTICIPANTS IN GOVERNMENT PROGRAMS, COMMUNITY HEALTH EDUCATION AND DONATIONS TO OTHER COMMUNITY AGENCIES. SPECIFIC COMMUNITY SERVICES AND PROGRAMS INCLUDE: WELLNESS AND PREVENTION EDUCATION PROGRAMS, COMMUNITY DIAGNOSTIC SCREENING PROGRAMS, SENIOR CITIZEN HEALTH AWARENESS PROGRAMS, AWARENESS PROGRAMS FOR YOUTH AT RISK, AND AWARENESS PROGRAMS FOR PERSONS WITH SPECIAL PHYSICAL OR MENTAL NEEDS. INDIVIDUALS SERVED AMOUNTED TO 17,122 VISITS TO OUR EMERGENCY DEPARTMENTS, 150 INPATIENT SURGERY PROCEDURES, 879 OUTPATIENT SURGERY PROCEDURES, 990 PATIENTS WHO WERE ADMITTED TO OUR HOSPITALS FOR CARE, AND 72,926 PATIENTS WHO RECEIVED OUTPATIENT CARE. Christus Northeast Texas Health System Corporation recognizes the leadership and value of our associates in giving their time and guidance to other not for profit organizations that work to improve the lives of the people of Texas. Individuals who give of their time and are compensated for it will report the event as a community benefit. These programs address community-wide workforce issues - not the workforce needs of the health care organization. These health career mentoring projects include job shadowing. Many times it is also a community collaboration that includes schools, colleges, universities, or private businesses. It may also include special need students. Offerings will be available for students from all economic areas and needs. Hours spent interviewing, orienting, scheduling, and touring high school and college job shadow students. Orientations include training on our health system, confidentiality and HIPPA, infection control, hospital codes, and other policies and procedures. Christus Northeast Texas Health System Corporation Region has adopted a policy of requiring an application for any request for in-kind or cash donations. There are guidelines for approving a request for grants and donation. These guidelines are given to each entity requesting a donation. Once the donation request is reviewed a notice is given to the non-profit group if approved, denied for either a donation community benefit) or a grant (community benefit). 42594137 true false false false false false false false false true true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 0 0 true 0 false false false false false false false false false false false false X 15 12 true false true false true true true true true false false true true true true true true true true false X LEE SONNE 4692822000 919 HIDDEN RIDGE IRVING TX 75038 Jeff Puckett Director (as of 01/2021) 14.0 26.0 X 0 6066691 3013219 PETER SIRIANNI MD DIRECTOR (thru 12/20) 8.0 32.0 X 0 1604759 31969 Chris Glenney FORMER DIR/CHAIR (TERM 11/17) 0.0 40.0 X 0 1186012 324724 Mark Anderson MD Board Director (as of 01/2021) 10.0 30.0 X 0 1012965 275635 Scott Smith Director 5.0 35.0 X 0 997431 159258 Todd Hancock Former Director (Term 2/17) 0.0 40.0 X 0 825590 226231 JASON PROCTOR DIR/CHAIR/EX-OFF (thru 12/20) 0.0 40.0 X X 0 654623 148710 ELIZABETH PULLIAM VP 4.0 36.0 X 0 526633 71246 Greg Freimer MD DIRECTOR (thru 12/20) 2.0 0.0 X 0 478920 62424 J Lindsey Bradley Former Sys Pres (Term 6/17) 0.0 0.0 X 0 435151 0 ANNE PILEGGI FORMER DIRECTOR (TERM 12/19) 0.0 40.0 X 0 338262 45123 Barry Lofquist DIR/SEC/ASSOC. VP 40.0 0.0 X X 0 261848 25510 BILL CHEN PHD BOARD DIRECTOR (AS OF 01/2021) 8.0 0.0 X 0 15133 0 DICK STONE DIRECTOR 8.0 0.0 X 0 0 0 GLEN HAMILTON DIR/Vice Chair (thru 12/20) 6.0 0.0 X X 0 0 0 Randy Gorham Director (thru 12/20) 8.0 0.0 X 0 0 0 JOE BOB BURGIN BOARD DIRECTOR (AS OF 01/2021) 8.0 0.0 X 0 0 0 Randy Childress BOARD DIRECTOR (AS OF 01/2021) 8.0 0.0 X 0 0 0 Shannon Dacus Boar director (AS OF 01/2021) 8.0 0.0 X 0 0 0 Sister Rita Fanning BOARD DIRECTOR (AS OF 01/2021) 8.0 0.0 X 0 0 0 Michael Hallum BOARD DIRECTOR (AS OF 01/2021) 1.0 0.0 X 0 0 0 Fred Harris Jr BOARD DIRECTOR (AS OF 01/2021) 12.0 0.0 X 0 0 0 Sonja Yates Hubbard BOARD DIRECTOR (AS OF 01/2021) 8.0 0.0 X 0 0 0 Joe Bob Joyce BOARD DIRECTOR (AS OF 01/2021) 8.0 0.0 X 0 0 0 Sister Guadalupe Ruiz BOARD DIRECTOR (AS OF 01/2021) 8.0 0.0 X 0 0 0 Preston Smith Board Director (as of 01/2021) 14.0 0.0 X 0 0 0 0 14404018 4384049 0 true true false CROTHALL FACILITIES MANAGMENT 1500 Liberty Ridge Drive Suite 210 WAYNE PA 19087 BIOMEDICAL SERVICES 227000 HHS ENVIRONMENTAL SERVICES LLC PO BOX 734367 SUITE 210 DALLAS TX 75373 HOUSEKEEPING SVCS 169311 WELLBORN MECHANICAL SERVICES PO BOX 8935 LONGVIEW TX 75607 MECHANICAL SERVICES 157361 3 0 23585 0 23585 NET PATIENT REVENUE 621110 69739002 69739002 0 0 PHARMACY REVENUE 446110 1519025 1519025 0 0 RENTAL REVENUE 532000 73397 73397 0 0 ALL OTHER PROGRAM SERVICE 900099 47560 47560 0 0 71378984 -2875 -2875 0 0 0 0 0 2750 2750 2750 2750 0 0 0 0 0 0 0 0 0 ALL OTHER REVENUE 900099 1580436 0 0 1580436 REBATES 900099 5662 0 0 5662 1586098 72988542 71378984 0 1585973 X 386 386 0 0 0 0 0 0 0 0 0 0 0 13692398 12164619 1527779 0 0 0 0 0 2148889 1867959 280930 0 947444 853661 93783 0 2782309 2782309 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13338170 9468732 3869438 0 10563 10563 0 953634 596210 357424 0 0 0 0 0 0 0 0 0 2201366 384078 1817288 0 16028 16028 0 0 0 0 0 7494 7494 0 2152 2152 0 0 0 0 0 1459168 1237050 222118 0 530474 530474 0 Medical Supplies 9747498 9716428 31070 0 BAD DEBT EXPENSE 6302504 6302504 0 0 Subscriptions 175 0 175 0 All Other Expenses 2237189 2510 2234679 0 56377841 42594137 13783704 0 0 477195 38268 0 0 0 0 5716201 4359546 0 0 0 0 97611 11424 280345 280345 3436 59584 9206450 3360196 6242220 5846254 0 0 0 0 0 0 0 0 83097 994309 12900105 11589730 19948552 2764564 0 0 2546926 1435329 0 0 0 0 0 0 0 0 0 0 88940 1083324 22584418 5283217 X -9684313 6306513 0 0 -9684313 6306513 12900105 11589730 X 16610701 0 0 0 27603803 -28223678 X false true X true true true X 3951360 708623 53054 4606929 3883058 83627 15325 3951360 3676633 10000 206545 10120 3883058 3522036 30000 200996 76399 3676633 3185371 0 345766 9101 0 0 3522036 0.55330 0.44670 false false 0 2422335 240635 2181700 6784115 3119561 3664554 5846254 ASSET CLEARING 652689 ROU OPERATING 294379 ROU FINANCING 29658 OTHER ASSETS 17583 994309 0 Deferred Medicare Payable 767417 Capital Lease 315907 1083324 X SCHEDULE D, PART V, LINE 4 INTENDED USE OF ENDOWMENT THE ORGANIZATION HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR THE ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS AND ITEMS SUPPORTED BY THE ENDOWMENT WHILE SEEKING TO MAINTAIN ITS PURCHASING POWER. SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS UNDER ASC 740 PER FOOTNOTE 3 IN THE CONSOLIDATED FINANCIAL STATEMENTS, THERE ARE NO MATERIAL UNRECORDED TAX LIABILITIES AS OF JUNE 30, 2021 AND 2020. true true X true X 300. true X true true false true true 3350253 3350253 0.06690 3321153 5306986 6671406 5306986 3350253 0.06690 3 4371 7220 7220 0.00010 5 100 57220 57220 0.00110 8 4471 64440 64440 0.00120 8 4471 6735846 5306986 3414693 0.06810 1 4386 4386 0.00010 1 156 10859 10859 0.00020 2 156 15245 15245 0.00030 true 6302504 29997 17374621 15594218 1780403 X true true 1 1 MOTHER FRANCES HOSPITAL-JACKSONVILLE 1026 JACKSON STREET JACKSONVILLE TX 75766 See Part V, Section C, Supplemental Info 007254 X X X X MOTHER FRANCES HOSPITAL-JACKSONVILLE 1 false false true X X X X X X X X X 19 true true false true X SEE PART V, SECTION C X SEE PART V, SECTION C X true 19 true SEE PART V, SECTION C false true X 300. 400. X X X X X true true X X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X X X true X false false Schedule H, Part V, Section A, Line 1 HTTPS://WWW.CHRISTUSHEALTH.ORG/TRINITY/JACKSONVILLE SCHEDULE H, PART V, SECTION B, LINE 3e CHRISTUS MOTHER FRANCES HOSPITAL - JACKSONVILLE IDENTIFIED AND ADDRESSED THE FOLLOWING PRIORITIES THROUGH ITS IMPLEMENTATION PLAN: 1) BEHAVIORAL HEALTH 2) HIGH EMERGENCY DEPARTMENT USE 3) SPECIALTY CARE AND CHRONIC ILLNESS 4) PRIMARY CARE AND ELDERLY NEEDS 5) EDUCATION SCHEDULE H, PART V, SECTION B, LINE 5 REPRESENTATIVES FROM THE COMMUNITY: IN THE MOST RECENT CHNA PERSONS FROM THE COMMUNITY PARTICIPATED IN FOCUS GROUPS WITH INPUT TO HELP IDENTIFY AND DISCUSS THE HEALTH NEEDS OF THE COMMUNITY, ACCESS ISSUES, BARRIERS AND ISSUES RELATED TO SPECIFIC POPULATIONS. THE INTERVIEWEES INCLUDED BUT WERE NOT LIMITED TO, INDIVIDUALS FORM THE FOLLOWING ORGANIZATIONS: TYLER FAMILY CIRCLE OF CARE, LITERACY COUNCIL OF TYLER, ANDREWS CENTER, NORTHEAST TEXAS PUBLIC HEALTH DISTRICT, CITY OF TYLER, EAST TEXAS HUMAN NEEDS NETWORK, BEHAVIORAL HEALTH LEADERSHIP TEAM, HELPING OTHER PURSUE ENRICHMENT (HOPE), CHEROKEE COUNTY PUBLIC HEALTH, CITY OF JACKSONVILLE, JACKSONVILLE CHAMBER COMMERCE, RANDY GORHAM, CPA, ALZHEIMER'S ALLIANCE OF SMITH COUNTY, BETHESDA HEALTH CLINIC, CATHOLIC CHARITIES DIOCESE OF TYLER, TYLER JUNIOR COLLEGE, UNIVERSITY OF TEXAS AT TYLER, EAST TEXAS CRISIS CENTER, SAMARITAN COUNSELING CENTER OF EAST TEXAS. SCHEDULE H, PART V, SECTION B, LINE 6A OTHER FACILITIES HOSPITAL FACILITIES INCLUDE: CHRISTUS MOTHER FRANCES HOSPITAL, LOUIS PEACHES OWEN HEART HOSPITAL, CHRISTUS MOTHER FRANCES HOSPITAL - JACKSONVILLE, CHRISTUS MOTHER FRANCES HOSPITAL - WINNSBORO, CHRISTUS MOTHER FRANCES HOSPITAL - SULPHUR SPRINGS, CHRISTUS MOTHER FRANCES - SOUTH TYLER PART V, SECTION B, LINE 7A THE HOSPITAL FACILITIES WEBSITE IS: https://www.christushealth.org/trinity/jacksonville SCHEDULE H, PART V, SECTION B, LINE 7B THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT THE FOLLOWING WEBSITE: https://www.christushealth.org/-/media/about/2020--2022-tmfhs-tyler-commun ity-health-needs-assessment.ashx SCHEDULE H, PART V, SECTION B, LINE 10A THE HOSPITAL FACILITY'S MOST RECENT ADOPTED IMPLEMENTATION STRATEGY IS POSTED ON THE FOLLOWING WEBSITE: https://www.christushealth.org/-/media/about/christus-trinity-mother-franc es-chip-2019.ashx?la=en SCHEDULE H, PART V, SECTION B, LINE 11 THE NEEDS IDENTIFIED IN THE CHNA: CHRISTUS MOTHER FRANCES HOSPITAL - JACKSONVILLE IDENTIFIED AND ADDRESSED THE FOLLOWING PRIORITIES THROUGH ITS IMPLEMENTATION PLAN: 1) BEHAVIORAL HEALTH 2) HIGH EMERGENCY DEPARTMENT USE 3) SPECIALTY CARE AND CHRONIC ILLNESS 4) PRIMARY CARE AND ELDERLY NEEDS 5) EDUCATION CNTHSC'S CHIP FOR THE UPCOMING TRIENNIUM REFLECTS THE ORGANIZATION'S ONGOING PURSUIT OF REGIONAL HEALTH EQUITY AND COMMITMENT TO PROMOTE CONDITIONS THAT ALLOW EVERY PERSON TO ATTAIN THE HIGHEST POSSIBLE STANDARD OF HEALTH. 1) BEHAVIORAL HEALTH -EXPAND AND SUPPORT BEHAVIORAL HEALTH SERVICES IN THE COMMUNITY FOR INDIVIDUALS AND FAMILIES. -ADDRESS SOCIAL AND ENVIRONMENTAL DETERMINANTS OF HEALTH. 2) HIGH EMERGENCY DEPARTMENT USE -EDUCATE THE PUBLIC ON THE APPROPRIATE USE OF THE EMERGENCY DEPARTMENT AND ALTERNATIVE COMMUNITY RESOURCES. -SUPPORT AND EXPAND ACCESS TO FQHC SERVICES AS A SUBSTITUTE FOR INAPPROPRIATE ED USE. -TRACK REFERRALS TO FQHC'S AND INAPPROPRIATE USE OF THE ED. 3) SPECIALTY CARE AND CHRONIC ILLNESS -SUPPORT ONGOING AND NEW CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION PROGRAMS. -PROVIDE FREE ORTHOPEDIC SERVICES TO LOW INCOME SCHOOLS, INCLUDING (1) ON-SITE SERVICES AND SCREENINGS, AND (2) FREE/SUBSIDIZED ORTHOPEDIC AND SPORTS MEDICINE PROFESSIONALS AS NEEDED. -PROVIDE MAMMOGRAM PROGRAMS AS LOW-INCOME WOMEN IN NEED OF SCREENING IN THE COMMUNITY THROUGH THE MOBILE MAMMOGRAPHY UNIT OR CLINICS. SCHOOLS IN CHEROKEE COUNTY WHO HAVE ASKED FOR HELP ARE: RUSK ISD, JACKSONVILLE COLLEGE. 4) ACCESS TO PRIMARY CARE AND ELDERLY NEEDS -SUPPORT AND EXPAND ACCESS TO FQHC -PROVIDE MAMMOGRAM PROGRAMS TO LOW-INCOME WOMEN IN NEED OF SCREENING IN THE COMMUNITY THROUGH THE MOBILE MAMMOGRAPHY UNIT OR CLINICS. THE MOBILE MAMMOGRAPHY UNIT COMES TO THE COMMUNITIES IN CHEROKEE COUNTY AS REQUEST FOR MAMMOGRAMS AND THE CLINIC HAS PARTICIPATED IN THE DISCOUNTED RATES OR FREE MAMMOGRAMS IN THE MEDICAIAD WAIVER PROGRAM SUPPORTED BY THE SYSTEM. 5) MAINTAIN AND INCREASE EDUCATION AND TRAINING OPPORTUNITIES FOR HEALTH PROFESSIONALS WHILE ENCOURAGING YOUTH AND YOUNG ADULTS TO ENTER CAREERS AS HEALTH PROFESSIONALS OR PARA-PROFESSIONALS. SCHEDULE H, PART V, SECTION B, LINE 13B INCOME LEVEL USED FOR FAP ELIGIBILITY: UNINSURED PATIENTS WHO APPLY FOR THE FINANCIAL ASSISTANCE PROGRAM MAY ALSO QUALIFY FOR ASSISTANCE UNDER THE POLICY, REGARDLESS OF INCOME LEVEL, IF THEY HAVE MEDICAL OR HOSPITAL BILLS THAT EXCEED 10% OF THEIR GROSS FAMILY INCOME. SCHEDULE H, PART V, SECTION BY, LINE 15E FAP APPLICATION FORM'S METHOD FOR APPLYING FOR FINANCIAL ASSISTANCE IN ADDITION TO REGULAR APPLICATIONS, THE HOSPITAL ALSO ASSESSED PATIENTS FOR PRESUMPTIVE ELIGIBILITY TO FACILITATE GIVING ASSISTANCE TO NEEDY PATIENTS. THE HOSPITAL IMPLEMENTED ELECTRONIC ELIGIBILITY TOOLS THAT USED PATIENT DEMOGRAPHIC DATA, CREDIT REPORTS, AND OTHER PUBLICLY AVAILABLE INFORMATION TO ESTIMATE A PATIENT'S INCOME, ASSETS, AND LIQUIDITY. PATIENTS WERE SCREENED AS PART OF THE COLLECTION ATTEMPT PROCESS. WHEN ELECTRONIC SCREENING WAS USED AS THE BASIS FOR PRESUMPTIVE ELIGIBILITY, THE HIGHEST DISCOUNT OF FULL FREE CARE WAS GRANTED FOR ELIGIBLE SERVICES FOR RETROSPECTIVE DATES OF SERVICE ONLY. IF A PATIENT DID NOT QUALIFY UNDER THE ELECTRONIC ENROLLMENT PROCESS, THE PATIENT COULD STILL BE CONSIDERED UNDER THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, & 16C FAP Documents available to the public: The hospital's FAP, FAP application form, and plain language summary are available at the following website: www.CHRISTUSHEALTH.ORG/TRINITY/JACKSONVILLE SCHEDULE H, PART V, SECTION B, LINE 16J HOW THE HOSPITAL FACILITY PUBLICIZES THE FINANCIAL ASSISTANCE POLICY A SUMMARY OF THE POLICY AND DOCUMENTS NEEDED TO APPLY FOR ASSISTANCE WAS WIDELY AVAILABLE AT WWW.CHRISTUSHEALTH.ORG/CHARITYCARE. (THIS WEBSITE WAS THE FIRST RESULT IN GOOGLE WHEN PATIENTS SEARCHED FOR THE HOSPITAL NAME AND CHARITY CARE OR FINANCIAL ASSISTANCE.) EFFECTIVE JULY 1, 2016, THE INDIVIDUAL HOSPITAL'S HOMEPAGE HAD A CONSPICUOUS FINANCIAL ASSISTANCE LINK DIRECTING PATIENTS TO THE CHARITY CARE HOMEPAGE. FINANCIAL COUNSELORS ALSO PUBLICIZED THE AVAILABILITY OF FINANCIAL ASSISTANCE DURING ONE-ON-ONE VISITS WITH PATIENTS. THE HOSPITAL ATTEMPTED TO PROVIDE ALL UNINSURED PATIENTS WITH FINANCIAL COUNSELING. SPENDING TIME FACE-TO-FACE WITH PATIENTS ALLOWED COUNSELORS TO FACILITATE THE APPLICATION PROCESS FOR PATIENTS WHO OTHERWISE MIGHT NOT HAVE SOUGHT ASSISTANCE. COUNSELORS HELPED COMPLETE FINANCIAL ASSISTANCE APPLICATIONS AND EVALUATE PAYMENT PLANS FOR OUTSTANDING BALANCES. UNINSURED PATIENTS WERE SCREENED FOR MEDICAID ELIGIBILITY, AND COUNSELORS ALSO ASSISTED ELIGIBLE PATIENTS IN COMPLETING THOSE APPLICATIONS. SCHEDULE H, PART V, SECTION B, LINE 17 DID THE HOSPITAL FACILITY HAVE IN PLACE DURING THE TAX YEAR A SEPARATE BILLING AND COLLECTIONS POLICY, OR A WRITTEN FINANCIAL ASSISTANCE POLICY THAT EXPLAINED ACTION THE HOSPITAL FACILITY MAY TAKE UPON NON-PAYMENT? THE HOSPITAL DID NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS DURING THE TAX YEAR. THE POLICY STRICTLY PROHIBITED TAKING LEGAL ACTION AGAINST PATIENTS AND ALSO FORBADE PLACING A LIEN ON THE PATIENT'S HOME. IN THE EVENT OF NONPAYMENT, THE HOSPITAL AND ITS COLLECTIONS GROUPS WOULD SEND STATEMENTS AND MAKE PHONE CALLS. SCHEDULE H, PART V, SECTION B, LINE 20E NOTIFICATION OF FINANCIAL ASSISTANCE POLICY WHEN COLLECTION CALLS RESULTED IN PATIENT CONTACT, BUSINESS AGENTS PERFORMED A VERBAL SCREENING TO SEE IF THE PATIENT MIGHT BE ELIGIBLE FOR CHARITY CARE. IN ADDITION, BILLING STATEMENTS CONTAINED THE FOLLOWING NOTICE: YOU MAY QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON YOUR INCOME LEVEL. IF YOU DO NOT QUALIFY AND CANNOT MAKE PAYMENT IN FULL, WE WILL WORK WITH YOU TO SET UP AN ACCEPTABLE PAYMENT PLAN. SCHEDULE H, PART V, SECTION B, LINE 22B DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE THE HOSPITAL USED THE AVERAGE COMMERCIAL INSURANCE REIMBURSEMENT RATE FROM FISCAL YEAR ENDING 6/30/09 TO DETERMINE AMOUNTS GENERALLY BILLED TO PATIENTS WITH INSURANCE. THIS AVERAGE RATE WAS THE AVERAGE REIMBURSEMENT RECEIVED FOR CATEGORIES OF SERVICES FROM ALL PRIVATE INSURERS THAT REIMBURSE HOSPITALS ACROSS THE CHRISTUS HEALTH SYSTEM, EXCEPT FOR ST. VINCENT AND Long-term hospitals, and excluding implant and drug contribution dollars. All uninsured patients were charged no more than 45% of charges for the relevant service line. Patients eligible for additional financial assistance were charged no more than the average rate (for income levels from 301% to 400% of the FPL) or received free care (for incomes at or below 300% of the FPL). For lab services, eligible patients were charged a percentage of the Medicare rate. SCHEDULE H, PART I, LINE 3C FACTORS OTHER THAN THE FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING OTHER CRITERIA TO DETERMINE ELIGIBILITY FOR FREE DISCOUNTED CARE: 1) INCOME LEVEL 2) ASSET LEVEL 3) MEDICAL INDIGENCY 4) INSURANCE STATUS 5) UNDERINSURANCE STATUS 6) RESIDENCY SCHEDULE H, PART I, LINE 5 BUDGETED CHARITY CARE THE ORGANIZATION BUDGETS CHARITY CARE FOR INTERNAL FINANCIAL REVIEW PURPOSES ONLY. THE PROVISION OF CHARITY CARE IS NOT LIMITED TO AMOUNTS ESTABLISHED FOR BUDGETARY PURPOSES. SCHEDULE H, PART I, LINE 6A ANNUAL COMMUNITY BENEFIT REPORT A REPORT OF COMMUNITY BENEFIT IS INCLUDED IN A WRITTEN ANNUAL REPORT FOR CHRISTUS HEALTH, THE ORGANIZATION'S PARENT COMPANY. CHRISTUS HEALTH IS AN INTERNATIONAL, CATHOLIC, FAITH BASED, NONPROFIT HEALTH SYSTEM FORMED IN 1999 WITH A MISSION "TO EXTEND THE HEALING MINISTRY OF JESUS CHRIST." THE ANNUAL COMMUNITY BENEFIT REPORT SUMMARIZES ACTIVITIES AND PROGRAMS CONDUCTED DURING THE PAST YEAR TO IMPROVE HEALTH INCLUDING PROACTIVE COMMUNITY HEALTH SERVICES. HOWEVER, THE ANNUAL REPORT IS ONLY A SNAPSHOT OF HOW THE ORGANIZATION DISTINGUISHES ITSELF IN ITS VISION TO BE A LEADER, A PARTNER, AND AN ADVOCATE IN CREATING INNOVATIVE HEALTH AND WELLNESS SOLUTIONS THAT IMPROVE THE LIVES OF INDIVIDUALS AND COMMUNITIES. SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) IS $56,377,841. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT IS $6,302,504. THIS LEAVES A TOTAL EXPENSE OF $50,075,337 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). PART I, LINE 7, COLUMN (F) DESCRIPTION OF FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFITS AS PERCENTAGE OF TOTAL COSTS THE ORGANIZATION'S TOTAL COMMUNITY BENEFIT EXPENSE AS REPORTED ON PART I, LINE 7K, COLUMN (C) AS A PERCENTAGE OF TOTAL EXPENSE IS 13.45, WHICH EXCEEDS THE AMOUNT REPORTED ON PART I, LINE 7K COLUMN (F) WHICH IS COMPUTED USING NET COMMUNITY BENEFIT EXPENSE. PART I, LINE 7I CASH AND IN-KIND CONTRIBUTIONS MFJ JACKSONSVILLE MADE OVER $57,220 IN CASH AND IN KIND CONTRIBUTIONS DURING FISCAL YEAR 2021. THE AFOREMENTIONED AMOUNT IS DETERMINED IN ACCORDANCE WITH REPORTING RULES FOR SCHEDULE H, WORKSHEET 8. AS SUCH THIS AMOUNT DIFFERS FROM GRANTS REPORTED AT FORM 990, SCHEDULE I, GRANTS AND OTHER ASSISTANCE TO ORGANIZATIONS, GOVERNMENTS, AND INDIVIDUALS AND PART IX, LINES 1 THROUGH 3 GRANTS AND OTHER ASSISTANCE. PART I, LINE 7 LINE 7A: RATIO OF PATIENT CARE COST TO CHARGES BASED ON SCHEDULE H, WORKSHEET 2 Line 7b: Ratio of Patient Care Cost to Charges Based on Schedule H Worksheet 2 Line 7c: Ratio of Patient Care Cost to Charges Based on Schedule H Worksheet 2 LINE 7E: ACTUAL EXPENSES LESS ANY DIRECT OFFSETTING REVENUE Line 7g: Subsidized Health Services Cost is at FMV LINE 7I: ACTUAL EXPENSE OF THE CONTRIBUTIONS SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES The Christus Health Advocacy Department is working in partnership with local, state and federal policy makers to ensure activities and programs are in place that will enhance public health and advance general knowledge. During FY 2021, Christus Health advocated for improving public policies, working to establish, and in some instances, augment, grassroots advocacy and greater access to health care services for the patients we serve. Some of the main community building activities are improving access to health services and building collaborative relationships with other organizations seeking to address chronic conditions that disproportionately impact the poor and underserved. SCHEDULE H, PART III, SECTION A, LINE 1 BAD DEBT REPORTING IN ACCORDANCE WITH HFMA STATEMENT 15 CHRISTUS HEALTH FOLLOWS IN PRINCIPLE HEALTHCARE FINANCIAL MANAGEMENT ASSOCATION STATEMENT NO. 15. THE SYSTEM HAS ADOPTED AN UNCOMPENSATED CARE POLICY WHERE REVENUE FROM SERVICES PROVIDED TO THE UNINSURED IS RECOGNIZED AT THE TIME OF PAYMENT, RATHER THAN AT THE TIME OF SERVICE. THIS POLICY IS THE RESULT OF A LACK OF REASONABLE ASSURANCE OF COLLECTION FOR SERVICES PROVIDED TO THE UNINSURED DUE TO THE SYSTEM'S HISTORICALLY LOW COLLECTION RATE. MANAGEMENT HAS ESTIMATED THAT THE DIFFERENCE BETWEEN RECORDING REVENUE FROM THE UNINSURED ON A CASH BASIS, RATHER THAN THE ACCRUAL BASIS, IS IMMATERIAL. ACCORDINGLY, ALL ACCOUNTS RECEIVABLE FROM THE UNINSURED HAVE BEEN FULLY RESERVED IN THE ALLOWANCE FOR UNCOMPENSATED CARE. SCHEDULE H, PART III, LINE 2 METHODOLOGY USED IN DETERMINING BAD DEBT THE ORGANIZATION'S TOTAL BAD DEBT EXPENSE (TOTAL OF ALL HOSPITAL FACILITIES) IS IN ACCORDANCE WITH THE ORGANIZATION'S FINANCIAL STATEMENTS, WHICH IS COMPUTED AS BAD DEBT NET OF CONTRACTUAL ALLOWANCE, PAYMENTS RECEIVED AND RECOVERIES OF BAD DEBT PREVIOUSLY WRITTEN OFF. SCHEDULE H, PART III, LINE 3 ESTIMATE OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER ORGANIZATION'S CHARITY CARE POLICY MOTHER FRANCIS HOSPITAL - JACKSONVILLE RECOGNIZED THAT SOME PATIENTS ARE UNABLE OR UNWILLING TO SEEK FINANCIAL ASSISTANCE DUE TO BARRIERS SUCH AS EDUCATIONAL LEVEL, LITERACY, DOCUMENTATION REQUIREMENTS, OR BEING INTIMIDATED BY THE APPLICATION PROCESS. IN ORDER TO ESTIMATE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAVE NOT SUBMITTED AN APPLICATION, THE ORGANIZATION ENGAGED PARO DECISION SUPPORT, LLC. PARO CHARITY SCORE IS DESIGNED TO IDENTIFY PATIENTS THAT LIKELY QUALIFY FOR FINANCIAL ASSISTANCE BASED ON A PREDICTIVE MODEL AND OTHER FINANCIAL AND ASSET ESTIMATES FOR THE PATIENT DERIVED FROM PUBLIC RECORD SOURCES. FOR THE FISCAL YEAR ENDING JUNE 30, 2011, THE ORGANIZATION REPORTED THAT 30 PERCENT OF BAD DEBT EXPENSES WERE ATTRIBUTABLE TO PATIENTS WHO MAY HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE BUT WERE NOT RESPONSIVE TO THE APPLICATION PROCESS EXISTING AT THAT TIME. THIS FIGURE WAS BASED ON THE PARO ANALYSIS AND ESTIMATES OF PATIENTS' FINANCIAL NEEDS THAT EXAMINED WHETHER PATIENTS WERE CHARACTERSTIC OF OTHERS WHO HISTORICALLY QUALIFIED FOR ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. THE PRESUMPTIVE CHARITY CARE ANALYSIS PERFORMED FOR THE PRIOR FISCAL YEAR DETERMINED A BENCHMARK OF BAD DEBT ACCOUNTS IN THE CHRISTUS HEALTH SYSTEM THAT LACKED THE INFORMATION TO QUALIFY FOR CHARITY CARE UNDER THE FILING ORGANIZATION'S CUSTOMARY PROCESS BUT WOULD HAVE LIKELY QUALIFIED FOR ASSISTANCE. DURING THE FISCAL YEAR ENDING JUNE 30, 2021, THE ORGANIZATION UTILIZED THE PARO SCORE TO IDENTIFY THE ACCOUNTS OF INDIVIDUAL PATIENTS THAT WERE LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE DESPITE HAVING NOT COMPLETED AN APPLICATION, AND SUCH ANALYSIS DETERMINED THAT 3.73% OF SUCH ACCOUNTS WERE LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE. THE ORGANIZATION GRANTED PRESUMPTIVE ELIGIBILITY FOR THESE ACCOUNTS AND THEY WERE RECLASSIFIED UNDER OUR FINANCIAL ASSISTANCE POLICY. THE AMOUNTS WERE NOT REPORTED AS BAD DEBT. THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 3 IS THE DIFFERENCE BETWEEN THE PRESUMPTIVE CHARITY CARE BENCHMARK ESTABLISHED IN THE FISCAL YEAR ENDING JUNE 30, 2011 AND THE AGGREGATE OF INDIVIDUAL ACCOUNTS FOR WHICH THE ORGANIZATION GRANTED PRESUMPTIVE ELIGIBILITY IN THE FISCAL YEAR ENDING JUNE 30, 2021. THUS, THE ORGANIZATION ESTIMATES THAT ONLY 0.48% OF THE BAD DEBT EXPENSES IN FISCAL YEAR ENDING JUNE 30, 2021 ARE ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY HAVE QUALIFIED FOR FINANCIAL ASSISTANCE. IT IS IMPORTANT TO NOTE THAT THE FIGURE CALCULATED FOR FISCAL YEAR ENDING JUNE 30, 2011 WAS ESTIMATED AND NOT EXACT, AND THEREFORE THE DIFFERENCE BETWEEN THE AMOUNTS QUALIFIED AS PRESUMPTIVE CHARITY CARE IN ANY FISCAL YEAR MAY VARY FROM THE BENCHMARK ESTABLISHED IN FISCAL YEAR ENDING JUNE 30, 2011. BENCHMARK ESTABLISHED IN FISCAL YEAR ENDING JUNE 30, 2011. BENCHMARK ESTABLISHED IN FISCAL YEAR ENDING JUNE 30, 2011. SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE FOOTNOTE THE FOOTNOTE TO THE CHRISTUS HEALTH CONSOLIDATED FINANCIAL STATEMENTS SAYS, "THE PREPARATION OF THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS IN CONFORMITY WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES (U.S. GAAP) REQUIRES MANAGEMENT OF THE SYSTEM TO MAKE ASSUMPTIONS, ESTIMATES, AND JUDGMENTS THAT AFFECT THE AMOUNTS REPORTED IN THE FINANCIAL STATEMENTS, INCLUDING THE NOTES THERETO, AND RELATED DISCLOSURES OF COMMITMENTS AND CONTINGENCIES, IF ANY AT THE DATE OF THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT RELIES ON HISTORICAL EXPERIENCE AND ON OTHER ASSUMPTIONS BELIEVED TO BE REASONABLE UNDER THE CIRCUMSTANCES IN MAKING ITS JUDGMENT AND ESTIMATES. ACTUAL RESULTS COULD DIFFER MATERIALLY FROM THESE ESTIMATES." SCHEDULE H, PART III, LINE 8 COSTING METHODOLOGY The Medical Center uses Medicare cost report methodology, which apportions routine costs (room and board) based on Medicare or Medicaid days to total days and apportions ancillary costs based on program charges to total charges. SCHEDULE H, PART III, LINE 9B COLLECTION POLICY IT IS THE POLICY OF THE ORGANIZATION TO PURSUE COLLECTIONS OF PATIENT BALANCES FROM PATIENTS WHO HAVE THE ABILITY TO PAY FOR THESE SERVICES. CHRISTUS HEALTH APPLIES ITS COLLECTION EFFORTS CONSISTENTLY AND FAIRLY TO ALL PATIENTS REGARDLESS OF INSURANCE. IF A PATIENT DOES NOT HAVE THE FINANCIAL RESOURCES TO PAY THEIR OUTSTANDING BALANCES, THE GOAL OF THE ORGANIZATION IS TO QUALIFY THESE PATIENTS THROUGH THE ORGANIZATION'S CHARITY POLICY OR SCREEN THE PATIENTS THROUGH ORGANIZATION'S PRESUMPTIVE CHARITY TESTS. IF THE PATIENT QUALIFIES UNDER EITHER POLICY THE ACCOUNT WILL BE WRITTEN OFF BASED UPON LEVEL OF QUALIFICATION. THESE POLICIES SUPPORT THE MISSION AND VISION OF THE ORGANIZATION AND ARE APPROVED BY SENIOR LEADERSHIP. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT The hospital's community health profiles provide a snapShot of surburban, urban, and rural service areas within Texas using key health indicators, which facilitate comparisons locally, regionally, and over time. Community health profiles are intended to assist internal stakeholders, community health council members, and the community health improvement department in deciding where to allocate resources and address health inequalities. All entity advocates use national, state, and local secondary and primary data sources to provide a current overview of local health needs, factors impacting disease and injury burden, socioeconomic status, access to health care, age distribution, indicators and lifestyle behaviors. This data is used to galvanize joint community health efforts to improve health and reduce health inequalities and to empower the greater community. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE CHRISTUS TRINITY MOTHER FRANCES HOSPITAL - JACKSONVILLE MAKES EVERY EFFORT TO EDUCATE PATIENTS ON ITS CHARITY AND DISCOUNT POLICY AND ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS DURING REGISTRATION, PRE REGISTRATION (FOR SCHEDULED TESTS AND SURGERIES), POST REGISTRATION (DURING THEIR HOSPITALIZATION) AND FOLLOWING DISCHARGE (TELEPHONE OR WRITTEN INQUIRY) IN LANGUAGES APPROPRIATE FOR THE POPULATION BEING SERVED. PATIENTS ARE GIVEN INFORMATION AND FORMS BY A FINANCIAL COUNSELOR WHO HELPS THEM COMPLETE THE FORMS DURING THEIR INPATIENT AND OUTPATIENT VISITS. PATIENTS ARE ASKED TO BRING OR MAIL SUPPORTING DOCUMENTATION TO DETERMINE INCOME, ASSETS AND HOUSEHOLD EXPENSES. THE BUSINESS OFFICE REVIEWS THE APPLICATION BASED ON THE INFORMATION PROVIDED BY THE PATIENT. IF THE PATIENT QUALIFIES FOR CHARITY CARE OR A DISCOUNT, A NEW BILL IS GENERATED. PATIENTS WHO DO NOT PROVIDE THE REQUIRED DOCUMENTATION ARE CONSIDERED INELIGIBLE AND ARE BILLED ACCORDINGLY. IF THE DOCUMENTATION IS PROVIDED AT A LATER TIME, THE PATIENT MAY THEN BE DETERMINED TO BE ELIGIBLE FOR CHARITY CARE OR A DISCOUNT. DOCUMENTATION IS RETAINED BY THE BILLING OFFICE FOR SEVEN YEARS. A PUBLIC NOTICE REGARDING THE CHARITY CARE POLICY IS POSTED IN PROMINENT PLACES THROUGHOUT THE HOSPITALS, INCLUDING BUT NOT LIMITED TO THE EMERGENCY ROOM WAITING AREAS AND THE ADMISSIONS OFFICE WAITING AREAS, AS REQUIRED BY BOTH THE STATE OF TEXAS COMMUNITY BENEFIT STANDARD (WHICH ADDRESSES THE DUTIES AND RESPONSIBILITIES OF NONPROFIT HOSPITALS) AND CHRISTUS HEALTH COMMUNITY BENEFIT GUIDELINES #050. IN ADDITION, A PUBLIC NOTICE REGARDING THE CHARITY CARE POLICY AND INFORMATION ON FINANCIAL ASSISTANCE ARE ALSO POSTED ON THE CHRISTUS HEALTH WEBSITE. THE INFORMATION ON FINANCIAL ASSISTANCE INCLUDES EXPLANATIONS ON THE AVAILABILITY OF FINANCIAL ASSISTANCE, WHO QUALIFIES, AND HOW TO APPLY FOR FINANCIAL ASSISTANCE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION CHRISTUS MOTHER FRANCES HOSPITAL - JACKSONVILLE IS A 25-BED ACUTE CARE MEDICARE CERTIFIED CRITICAL CARE ACCESS HOSPITAL. CHEROKEE COUNTY, THE PRIMARY SERVICE AREA FOR CMFH-J, HAS A POPULATION OF APPROXIMATELY 51,668 RESIDENTS WITH A MEDIAN HOUSEHOLD INCOME FOR THE SERVICE AREA OF $41,355. 19% HOUSEHOLDS LIVE AT OR BELOW THE POVERTY LEVEL. THE HOSPITAL'S SERVICE AREA HAS AN UNINSURED RATE OF 31% OF THE POPULATION AND 29% HAVING MENTAL ILLNESS. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: 1. JOB SHADOWING DESCRIPTION: STUDENTS PARTICIPATE IN JOB SHADOWING PROJECTS THROUGHOUT THE YEAR AND LEARN FROM PROFESSIONALS AND REQUIREMENTS AND DUTIES OF VARIOUS HEALTH CARE RELATED JOBS, SUPPORT SERVICES, AFFILIATED JOBS, AND SUPPORT AND ADMINISTRATIVE AREAS. THEY SPENT TIME IN THE AREAS TO SEE FIRSTHAND WHAT THE JOBS ENTAILED. PURPOSE: TO PROVIDE YOUNG HIGH SCHOOL STUDENTS THE OPPORTUNITY TO LEARN MORE ABOUT HEALTH CARE PROFESSIONALS AND OTHERS WHO SUPPORT THE SYSTEM, AND THE HEALTHCARE WORK ENVIRONMENT. INFORMATION WAS GIVEN ON JOB OPPORTUNITIES AND JOB PROJECTED SHORTAGES OF WORKERS IN ALL AREAS. 2. JACKSONVILLE ROTARY, ACCESS, AND OTHERS DESCRIPTION: PROVIDED DONATIONS, GRANTS, STAFFING, AND DEVELOPMENT OF PROGRAMS AND EVENTS FOR THE LOCAL COMMUNITY. ORGANIZATIONS INCLUDED LIONS CLUB, ROTARY, KIWANIS, ACCESS, UNITED FUND, AMERICAN CANCER SOCIETY, JACKSONVILLE CHAMBER OF COMMERCE, AND EAST TEXAS HUMAN NEEDS NETWORK. MEMBERS OF THE STAFF SERVE IN LEADERSHIP POSITIONS AND VOLUNTEERS FOR PROGRAMS ON VARIOUS BOARDS AND NON-PROFITS IN THE COMMUNITY. PURPOSE: THESE PROGRAMS BENEFITS THE RESIDENTS OF THE AREA AND ORGANIZATIONS THAT PROVIDE SERVICES WHICH ARE NOT PROVIDED BY THE HOSPITAL BUT IMPACT THE HEALTH OF THE RESIDENTS IN ANDERSON/CHEROKEE COUNTIES. FINDING LEADERSHIP TALENT FOR VOLUNTEER POSITIONS IS AN EVER-GROWING PROBLEM FOR ALL COMMUNITIES. TARGET POPULATION FOR SERVICES IS THE GENERAL PUBLIC. 3. COMMUNITY NON-PROFITS AND RURAL HOSPITAL SUPPORT PROGRAMS DESCRIPTION: CHRISTUS MOTHER FRANCES HOSPITAL - JACKSONVILLE PROVIDES DIRECT FINANCIAL SUPPORT TO NOT-FOR-PROFIT ORGANIZATIONS INCLUDING THE CHAMBER OF COMMERCE, ROTARY, UNITED WAY, AND KIWANIS CLUB. PRIORITY IS GIVEN TO AGENCIES OR ORGANIZATIONS THAT PROVIDE SUPPORT OR DIRECT HEALTH RELATED SERVICES OR BENEFITS AND HAVE A MISSION TO SERVE THE UNDERINSURED AND UNINSURED. PURPOSE: THESE ORGANIZATIONS OR AGENCIES PROVIDE SERVICES THAT OTHERWISE WOULD HAVE TO BE PROVIDED BY CHRISTUS MOTHER FRANCES HOSPITAL -JACKSONVILLE OR COULD BE PREVENTING PATIENTS FROM ENTERING OUR FACILITIES, PARTICULARLY THE EMERGENCY ROOM. MANY PROVIDE EDUCATION OR RESEARCH PROGRAMS WHICH ARE NOT AVAILABLE AT CMFH-JACKSONVILLE OR IT MAY BE TOO FAR FOR THEIR PATIENTS TO TRAVEL TO RECEIVE SERVICES AT OUR PRIMARY FACILITIES. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM Christus Mother Frances Hospital - Jacksonville is part of an affiliated health care system called CHRISTUS Northeast Texas Health System Corporation. CHRISTUS Northeast Texas is a faith-based organization dedicated to creating healthy lives for people and communities. CMFH-Jacksonville and its affiliates promote the health of the communities served by providing acute care facilities and critical access facilities, whose operations consist primarily of providing inpatient and outpatient acute care and medical services to patients in East Texas. SCHEDULE H, PART VI, LINE 7 COMMUNITY BENEFIT REPORT State filing of community benefit report: Texas X true true X X X X X true true false false false false false false false JASON PROCTOR DIR/CHAIR/EX-OFF (thru 12/20) 0 479377 0 174046 0 1200 0 134545 0 14165 0 803333 0 0 PETER SIRIANNI MD DIRECTOR (thru 12/20) 0 1529069 0 3000 0 72690 0 0 0 0 0 1604759 0 0 ELIZABETH PULLIAM VP 0 334869 0 125290 0 66474 0 62864 0 8382 0 597879 0 0 Barry Lofquist DIR/SEC/ASSOC. VP 0 206730 0 55118 0 0 13221 0 12289 0 287358 0 0 Greg Freimer MD DIRECTOR (thru 12/20) 0 264635 0 0 0 214285 0 30900 0 31524 0 541344 0 0 J Lindsey Bradley Former Sys Pres (Term 6/17) 0 13508 0 0 0 421643 0 0 0 0 0 435151 0 0 Todd Hancock Former Director (Term 2/17) 0 570498 0 254442 0 650 0 202319 0 23912 0 1051821 0 0 Chris Glenney FORMER DIR/CHAIR (TERM 11/17) 0 837158 0 348204 0 650 0 311373 0 13351 0 1510736 0 0 Scott Smith Director 0 635755 0 346176 0 15500 0 140903 0 18355 0 1156689 0 0 Jeff Puckett Director (as of 01/2021) 0 3561985 0 2200456 0 304250 0 3000239 0 12980 0 9079910 0 142706 Mark Anderson MD Board Director (as of 01/2021) 0 738525 0 262691 0 11749 0 202519 0 73116 0 1288600 0 0 ANNE PILEGGI FORMER DIRECTOR (TERM 12/19) 0 265756 0 68560 0 3946 0 41871 0 3252 0 383385 0 0 FORM 990, PART VII, LINE 1A AND SCHEDULE J, PART II SUPPLEMENTAL COMPENSATION INFORMATION DIRECTORS AND EX-OFFICIO DIRECTORS PROVIDE THEIR SERVICES AS MEMBERS OF THE BOARD WITHOUT COMPENSATION OR BENEFITS. ANY COMPENSATION AND BENEFITS DISCLOSED FOR SUCH PERSON IS EARNED IN THE RESPECTIVE INDIVIDUAL'S ROLE AS AN OFFICER OR EMPLOYEE OF THE ORGANIZATION, NOT FOR THE INDIVIDUAL'S ROLE AS A BOARD MEMBER OR DIRECTOR. OFFICERS, KEY EMPLOYEES AND HIGHEST PAID EMPLOYEES ARE FULL-TIME EMPLOYEES. BOARD MEMBERS SPEND TIME AS NEEDED FOR BOARD MEETING AND FUNCTIONS. FORM 990, SCHEDULE J, PART I, LINE 3 EXPLANATION OF RELATED ORGANIZATION DETERMINING CEO COMPENSATION THE FILING ORGANIZATION'S CEO/EXECUTIVE DIRECTOR IS AN EMPLOYEE OF CHRISTUS HEALTH, A RELATED ORGANIZATION. AS A RESULT, COMPENSATION IS ESTABLISHED AT THE CHRISTUS HEALTH LEVEL AND THE FILING ORGANIZATION DOES NOT HAVE A ROLE IN IMPLEMENTING THE METHODS USED TO ESTABLISH COMPENSATION OR IN DETERMINING CEO/EXECUTIVE DIRECTOR COMPENSATION. CHRISTUS HEALTH USES AN EXECUTIVE COMPENSATION COMMITTEE TO ESTABLISH AND APPROVE THE COMPENSATION OF THE FILING ORGANIZATION'S CEO/EXECUTIVE DIRECTOR. THIS COMMITTEE USES AN INDEPENDENT COMPENSATION CONSULTANT WHO PERFORMS BI-ANNUAL COMPENSATION SURVEY. FORM 990, SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENT THE FOLLOWING RECEIVED SEVERANCE PAYMENTS DURING 2020: J. LINDSEY BRADLEY RECEIVED $421,643 AS A SEVERANCE PAYMENT DURING CALENDAR YEAR 2020. FORM 990, SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DEFERRED COMPENSATION INCLUDES EXECUTIVE DEFERRED INCOME ACCOUNT, SUPPLEMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN, AND PENSION RESTORATION PLAN. ESTIMATED PENSION BENEFITS WERE CALCULATED BASED ON THE PROVISIONS OF THE CURRENT PENSION RESTORATION PLAN AT 6% OF PENSIONABLE EARNINGS WHICH ARE OVER THE IRS LEGISLATIVE COMPENSATION LIMIT. SOME ASSOCIATES ARE GRANDFATHERED UNDER AN EARLIER LEGACY PENSION PLAN. IF A PARTICIPANT HAS PROTECTED PENSION BENEFITS UNDER SUCH LEGACY PLANS, HIS/HER PERCENTAGE IS ZERO UNDER THE SUPPLEMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN, AS THE PROTECTED BENEFIT IS ALREADY EQUAL TO OR BETTER THAN CURRENT MARKET. ELIZABETH PULLIAM RECEIVED $65,824 DURING THE CALENDAR YEAR 2020 UNDER A SUPPLEMENTAL RETIREMENT PLAN. ANNE PILEGGI RECEIVED $1,869 DURING THE CALENDAR YEAR 2020 UNDER A SUPPLEMENTAL RETIREMENT PLAN. FORM 990, SCHEDULE J, PART II SUPPLEMENTAL COMPENSATION INFORMATION W-2 COMPENSATION MAY INCLUDE PAYMENTS RELATED TO COMPENSATION DEFERRED IN PRIOR YEARS. DEFERRED COMPENSATION MAY INCLUDE DEFERRALS OF CURRENT YEAR COMPENSATION UNDER EXECUTIVE DEFERRED INCOME ACCOUNT, SUPPLEMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN AND PENSION RESTORATION PLAN. FORM 990, SCHEDULE J, PART II, COLUMN B(II) SUPPLEMENTAL COMPENSATION INFORMATION BONUS AND INCENTIVE COMPENSATION MAY INCLUDE AMOUNTS THAT WERE DEFERRED IN A PRIOR YEAR BUT PAID OUT IN CALENDAR YEAR 2020. FORM 990, SCHEDULE J, PART II, COLUMN C DEFERRED COMPENSATION DEFERRED COMPENSATION INCLUDES EXECUTIVE DEFERRED INCOME ACCOUNT, SUPPLEMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN, EMPLOYER CONTRIBUTION TO 403(B) MATCHED SAVINGS PLAN, PENSION RESTORATION PLAN AND ESTIMATED PENSION BENEFITS UNDER CHRISTUS HEALTH CASH BALANCE PLAN. ESTIMATED PENSION BENEFITS WERE CALCULATED BASED ON THE PROVISIONS OF THE CURRENT CASH BALANCE PLAN AT 6% OF PENSIONABLE EARNINGS. SOME ASSOCIATES ARE GRANDFATHERED UNDER AN EARLIER PENSION PLAN. THESE GRANDFATHERED PARTICIPANTS, BASED ON COMPUTATION AT THE TIME OF THEIR RETIREMENT, WILL RECEIVE THE LARGER OF THE RETIREMENT BENEFIT COMPUTED UNDER THE CASH BALANCE PLAN COMPARED TO THE PREVIOUS PENSION PLAN. DUE TO THE COMPLEXITY OF CALCULATING AN ACCURATE BENEFIT COST FOR GRANDFATHERED PARTICIPANTS, THE FORM 990 REPORTS AS PENSION BENEFITS THEIR ANNUAL ESTIMATED CASH BALANCE PLAN ACCRUAL. FORM 990, PART I, BOX C DOING BUSINESS AS CHRISTUS MOTHER FRANCES HOSPITAL - JACKSONVILLE FORM 990, PART VI, LINE 2 BUSINESS OR FAMILY RELATIONSHIPS WITH OTHER OFFICERS, DIRECTORS, OR KEY EMPLOYEES GLEN HAMILTON AND RANDY GORHAM, BOTH HAVE INVESTMENT ACCOUNTS WITH DICK STONE. FORM 990, PART VI, LINE 4 SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS SINCE THE PRIOR FORM 990 WAS FILED PRIMARILY, THE NEW ORGANIZATIONAL DOCUMENTS DISTINCTLY ESTABLISHED CERTAIN POWERS, THAT ARE EXPRESSLY RESERVED FOR THE ORGANIZATION'S MEMBER, BOARD, AND THE MEMBER'S CHIEF EXECUTIVE OFFICER, A SUMMARY OF THESE RESERVED POWERS ARE AS FOLLOWS: (I) THE APPROVAL OF TRANSACTIONS INVOLVING REAL PROPERTY AND OTHER ORGANIZATIONAL PROPERTY; (II) THE AMENDMENT OF GOVERNANCE DOCUMENTS; (III) THE APPROVAL OF THE INCURRENCE, FORGIVENESS, AND GUARANTEE OF DEBT; (IV) THE APPROVAL OF CAPITAL PROJECTS, (V) THE ESTABLISHMENT OF NEW ORGANIZATIONAL ENTITIES, WHICH INCLUDE MERGERS AND ACQUISITIONS, AND (VI) OTHER AUTHORITY AS DELEGATED BY THE APPLICABLE ORGANIZATIONAL AUTHORITY. IN ADDITION TO THE ESTABLISHMENT OF RESERVED POWERS, THE REVISED ORGANIZATIONAL DOCUMENTS ALSO CLARIFIED THE RESPONSIBILITIES OF ORGANIZATIONAL OFFICERS AND BOARD COMMITTEES. THE AMENDED BYLAWS ALSO ESTABLISHED A NEW MEMBER/PARENT FOR THE ORGANIZATION. THE PRIOR MEMBER AND PARENT WAS CHRISTUS TRINITY MOTHER FRANCES HEALTH SYSTEM, WHICH WAS CHANGED TO CHRISTUS NORTHEAST TEXAS HEALTH SYSTEM CORPORATION. FORM 990, PART VI, LINE 6 MEMBER OR STOCKHOLDERS Christus Northeast Texas Health System Corporation IS THE SOLE MEMBER OF MOTHER FRANCES HOSPITAL - JACKSONVILLE. FORM 990, PART VI, LINE 7A POWER TO ELECT OR APPOINT MEMBERS THE SOLE MEMBER, Christus Northeast Texas Health System Corporation, HAS THE POWER TO APPOINT ALL DIRECTORS AND THEIR SUCCESSORS TO THE GOVERNING BOARD. FORM 990, PART VI, LINE 7B DECISIONS RESERVED TO MEMBERS OR STOCKHOLDERS THE MEMBER HAS THE RIGHT TO APPROVE OR DISAPPROVE CERTAIN ACTIONS THAT HAVE BEEN APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, LINE 11B PROCESS USED TO REVIEW THE FORM 990 THE FORM 990 IS PREPARED AND REVIEWED BY THE ORGANIZATION'S EXTERNAL INDEPENDENT ACCOUNTANTS. THE CHRISTUS HEALTH ACCOUNTING DEPARTMENT WORKS WITH AN EXTERNAL ACCOUNTING FIRM IN PREPARATION AND REVIEW OF THE FORM 990. THE FILING ORGANIZATION'S CFO, OR OTHER DESIGNEE, REVIEWS THE FORM 990. THE FINAL FORM 990 THAT WILL BE FILED WITH THE IRS IS POSTED TO A SECURE INTERNET PORTAL FOR ALL MEMBERS OF THE BOARD OF DIRECTORS TO VIEW. REVIEW OF THE FINAL FORM 990 OCCURS PRIOR TO FILING WITH THE IRS IN THE SPRING OF 2022 VIA A WEB PORTAL POLLING TOOL BY THE RESPECTIVE CHRISTUS ORGANIZATION'S BOARD, BASED ON A SET OF SUGGESTED REVIEW PROCESSES DEVELOPED BY CHRISTUS HEALTH. FORM 990, PART VI, LINE 12C DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICT OF INTEREST AT THE END OF EACH CALENDAR YEAR, THE CHRISTUS HEALTH CORPORATE SECRETARY DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE TO ALL OF THE ORGANIZATION'S BOARD AND COMMITTEE MEMBERS FOR COMPLETION PRIOR TO THE 1ST OF JANUARY IN THE NEXT YEAR. THE CORPORATE SECRETARY THOROUGHLY REVIEWS ALL COMPLETED AND EXECUTED CONFLICT OF INTEREST QUESTIONNAIRE FORMS TO ENSURE ACCURACY AND THAT NO POTENTIAL OR IDENTIFIED CONFLICT IS DISCLOSED OR EXISTS. THE ORGANIZATION'S BOARD OF DIRECTORS IS RESPONSIBLE FOR ENFORCEMENT OF THE CONFLICT OF INTEREST POLICY OF THE ORGANIZATION. FORM 990, PART VI, LINES 15A & 15B COMPENSATION DETERMINATION PROCESS THE EXECUTIVE COMPENSATION COMMITTEE OF CHRISTUS HEALTH DETERMINES THE COMPENSATION OF THE CEO (OR EXECUTIVE DIRECTOR, AS APPLICABLE), OFFICERS AND KEY EMPLOYEES OF CHRISTUS HEALTH AND CERTAIN OTHER OFFICERS AND KEY EMPLOYEES OF RELATED ORGANIZATIONS, INCLUDING MOTHER FRANCES HOSPITAL JACKSONVILLE. THE EXECUTIVE COMPENSATION COMMITTEE IS COMPOSED OF INDIVIDUALS WHO HAVE NO CONFLICT OF INTEREST WITH THE COMPENSATION ARRANGEMENTS AT HAND. THE EXECUTIVE COMPENSATION COMMITTEE OF THE CHRISTUS HEALTH BOARD SELECTS AN INDEPENDENT EXTERNAL FIRM TO PERFORM AN INDEPENDENT COMPENSATION REVIEW, TO ENSURE THAT ALL COMPENSATION IS REASONABLE AND COMPARABLE TO OTHER SIMILARLY SITUATED ORGANIZATIONS, FOR SIMILIARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS, AND TO PROVIDE SUPPORTING INFORMATION OF COMPENSATION DECISIONS. ON AN ANNUAL BASIS THE EXTERNAL CONSULTANT: 1. DEVELOPS THE MERIT INCREASE RECOMMENDATIONS FOR ALL DESIGNATED SYSTEM EXECUTIVES BASED ON MARKET COMPARABILITY. 2. RECOMMENDS THE CHANGES IN THE COMPENSATION STRUCTURE (GRADES) BASED ON THE MARKET CHANGES. 3. COMPLETES A REVIEW AND EVALUATION OF NEWLY CREATED POSITIONS TO RECOMMEND A GRADE PLACEMENT TO THE COMMITTEE FOR ITS DISCUSSION AND APPROVAL. ON A BI-ANNUAL BASIS, THE EXTERNAL CONSULTANT COMPLETES A DETAILED REVIEW OF ALL OTHER DESIGNATED SYSTEM EXECUTIVES' COMPENSATION AND BENEFITS. THIS GROUP INCLUDES ALL TOP MANAGEMENT OFFICIALS, OTHER OFFICERS AND KEY LEADERS OF THE ORGANIZATION. THE REVIEW INCLUDES RECOMMENDATIONS TO THE COMMITTEE ON ANY CHANGES NECESSARY IN EITHER SPECIFIC COMPENSATION OR COMPENSATION STRUCTURE TO ENSURE MARKET COMPETITIVENESS, REASONABLENESS AND INTERNAL EQUITY. UPON RECOMMENDATIONS FROM THE INDEPENDENT EXTERNAL FIRM, THE EXECUTIVE COMPENSATION COMMITTEE MAKES FINAL COMPENDATION DECISION. ADDITIONALLY, THE EXECUTIVE COMPENSATION COMMITTEE REVIEWS ALL COMPENSATION PAYMENTS FOR EXCESS BENEFIT TRANSACTIONS. THE DISCUSSION AND DECISIONS OF THE COMMITTEE ARE DOCUMENTED AND FORMALIZED IN THE COMMITTEE MINUTES AND MAINTAINED ON RECORD. THE FILING ORGANIZATION DETERMINES THE COMPENSATION OF THE SECRETARY BY USE OF AN INDEPENDENT AND EXTERNAL CONSULTANT. THE CONSULTANT HELPS DETERMINE PAY RATES FOR THE ASSOCIATES OF THE FILING ORGANIZATION, TAKING INTO ACCOUNT MARKET DATA AND SHIFT DIFFERENTIAL. THE COMPENSATION RATES ARE APPROVED BY THE FILING ORGANIZATION. BASED ON THE AFOREMENTIONED PROCEDURE, THE SECRETARY'S COMPENSATION IS NOT REVIEWED BY A COMPENSATION COMMITTEE. FORM 990, PART VI, QUESTION 18 PUBLIC DISCLOSURE OF 1023 AND FORMS 990 & 990-T CHRISTUS HEALTH AND MOST OF ITS AFFILIATED ENTITIES DO NOT HAVE FORMS 1023 BECAUSE OF THEIR INCLUSION IN THE IRS GROUP RULING WITH THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS, WHICH COVERS THE ORGANIZATION LISTED IN THE ANNUAL OFFICIAL CATHOLIC DIRECTORY. CHRISTUS HEALTH'S WEBSITE DISPLAYS THE IRS GROUP RULING AND RELEVANT ANNUAL OFFICIAL CATHOLIC DIRECTORY PAGES FOR THE ORGANIZATIONS RELATED TO CHRISTUS HEALTH. FORMS 990 AND 990-T ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 PROCESS FOR MAKING DOCUMENTS AVAILABLE TO THE PUBLIC THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CHRISTUS HEALTH ARE MADE AVAILABLE TO THE PUBLIC VIA THE CHRISTUS HEALTH WEBSITE. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS CHANGE IN INTERCOMPANY NET ASSETS ($28,223,679) ROUNDING $1 FORM 990 PART IX LINE 11G DESCRIPTION:CHARGE OUT FEES TOTAL FEES:6064979 FORM 990 PART IX LINE 11G DESCRIPTION:INFORMATION SERVICE FEES TOTAL FEES:225578 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:1141128 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL SERVICES TOTAL FEES:53084 FORM 990 PART IX LINE 11G DESCRIPTION:BILINGS & COLLECTIONS TOTAL FEES:76796 FORM 990 PART IX LINE 11G DESCRIPTION:R&M TOTAL FEES:348698 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASE SERVICES TOTAL FEES:5427907 MOTHER FRANCES HOSP REGIONAL HC CENTER 1315 DOCTORS DRIVE TYLER TX 75701 750818167 HOSPITAL TX 501(c)(3) 3 CHNSC true CHRISTUS-TRINITY MOTHER FRANCES FDN 1315 DOCTORS DRIVE TYLER TX 75701 752028241 SUPPORT TX 501(c)(3) 12-TYPE I CHNSC true Christus Northeast Health System Corp 1315 DOCTORS DRIVE TYLER TX 75701 752616975 HEALTHCARE TX 501(c)(3) 12-TYPE II CH false TRINITY CLINIC 1315 DOCTORS DRIVE TYLER TX 75701 752616977 HEALTHCARE TX 501(c)(3) 3 CHNSC true MOTHER FRANCES HOSPITAL - WINNSBORO 1315 DOCTORS DRIVE TYLER TX 75701 752771569 HOSPITAL TX 501(c)(3) 3 CHNSC true CHRISTUS HEALTH 919 HIDDEN RIDGE DRIVE IRVING TX 75038 760590551 SPT HLTH SVCS TX 501(c)(3) 10 NA false CHRISTUS HEALTH ARK-LA-TEX 2600 ST MICHAEL DRIVE TEXARKANA TX 75503 752796815 HLTHCARE SVCS TX 501(C)(3) 3 CHNSC true CHRISTUS HOPKINS HEALTH ALLIANCE 115 AIRPORT RD SULPHUR SPRINGS TX 75482 811708177 HLTHCARE SVCS TX 501(C)(3) 3 CHNSC true TRINCARE INC 1315 DOCTORS DRIVE TYLER TX 75701 752161369 RETAIL HEALTH SVC TX CHNSC C Corp true HEALTHPLAN OF TEXAS INC 1315 DOCTORS DRIVE TYLER TX 75701 752636832 THIRD PARTY ADMIN TX CHNSC C Corp true true false false false false false false false false true true true true false true true true true true MOTHER FRANCES HOSP REG HEALTH CARE CENTER A(IV) 908584 ACCRUED MOTHER FRANCES HOSP REG HEALTH CARE CENTER J 151431 ACCRUED MOTHER FRANCES HOSP REG HEALTH CARE CENTER K 908584 ACCRUED MOTHER FRANCES HOSP REG HEALTH CARE CENTER L 122185 ACCRUED MOTHER FRANCES HOSP REG HEALTH CARE CENTER M 64026 ACCRUED MOTHER FRANCES HOSP REG HEALTH CARE CENTER P 462890 ACCRUED MOTHER FRANCES HOSP REG HEALTH CARE CENTER Q 550305 ACCRUED TRINITY CLINIC A(IV) 23565 ACCRUED TRINITY CLINIC L 5396832 ACCRUED TRINITY CLINIC M 2897326 ACCRUED