2022-07-14T22:21:20-05:00 2021-08-31 FORVIS LLP 2700 Post Oak Blvd Ste 1500 HOUSTON TX 77056 990 2020-09-01 752660403 Hendrick Provider Network % JEREMY WALKER HEND 3256702000 PO BOX 3117 ABILENE TX 79604 JEREMY WALKER CFO 7134994600 2022-07-15 true Jeremy Walker XXX-XX-XXXX Amanda Maya P01067777 7134994600 2022-07-15 2 2020 2022-09-23 18:48:47Z BRAD HOLLAND 1242 N 19TH ST ABILENE TX 79604 65842875 false X WWW.EHENDRICK.ORG X 1995 TX TO PROVIDE MEDICAL CARE TO THE COMMUNITY OF ABILENE AND SURROUNDING AREAS. MANY PATIENTS ARE ON MEDICAID. SERVICES ARE PROVIDED REGARDLESS OF ABILITY TO PAY. 5 0 803 0 0 0 0 0 46926563 64238762 -4276 -32562 2541633 1604113 49463920 65810313 1854 1649 0 0 67226932 95240333 0 0 0 20577620 25293951 87806406 120535933 -38342486 -54725620 20441063 16422730 22724323 13851495 -2283260 2571235 TO PROVIDE MEDICAL CARE TO THE COMMUNITY OF ABILENE AND SURROUNDING AREAS. MANY PATIENTS ARE ON MEDICAID. SERVICES ARE PROVIDED TO PROMOTE BEST HEALTH PRACTICES REGARDLESS OF ABILITY TO PAY. false false 108538152 1649 64189071 HENDRICK PROVIDER NETWORK PROVIDES A VARIETY OF HEALTH SERVICES ACROSS A WIDE RANGE OF SPECIALTIES FOR PATIENTS IN THE ABILENE AND SURROUNDING AREA, MANY OF WHOM ARE UNINSURED OR ARE ON MEDICAID. THESE SERVICES ARE PROVIDED BY PHYSICIANS EMPLOYED BY THE COMPANY. 51379 HENDRICK PROVIDER NETWORK SUBLEASES THE BUILDING FOR THE ABILENE BRANCH OF TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER SCHOOL OF NURSING AND SCHOOL OF PHARMACY. 108538152 true false false true false false false false false false true false false false true false false true false false false false false false false false false false false true false false false false false false false false false false false false true true true false false false true 65 0 true 803 true false false false false false false false false false false false false X 5 0 false false false false true true true true true false false true true true true true true true false false X JEREMY WALKER 3256702000 1900 PINE STREET ABILENE TX 79601 X JOJI VARGHESE PHYSICIAN 40.0 0.0 X 1297974 0 33957 BONNIE HAYASHI PHYSICIAN 40.0 0.0 X 1291268 0 35849 BRENT MAHONEY DIRECTOR 40.0 0.0 X 1274137 0 41046 REN ZHANG DIRECTOR 40.0 0.0 X 1297975 0 13172 NAGESWARI DAGGUBATI PHYSICIAN 40.0 0.0 X 1275010 0 18614 DANIEL CANARIO PHYSICIAN 40.0 0.0 X 1216976 0 45715 BRAD HOLLAND PRESIDENT 2.0 50.0 X 0 1087968 163243 KEVIN BRIDGE PHYSICIAN 40.0 0.0 X 1206273 0 32237 GARY BINKLEY DIRECTOR 40.0 2.0 X 954288 0 10110 JOSE VEGA SECRETARY/PHYSICIAN 0.0 0.0 X 505262 0 38438 JACQUELINE ZIMMERMAN DIRECTOR 40.0 2.0 X 491908 0 31153 JEREMY WALKER CFO 2.0 48.0 X 0 427138 86459 ROBERT DICKEY DIRECTOR 40.0 0.0 X 478944 0 22134 HENDRY FOSAH DIRECTOR 40.0 2.0 X 357384 0 30809 DAVID STEPHENSON VICE PRESIDENT 20.0 22.0 X 218000 0 51529 ROBERT WILEY MD VICE PRESIDENT 2.0 44.0 X 0 96978 780 MICHAEL MURPHY VICE PRESIDENT 2.0 44.0 X 0 82999 8269 JOHN MASTERSON DIRECTOR 40.0 0.0 X 81159 0 2280 SANDIP MATHUR DIRECTOR 40.0 2.0 X 78044 0 2285 12024602 1695083 668079 109 true true false STAR GASTROENTEROLOGY PLLC 4101 PERCHERON BEND CEDAR PARK TX 78613 PHYSICIAN SERVICES 529000 GUIDEHOUSE MANAGED SERVICES 150 NORTH RIVERSIDE PLAZA CHICAGO IL 606061528 CONSULTANTS 525158 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 303845547 LOCUM SERVICES 496143 ELANGO VINJIRAYER MD PA 5808 FARR OAK DRIVE PLANO TX 75093 PHYSICIAN SERVICES 421119 HAYES LOCUMS PO BOX 88122 CHICAGO IL 606801122 LOCUM SERVICES 320420 9 0 Net Patient Fees 621500 64189071 64189071 Related NMTC Rental Revenue 531120 49691 49691 64238762 0 0 0 1688 1688 0 1688 1688 32562 -32562 -32562 -32562 0 0 0 0 0 0 0 0 0 Miscellaneous Income 900099 1602425 1602425 1602425 65810313 64240450 1569863 1649 1649 0 0 0 5436357 5102540 333817 0 79078304 74469570 4608734 1392661 1275500 117161 5538620 4571936 966684 3794391 3451356 343035 87403 87403 30700 630 30070 3100 3100 0 0 0 5831183 3340723 2490460 151223 110104 41119 788917 577238 211679 1209730 44989 1164741 0 4041955 3871525 170430 76150 74359 1791 0 0 0 0 1854436 753479 1100957 592540 592540 Medical Supplies 2744483 2744483 Minor Equipment 367803 274568 93235 TIME ALLOCATIONS 277863 6718 271145 Bad Debt 6456321 6456321 780144 730521 49623 120535933 108538152 11997781 0 39584 418672 98543 220527 0 0 2602052 7493577 0 0 0 0 0 0 879498 1110231 808225 205136 14153222 7356471 3632590 6796751 0 0 0 0 0 0 53866 13466 12326705 164370 20441063 16422730 6487439 9836987 0 0 2817324 2086575 0 0 0 0 0 0 12880000 0 0 0 539560 1927933 22724323 13851495 X -2283260 2571235 0 0 -2283260 2571235 20441063 16422730 X -54725620 59580115 X false true X true false X 0 0 0 0 0 0 35527801 40372916 44303235 46926563 64238762 231369277 0 0 0 35527801 40372916 44303235 46926563 64238762 231369277 0 0 0 231369277 1712 1628 1373 1647 1688 8048 0 1712 1628 1373 1647 1688 8048 0 912645 824744 1406074 2539986 1602425 7285874 36442158 41199288 45710682 49468196 65842875 238663199 0.96944 0.96873 0.00003 0.00004 X false false false false false false false false true 4800 4800 false PART II-B, QUESTION 1I Amount reported in Part II-B, Question 1I represents portion of dues paid to trade associations that is attributable to lobbying activities. 14667 11934 2733 38478 38478 0 13927439 7294601 6632838 172638 11458 161180 6796751 0 Deferred Payroll Taxes Payable 1144627 Operating Lease Liabilities 783306 1927933 59342220 -6456321 -6456321 65798541 11772 11772 65810313 114067840 -11772 -11772 114079612 6456321 6456321 120535933 SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS TO FORM 990 REVENUE ON BOOKS, NOT ON RETURN: BAD DEBT EXPENSE IN AUDIT REVENUE $ (6,456,321) SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS TO FORM 990 REVENUE ON RETURN, NOT ON BOOKS: RENTAL INCOME INCLUDED IN AUDIT EXPENSE $ 44,334 REALIZED GAIN ON DISPOSAL OF ASSETS IN AUDIT EXPENSE (32,562) --------- $ 11,772 SCHEDULE D, PART XII, LINE 2D RECONCILIATION OF EXPENSE PER AUDITED FINANCIAL STATEMENTS TO FORM 990 EXPENSE ON BOOKS, NOT ON RETURN: RENTAL INCOME INCLUDED IN AUDIT EXPENSE $ (44,334) REALIZED GAIN ON DISPOSAL OF ASSETS IN AUDIT EXPENSE 32,562 --------- $ (11,772) SCHEDULE D, PART XII, LINE 4B RECONCILIATION OF EXPENSE PER AUDITED FINANCIAL STATEMENTS TO FORM 990 EXPENSE ON RETURN, NOT ON BOOKS: BAD DEBT EXPENSE IN AUDIT REVENUE $ 6,456,321 X X X X X false true false false false false false false false BRAD HOLLAND PRESIDENT 0 496926 0 498126 0 92916 0 136582 0 26661 0 1251211 0 92916 JEREMY WALKER CFO 0 236508 0 154762 0 35868 0 58958 0 27501 0 513597 0 32605 DAVID STEPHENSON VICE PRESIDENT 134498 0 69135 0 14367 0 27375 0 24154 0 269529 0 14367 0 REN ZHANG DIRECTOR 649109 0 624593 0 24273 0 8550 0 4622 0 1311147 0 0 0 ROBERT DICKEY DIRECTOR 439957 0 10000 0 28987 0 8550 0 13584 0 501078 0 0 0 HENDRY FOSAH DIRECTOR 243121 0 113884 0 379 0 5019 0 25790 0 388193 0 0 0 BRENT MAHONEY DIRECTOR 688521 0 563338 0 22278 0 8550 0 32496 0 1315183 0 0 0 GARY BINKLEY DIRECTOR 640862 0 292363 0 21063 0 8550 0 1560 0 964398 0 0 0 JACQUELINE ZIMMERMAN DIRECTOR 330083 0 161394 0 431 0 8550 0 22603 0 523061 0 0 0 BONNIE HAYASHI PHYSICIAN 281271 0 1009574 0 423 0 8550 0 27299 0 1327117 0 0 0 NAGESWARI DAGGUBATI PHYSICIAN 1079050 0 171295 0 24665 0 8550 0 10064 0 1293624 0 0 0 DANIEL CANARIO PHYSICIAN 377235 0 838494 0 1247 0 8550 0 37165 0 1262691 0 0 0 KEVIN BRIDGE PHYSICIAN 719486 0 485656 0 1131 0 8550 0 23687 0 1238510 0 0 0 JOJI VARGHESE PHYSICIAN 654550 0 624593 0 18831 0 8550 0 25407 0 1331931 0 0 0 JOSE VEGA SECRETARY/PHYSICIAN 347355 0 157104 0 803 0 8550 0 29888 0 543700 0 0 0 PART 1, LINE 4B PARTICIPATION IN OR PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PARTICIPANTS IN 457(F) REPORTED W-2 DEFERRED COMP. PAID BY --------------------- ------------ -------------- ------- JEREMY WALKER $ 32,605 $ 50,408 HMC DAVID STEPHENSON $ 14,367 $ 21,988 HPN BRAD HOLLAND $ 92,916 $ 128,032 HMC FORM 990, PART VI, SECTION A, LINE 6 HENDRICK MEDICAL CENTER IS THE SOLE MEMBER OF HENDRICK PROVIDER NETWORK. FORM 990, PART VI, SECTION A, LINE 7A PERSONS WHO MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY: THE MEMBER, HENDRICK MEDICAL CENTER, SHALL ELECT THE SUCCESSORS OF THE INITIAL DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY OTHER PERSONS: ARTICLE VII OF THE RESTATED ARTICLES OF INCORPORATION PROVIDES, IN PART, THAT AN AMENDMENT TO ARTICLE II RELATING TO THE PURPOSE OF THE CORPORATION AND ARTICLE VI RELATING TO THE NUMBER AND METHOD OF THE ELECTION OR APPOINTMENT OF THE BOARD OF TRUSTEES SHALL OCCUR ONLY WITH THE CONSENT OF THE BAPTIST GENERAL CONVENTION OF TEXAS OR ITS EXECUTIVE BOARD. FORM 990, PART VI, SECTION B, LINE 11B DESCRIBE REVIEW PROCESS OF FORM 990: THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS PRIOR TO FILING FORM 990, PART VI, SECTION B, LINE 12C DESCRIBE THE ORGANIZATION'S PRACTICE FOR MONITORING COMPLIANCE WITH POLICY: THE ORGANIZATION CONDUCTS, AT A MINIMUM, ANNUAL REVIEWS OF THE POSSIBLE CONFLICTS OF INTEREST AND OTHER FINANCIAL RELATIONSHIPS IDENTIFIED UNDER THIS CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15A PROCESS FOR DETERMINING COMPENSATION OF CEO, DIRECTORS, OR TOP OFFICIALS: A COMPREHENSIVE REVIEW OF COMPENSATION IS CONDUCTED BY AN INDEPENDENT PARTY AT LEAST EVERY THREE YEARS. THIS REPORT PRESENTS THE RESULTS OF THE ANALYSIS OF SALARY, INCENTIVE, TOTAL CASH COMPENSATION (SALARY PLUS INCENTIVE), BENEFITS, AND TOTAL COMPENSATION (TOTAL CASH AND BENEFITS). INTEGRATED HEALTHCARE STRATEGIES (IHS) WORKS WITH THE PERSONNEL COMMITTEE TO FORMALLY DEFINE AN EXECUTIVE TOTAL COMPENSATION PHILOSOPHY. HENDRICK HEALTH SYSTEM'S CURRENT PHILOSOPHY IS TO USE RANGES BUILT AROUND THE MEDIAN OF THE MARKET WITH A 50% SPREAD FROM MINIMUM TO MAXIMUM. INCENTIVE OPPORTUNITY LEVELS ARE COMPETITIVE WITH PRACTICES OF PEER GROUPS AND BENEFITS WILL BE DELIVERED AT MARKET COMPETITIVE LEVELS. SEVERANCE AND PERQUISITES REFLECT A CONSERVATIVE PHILOSOPHY. THE COMMITTEE DETERMINED THAT THE PEER GROUP WOULD BE PRIMARILY REGIONAL NOT-FOR-PROFIT HOSPITALS OF SIMILAR SIZE AND COMPLEXITY. NATIONAL PEER GROUP WILL BE USED FOR REFERENCE PURPOSES WHERE APPROPRIATE. THE HENDRICK HEALTH SYSTEM PERSONNEL COMMITTEE IS DELEGATED THE RESPONSIBILITY FOR THE EXECUTIVE COMPENSATION PROGRAM BY THE BOARD OF TRUSTEES. THE COMMITTEE: SETS THE OVERALL EXECUTIVE COMPENSATION PHILOSOPHY TO BE IMPLEMENTED BY HENDRICK HEALTH SYSTEM; SETS COMPENSATION COMPONENTS FOR THE PRESIDENT AND CEO; REVIEWS, DISCUSSES AND MAKES DECISIONS BASED ON THE PRESIDENT AND CEO'S RECOMMENDATIONS FOR HIS DIRECT REPORTS; REPORTS A SUMMARY OF THE PROCESS BACK TO THE BOARD OF TRUSTEES ALONG WITH THE ACTUAL COMPENSATION APPROVED FOR THE PRESIDENT AND CEO; AND APPROVES ALL INCENTIVE GOALS AND AWARDS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: TRANSFERS FROM AFFILIATES $59,580,115 HPN RO BILLING SERVICES LLC 1900 PINE ST ABILENE TX 79601 813892121 RADIOLOGY SVC TX -523849 0 HPN HPN PHYSICIAN BILLING LLC 1900 PINE ST ABILENE TX 79601 815158335 BILLING SRVCS TX 10603091 0 HPN HENDRICK CLINIC BILLING PLLC 1900 PINE ST ABILENE TX 79601 862815377 BILLING SRVCS TX 0 0 HPN HENDRICK MEDICAL CENTER PO BOX 3117 ABILENE TX 79604 750827446 HOSPITAL TX 501(C) (3) 3 NA false HENDRICK ANESTHESIA NETWORK PO BOX 3117 ABILENE TX 79604 752728889 ANESTHESIA TX 501(C) (3) 10 HMC true HENDRICK HOSPICE CARE PO BOX 3117 ABILENE TX 79604 751835287 HOSPICE CARE TX 501(C) (3) 10 HMC true HMC HOSPICE PROPERTIES PO BOX 3117 ABILENE TX 79604 814244839 PROPERTY MGMT TX 501(C) (3) 12A, TYPE 1 HMC true HENDRICK MEDICAL CENTER FOUNDATION PO BOX 3117 ABILENE TX 79604 237413284 FUNDRAISING TX 501(C) (3) 7 HMC true HENDRICK MEDICAL CENTER BROWNWOOD 1900 PINE ST ABILENE TX 79601 851941193 HEALTHCARE TX 501(C) (3) 3 HMC true HENDRICK SURGERY CENTER LLC PO BOX 3117 ABILENE TX 79604 811804826 SURGERY CENTER TX HMC RELATED false false HENDRICK DIALYSIS CENTER 1900 PINE ST ABILENE TX 79601 834206582 DIALYSIS CENTER TX HMC RELATED false false TEXAS MIDWEST SURGERY CENTER 751 N 18TH STREET ABILENE TX 79601 752800127 SURGERY CENTER TX HMC RELATED false false HENDRICK HEALTH NETWORK PO BOX 3117 ABILENE TX 79604 721619011 HEALTH INSURANCE TX HMC C-CORPORATION true HENDRICK SOUTHWESTERN HEALTH DEV CORP PO BOX 3117 ABILENE TX 79604 751598794 RETAIL SALES TX HMC C-CORPORATION true false false true false false false false false false false true false false false false false false false false