2021-08-09T16:59:52-05:00 2020-09-30 BKD LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2019-10-01 752717782 JPS Foundation % EDWIN LEFFALL JPSF 8177021052 1350 S Main Street Suite 4000 Fort Worth TX 76104 SHARON CLARK SENIOR EVP/CFO TCHD 1111111111 2021-08-16 true Jeanette Verrelli P00742631 9727028262 2019 2022-09-23 18:48:47Z ROBERT EARLEY 1350 S MAIN STREET STE 4000 FORT WORTH TX 76104 3933870 false X WWW.JPSHEALTHNET.ORG/ABOUT-JPS/JPS-FOUNDATION X 1997 TX JPS FOUNDATION IS A NONPROFIT WHOSE PURPOSE IS TO PERFORM SERVICES ON BEHALF OF THE TARRANT COUNTY HOSPITAL DISTRICT, INCLUDING ... (CONTINUED ON SCHEDULE O) 9 9 0 8 0 0 2672238 3586338 122400 108141 104926 92733 -44128 12897 2855436 3800109 819633 801240 0 0 0 0 0 0 0 976421 1719328 1796054 2520568 1059382 1279541 5096553 6248402 325716 108493 4770837 6139909 JPS FOUNDATION IS A PUBLIC/PRIVATE COLLABORATION DEDICATED TO ACTS OF SERVICE AND SUPPORT TO IMPROVE THE HEALTH STATUS OF FAMILIES RECEIVING HEALTH CARE VIA JPS HEALTH NETWORK. IT IS THE FOUNDATION FOR JPS HEALTH NETWORK. false false 2449632 801240 108141 FOR THE YEAR ENDED SEPTEMBER 30, 2020, HEALTH AND HUMAN ASSISTANCE SERVICES WERE PROVIDED FOR PATIENTS AND EMPLOYEES OF THE TARRANT COUNTY HOSPITAL DISTRICT DBA JPS HEALTH NETWORK (TCHD) THROUGH PATIENT ASSISTANCE, DENTAL VOUCHERS, AND EMPLOYEE GIVING CAMPAIGN. JPS FOUNDATION ALSO PROVIDES SUPPORT FOR ACTIVITIES OF TCHD, THE SUPPORTED ORGANIZATION, INCLUDING CAPITAL PROJECTS AND OTHER PROGRAMS. 2449632 true true false false false true false false false true true false false false true false true true false false false false false false true false false true true true false false false false false false false false true true false false false true true true false false true 21 0 0 false false false false false true false false false false false false false false false false X 9 9 false false false false false true false true true false false true true true true true true false false false X EDWIN LEFFALL 8177027308 1350 S MAIN STREET STE 4000 FORT WORTH TX 76104 ROBERT EARLEY PRESIDENT AND CEO TCHD 2.0 38.0 X 0 1471904 164299 JILL LABBE SVP COMMUNITY AFFAIRS & DEVELO 28.0 12.0 X 0 326768 25214 KRISTIN SULLIVAN EXECUTIVE DIRECTOR END: 11/19 40.0 0.0 X 0 174713 17118 WILLIAM KINGSTON VP PHILANTHROPY AND COMM. DEV 0.0 0.0 X 0 110307 3101 BOB HERCHERT DIRECTOR 1.0 0.0 X 0 0 0 GLORIA STARLING DIRECTOR 1.0 0.0 X 0 0 0 JACK JACKSON SECRETARY 1.0 0.0 X X 0 0 0 JOHN MURPHEY VICE CHAIRMAN 1.0 0.0 X X 0 0 0 TODD TRUITT TREASURER 1.0 0.0 X X 0 0 0 JUDGE B GLEN WHITLEY DIRECTOR 1.0 0.0 X 0 0 0 LARRY ANFIN DIRECTOR 1.0 0.0 X 0 0 0 MAYOR LAURA WHEAT CHAIRMAN 1.0 0.0 X X 0 0 0 AMANDA ARIZOLA JPS BOARD OF MANAGERS LIAISON 1.0 0.0 X 0 0 0 0 2083692 209732 0 true true false 0 10551 362163 53620 3160004 442671 3586338 OPERATING REVENUE 624100 108141 108141 108141 88342 88342 0 0 0 0 0 111749 107358 4391 4391 4391 39300 10551 26403 12897 12897 0 0 0 0 0 0 0 3800109 108141 105630 X 441952 441952 359288 359288 0 0 0 0 0 0 0 0 0 0 0 0 0 18076 18076 959611 958299 1312 46 46 192303 177881 14422 0 0 24244 23821 423 19129 19129 0 3683 3683 0 0 131 131 0 EQUIPMENT EXPENSE 152165 152165 COMMUNITY RELATIONS 35325 34825 500 TRAINING EXPENSE 189975 181627 8348 RESEARCH & DEVELOPMENT 73440 73440 51200 23522 27678 2520568 2449632 70936 0 0 0 2667576 3781933 55119 5849 50628 18851 0 0 0 0 0 0 0 0 38967 26883 23829 23696 265 133 2273151 2406400 0 0 0 0 0 0 10847 8353 5096553 6248402 39613 4722 0 0 200000 3300 0 0 0 0 0 0 0 0 0 0 86103 100471 325716 108493 X 2257704 2744770 2513133 3395139 4770837 6139909 5096553 6248402 1279541 89531 X X false true X false false X X 1 TARRANT COUNTY HOSPITAL DISTRICT 756000439 6 true 2449632 0 1 2449632 true false false false false false false false false false false false false false false true false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 250100 236233 false false 512446 1025 30036 5976 537531 417876 62173 38333 5936 512446 405535 17711 5370 417876 379865 30700 5030 405535 364987 20484 5606 379865 0.75000 0.25000 false false 23829 23696 133 133 0 Due to affiliates 100471 100471 4920714 89531 1004671 1094202 3826512 -26403 -26403 3800109 3551642 1004671 26403 1031074 2520568 2520568 SCHEDULE D, PART V, LINE 4 INTENDED USE OF ENDOWMENT FUNDS: THE PERMANENTLY RESTRICTED NET ASSETS OF JPS FOUNDATION REPRESENT FUNDS RESTRICTED BY THE DONOR TO ESTABLISH A PERMANENT ENDOWMENT. THE INCOME FROM THE ALCON OPHTHALMOLOGY ENDOWMENT IS FOR THE OPHTHALMOLOGY TEACHING PROGRAM AT JPS. THE INCOME FROM THE HEALING WINGS ENDOWMENT WAS ESTABLISHED FOR THE ONGOING PRESERVATION OF THE HEALING WINGS UNIT. THE MEDICAL LIBRARY ENDOWMENT MAY BE SPENT ON EQUIPMENT AND MATERIALS TO IMPROVE THE MEDICAL LIBRARY. THE INCOME FROM THE JPS HEALTH NETWORK ENDOWMENT FOR PODIATRIC RESIDENCY IS ALLOCATED 25% TO UNRESTRICTED FUNDS TO SUPPORT THE OVERALL MISSION OF THE FOUNDATION AND 75% TO SUPPORT THE JPS PODIATRIC RESIDENCY PROGRAM. SCHEDULE D, PART X, LINE 2 ASC 740 FOOTNOTE: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUE PER AUDITED FINANCIALS WITH RETURN: FUNDRAISING EXPENSES $(26,403) SCHEDULE D, PART XII, LINE 2D RECONCILIATION OF EXPENSES PER AUDITED FINANCIALS WITH RETURN: FUNDRAISING EXPENSES $26,403 Rhythm & Roman 49851 10551 39300 6553 16366 1800 1684 0 49851 10551 39300 6553 16366 1800 1684 26403 12897 true TARRANT COUNTY HOSPITAL DISTRICT 1500 S MAIN STREET FORT WORTH TX 76104 756000439 501(C)(3) 441952 Improve health status of community 1 PATIENT ASSISTANCE 501 3869 EMPLOYEE ASSISTANCE 15 7103 PATIENT TRANSPORTATION 4491 31088 ACA CONNECTION SUPPLEMENTAL TO INSURANCE 2266 317228 SCHEDULE I, PART I, LINE 2 MONITORING USE OF GRANT FUNDS IN THE UNITED STATES: PATIENT ASSISTANCE FOR MEDICAL TREATMENT, TRANSPORTATION AND SUPPLIES - FUNDS ARE AVAILABLE TO HELP JPS PATIENTS WITH TRANSPORTATION, MEDICAL TREATMENT AND SUPPLY COSTS, SUCH AS WHEELCHAIR RENTALS, NEBULIZERS, DIABETIC EQUIPMENT, BATH CHAIRS, MEDICAL BEDS, ETC. REQUESTS FOR DISTRIBUTIONS FROM THESE FUNDS ARE SUBMITTED FROM THE SOCIAL SERVICES DEPARTMENT TO JPS FOUNDATION. UPON RECEIPT, THE REQUESTS ARE REVIEWED AND APPROVED BY THE MANAGEMENT AT JPS FOUNDATION FOR CHECK DISBURSEMENT. A LOG OF GAS CARDS, BUS PASSES AND TAXI VOUCHERS IS REVIEWED MONTHLY BY THE Foundation ACCOUNTANT. EMPLOYEE EMERGENCY ASSISTANCE - IN ORDER FOR A JPS EMPLOYEE TO SUBMIT AN APPLICATION FOR EMERGENCY ASSISTANCE, THEY MUST MEET THE CRITERIA OF (1) FULL TIME EMPLOYMENT AT JPS FOR AT LEAST SIX MONTHS OR PART TIME FOR ONE YEAR, (2) NO DISCIPLINARY ACTIONS WITHIN THE LAST TWELVE MONTHS OR CURRENTLY UNDER INVESTIGATION WITH ANY MAJOR AREA OF CONCERN, AND (3) SITUATION MUST BE A NATURALLY OCCURRING EMERGENCY OR CATASTROPHE (FIRE, FLOOD, TORNADO, ETC). APPLICATIONS FOR EMERGENCY ASSISTANCE ARE SUBMITTED TO THE JPS FOUNDATION AND FORWARDED TO A REVIEW COMMITTEE AND A MAJORITY DECISION VOTE IS MADE TO APPROVE OR REJECT THE APPLICATION. APPROVED APPLICATIONS ARE FORWARDED TO THE ACCOUNTANT FOR PAYMENT OF EMERGENCY EXPENSES FROM THE FUND. ASSISTANCE IS MADE BY PAYING BILLS DIRECTLY, PROVIDING GROCERY VOUCHERS, ETC. IT IS INTENDED TO HELP WITH LIFE SUSTAINING OR ESSENTIAL EXPENSES. TYPICALLY, LIFE SUSTAINING OR ESSENTIAL INCLUDES UTILITIES, CAR PAYMENT, HOUSE PAYMENT, APARTMENT RENT, TRAVEL (TO ATTEND FUNERAL OR REACH BEDSIDE OF TERMINALLY ILL FAMILY MEMBER), FOOD, ETC. DIRECT PAYMENTS TO THE EMPLOYEE TYPICALLY ARE NOT DONE. THE MAXIMUM AMOUNT OF ASSISTANCE PER EMPLOYEE IN AN EIGHTEEN MONTH PERIOD IS $500. WEEKLY, THE JPS HEALTH NETWORK WILL DONATE FUNDS TO THE FOUNDATION TO COVER ELIGIBLE PATIENT EXPENSES. THE NETWORK ESTABLISHED THE JPS CONNECTION PROGRAM TO ASSIST INDIVIDUALS WHO NEED MEDICAL ASSISTANCE BUT ARE WITHOUT THE FINANCIAL MEANS TO AFFORD NECESSARY MEDICAL SERVICES. THE NETWORK WILL IDENTIFY A PORTION OF THE NETWORK'S ELIGIBLE JPS CONNECTION POPULATION WHO ARE ELIGIBLE FOR ENROLLMENT AND/OR MAY ENROLL IN THE FUTURE IN A QUALIFIED HEALTH PLAN OR STAND ALONE DENTAL PLAN AND LACK THE FINANCIAL RESOURCES FOR PAYMENT OF THE REQUIRED INSURANCE PREMIUMS AND OTHER ELIGIBLE PATIENT EXPENSES. ONLY THE PATIENTS' NEED AND NOT THEIR HEALTH STATUS IS CONSIDERED. ASSISTANCE, WHERE APPLICABLE, MUST COVER THE ENTIRE POLICY YEAR, BE PROVIDED IN AMOUNTS THAT ARE CONSISTENT WITH APPLICABLE FAIR MARKET VALUE, AND BE CONSISTENT WITH APPLICABLE NETWORK POLICIES AND PROCEDURES. PAYMENTS ARE THEN WIRED WEEKLY FROM THE FOUNDATION TO VARIOUS PHYSICIAN NETWORKS THAT PROVIDE SERVICES TO THESE PATIENTS. true false false false false false false false false ROBERT EARLEY PRESIDENT AND CEO TCHD 0 826912 0 389801 0 255191 0 131293 0 33006 0 1636203 WILLIAM KINGSTON VP PHILANTHROPY AND COMM. DEV 0 85729 0 0 0 24578 0 0 0 3101 0 113408 KRISTIN SULLIVAN EXECUTIVE DIRECTOR END: 11/19 0 143826 0 0 0 30887 0 6579 0 10539 0 191831 JILL LABBE SVP COMMUNITY AFFAIRS & DEVELO 0 230227 0 62932 0 33609 0 15738 0 9476 0 351982 Schedule J, Part I, Line 3 EXECUTIVE COMPENSATION: THE TARRANT COUNTY HOSPITAL DISTRICT, A RELATED ORGANIZATION, DETERMINES COMPENSATION OF THE FOUNDATION'S EXECUTIVE DIRECTOR THROUGH THE USE OF the following: - Compensation surveys or studies - approval by the board or compensation committee SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENT: WILLIAM KINGSTON RECEIVED A PAYMENT OF $19,232 FOR A SEVERANCE PERIOD OF 4 WEEKS. KRISTIN SULLIVAN RECEIVED A PAYMENT OF $26,925 FOR A SEVERANCE PERIOD OF 8 WEEKS. X 1 500 FMV X 1815 FMV X 184399 FMV X 129 100247 FMV X 72 155710 FMV false true false SCHEDULE M, PART I, COLUMN B NUMBER OF CONTRIBUTIONS OR ITEMS RECEIVED: THE AMOUNTS REPORTED IN THIS COLUMN ARE THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART I, LINE 1 ORGANIZATION'S MISSION: CONTINUED FROM FORM 990, PART I... ORGANIZING FUNDRAISING ACTIVITIES, PROVIDING PATIENT ASSISTANCE PROGRAMS, PARTICIPATING IN RECRUITING FUNCTIONS AND CONDUCTING ADMINISTRATIVE SERVICES. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OR STOCKHOLDERS WHO CAN ELECT MEMBERS OF THE GOVERNING BODY: AT ALL TIMES THE JPS FOUNDATION BOARD WILL CONSIST OF MEMBERS OF THE TCHD BOARD, THE TCHD CEO AND PERSONS SELECTED BY THE TCHD CEO. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: FORM 990 IS REVIEWED BY THE SENIOR EXECUTIVE V.P. OF FINANCE AT TARRANT COUNTY HOSPITAL DISTRICT AND CONTROLLER PRIOR TO SUBMISSION. AN ELECTRONIC VERSION WILL BE PROVIDED TO THE BOARD MEMBERS AND THE SVP OF COMMUNITY AFFAIRS & DEVELOPMENT FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: MEMBERS ARE ASKED TO DISCLOSE, ANNUALLY, ANY BUSINESS RELATIONSHIPS THAT POTENTIALLY GIVE RISE TO CONFLICTS. ANY CONFLICTS THAT ARISE ARE RESOLVED AT THE BOARD LEVEL. IN THE EVENT OF A CONFLICT, THE BOARD MEMBER ABSTAINS FROM VOTING AND DISCUSSION OF THE RELATED MATTER. FORM 990, PART VI, SECTION B, LINE 15A REVIEW OF CEO OR TOP MGMT OFFICIAL COMPENSATION: NO COMPENSATION IS PAID BY JPS FOUNDATION. COMPENSATION IS PAID THROUGH TARRANT COUNTY HOSPITAL DISTRICT WHICH REVIEWS, APPROVES, AND SETS ALL SALARIES. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FINANCIAL STATEMENTS ARE ALSO AVAILABLE ON THE JPS HEALTH NETWORK WEBSITE. FORM 990, PART XII, LINE 2C COMMITTEE RESPONSIBLE OVER THE AUDIT: TARRANT COUNTY HOSPITAL DISTRICT, A RELATED ORGANIZATION, HAS THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL SERVICES TOTAL FEES:849610 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:48617 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTATION FEES TOTAL FEES:45000 FORM 990 PART IX LINE 11G DESCRIPTION:OUTSIDE SERVICES TOTAL FEES:16384 TARRANT COUNTY HOSPITAL DISTRICT 1500 SOUTH MAIN STREET FORT WORTH TX 76104 756000439 HEALTHCARE TX 501(C)(3) 3 NA false ACCLAIM PHYSICIAN GROUP 200 W MAGNOLIA AVE SUITE 201 FORT WORTH TX 761047644 352526373 HEALTHCARE TX 501(C)(3) 3 TCHD true false true true false false false false false false false false true false true true true true true false Acclaim Physician Group R 342790 FMV