2020-06-26T15:13:29-05:00 2019-06-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE STE 4000 INDIANAPOLIS IN 46204 990 2018-07-01 751976930 Mother Frances Hospital - Jacksonville % SHELLY RUTHERFORD MOTH 9036065639 1315 DOCTORS DRIVE TYLER TX 75701 ELIZABETH PULLIAM VP 9036065639 2020-06-25 true JANICE K MARTIN P00900299 3176817000 104.59.202.31 35057220201785000004 2020-06-26 P E640DDFFD70912175ABAA4BDED726C42A4EA1B76 4649FBF9538438D828890CF76278F3989A1FB147 2018 2020-09-23 17:36:50Z SEE SCHEDULE O JASON PROCTOR 1315 DOCTORS DRIVE TYLER TX 75701 57432781 false X WWW.TMFHC.ORG/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. 7 3 0 3 0 0 46665 0 50781897 55863072 0 0 43080 1569709 50871642 57432781 383000 391402 0 0 18156684 19785468 0 0 0 21986954 25864107 40526638 46040977 10345004 11391804 19716809 27539796 5409872 1841055 14306937 25698741 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 34313643 391402 55863072 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 17,781 VISITS TO OUR EMERGENCY DEPARTMENTS, 83 INPATIENT SURGERY PROCEDURES, 517 OUTPATIENT SURGERY PROCEDURES, 980 PATIENTS WHO WERE ADMITTED TO OUR HOSPITALS FOR CARE, AND 67,428 PATIENTS WHO RECEIVED OUTPATIENT CARE. CHRISTUS TRINITY MOTHER FRANCES 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 Trinity Mother Frances Health System 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). 34313643 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 7 3 true false false false true true true true true false false true true true true true true true true false X SHELLY RUTHERFORD 9036065057 1315 DOCTORS DRIVE TYLER TX 75701 Randy Gorham Director 5.0 0.0 X 0 0 0 GLEN HAMILTON DIRECTOR/Vice ChairPerson 9.0 0.0 X X 0 0 0 ANNE PILEGGI DIRECTOR/SECRETARY/ASSOC. VP 9.0 0.0 X X 0 240290 6258 JASON PROCTOR CHAIRPERSON/PRESIDENT 5.0 35.0 X X 0 522987 113462 PETER SIRIANNI MD DIRECTOR 6.0 34.0 X 0 1676583 45022 Scott Smith MD Director 5.0 35.0 X 0 983696 155426 DICK STONE DIRECTOR 9.0 0.0 X 0 0 0 ELIZABETH PULLIAM VP 4.0 36.0 X 0 452473 71254 J Lindsey Bradley Sys Pres (Term 6/17) 0.0 0.0 X 0 843286 0 CHRIS GLENNEY DIRECTOR/CHAIR (TERM 11/17) 3.0 0.0 X 0 1666029 315046 TODD HANCOCK DIRECTOR (TERM 2/17) 0.0 0.0 X 0 1171176 204302 0 7556520 910770 0 true true false MCKESSON DRUG CONROE 3301 POLLOK DR CONROE TX 77303 DRUGS 856791 MEDTRONIC USA INC 710 MEDTRONIC PARKWAY MINNEAPOLIS MN 55432 MEDICAL SUPPLIES 682819 NOVITAS SOLUTIONS 2020 TECHNOLOGY PARKWAY SUITE 100 MECHANICSBURG PA 17050 MEDICARE 344112 STRYKER SALES CORPORATION 1901 ROMENCE ROAD PARKWAY PORTAGE MI 49002 MEDICAL SUPPLIES 198313 SIEMENS MEDICAL SOLUTIONS USA INC 40 LIBERTY BOULEVARD MALVERN PA 19355 EDUCATIONAL MATERIAL 158113 10 0 0 0 NET PATIENT REVENUE 621110 54546386 54546386 0 0 RENTAL REVENUE 532000 67360 67360 0 0 PHARMACY REVENUE 446110 1249326 1249326 0 0 55863072 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CAFETERIA 722514 1310 0 0 1310 ALL OTHER REVENUE 900099 1568399 0 0 1568399 1569709 57432781 55863072 0 1569709 391402 391402 0 0 0 0 0 0 0 0 0 0 0 0 0 0 17420052 15608367 1811685 0 0 0 0 0 1583424 1303475 279949 0 781992 652572 129420 0 5048697 0 5048697 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2684477 1859269 825208 0 0 0 0 0 3033607 1000180 2033427 0 0 0 0 0 0 0 0 0 523041 38130 484911 0 12401 0 12401 0 0 0 0 0 22310 0 22310 0 4082 4082 0 0 0 0 0 0 728683 74253 654430 0 380547 0 380547 0 BAD DEBT EXPENSE 6307057 6307057 0 0 MEDICAL SUPPLIES 6040156 6015391 24765 0 SUBSCRIPTIONS 19584 0 19584 0 COMMUNITY BENEFIT 1055284 1055284 0 0 4181 4181 46040977 34313643 11727334 0 0 0 34591 0 0 0 0 3582396 4548560 0 0 0 0 0 337 200760 264745 38473 6267 4874748 1600734 2757471 3274014 0 0 0 0 0 0 0 0 13137709 19411282 19716809 27539796 1899749 1687468 0 0 910 0 0 0 0 0 0 0 0 0 0 0 3509213 153587 5409872 1841055 X 14306937 25698741 0 0 0 0 14306937 25698741 19716809 27539796 11391804 0 0 0 0 X false true X true true true X 3676633 10000 206545 10120 3883058 3522036 30000 200996 76399 3676633 3185371 0 345766 9101 0 0 3522036 2885950 445000 -118741 26838 0 0 3185371 2762072 0 124878 1000 0 0 2885950 0.69110 0.30890 false true true 0 812181 92183 719998 4062567 1508551 2554016 3274014 DUE FROM AFFILIATES 19411282 19411282 0 CAPITAL LEASE 102701 LIABILITY INDEMNITY RESERVE 12783 NOTES PAYABLE 38103 153587 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, 2019 AND 2018. true true X true X 300. true X true true false true true 2440123 2440123 0.06140 2601952 3594201 0.00000 88964 81433 7531 0.00020 5131039 3675634 2447654 0.06160 4 1678 9769 9769 0.00020 5 2142 57927 57927 0.00150 9 3820 67696 67696 0.00170 9 3820 5198735 3675634 2515350 0.06330 1 1222 31599 31599 0.00080 1 1222 31599 31599 0.00080 true 6307057 30905 16618589 15265382 1353207 X true true 1 1 MOTHER FRANCES HOSPITAL-JACKSONVILLE 1026 JACKSON STREET JACKSONVILLE TX 75766 WWW.TMFHC.ORG 007254 X X X X MOTHER FRANCES HOSPITAL-JACKSONVILLE 1 false false true X X X X X X X X X 19 true false 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 true true 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 B, LINE 3e MOTHER FRANCES HOSPITAL-JACKSONVILLE IDENTIFIED AND ADDRESSED THE FOLLOWING PRIORITIES THROUGH ITS IMPLEMENTATION PLAN: 1) ACCESS TO PRIMARY CARE SERVICES 2) NEED FOR INCREASED EMPHASIS ON COLLABORATIVE CONTINUUM OF CARE 3) PREVENTION, EDUCATION, AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC CONDITIONS, AND UNHEALTHY LIFESTYLES 4) ACCESS TO SPECIALTY CARE SERVICES 5) ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE 6) ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS SCHEDULE H, PART V, SECTION B, LINE 5 REPRESENTATIVES FROM THE COMMUNITY: MOTHER FRANCES HOSPITAL-JACKSONVILLE CONDUCTED 48 INTERVIEWS WITH THE TWO GROUPS OUTLINED IN IRS FINAL REGULATIONS ISSUED DECEMBER 29, 2014. DURING THESE INTERVIEWS THE HOSPITAL DISCUSSED THE HEALTH NEEDS OF THE COMMUNITY, ACCESS ISSUES, BARRIERS AND ISSUES RELATED TO SPECIFIC POPULATIONS. THE INTERVIEWEES INCLUDED, BUT WERE NOT LIMITED TO, INDIVIDUALS FROM THE FOLLOWING ORGANIZATIONS: TYLER FAMILY CIRCLE OF CARE CLINICS, ST. PAUL CHILDREN'S FOUNDATION, WHISPERING PINES NURSING HOME, LITERACY COUNCIL OF TYLER, NORTHEAST TEXAS CHILD ADVOCACY CENTER, BETHESDA HEALTH CLINIC, YOUR PHILANTHROPY, EAST TEXAS HUMAN NEEDS NETWORK, PEOPLE ATTEMPTING TO HELP (PATH), SAMARITAN COUNSELING CENTER, AND EAST TEXAS COUNCIL OF GOVERNMENTS AREA AGENCY ON AGING. ADDITIONALLY, A SURVEY WAS SENT TO A SELECT GROUP OF 940 INDIVIDUALS/ORGANIZATIONS WHO ARE MEMBERS OF THE EAST TEXAS HUMAN NEEDS NETWORK (ETHNN) ON BEHALF OF CTMFHS. THE SURVEY ASKED QUESTIONS RELATED TO HEALTH PROBLEMS, BARRIERS FOR LOW INCOME RESIDENTS, AND HEALTH EDUCATION. THE MAJORITY OF RESPONDENTS WORKED FOR A NOT FOR PROFIT ORGANIZATION. PART V, SECTION B, LINES 7A THE URL FOR THE ORGANIZATION'S MOST RECENTLY ADOPTED COMMUNITY HEALTH NEEDS ASSESSMENT IS: https://www.christushealth.org/-/media/files/chip/christus-tmf-jacksonvill e-chna--chip-2016.ashx?la=en SCHEDULE H, PART V, SECTION B, LINE 7B THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT THE FOLLOWING WEBSITE: https://www.christushealth.org/about/donate/community-health/community-hea lth-needs-assessment-and-implementation-plan 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/files/chip/christus-tmf-jacksonvill e-chna--chip-2016.ashx?la=en SCHEDULE H, PART V, SECTION B, LINE 11 NEEDS IDENTIFIED IN CHNA ADDRESSED AND NOT ADDRESSED: MOTHER FRANCES HOSPITAL-JACKSONVILLE IDENTIFIED AND ADDRESSED THE FOLLOWING PRIORITIES THROUGH ITS IMPLEMENTATION PLAN: 1) ACCESS TO PRIMARY CARE SERVICES 2) NEED FOR INCREASED EMPHASIS ON COLLABORATIVE CONTINUUM OF CARE 3) PREVENTION, EDUCATION, AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC CONDITIONS, AND UNHEALTHY LIFESTYLES 4) ACCESS TO SPECIALTY CARE SERVICES 5) ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE 6) ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS PROPOSED COMMUNITY PROGRAMS INCLUDE: 1) COLLABORATION WITH CHRISTUS MOTHER FRANCES HOSPITAL-TYLER FOR THE CONTINUED MAINTENANCE OF THE MEDICAID WAIVER PROGRAMS 2) CANCER AWARENESS AND PREVENTION ACTIVITIES THROUGH CANCER RELAY FOR LIFE 3) COLLABORATION WITH LOCAL NON-PROFIT COMMUNITY GROUPS PROVIDING ESSENTIAL SERVICES 4) PREVENTION SCREENING AND WELLNESS PROGRAMS AT THE COUNTY FAIR 5) PROVIDING SUPPORT FOR RURAL AREA MEDICAL SERVICES RELATED TO KID'S SAFETY ISSUES AND EMS SERVICES 6) COLLABORATION WITH FAMILY CIRCLE OF CARE THE HOSPITAL DECIDED NOT TO SPECIFICALLY ADDRESS "ACCESS TO DENTAL SERVICES" LARGELY DUE TO ITS POSITION (LAST) ON THE PRIORITIZED LIST AND THE HOSPITAL'S CAPACITY TO ADDRESS THAT NEED. DENTAL SERVICES ARE NOT CORE BUSINESS FUNCTIONS OF THE HOSPITAL. HOSPITAL LEADERSHIP FELT THAT RESOURCES AND EFFORTS WOULD BE BETTER SPENT ADDRESSING THE FIRST SIX PRIORITIZED NEEDS. 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 B, 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: http://www.tmfhc.org/patients-visitors/financial-assistance SCHEDULE H, PART V, SECTION B, LINE 16J HOW THE HOSPITAL FACILITY PUBLICIZES THE FINANCIAL ASSISTANCE POLICY THE HOSPITAL POSTED SIGNS TO INFORM PATIENTS ABOUT THE AVAILABILITY OF CHARITY CARE IN THE EMERGENCY DEPARTMENT, LOBBY, AND ADMISSIONS AREAS. (THE SIGNS DID NOT SPECIFICALLY REFERENCE THE POLICY (FAP), WHICH IS WHY THE HOSPITAL DID NOT SELECT "YES" IN RESPONSE TO LINE 16F). IN ADDITION, 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 22D 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 THE AVERAGE REIMBURSEMENT RATE FOR THE RELEVANT SERVICE LINE. PATIENTS ELIGIBLE FOR ADDITIONAL FINANCIAL ASSISTANCE WERE CHARGED 70% OF THE AVERAGE RATE (FOR INCOME LEVELS FROM 301% TO 400% OF FPL), 50% OF THE AVERAGE RATE (FOR INCOME LEVELS FROM 201% TO 300% OF FPL) OR RECEIVED FREE CARE (INCOMES BELOW 200% 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 $46,040,977. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT IS $6,307,057. THIS LEAVES A TOTAL EXPENSE OF $39,733,920 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 13.08%, 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 $57,927 IN CASH AND IN KIND CONTRIBUTIONS DURING FISCAL YEAR 2019. 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 2019, 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% 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, 2019, 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 0.6% 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 PRESEUMPTIVE ELIGIBILITY IN THE FISCAL YEAR ENDING JUNE 30, 2019. THUS, THE ORGANIZATION ESTIMATES THAT ONLY 3.73% OF THE BAD DEBT EXPENSES IN FISCAL YEAR ENDING JUNE 30, 2018 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. 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. THE SYSTEM CONSIDERS CRITICAL ACCOUNTING POLICIES TO BE THOSE THAT REQUIRE MORE SIGNIFICANT JUDGMENTS AND ESTIMATES IN THE PREPARATION OF ITS FINANCIAL STATEMENTS, INCLUDING THE FOLLOWING: RECOGNITION OF NET PATIENT SERVICE REVENUES, WHICH INCLUDE CONTRACTUAL ALLOWANCES; AND THE PROVISIONS FOR BAD DEBT; ESTIMATES FOR REIMBURSEMENT UNDER THE UPPER PAY LIMIT, DISPROPORTIONATE SHARE MEDICAID 1115 WAIVER PROGRAMS; RESERVES FOR LOSSES AND EXPENSES RELATED TO HEALTH CARE PROFESSIONAL AND GENERAL ABILITIES; ACCRUALS FOR CLAIMS INCURRED BUT NOT YET REPORTED RELATED TO THE SYSTEM'S HEALTH PLANS; DETERMINATION OF FAIR VALUES OF CERTAIN FINANCIAL INSTRUMENTS; DETERMINATION OF FAIR VALUE OF CERTAIN GOODWILL AND LONG-LIVED ASSETS, INCLUDING ASSETS ACQUIRED; AND RISKS AND ASSUMPTIONS FOR MEASUREMENT OF PENSION AND RETIREE MEDICAL LIABILITIES. 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 GOALD 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 join 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 MOTHER FRANCIS 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 ASSITANCE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION Mother Frances Hospital-Jacksonville is a 25-bed acute care medicare certified critical access hospital. Cherokee County, the primary service area for MFH-Jacksonville, has a population of approximately 57,000 and is primarily 48,000 in a 1,052 square mile. The median income of Cherokee County is $38,465. THE secondary service area includes the southern part of Smith County. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH 1. Name: Cherokee County Relay for Life Description: Provided in-kind donations and staffing support for Cherokee County Relay for Life. Staff raised funds for cancer awareness throughout the year and sold food at the event. Purpose: To increase awareness about cancer and to help in fundraising efforts for a county that has an above average rate of cancer. Educational programs targeted the community at large but efforts were made to reach the uninsured. 2. Name: Jacksonville Chamber of Commerce Job Shadowing Description: Students participate in job shadowing projects throughout the year and learn from professionals the 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 projected shortages of workers in all areas. 3. Name: Jacksonville Rodeo Description: Handed out fans and water to participants and spectators at the rodeo. Provided volunteers to interact on issues for 3 hours each of 3 nights. Purpose: To help educate participants about the dangers of heat and injuries caused by extensive heat. Reached over 500 people with heat prevention information and medical support on site. 4. Name: 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 Breast Cancer Awareness. 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. 5. Name: Health Education Programs Description: Community education for healthy life styles focused to Women with Heart Disease was provided. Dinner and recognition for women across the region who were selected as champions for women affected by heart disease were recognized. Health fair and screenings were also done at the Tomato Fest, Methodist Church Health Fair, Our Lady of Sorrows Catholic Church Health Festival, and the Cherokee County Co-Op Health Fair. Purpose: East Texas has an extremely high rate for diabetes, stroke, heart disease, and pulmonary disease. This east Texas region of the state has one of the fastest growing aging groups and high risk for ethnic minorities. The need to educate women on heart disease was targeted. 6. Name: Community Non Profits and Rural Hospital Support Programs Description: Mother Frances Hospital - Jacksonville provides direct financial support to not-for-profit organizations including the Chamber of Commerce, American Cancer Society, Rotary, The Crisis Center of Cherokee and Anderson Counties, and Literary Council. 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 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 MFH-JACKSONVILLE or it may be too far for their patients to travel to receive services at our primary facilities. 7. Name: Fundraising for not-for-profits Description: MFH-Jacksonville supports the United Fund Drive with an in-house program as well as Childrens Miracle Network by raising money through direct financial donations, bake sales, jean days, special lunch offerings, etc. Purpose: The goal is to raise money for services that otherwise would not be available for the community unless these monies were raised. The programs often target those less fortunate or have open door policies for all those who need the care. Additionally, these programs provide new leadership opportunities for the staff. crisis for blood and supporting those needs is a way of giving back to our community and our transfer receiving hospitals. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM Mother Frances Hospital - Jacksonville is part of an affiliated health care system called CHRISTUS Trinity Mother Frances Health System. CHRISTUS Trinity Mother Frances is a faith-based organization dedicated to creating healthy lives for people and communities. MFH-Jacksonville and its affiliates promote the health of the communities served by providing acute care facilities and critical access facilites, 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 X X X X true true false false false false false false false ANNE PILEGGI DIRECTOR/SECRETARY/ASSOC. VP 188123 49262 2905 0 0 0 6258 0 246548 0 0 JASON PROCTOR CHAIRPERSON/PRESIDENT 368906 149668 4413 0 95907 0 17555 0 636449 0 0 PETER SIRIANNI MD DIRECTOR 1587578 1464 87541 0 12375 0 32647 0 1721605 0 0 Scott Smith MD Director 596969 361727 25000 0 129079 0 26347 0 1139122 0 0 ELIZABETH PULLIAM VP 313194 129125 10154 0 58627 0 12627 0 523727 0 0 J Lindsey Bradley Sys Pres (Term 6/17) 843286 0 0 0 0 0 843286 0 0 CHRIS GLENNEY DIRECTOR/CHAIR (TERM 11/17) 639605 1013387 13037 0 294769 0 20277 0 1981075 0 0 TODD HANCOCK DIRECTOR (TERM 2/17) 433569 712364 25243 0 180254 0 24048 0 1375478 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 INDIVIDUALS ROLE AS AN OFFICER OR EMPLOYEE OF THE ORGANIZATION, NOT FOR THE INDIVIDUALS 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 2018: J. LINDSEY BRADLEY RECEIVED $843,286 AS A SEVERANCE PAYMENT DURING CALENDAR YEAR 2018. 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. 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 2018. 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 DEANNA HAMILTON HAVE A FAMILY RELATIONSHIP. GLEN HAMILTON AND RANDY GORHAM, BOTH HAVE INVESTMENT ACCOUNTS WITH DICK STONE. FORM 990, PART VI, LINE 6 MEMBER OR STOCKHOLDERS CHRISTUS TRINITY MOTHER FRANCES HEALTH SYSTEM 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 TRINITY MOTHER FRANCES HEALTH SYSTEM, 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 2020 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 SILILARLY 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 SECRETARYS COMPENSATION IS NOT REVIEWD 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. MOTHER FRANCES HOSP REGIONAL HC CENTER 1315 DOCTORS DRIVE TYLER TX 75701 750818167 HOSPITAL TX 501(c)(3) 3 CTMFHS true CHRISTUS-TRINITY MOTHER FRANCES FDN 1315 DOCTORS DRIVE TYLER TX 75701 752028241 SUPPORT TX 501(c)(3) 12-TYPE I CTMFHS true CHRISTUS TRINITY MF HEALTH SYSTEM 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 CTMFHS true MOTHER FRANCES HOSPITAL - WINNSBORO 1315 DOCTORS DRIVE TYLER TX 75701 752771569 HOSPITAL TX 501(c)(3) 3 CTMFHS true CHRISTUS HEALTH 919 HIDDEN RIDGE DRIVE IRVING TX 75038 760590551 SPT HLTH SVCS TX 501(c)(3) 10 NA false TRINCARE INC 1315 DOCTORS DRIVE TYLER TX 75701 752161369 RETAIL HEALTH SVC TX CTMFHS C Corp true HEALTHPLAN OF TEXAS INC 1315 DOCTORS DRIVE TYLER TX 75701 752636832 THIRD PARTY ADMIN TX CTMFHS C Corp true THE REGIONAL HEALTHCARE ALLIANCE 1315 DOCTORS DRIVE TYLER TX 75701 752484109 PREFER PROVIDER TX CTMFHS C Corp true false false false false false false false false false false true false false false false true false true false