2019-11-14T11:38:37-06:00 2018-12-31 BKD LLP 14241 DALLAS PARKWAY STE 1100 DALLAS TX 75254 990 2018-01-01 452230827 Swisher Memorial Healthcare System % LUKE BREWER SWIS 8069953581 PO Box 808 Tulia TX 79088 LUKE BREWER INTERIM CEO/CFO 9727028262 2019-11-15 true Jeanette Verrelli P00742631 9727028262 167.68.126.162 70234720193185000003 2019-11-14 P 98C67C06075FADA3594A58B7FA41D63CA3097B7E EB976710118F518B8933A72D91D1D85239D99EDA 2018 2020-04-17 16:48:07Z LUKE BREWER 539 SE SECOND STREET TULIA TX 79088 11004222 false X WWW.SWISHERHOSPITAL.COM X 2011 TX TO PROVIDE QUALITY HEALTHCARE TO THE CITIZENS OF SWISHER COUNTY AND THE SURROUNDING AREAS. 5 5 102 5 0 0 108358 98629 11352659 10751785 -7981 6424 131104 147384 11584140 11004222 5770 5720 0 0 5070673 4842229 0 0 0 6553320 5570921 11629763 10418870 -45623 585352 5374907 5945115 1552430 1537286 3822477 4407829 X TO PROVIDE QUALITY HEALTHCARE TO THE CITIZENS OF SWISHER COUNTY AND THE SURROUNDING AREAS. false false 8856821 5720 10825916 PROVIDED ACCESSIBLE AND QUALITY HEALTHCARE SERVICES TO THE CITIZENS OF SWISHER COUNTY AND THE SURROUNDING AREAS. THE HOSPITAL HAD 23,004 ENCOUNTERS - 14,162 CLINIC, 1,945 ER, 219 INPATIENT, 6,557 OUTPATIENT, 90 SWINGBED, 25 OBSERVATION, 6 ASSISTED LIVING; 0 SURGERIES; 661 INPATIENT DAYS; 963 SWINGBED DAYS. IN 2018, SWISHER MEMORIAL CONTINUED TO OFFER CHIROPRACTIC SERVICES ONCE A WEEK. THE MEDICAL ADVICE LINE THAT IS AVAILABLE 24/7 TO OUR PATIENTS AND COMMUNITY IS STILL RUNNING SMOOTHLY. SMHS HOSTED ITS 4TH ANNUAL COMMUNITY WIDE HEALTH FAIR. THE HEALTH FAIR INCLUDED HEALTH EDUCATION, HEALTH SCREENINGS, INFLUENZA AND PNEUMONIA VACCINATIONS, AND MORE. 8856821 true true false true false false false false false false true false false true true false true false 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 false false false false true 24 0 102 true false false false false false false false false false false false false X 5 5 false false false false false false false true false false false true true true true true true true true false X LUKE BREWER 8069958268 539 SE SECOND STREET TULIA TX 79088 X CHARLOTTE O'DANIEL SECRETARY 1.0 0.0 X X 0 0 0 JORY RUNNELS PRESIDENT 1.0 0.0 X X 0 0 0 RAY DE LOS SANTOS VICE - PRESIDENT 1.0 0.0 X X 0 0 0 SCOT BLAKEMAN DO DIRECTOR 57.0 0.0 X 0 0 0 KA WILFONG DIRECTOR 1.0 0.0 X 0 0 0 LUKE BREWER INTERIM CEO/CFO 40.0 0.0 X 239108 0 20264 CYNTHIA ARCHER PHYSICIAN'S ASSISTANT 40.0 0.0 X 233354 0 9321 SCOTT DYER PHYSICAL THERAPIST 40.0 0.0 X 158462 0 19861 KELLY MAXWELL CNO 40.0 0.0 X 136447 0 33680 KARA DYER PHYSICAL THERAPIST 40.0 0.0 X 164032 0 9321 Kim George Nurse Practitioner 40.0 0.0 X 103642 0 20295 1035045 0 112742 7 false true false CERNER CORPORATION 2800 ROCKCREEK PKWY KANSAS CITY KS 64117 EHR SERVICES 389963 CARDINAL HEALTH 411 INC PO BOX 847384 DALLAS TX 75284 PHARMACEUTICALS 509317 US FOODSERVICE PO BOX 840450 DALLAS TX 75284 DIETARY SERVICES 134806 BKD 510 N VALLEY MILLS DRIVE WACO TX 76710 ACCOUNTING SERVICES 134366 SIEMENS MEDICAL PO BOX 120001 DALLAS TX 75312 LAB DIAGNOSTICS 117107 5 8629 90000 98629 Patient Service Revenue 621110 9279158 9279158 Incentive Revenue 900099 1072876 1072876 PHARMACY 446110 399751 399751 10751785 6424 6424 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Guest & Employee Meals 722514 70087 70087 Wellness Center Revenue 713940 22359 22359 Medical Records 561000 1738 1738 53200 50034 3166 147384 11004222 10825916 79677 X 5720 5720 0 0 0 259372 129686 129686 0 3334523 2791707 542816 155353 128943 26410 0 806532 676109 130423 0 286449 238317 48132 0 70445 70445 0 134366 134366 0 0 0 1258910 1082439 176471 14534 2883 11651 206028 116210 89818 249023 240211 8812 0 1083966 1061841 22125 4406 4333 73 0 13907 7695 6212 55218 45831 9387 0 641210 532204 109006 70617 58612 12005 Bad Debt Expense 232301 232301 Medical Supplies 1414498 1414498 REPAIRS & MAINTENANCE 30490 25172 5318 DUES AND SUBSCRIPTIONS 20241 6210 14031 70761 55899 14862 10418870 8856821 1562049 0 88804 1070606 0 0 0 0 778410 1121836 0 0 0 0 5000 0 205659 207170 445902 798195 4636354 2710457 2506479 1925897 0 0 0 0 0 0 0 0 1344653 821411 5374907 5945115 1066607 523548 0 0 0 0 0 0 0 0 0 0 109317 923678 0 0 376506 90060 1552430 1537286 X 3822477 4407829 0 0 0 0 3822477 4407829 5374907 5945115 585352 X X false true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 3154 3154 false SCHEDULE C, PART II-B, LINE 1I OTHER ACTIVITIES: Dues Paid % Lobbying Lobbying THA $3,011 10.03% $302 AHA $8,731 21.78% $1,902 TORCH $3,800 25.00% $950 ---------------------------------------------------- Total $15,542 $3,154 1059595 619449 440146 3493692 2042446 1451246 83067 48562 34505 1925897 Due from 3rd Party payer 755820 Other Asset 65591 821411 0 Est Self-Insurance Costs 90060 90060 12134454 1447662 -232301 1215361 10919093 85129 85129 11004222 11634231 1447662 1447662 10186569 232301 232301 10418870 Schedule D, Part XI, Line 2d RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: Bad Debt Expense $(232,301) Schedule D, Part XI, Line 4b RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: Contribution for acquisition of Property & Equipment $85,129 Schedule D, Part XII, Line 4b Reconciliation of expenses per audited financial statements with return: Bad Debt Expense $232,301 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. true true X true X 300. true X true true true false true false 1178755 1178755 0.11570 935039 1084290 342013 342013 0.03360 2455807 1084290 1520768 0.14930 78291 78291 0.00770 5720 5720 0.00060 84011 84011 0.00830 2539818 1084290 1604779 0.15760 true 232301 5385304 5262838 122466 X true true 1 1 SWISHER MEMORIAL HEALTHCARE SYSTEM 539 SE SECOND STREET TULIA TX 79088 WWW.SWISHERHOSPITAL.COM 100122 X X X 1 SWISHER MEMORIAL HEALTHCARE SYSTEM 1 false false true X X X X X X X X X 17 true false false true X SEE PART V, SECTION C X true 17 true SEE PART V, SECTION C false true X 300. 300. X X X X X true true 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 true X false X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY: THE HOSPITAL COMPLETED INTERVIEWS AND FOCUS GROUPS WITH REPRESENTATIVES FROM VARIOUS AREAS OF THE COMMUNITY INCLUDING: BUSINESS AND INDUSTRY LEADERS, SCHOOL SUPERINTENDENT, SCHOOL NURSES, ELECTED CITY OFFICIALS, HOSPITAL AUXILIARY EMPLOYEES, CITIZENS OF OUTLYING COMMUNITIES, SENIOR CITIZENS AND YOUNG ADULTS, HOME HEALTH REPRESENTATIVES, REPRESENTATIVES OF THE LOCAL CHURCH, THE CHAMBER OF COMMERCE, AND BOARD MEMBERS OF THE DISTRICT. ADDITIONAL INTERVIEWS WITH THE HOSPITAL DIRECTORS, THE CEO AND THE CFO WERE CONDUCTED AS WELL. SCHEDULE H, PART V, SECTION B, LINE 11 NEEDS IDENTIFIED IN CHNA: THE STRATEGY TO ADDRESS THE NEEDS IDENTIFIED IS INCLUDED IN THE CHNA WHICH IS POSTED ON THE HOSPITAL'S WEBSITE. THE HOSPITAL COMPLETED THE COMMUNITY HEALTH NEEDS ASSESSMENT IN MAY 2017. THE 2017 CHNA IDENTIFIED THAT IT NEEDED TO CONTINUE TO ADDRESS THE FOUR NEEDS OF THE COMMUNITY IDENTIFIED IN THE 2014 CHNA: - AVAILABILITY OF LOCAL SPECIALISTS - CHRONIC DISEASE MANAGEMENT - COMMUNITY EDUCATION ON CHRONIC DISEASE, NUTRITION, AND HEALTHY LIFESTYLES - MARKETING OF THE HOSPITAL All NEEDS IDENTIFIED IN THE CHNA ARE BEING ADDRESSED BY THE HOSPITAL. THE HOSPITAL'S NEWEST PHYSICIAN SPECIALIZES IN PEDIACTRIC CARE, and WE HAVE THREE SPECIALISTs COME IN MONTHLY - AN ORTHOPEDIC SURGEON, CARDIOLOGIST, AND AN OBSTRETRICIAN. THE HEALTH NEEDS OF AN AGING POPULATION WERE DISCUSSED BY MANY. WE STILL HAVE THE ARCHITECTUAL PLANS FOR A NEW ASSISTED LIVING FACILITY, BUT ARE STILL ON HOLD FOR THAT PROJECT UNTIL FUNDING ALIGNS. WE HAVE IMPLEMENTED A CHRONIC CARE MANAGEMENT PROGRAM FOR OUR MEDICARE AGED POPULATION TO BETTER MANAGE THOSE CONDITIONS OF OUR AGING POPULATION. ADDRESSING MENTAL HEALTH, DRUG, AND ALCOHOL ABUSE WERE ALSO DISCUSSED DURING THE FOCUS GROUPS. THE HOSPITAL FACILITATED A TELEPSYCHIATRY OPPORTUNITY FOR AN EXTENDED PERIOD OF TIME, BUT HAD LITTLE TO NO USAGE OF IT. WE ARE EXPLORING OTHER OPPORTUNITIES TO BETTER CARE FOR THOSE PATIENTS IN NEED. SWISHER MEMORIAL HEALTHCARE SYSTEM CONTINUES TO OFFER COMMUNITY WIDE HEALTH FAIRS AND HAS HAD GREAT PARTICPATION FROM THE COMMUNITY. WE WILL CONTINUE TO OFFER EDUCATION ON DIABETES, NUTRITION, ALZHEIMER'S, AND DEMENTIA. THE HOSPITAL'S MARKETING EFFORTS ARE CONTINUING TO PAY OFF. WE WILL CONTINUE TO PROMOTE OUR SERVICES AND PROVIDERS. WE WILL CONTINUE TO BRING READING MATERIALS IN BOTH ENGLISH AND SPANISH, AS OVER 40% OF THE POPULATION IS HISPANIC. SCHEDULE H, PART V, SECTION B, LINE 7A & 10 CHNA & Implementation Strategy MADE AVAILABLE: THE HOSPITAL'S MOST RECENT CHNA and implementation strategy CAN BE FOUND AT THE FOLLOWING WEBSITE: http://www.swisherhospital.com/getpage.php?name=Community_Health_Needs_Ass SCHEDULE H, PART V, LINE 13H OTHER CRITERIA FOR FINANCIAL ASSISTANCE: THE OTHER ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE IS THE PATIENT'S HOUSEHOLD SIZE. SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, & 16C Availability of Financial Assistance Information: The Hospital's financial assistance policy, application and plain language summary can be found at the following site: http://www.swisherhospital.com/getpage.php?name=Financial_Assistance&sub=F inancial+Assistance SCHEDULE H, PART V, SECTION B Compliance with 501r: Swisher Memorial Healthcare System identified a couple areas where it was not yet fully compliant with the final 501r regulations. The hospital realized the most recent implementation strategy was not on the hospitals website. Once this was identified, the hospital uploaded the document. The hospital also identified that the financial assistance policy does not list the most recent AGB calculation on Addendum 1. However, the policy does list where the most recent calculation can be requested, and the hospital will update Addendum 1 as soon as possible. Also, the Plain Language Summary has a minor update needed to the website link where the financial assistance documents can be found. It will be updated as soon as possible. Swisher Memorial Healthcare System personnel are working diligently to maintain compliance and will correct any additional failures to comply as they are identified. Top management will monitor the website annually to confirm the hospital continues to stay compliant with the widely publicized requirements under 501r. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER FINANCIAL ASSISTANCE POLICY: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. BAD DEBT EXPENSE SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE THIS IS UNCOMPENSATED HEALTHCARE PROVIDED TO RESIDENTS OF THE COMMUNITY. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT FOOTNOTE: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE SYSTEM'S ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FOR SELF-PAY PATIENTS WAS APPROXIMATELY 92% AND 94% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2018 AND AT DECEMBER 31, 2017, RESPECTIVELY. THE SYSTEM'S WRITE-OFFS WERE APPROXIMATELY $2,370,000 AND $1,076,000 FOR THE YEARS ENDED DECEMBER 31, 2018 AND 2017, RESPECTIVELY. THE INCREASE IN WRITE-OFFS in 2018 IS A RESULT OF SYSTEM EFFORTS TO IDENTIFY AND WRITE-OFF UNCOLLECTiBLE ACCOUNTS IN A MORE TIMELY MANNER. THESE AMOUNTS WERE PREVIOUSLY IDENTIFIED AS UNLIKELY TO COLLECT AND ALLOWANCES HAD BEEN APPLIED TO THESE ACCOUNTS. SCHEDULE H, PART III, SECTION B, LINE 8 COSTING METHODOLOGY: THE SYSTEM 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, SECTION C, LINE 9B COLLECTION PRACTICES: ONCE A PATIENT HAS QUALIFIED FOR OUR INDIGENT PROGRAM, NO ADDITIONAL COLLECTION EFFORTS ARE MADE ON THAT ACCOUNT. THERE ARE DIFFERENT LEVELS OF CHARITY THAT WE AWARD, MOST OF THE TIME 90%, AND WE DO TRY TO COLLECT ON THE REMAINING 10%. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: SWISHER MEMORIAL HEALTHCARE SYSTEM UTILIZES HCAHPS SURVEYS TO MEASURE THE PATIENTS' PERSPECTIVES AND SATISFACTION REGARDING HOSPITAL CARE. IN ADDITION, THE SYSTEM IS ACTIVE IN ALL OF ITS COMMUNITY SERVICE ORGANIZATIONS. THE CEO ATTENDS THESE SERVICE CLUB MEETINGS TO INVITE PATIENTS, THEIR FAMILIES, AND LOCAL CITIZENS TO SHARE THEIR CONCERNS ABOUT THE COMMUNITY'S NEEDS WITH THE ORGANIZATION. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY CAN BE FOUND ON THE SYSTEM'S WEBSITE IN BOTH ENGLISH AND SPANISH AND DISCUSSED AT SERVICE ORGANIZATION MEETINGS IN OUR COMMUNITY. IT IS ALSO SHARED WITH VARIOUS GOVERNMENT AGENCIES SUCH AS HEALTH AND HUMAN SERVICES. FINALLY, ALL UNINSURED PATIENTS WHO ARE SEEN IN THE SYSTEM'S CLINIC OR EMERGENCY DEPARTMENT ARE REFERRED TO OUR PATIENT ADVOCATE WHO INVESTIGATES ALL POTENTIAL SOURCES OF ASSISTANCE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: SWISHER MEMORIAL HEALTHCARE SYSTEM SERVES ALL OF SWISHER COUNTY, TX AS WELL AS SOUTHERN RANDALL COUNTY, WESTERN BRISCOE COUNTY, AND EASTERN CASTRO COUNTY. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: OUR HOSPITAL CEO MEETS WITH LOCAL AND COUNTY GOVERNMENT OFTEN TO DISCUSS ANY ACTIONS THE SYSTEM AND/OR DISTRICT MAY BE ABLE TO PARTICIPATE IN, PERFORM, OFFER, OR ENCOURAGE WITHIN OUR COMMUNITY. ALSO, OUR QUALITY ASSURANCE/PERFORMANCE IMPROVEMENT/DISASTER PREPAREDNESS DIRECTOR AND EMS DIRECTOR ARE ACTIVE WITH THE REGIONAL ADVISORY COUNCIL AND OTHER COMMUNITY-PREPAREDNESS ACTIVITIES. WE STAY ABREAST TO SITUATIONS WITHIN OUR SCHOOL DISTRICT WITH UPDATES PROVIDED BY THE REGISTERED SCHOOL NURSE, WHO IS ALSO AN ACTIVE DISTRICT AND FOUNDATION BOARD MEMBER. OUR CLINIC OFFERS AN INFLUENZA VACCINATION CLINIC YEARLY, FOR A FLAT FEE, WITH THE OPTION TO BILL MEDICARE FOR MEDICARE PATIENTS. WE CONTINUE TO PROVIDE A MEDICAL ADVICE LINE TO OUR PATIENTS FREE OF CHARGE THROUGH THE 1115 WAIVER. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: ALTHOUGH THERE IS NOT A CONTROL OF GOVERNANCE, SWISHER MEMORIAL HEALTHCARE SYSTEM AND SWISHER MEMORIAL HOSPITAL DISTRICT DO COOPERATE IN PROVIDING HEALTH CARE TO THE COMMUNITY. AS HIGHLIGHTED IN THE SCHEDULE H, PART VI - PROMOTION OF COMMUNITY HEALTH, BOTH ENTITIES PARTICIPATE IN VARIOUS PROGRAMS AND CLINICS TO FURTHER THE HEALTH OF SWISHER COUNTY. SWISHER MEMORIAL HOSPITAL DISTRICT OPERATES A TRAINED AND CERTIFIED AMBULATORY UNIT TO THE WHOLE POPULATION OF SWISHER COUNTY. SWISHER MEMORIAL HEALTHCARE SYSTEM OFFERS A LEVEL 4 EMERGENCY DEPARTMENT, CRITICAL ACCESS HOSPITAL WITH TWENTY BEDS, AND TULIA RURAL HEALTH CLINIC THAT SERVICES THE MAJORITY OF SWISHER COUNTY. THE DISTRICT AND THE SYSTEM WORK TOGETHER COHESIVELY IN PROVIDING EXCELLENT CARE TO ALL PATIENTS THAT UTILIZE OUR SERVICES. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: TEXAS Schedule H, Part I, Line 3C FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING OTHER CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: - Asset level - MEDICAL INDIGENCY - INSURANCE STATUS - UNDERINSURANCE STATUS - Household size SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: BAD DEBT EXPENSE OF $232,301 WAS INCLUDED IN TOTAL EXPENSE ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT WAS SUBTRACTED FROM TOTAL EXPENSE FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSE IN COLUMN (F). X X X false false false false false false false true false LUKE BREWER INTERIM CEO/CFO 119108 0 120000 0 0 0 0 0 20264 0 259372 0 0 0 CYNTHIA ARCHER PHYSICIAN'S ASSISTANT 232778 0 576 0 0 0 0 0 9321 0 242675 0 0 0 SCOTT DYER PHYSICAL THERAPIST 155375 0 3087 0 0 0 0 0 19861 0 178323 0 0 0 KELLY MAXWELL CNO 131117 0 5330 0 0 0 0 0 33680 0 170127 0 0 0 KARA DYER PHYSICAL THERAPIST 163657 0 375 0 0 0 0 0 9321 0 173353 0 0 0 SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: A PERCENTAGE OF INCENTIVE COMPENSATION REPORTED BY THE INDIVIDUALS LISTED ON PART VII, SECTION A IS CONTINGENT ON MEETING THE ANNUAL BUDGET. FORM 990, PART VI, SECTION A, LINE 8B DOCUMENTATION OF COMMITTEES ACTING ON BEHALF OF THE GOVERNING BODY: ANY ACTIONS OF THE COMMITTEES (MEDICAL STAFF, QAPI, NURSING) THAT ARE PART OF THE SYSTEM'S OPERATION ARE REPORTED BY THE CNO/CEO AT QUARTERLY BOARD MEETINGS. THERE ARE NO COMMITTEES OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE ORGANIZATION'S INTERIM CEO REVIEWS THE RETURN PRIOR TO FILING. A COPY IS ALSO SENT OUT TO THE GOVERNING BODY FOR REVIEW AND APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: BOARD MEMBERS ARE POLLED ANNUALLY TO DETERMINE IF/WHERE CONFLICTS MAY OCCUR. DEBBIE GARZA OF THE HR DEPARMENT MONITORS COMPLIANCE, AND IF A MEMBER HAS A POSSIBLE CONFLICT THEY ABSTAIN FROM VOTING ON THE TRANSACTION. FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION REVIEW: ALL KEY POSITIONS ARE EVALUATED IN COMPARISON TO THE TORCH ANNUAL SURVEY OF HOSPITAL SALARIES AND OTHER SOURCES. EVALUATIONS ARE CONDUCTED EACH YEAR ON COMPENSATION. ONCE THEY HAVE BEEN REVIEWED, WE TAKE IT TO THE BOARD FOR FURTHER REVIEW AND APPROVAL. THIS WAS DONE IN OCTOBER IN PRIOR YEARS AND PRESENTED TO THE BOARD AT THE OCTOBER BOARD MEETING. HOWEVER, WE HAVE SINCE MOVED ANNUAL REVIEWS AND RAISES TO BE CONDUCTED IN APRIL AND AWARDED IN MAY. ALL OF THE COMPENSATION APPROVAL IS DOCUMENTED IN THE BOARD MEETING MINUTES. HOWEVER, THERE WERE NO COMPENSATION REVIEWS AND/OR RAISES FOR THE 2018 YEAR. THE LAST COmpENSATION REVIEW WAS COMpLETED IN 2017 BY THE HOSPITAL CEO. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE BY REQUEST AT THE ORGANIZATION'S OFFICE. FORM 990, PART XII, LINE 2C RESPONSIBILITY FOR OVERSIGHT OF AUDIT: DUE TO THE SIZE OF THE BOARD, THERE IS NO COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT. INSTEAD, THE FULL BOARD IS RESPONSIBILE. FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:473129 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:166556 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:521347 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:97878