MOTHER FRANCES HOSPITAL JACKSONVILLE: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- MOTHER FRANCES HOSPITAL JACKSONVILLE (EIN 75-1976930)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-10
- IRS object ID
- 201811309349300506
- Schema version
- 2016v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule N
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-10T06:10:55-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE SUITE 4000 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 751976930 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOTHER FRANCES HOSPITAL - JACKSONVILLE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % CHRISSY RAMSEY | InCareOfNm |
| Business Name Control | MOTH | BusinessNameControlTxt |
| Phone | 9036065639 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1315 DOCTORS DRIVE | AddressLine1Txt |
| City | TYLER | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75701 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ELIZABETH PULLIAM | PersonNm |
| Person Title | SYSTEM CFO | PersonTitleTxt |
| Phone | 9036065639 | PhoneNum |
| Signature | 2018-05-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JANICE K MARTIN | PreparerPersonNm |
| PTIN | P00900299 | PTIN |
| Phone | 3176817000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHRISTUS MFH - JACKSONVILLE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Chris Glenney | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2026 SOUTH JACKSON | AddressLine1Txt |
| City | JACKSONVILLE | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75766 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $41,561,651 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.TMFHC.ORG/JACKSONVILLE | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2000 | FormationYr |
| Legal Domicile State | TX | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 193 | TotalEmployeeCnt |
| Total Volunteers | 5 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $39,695,631 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $41,479,069 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $82,582 | CYOtherRevenueAmt |
| PY Total Revenue | $39,695,634 | PYTotalRevenueAmt |
| CY Total Revenue | $41,561,651 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,642,814 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,374,251 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,105,652 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $17,151,081 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $23,622,056 | PYOtherExpensesAmt |
| CY Other Expenses | $15,869,402 | CYOtherExpensesAmt |
| PY Total Expenses | $36,370,522 | PYTotalExpensesAmt |
| CY Total Expenses | $34,394,734 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,325,112 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $7,166,917 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $31,688,163 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,315,597 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $8,704,988 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,306,901 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $22,983,175 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,008,696 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $24,788,027 | ExpenseAmt |
| Grant | $1,374,251 | GrantAmt |
| Revenue | $41,561,651 | RevenueAmt |
| Desc | 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 755 INPATIENTS ADMITTED RESULTING IN 3,764 PATIENT DAYS; 52,720 OUTPATIENTS ADMITTED RESULTING IN 27,179 PATIENT DAYS; AND 16,801 EMERGENCY ROOM VISITS RESULTING IN 1,465 PATIENT DAYS. | Desc |
| Total Program Service Expenses | $24,788,027 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | Yes (true) | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 17 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 193 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRISSY RAMSEY | PersonNm |
| Phone | 9036065639 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1315 DOCTORS DRIVE | AddressLine1Txt |
| City | TYLER | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75701 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| ANNE PILEGGI | ||||||||||
| DIRECTOR/SECRETARY/ASSOC. VP | 40.0 | 0.0 | Yes (X) | Yes (X) | $223,670 | $0 | $9,313 | |||
| GLEN HAMILTON | ||||||||||
| DIRECTOR | 9.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| J LINDSEY BRADLEY JR | ||||||||||
| DIRECTOR/SYS PRES (TERM 6/17) | 1.0 | 39.0 | Yes (X) | $0 | $6,021,392 | $18,308 | ||||
| RAY THOMPSON | ||||||||||
| DIRECTOR (TERM 10/16) | 1.0 | 39.0 | Yes (X) | $0 | $4,831,460 | $8,521 | ||||
| SCOTT SMITH MD | ||||||||||
| BOARD DIRECTOR | 4.0 | 36.0 | Yes (X) | $80,181 | $721,628 | $11,163 | ||||
| CHRIS GLENNEY | ||||||||||
| DIRECTOR (EFF 2/17) | 2.0 | 38.0 | Yes (X) | Yes (X) | $45,525 | $864,965 | $19,243 | |||
| DICK STONE | ||||||||||
| DIRECTOR | 9.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| PETER SIRIANNI | ||||||||||
| DIRECTOR | 9.0 | 31.0 | Yes (X) | $1,533,692 | $0 | $22,508 | ||||
| RANDY GORHAM | ||||||||||
| DIRECTOR | 9.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||||
| TODD HANCOCK | ||||||||||
| DIRECTOR (EFF 12/16) | 3.0 | 37.0 | Yes (X) | $725,325 | $0 | $7,836 | ||||
| ELIZABETH PULLIAM | ||||||||||
| SYSTEM CFO | 0.0 | 40.0 | $0 | $484,793 | $11,434 | Yes (X) | ||||
| BARRY THIBODEAUX | ||||||||||
| CRNA | 40.0 | 0.0 | $268,397 | $0 | $10,114 | Yes (X) | ||||
| ROMAN BAGWELL | ||||||||||
| CRNA | 40.0 | 0.0 | $222,787 | $0 | $14,014 | Yes (X) | ||||
| KEITH MARTIN | ||||||||||
| RN | 40.0 | 0.0 | $130,331 | $0 | $8,931 | Yes (X) | ||||
| MARILYN CANTERO | ||||||||||
| MT | 40.0 | 0.0 | $193,875 | $0 | $2,952 | Yes (X) | ||||
| thomas n cammack jr | ||||||||||
| CEO | 40.0 | 0.0 | $189,965 | $0 | $0 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $3,613,748 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $12,924,238 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $144,337 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DELTA LOCUM TENENS | PersonNm |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1755 WITTINGTON PLACE SUITE 175 | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75234 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | STAFFING SERVICES | ServicesDesc |
| Compensation | $123,750 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621110 | $40,170,090 | $40,170,090 |
| RENTAL REVENUE | 532000 | $71,940 | $71,940 |
| PHARMACY REVENUE | 446110 | $1,237,039 | $1,237,039 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $41,479,069 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| SWING BED TRANS REVENUE | 900099 | $63,162 | $63,162 |
| MEDICAL RECORDS REVENUE | 900099 | $10,976 | $10,976 |
| PHYSICIAN SUPPORT SERVICE | 900099 | $7,858 | $7,858 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $586 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $586 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $82,582 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $41,561,651 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $41,561,651 | RelatedOrExemptFuncIncomeAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,374,251 | TotalAmt |
| Program Services | $1,374,251 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,608,393 | TotalAmt |
| Program Services | $2,337,125 | ProgramServicesAmt |
| Management And General | $271,268 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,965 | TotalAmt |
| Program Services | $170,209 | ProgramServicesAmt |
| Management And General | $19,756 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,437,861 | TotalAmt |
| Program Services | $11,144,346 | ProgramServicesAmt |
| Management And General | $1,293,515 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,280,800 | TotalAmt |
| Program Services | $1,054,360 | ProgramServicesAmt |
| Management And General | $226,440 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $634,062 | TotalAmt |
| Program Services | $529,145 | ProgramServicesAmt |
| Management And General | $104,917 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,964,285 | TotalAmt |
| Management And General | $3,964,285 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,092,988 | TotalAmt |
| Program Services | $1,449,681 | ProgramServicesAmt |
| Management And General | $643,307 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,223 | TotalAmt |
| Management And General | $36,223 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,844,165 | TotalAmt |
| Program Services | $937,660 | ProgramServicesAmt |
| Management And General | $1,906,505 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,227 | TotalAmt |
| Program Services | $37,001 | ProgramServicesAmt |
| Management And General | $48,226 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $343,073 | TotalAmt |
| Program Services | $24,999 | ProgramServicesAmt |
| Management And General | $318,074 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,524 | TotalAmt |
| Program Services | $3,734 | ProgramServicesAmt |
| Management And General | $1,790 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,802 | TotalAmt |
| Program Services | $12,184 | ProgramServicesAmt |
| Management And General | $5,618 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $545,152 | TotalAmt |
| Program Services | $55,563 | ProgramServicesAmt |
| Management And General | $489,589 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,454 | TotalAmt |
| Management And General | $167,454 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $3,705,482 | $3,690,471 | $15,011 |
| OTHER TAX | $1,653,687 | $1,652,870 | $817 |
| BAD DEBT EXPENSE | $314,428 | $314,428 | |
| SUBSCRIPTIONS | $93,912 | $93,912 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,394,734 | TotalAmt |
| Program Services | $24,788,027 | ProgramServicesAmt |
| Management And General | $9,606,707 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,639 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,618,894 | BOYAmt |
| EOY | $1,407,785 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $139,580 | BOYAmt |
| EOY | $115,598 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,906 | BOYAmt |
| EOY | $77,365 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $2,644,548 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $698,825 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,190,768 | BOYAmt |
| EOY | $1,945,723 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,660,376 | BOYAmt |
| EOY | $4,769,126 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,688,163 | BOYAmt |
| EOY | $8,315,597 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,490,559 | BOYAmt |
| EOY | $1,581,038 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,214,429 | BOYAmt |
| EOY | $2,725,863 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,704,988 | BOYAmt |
| EOY | $4,306,901 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,983,175 | BOYAmt |
| EOY | $4,008,696 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,983,175 | BOYAmt |
| EOY | $4,008,696 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,688,163 | BOYAmt |
| EOY | $8,315,597 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $7,166,917 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$26,141,396 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,185,371 | BeginningYearBalanceAmt |
| Contributions | $0 | ContributionsAmt |
| Investment Earnings Or Losses | $345,766 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $9,101 | GrantsOrScholarshipsAmt |
| Other Expenditures | $0 | OtherExpendituresAmt |
| Administrative Expenses | $0 | AdministrativeExpensesAmt |
| End Year Balance | $3,522,036 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,885,950 | BeginningYearBalanceAmt |
| Contributions | $445,000 | ContributionsAmt |
| Investment Earnings Or Losses | -$118,741 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $26,838 | GrantsOrScholarshipsAmt |
| Other Expenditures | $0 | OtherExpendituresAmt |
| Administrative Expenses | $0 | AdministrativeExpensesAmt |
| End Year Balance | $3,185,371 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,762,072 | BeginningYearBalanceAmt |
| Contributions | $0 | ContributionsAmt |
| Investment Earnings Or Losses | $124,878 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $1,000 | GrantsOrScholarshipsAmt |
| Other Expenditures | $0 | OtherExpendituresAmt |
| Administrative Expenses | $0 | AdministrativeExpensesAmt |
| End Year Balance | $2,885,950 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,414,694 | BeginningYearBalanceAmt |
| Contributions | $0 | ContributionsAmt |
| Investment Earnings Or Losses | $360,569 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $13,191 | GrantsOrScholarshipsAmt |
| Other Expenditures | $0 | OtherExpendituresAmt |
| Administrative Expenses | $0 | AdministrativeExpensesAmt |
| End Year Balance | $2,762,072 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,408,876 | BeginningYearBalanceAmt |
| Contributions | $0 | ContributionsAmt |
| Investment Earnings Or Losses | $163,752 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $157,934 | GrantsOrScholarshipsAmt |
| Other Expenditures | $0 | OtherExpendituresAmt |
| Administrative Expenses | $0 | AdministrativeExpensesAmt |
| End Year Balance | $2,414,694 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 0.71220 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.28780 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
| Land | LandGrp |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $356,580 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,078 | DepreciationAmt |
| Book Value | $354,502 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,287,968 | OtherCostOrOtherBasisAmt |
| Depreciation | $696,747 | DepreciationAmt |
| Book Value | $1,591,221 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Land Buildings | OtherLandBuildingsGrp | |
| Total Book Value Land Buildings | $1,945,723 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE FROM AFFILIATES | Desc |
| Book Value | $4,769,126 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $4,769,126 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| NOTES RECEIVABLE | $1,464,617 |
| DUE TO AFFILIATES | $917,938 |
| LIABILITY INDEMNITY RESERVE | $340,750 |
| DUE TO THIRD-PARTY PAYERS | $1,410 |
| EST SELF-INSURANCE COSTS | $1,148 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,725,863 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART V, LINE 4 | Intended Use of Endowment Funds 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, 2017 AND 2016. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,440,394 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,440,394 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10090 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,241,743 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,166,069 | DirectOffsettingRevenueAmt |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $120,549 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $68,802 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $51,747 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,802,686 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,234,871 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,492,141 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10240 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,275 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,275 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $381,760 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $381,760 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01120 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,374,150 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,374,150 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,768,185 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,768,185 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05190 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,570,871 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,234,871 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,260,326 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15430 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $314,428 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $14,082,506 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $12,797,035 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,285,471 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOTHER FRANCES HOSPITAL-JACKSONVILLE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1026 JACKSON STREET | AddressLine1Txt |
| City | JACKSONVILLE | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75766 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.TMFHC.ORG | WebsiteAddressTxt |
| State License | 007254 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOTHER FRANCES HOSPITAL-JACKSONVILLE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400. | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | false | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 & 10A THE URL FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT AND MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY IS: https://www.tmfhc.org/about-us/comprehensive-community-health-needs-assess ments/ |
| 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 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 22D | DESCRIPTION OF PROSPECTIVE MEDICARE METHOD CHRISTUS uses the prospective Medicare method to determine AGB, by using the billing and coding process it would use if the individual were a Medicare fee-for-service beneficiary and setting AGB for the care at the amount it determines Medicare and the Medicare beneficiary togEthEr would be expected to pay for the care. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 7, COLUMN F | PERCENT OF TOTAL EXPENSE TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) IS $34,394,734. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT IS $314,428. THIS LEAVES A TOTAL EXPENSE OF $34,080,306 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 25.15%, 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 $1,374,150 IN CASH AND IN KIND CONTRIBUTIONS DURING FISCAL YEAR 2017. 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 7E: ACTUAL EXPENSES LESS ANY DIRECT OFFSETTING REVENUE LINE 7F: ACTUAL EXPENSES LESS ANY DIRECT OFFSETTING REVENUE LINE 7I: ACTUAL EXPENSE OF THE CONTRIBUTIONS SCHEDULE H, PART III, LINE 2 BAD DEBT EXPENSE THE AMOUNT REPORTED ON LINE 2 IS BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, LINE 3 BAD DEBT AS COMMUNITY BENEFIT 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, LINE 4 | USE OF ESTIMATES 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 provision for bad debt; estimates for reimbursement under the upper payment limit, disproportionate share and Medicaid 1115 waiver programs; reserves for losses and expenses related to health care professional and general liabilities; accruals for claims incurred but not yet reported related to the Systems health plan; 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 judgments 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. THE SURPLUS ON PART III, LINE 7 IS NOT COUNTED AS COMMUNITY BENEFIT. THE AMOUNT ON SCHEDULE H, PART III, LINE 6 IS DETERMINED BY CALCULATING MEDICARE ALLOWABLE COSTS USING WORKSHEET A OF THE MEDICARE COST REPORT. WORKSHEET A OF THE MEDICARE COST REPORT REQUIRES THE ORGANIZATION TO REMOVE NON-ALLOWABLE EXPENSES FROM TOTAL EXPENSES VIA THE ADJUSTMENTS TO EXPENSES WITHIN THE MEDICARE COST REPORT. THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE FILING ORGANIZATION ASSOCIATED WITH THE FILING ORGANIZATION'S PROVISIONS OF SERVICES TO MEDICARE PATIENTS. SCHEDULE H, PART III, LINE 7 WOULD EQUAL A SURPLUS OF $1,285,471 IF TOTAL EXPENSES ALLOWABLE TO MEDICARE SERVICES WERE SUBSTITUTED ON SCHEDULE H, PART III, LINE 6. |
| SCHEDULE H, PART III, LINE 9B | Collection Policy The organization has a written policy covering procedures for collecting and writing off bad debts. According to the policy, if a patient appears to be indigent, accounts should be reviewed, at any time during the collection process, for possible consideration as a charity case in accordance with the organization's charity care policy. Unpaid discounted balances of patients who qualify for the financial assistance program are considered uncollectible bad debts. CHRISTUS does not conduct, or permit collection agencies to conduct on its behalf, extraordinary collection actions (ECAS), as defined under Internal Revenue Code Section 501(R), against individuals before reasonable efforts have been made to determine whether the patient is eligible for the financial assistance program. Reasonable efforts include the hospital making the determination that the patient is ineligible for the financial assistance program because the patient is covered by Medicare or Commercial insurance. The System Director of Patient Financial Services maintains oversight and responsibility for determining if CHRISTUS has made reasonable efforts and whether and ECA is appropriate. |
| 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 The hospital's financial assistance policy and contact information is posted in various areas of the hospital including admissions and registration, emergency, and outpatient departments. Additionally, financial assistance information is proviDed, verbally and in written brochures, to all self pay patients by financial assistance counselors. Financial assistance information is also included in every patient bill. The hospital's financiAl assistance policy is communicated to the patient by financial counselors who also screen self pay patients for potential eligibility for other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the financial counselor will assist the patient in completing any forms necessary to apply for the assistance. At the same time, the patients are provided with a charity care application and informational flyer. The patient is informed that Mother Frances Hospital - Jacksonville is a non-profit charitable organization offering financial assistance to patients who are deemed medically or financially indigent. The financial counselors will then assist the patient in completing the charity care application and obtain any available verifications. Once the patient is discharged, the financial counselors will continue to contact the patient to ensure all needed forms and verifications needed to file an application for governmental assistance and charity care have been provided. |
| 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 sponsorship and staffing support for Cherokee County Relay for Life. Staff raised funds for cancer awareness throughout the year and sold food at the event. 1,200 people participated. 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: 22 students participated in job shadowing projects and heard from health care professionals about their jobs. 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 professional and the healthcare work environment. Information was given on job opportunities and projected shortages of workers. 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 sponsorship, staffing, and development of programs and events for the local community. Organizations included Lions Club, Rotary, Kiwanis, Access, Hope Center, United Fund, American Cancer Society, Jacksonville Chamber of Commerce, and Jacksonville College. Members of the staff serve in leadership positions and as 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, and HOPE. 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. 8. Name: Miracle on Jackson Street Blood Drive Description: MFH-JacksonVILLE hosts several blood drives during the year. During December an annual blood drive in the community that included participation not only within the health system but it was open to the community. Purpose: Blood drives are an integral part of securing the much needed blood supplies in east Texas. Our regional hospitals are often in a 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 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| SERVICE ORGANIZATION OF PINEY WOODS | |||||||
| 2950 50TH STREET | LUBBOCK | TX | 79314 | 300630886 | 501(C)(3) | $826,000 | COMMUNITY HEALTHCARE |
| SERVICE ORGANIZATION OF NORTH & EAST TEXAS | |||||||
| 2950 50TH STREET | LUBBOCK | TX | 79314 | 260468622 | 501(C)(3) | $546,000 | COMMUNITY HEALTHCARE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PART IV, LINE 2 | FormAndLineReferenceDesc |
| Explanation | GRANT RECIPIENTS ARE REQUIRED TO ACKNOWLEDGE PRIOR TO THE ISSUANCE OF GRANT FUNDS THAT THE GRANT WILL BE USED IN ACCORDANCE WITH THE STATED PURPOSE OF THE GRANT APPLICATION AND ANY UNUSED FUNDS RELATED TO THE SPECIFIC PURPOSE OF THE GRANT WILL BE RETURNED TO THE ORGANIZATION. THE ORGANIZATION MONITORS AND REVIEWS THE FINANCIAL DATA OF RECIPIENTS TO ENSURE THAT THE GRANTED FUNDS ARE BEING USED PROPERLY. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ANNE PILEGGI | ||||||||||||||
| DIRECTOR/SECRETARY/ASSOC. VP | $173,006 | $0 | $41,778 | $0 | $8,886 | $0 | $6,321 | $0 | $2,992 | $0 | $232,983 | $0 | $0 | $0 |
| J LINDSEY BRADLEY JR | ||||||||||||||
| DIRECTOR/SYS PRES (TERM 6/17) | $0 | $960,694 | $0 | $450,000 | $0 | $4,610,698 | $0 | $11,263 | $0 | $7,045 | $0 | $6,039,700 | $0 | $0 |
| RAY THOMPSON | ||||||||||||||
| DIRECTOR (TERM 10/16) | $0 | $795,235 | $0 | $470,000 | $0 | $3,566,225 | $0 | $2,650 | $0 | $5,871 | $0 | $4,839,981 | $0 | $0 |
| SCOTT SMITH MD | ||||||||||||||
| BOARD DIRECTOR | $64,931 | $584,378 | $15,250 | $137,250 | $0 | $0 | $861 | $7,752 | $255 | $2,295 | $81,297 | $731,675 | $0 | $0 |
| BARRY THIBODEAUX | ||||||||||||||
| CRNA | $265,696 | $0 | $0 | $0 | $2,701 | $0 | $9,296 | $0 | $818 | $0 | $278,511 | $0 | $0 | $0 |
| ROMAN BAGWELL | ||||||||||||||
| CRNA | $222,392 | $0 | $0 | $0 | $395 | $0 | $7,412 | $0 | $6,602 | $0 | $236,801 | $0 | $0 | $0 |
| MARILYN CANTERO | ||||||||||||||
| MT | $193,727 | $0 | $0 | $0 | $148 | $0 | $740 | $0 | $2,212 | $0 | $196,827 | $0 | $0 | $0 |
| CHRIS GLENNEY | ||||||||||||||
| DIRECTOR (EFF 2/17) | $18,498 | $351,461 | $27,027 | $513,504 | $0 | $0 | $563 | $10,700 | $399 | $7,581 | $46,487 | $883,246 | $0 | $0 |
| PETER SIRIANNI | ||||||||||||||
| DIRECTOR | $1,529,252 | $0 | $0 | $0 | $4,440 | $0 | $11,262 | $0 | $11,246 | $0 | $1,556,200 | $0 | $0 | $0 |
| TODD HANCOCK | ||||||||||||||
| DIRECTOR (EFF 12/16) | $337,704 | $0 | $387,621 | $0 | $0 | $0 | $5,697 | $0 | $2,139 | $0 | $733,161 | $0 | $0 | $0 |
| thomas n cammack jr | ||||||||||||||
| CEO | $0 | $0 | $0 | $0 | $189,965 | $0 | $0 | $0 | $0 | $0 | $189,965 | $0 | $0 | $0 |
| ELIZABETH PULLIAM | ||||||||||||||
| SYSTEM CFO | $0 | $246,332 | $0 | $226,762 | $0 | $11,699 | $0 | $7,923 | $0 | $3,511 | $0 | $496,227 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VII, SECTION A 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 PERSONS IS EARNED IN THE RESPECTIVE INDIVIDUAL'S ROLE AS AN OFFICER OR EMPLOYEE OF THE ORGANIZATION, NOT FOR THE INDIVIDUAL'S ROLE AS A BOARD MEMBER OR DIRECTOR. SISTERS' COMPENSATION IS PAID TO THE RELIGIOUS CONGREGATION AND NOT THE INDIVIDUAL. OFFICERS, KEY EMPLOYEES AND HIGHEST PAID EMPLOYEES ARE FULL-TIME EMPLOYEES. BOARD MEMBERS SPEND TIME AS NEEDED FOR BOARD MEETINGS 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 | THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE YEAR. THOMAS N CAMMACK JR. - $189,965 RAYMOND THOMPSON - $3,566,225 J. LINDSEY BRADLEY - $4,610,698 |
| 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. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENT FORM 990, SCHEDULE J, PART I, LINE 4B AND FORM 990, SCHEDULE J, PART II, COLUMN (F) COMPENSATION REPORTED AS DEFERRED IN PRIOR YEAR |
| 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 2016. |
| 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, 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. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DEANNA HAMILTON | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | GLEN HAMILTON BRD MEMBER | RelationshipDescriptionTxt |
| Transaction | $76,708 | TransactionAmt |
| Transaction | SEE PART V | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART IV | FormAndLineReferenceDesc |
| Explanation | DESCRIPTION OF TRANSACTION 1) DEANNA HAMILTON, SPOUSE OF GLEN HAMILTON, A BOARD MEMBER, RECEIVED COMPENSATION FOR SERVICES OF $76,708. | ExplanationTxt |
Schedule N IRS990ScheduleN
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liquidation Of Assets Table | LiquidationOfAssetsTableGrp |
Disposition Of Assets Detail DispositionOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | CASH | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2017-06-30 | DistributionDt |
| Fair Market Value Of Asset | $26,141,396 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | BOOK VALUE | MethodOfFMVDeterminationTxt |
| EIN | 750818167 | EIN |
| Person | MOTHER FRANCES HOSPITAL REGIONAL HE | PersonNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1315 DOCTORS DRIVE | AddressLine1Txt |
| City | TYLER | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(C)(3) | IRCSectionTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | false | DirectorOfSuccessor2Ind |
| Employee Of Successor2 | false | EmployeeOfSuccessor2Ind |
| Owner Of Successor2 | false | OwnerOfSuccessor2Ind |
| Receive Compensation2 | false | ReceiveCompensation2Ind |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. 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 2018 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, LINE 15B | PROCESS FOR DETERMINING COMPENSATION THE ORGANIZATION USES COMPENSATION CONSULTANTS AND NATIONAL COMPENSATION SURVEYS TO DETERMINE COMPENSATION OF EMPLOYEES. COMPENSATION IS APPROVED BY THE ORGANIZATION'S GOVERNING BODY. THE MOST RECENT REVIEW OF OFFICER COMPENSATION WAS CONDUCTED IN 2016 BY LAURA LOCKHART, CTMFHS DIRECTOR OF TOTAL REWARDS, AND CANDY LAND, CTMFHS COMPENSATION ANALYST. ALL REVIEWS ARE DOCUMENTED IN THE MARKET ADJUSTMENT FILES. FORM 990, PART VI, QUESTION 18 PUBLIC DISCLOSURE OF 1023 AND FORMS 990 & 990-T CHRISTUS HEALTH AND MOST OF ITS AFFILIATED ENTITIES DO NOT HAVE FORMS 1023 BECAUSE OF THEIR INCLUSION IN THE IRS GROUP RULING WITH THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS, WHICH COVERS THE ORGANIZATION LISTED IN THE ANNUAL OFFICIAL CATHOLIC DIRECTORY. CHRISTUS HEALTH'S WEBSITE DISPLAYS THE IRS GROUP RULING AND RELEVANT ANNUAL OFFICIAL CATHOLIC DIRECTORY PAGES FOR THE ORGANIZATIONS RELATED TO CHRISTUS HEALTH. FORMS 990 AND 990-T ARE MADE AVAILABLE UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | PROCESS FOR MAKING DOCUMENTS AVAILABLE TO THE PUBLIC THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CHRISTUS HEALTH ARE MADE AVAILABLE TO THE PUBLIC VIA THE CHRISTUS HEALTH WEBSITE. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9 | OTHER CHANGES IN NET ASSETS TRANSFER TO AFFILIATE ($26,141,396) |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| MOTHER FRANCES HOSP REGIONAL HC CENTER | ||||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 750818167 | HOSPITAL | TX | 501(C)(3) | 3 | CTMFHS | Yes (true) |
| CHRISTUS-TRINITY MOTHER FRANCES FDN | ||||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 752028241 | SUPPORT | TX | 501(C)(3) | 12, TYPE I | CTMFHS | Yes (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 | Yes (true) |
| MOTHER FRANCES HOSPITAL - WINNSBORO | ||||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 752771569 | HOSPITAL | TX | 501(C)(3) | 3 | CTMFHS | Yes (true) |
| CHRISTUS HEALTH | ||||||||||
| 919 HIDDEN RIDGE | IRVING | TX | 75038 | 760590551 | SPT HLTH SVCS | TX | 501(C)(3) | 10 | NA | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| TRINCARE INC | |||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75201 | 752161369 | RETAIL HEALTH SVC | TX | CTMFHS | C-CORPORATION | Yes (true) |
| HEALTHPLAN OF TEXAS INC | |||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 752636832 | THIRD PARTY ADMIN | TX | CTMFHS | C-CORPORATION | Yes (true) |
| THE REGIONAL HEALTHCARE ALLIANCE | |||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 752484109 | PREFER PROVIDER | TX | CTMFHS | C-CORPORATION | Yes (true) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
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