2018-05-10T06:10:55-05:00 2017-06-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 4000 INDIANAPOLIS IN 46204 990 2016-07-01 751976930 MOTHER FRANCES HOSPITAL - JACKSONVILLE % CHRISSY RAMSEY MOTH 9036065639 1315 DOCTORS DRIVE TYLER TX 75701 ELIZABETH PULLIAM SYSTEM CFO 9036065639 2018-05-09 true JANICE K MARTIN P00900299 3176817000 2016 2022-09-23 18:48:47Z CHRISTUS MFH - JACKSONVILLE Chris Glenney 2026 SOUTH JACKSON JACKSONVILLE TX 75766 41561651 false X WWW.TMFHC.ORG/JACKSONVILLE X 2000 TX TO PROVIDE THE COMMUNITY WITH A FULL RANGE OF COMPREHENSIVE HEALTH CARE SERVICES WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. X 8 3 193 5 0 0 0 0 39695631 41479069 3 0 0 82582 39695634 41561651 1642814 1374251 0 0 11105652 17151081 0 0 0 23622056 15869402 36370522 34394734 3325112 7166917 31688163 8315597 8704988 4306901 22983175 4008696 X TO PROVIDE THE COMMUNITY WITH A FULL RANGE OF COMPREHENSIVE HEALTH CARE SERVICES WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. false false 24788027 1374251 41561651 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. 24788027 true false false false false false false false false true true false false true true true false true false false false false false false false false true true true false true false false false false false false true false false false false true false true true true false false true 17 0 true 193 true false false false false false false false false false false X 8 3 true false false false true true true true true false false true true true true true true true true false X CHRISSY RAMSEY 9036065639 1315 DOCTORS DRIVE TYLER TX 75701 ANNE PILEGGI DIRECTOR/SECRETARY/ASSOC. VP 40.0 0.0 X X 223670 0 9313 GLEN HAMILTON DIRECTOR 9.0 0.0 X 0 0 0 J LINDSEY BRADLEY JR DIRECTOR/SYS PRES (TERM 6/17) 1.0 39.0 X 0 6021392 18308 RAY THOMPSON DIRECTOR (TERM 10/16) 1.0 39.0 X 0 4831460 8521 SCOTT SMITH MD BOARD DIRECTOR 4.0 36.0 X 80181 721628 11163 CHRIS GLENNEY DIRECTOR (EFF 2/17) 2.0 38.0 X X 45525 864965 19243 DICK STONE DIRECTOR 9.0 0.0 X 0 0 0 PETER SIRIANNI DIRECTOR 9.0 31.0 X 1533692 0 22508 RANDY GORHAM DIRECTOR 9.0 0.0 X 0 0 0 TODD HANCOCK DIRECTOR (EFF 12/16) 3.0 37.0 X 725325 0 7836 ELIZABETH PULLIAM SYSTEM CFO 0.0 40.0 X 0 484793 11434 BARRY THIBODEAUX CRNA 40.0 0.0 X 268397 0 10114 ROMAN BAGWELL CRNA 40.0 0.0 X 222787 0 14014 KEITH MARTIN RN 40.0 0.0 X 130331 0 8931 MARILYN CANTERO MT 40.0 0.0 X 193875 0 2952 thomas n cammack jr CEO 40.0 0.0 X 189965 0 0 3613748 12924238 144337 8 true true false DELTA LOCUM TENENS 1755 WITTINGTON PLACE SUITE 175 DALLAS TX 75234 STAFFING SERVICES 123750 1 0 NET PATIENT SERVICE REVENUE 621110 40170090 40170090 RENTAL REVENUE 532000 71940 71940 PHARMACY REVENUE 446110 1237039 1237039 41479069 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SWING BED TRANS REVENUE 900099 63162 63162 MEDICAL RECORDS REVENUE 900099 10976 10976 PHYSICIAN SUPPORT SERVICE 900099 7858 7858 586 586 82582 41561651 41561651 1374251 1374251 0 0 0 2608393 2337125 271268 189965 170209 19756 12437861 11144346 1293515 0 1280800 1054360 226440 634062 529145 104917 3964285 3964285 0 0 0 0 0 2092988 1449681 643307 0 36223 36223 2844165 937660 1906505 85227 37001 48226 0 343073 24999 318074 5524 3734 1790 0 17802 12184 5618 0 0 545152 55563 489589 167454 167454 MEDICAL SUPPLIES 3705482 3690471 15011 OTHER TAX 1653687 1652870 817 BAD DEBT EXPENSE 314428 314428 SUBSCRIPTIONS 93912 93912 34394734 24788027 9606707 0 1639 0 0 0 0 0 3618894 1407785 0 0 0 0 0 0 139580 115598 76906 77365 2644548 698825 1190768 1945723 0 0 0 0 0 0 0 0 26660376 4769126 31688163 8315597 1490559 1581038 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7214429 2725863 8704988 4306901 X 22983175 4008696 0 0 0 0 22983175 4008696 31688163 8315597 X 7166917 -26141396 X false true X true true true X 3185371 0 345766 9101 0 0 3522036 2885950 445000 -118741 26838 0 0 3185371 2762072 0 124878 1000 0 0 2885950 2414694 0 360569 13191 0 0 2762072 2408876 0 163752 157934 0 0 2414694 0.71220 0.28780 false true true 356580 2078 354502 2287968 696747 1591221 1945723 DUE FROM AFFILIATES 4769126 4769126 0 NOTES RECEIVABLE 1464617 DUE TO AFFILIATES 917938 LIABILITY INDEMNITY RESERVE 340750 DUE TO THIRD-PARTY PAYERS 1410 EST SELF-INSURANCE COSTS 1148 2725863 X 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. true true X true X true X true true true false true true 3440394 3440394 0.10090 3241743 5166069 120549 68802 51747 0.00150 6802686 5234871 3492141 0.10240 12275 12275 0.00040 381760 381760 0.01120 1374150 1374150 0.04030 1768185 1768185 0.05190 8570871 5234871 5260326 0.15430 true 314428 14082506 12797035 1285471 X true true 1 1 MOTHER FRANCES HOSPITAL-JACKSONVILLE 1026 JACKSON STREET JACKSONVILLE TX 75766 WWW.TMFHC.ORG 007254 X X X X MOTHER FRANCES HOSPITAL-JACKSONVILLE 1 false false true X X X X X X X X X 15 true false false true X SEE PART V, SECTION C X true 15 true SEE PART V, SECTION C false true X 200. 400. X X X X X X true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X false X false X X X X true X X false false 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. 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 true SERVICE ORGANIZATION OF PINEY WOODS 2950 50TH STREET LUBBOCK TX 79314 300630886 501(C)(3) 826000 COMMUNITY HEALTHCARE SERVICE ORGANIZATION OF NORTH & EAST TEXAS 2950 50TH STREET LUBBOCK TX 79314 260468622 501(C)(3) 546000 COMMUNITY HEALTHCARE 2 0 SCHEDULE I, PART IV, LINE 2 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. X X X X X true true false false false false false false false ANNE PILEGGI DIRECTOR/SECRETARY/ASSOC. VP 173006 0 41778 0 8886 0 6321 0 2992 0 232983 0 0 0 J LINDSEY BRADLEY JR DIRECTOR/SYS PRES (TERM 6/17) 0 960694 0 450000 0 4610698 0 11263 0 7045 0 6039700 0 0 RAY THOMPSON DIRECTOR (TERM 10/16) 0 795235 0 470000 0 3566225 0 2650 0 5871 0 4839981 0 0 SCOTT SMITH MD BOARD DIRECTOR 64931 584378 15250 137250 0 0 861 7752 255 2295 81297 731675 0 0 BARRY THIBODEAUX CRNA 265696 0 0 0 2701 0 9296 0 818 0 278511 0 0 0 ROMAN BAGWELL CRNA 222392 0 0 0 395 0 7412 0 6602 0 236801 0 0 0 MARILYN CANTERO MT 193727 0 0 0 148 0 740 0 2212 0 196827 0 0 0 CHRIS GLENNEY DIRECTOR (EFF 2/17) 18498 351461 27027 513504 0 0 563 10700 399 7581 46487 883246 0 0 PETER SIRIANNI DIRECTOR 1529252 0 0 0 4440 0 11262 0 11246 0 1556200 0 0 0 TODD HANCOCK DIRECTOR (EFF 12/16) 337704 0 387621 0 0 0 5697 0 2139 0 733161 0 0 0 thomas n cammack jr CEO 0 0 0 0 189965 0 0 0 0 0 189965 0 0 0 ELIZABETH PULLIAM SYSTEM CFO 0 246332 0 226762 0 11699 0 7923 0 3511 0 496227 0 0 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. DEANNA HAMILTON GLEN HAMILTON BRD MEMBER 76708 SEE PART V false SCHEDULE L, PART IV DESCRIPTION OF TRANSACTION 1) DEANNA HAMILTON, SPOUSE OF GLEN HAMILTON, A BOARD MEMBER, RECEIVED COMPENSATION FOR SERVICES OF $76,708. CASH 2017-06-30 26141396 BOOK VALUE 750818167 MOTHER FRANCES HOSPITAL REGIONAL HE 1315 DOCTORS DRIVE TYLER TX 75701 501(C)(3) false false false false 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) MOTHER FRANCES HOSP REGIONAL HC CENTER 1315 DOCTORS DRIVE TYLER TX 75701 750818167 HOSPITAL TX 501(C)(3) 3 CTMFHS true CHRISTUS-TRINITY MOTHER FRANCES FDN 1315 DOCTORS DRIVE TYLER TX 75701 752028241 SUPPORT TX 501(C)(3) 12, TYPE I CTMFHS true CHRISTUS TRINITY MF HEALTH SYSTEM 1315 DOCTORS DRIVE TYLER TX 75701 752616975 HEALTHCARE TX 501(C)(3) 12, TYPE II CH false TRINITY CLINIC 1315 DOCTORS DRIVE TYLER TX 75701 752616977 HEALTHCARE TX 501(C)(3) 3 CTMFHS true MOTHER FRANCES HOSPITAL - WINNSBORO 1315 DOCTORS DRIVE TYLER TX 75701 752771569 HOSPITAL TX 501(C)(3) 3 CTMFHS true CHRISTUS HEALTH 919 HIDDEN RIDGE IRVING TX 75038 760590551 SPT HLTH SVCS TX 501(C)(3) 10 NA false TRINCARE INC 1315 DOCTORS DRIVE TYLER TX 75201 752161369 RETAIL HEALTH SVC TX CTMFHS C-CORPORATION true HEALTHPLAN OF TEXAS INC 1315 DOCTORS DRIVE TYLER TX 75701 752636832 THIRD PARTY ADMIN TX CTMFHS C-CORPORATION true THE REGIONAL HEALTHCARE ALLIANCE 1315 DOCTORS DRIVE TYLER TX 75701 752484109 PREFER PROVIDER TX CTMFHS C-CORPORATION true false false false false false false false false false false false false false false false true false false false