2017-05-15T10:50:35-05:00 2016-06-30 BKD LLP 14241 DALLAS PKWY STE 1100 DALLAS TX 75254 990 2015-07-01 750818167 Mother Frances Hospital Regional Health Care Center % CHRISSY RAMSEY MOTH 9036065639 1315 Doctors Drive Tyler TX 75701 ELIZABETH PULLIAM VP of Finance 9035315764 2017-05-15 true Jeanette Verrelli P00742631 9727028262 2015 2021-01-29 14:40:06Z CHRISTUS Trinity MF Tyler ELIZABETH PULLIAM 800 E DAWSON STREET TYLER TX 75701 1060478587 false X WWW.TMFHC.ORG X 1958 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. 9 3 4109 268 2218636 2831335 2538984 620936007 638428005 12071903 3316219 8447895 8467847 644287140 652751055 23095342 27555482 0 0 183265791 198596294 0 0 0 354692309 367353967 561053442 593505743 83233698 59245312 807350395 860312990 348205022 380407924 459145373 479905066 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 480294638 27555482 638833688 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 25,685 INPATIENTS ADMITTED RESULTING IN 112,381 PATIENT DAYS; 523,354 OUTPATIENTS ADMITTED RESULTING IN 341,548 PATIENT DAYS; AND 71,761 EMERGENCY ROOM VISITS RESULTING IN 9,650 PATIENT DAYS. 480294638 true true false true false false false false false true true false false true true true false true false true true false false false false false true true true false true true false false false false false false false false true false false false false false false true true true false false true 145 0 true 4109 true true true true CJ false false false false false false false false X 9 3 true false false false true true true true true false false true true true true true true true true true true X CHRISSY RAMSEY 9036065639 1315 DOCTORS DRIVE TYLER TX 75701 X RAY THOMPSON SYS EXEC VP/DIRECTOR/ASST SEC 16.0 24.0 X X 758801 1138203 33736 BEN FITZGERALD CHAIRMAN 1.0 0.0 X X 0 0 0 FAGG SANFORD MD DIRECTOR 1.0 39.0 X 0 945411 15909 SISTER MALGORZATA MAJSZCZYK DIRECTOR 1.0 0.0 X 0 0 0 SISTER IRENE ASZTEMBORSKA SECRETARY/TREASURER 1.0 1.0 X X 0 0 0 ANDY KIRKPATRICK DIRECTOR 1.0 39.0 X 0 663678 20047 PATRICK THOMAS MD DIRECTOR 1.0 1.0 X 49596 0 0 JOHN MCGREEVY SR VP/CEO OF MFH REG 39.0 1.0 X X 497497 0 33736 NOAH ISRAEL MD PHYSICIAN 1.0 0.0 X 10950 0 0 J LINDSEY BRADLEY SYSTEM PRESIDENT 9.0 31.0 X 482415 1661654 33736 STEVEN KEUER MD SYS PRESIDENT/CMO/DIRECTOR 1.0 39.0 X 0 1646802 19726 SCOTT SMITH MD EXECUTIVE VICE PRESIDENT 1.0 39.0 X 0 643587 14426 JOYCE HESTER SR. VICE PRESIDENT/CFO 10.0 30.0 X 149756 449269 31236 ROBERT ROSE SR. VP, PATIENT CARE SERVICES 40.0 0.0 X 329480 0 17068 TODD HANCOCK SR. VP/COO 40.0 0.0 X 336501 0 16018 LEE PORTWOOD VP 40.0 0.0 X 304828 0 14233 PATRICK SIMONSON VP 40.0 0.0 X 233707 0 6943 JASON PROCTOR VP 40.0 0.0 X 243479 0 9456 ELIZABETH PULLIAM VP OF FINANCE/CFO OF MFH REG 15.0 25.0 X 122344 203907 11673 WILLIAM SANDBERG CRNA 40.0 0.0 X 276259 0 11928 ROBERT BIENERT CRNA 40.0 0.0 X 363110 0 8760 TAWONDA FELTON CRNA 40.0 0.0 X 387949 0 11081 DUSTIN VIDRINE CRNA 40.0 0.0 X 280528 0 16025 TIMOTHY CLARK CRNA 40.0 0.0 X 273070 0 15170 CHRIS GLENNEY VP OPERATIONS/FORMER OFFICER 0.0 40.0 X 0 393970 38836 SCOTT FOSSEY VP/FORMER OFFICER 0.0 40.0 X 0 272864 11176 5100270 8019345 390919 143 true true false Sound Inpatient Physicians of Texas 1301 Solana Blvd 2200 WESTLAKE TX 76262 management services 10810041 Sodexo Inc and affiliates PO Box 536922 ATLANTA GA 30353 housekeeping/dietary 3020117 CSFN MISSION AND MINISTRY INC 800 E Dawson TYLER TX 75701 contract labor 2350000 Miller Weisbrod LLP 11551 Forest Central Dr 300 DALLAS TX 75243 legal fees 1800000 Tyler Neurosurgical Associates PA 700 Olympic Plaza Circle TYLER TX 75701 physician services 1789500 45 X 1730062 808922 2538984 NET PATIENT SERVICE REVENUE 621110 588467187 588467187 UPL MEDICAID 900099 25775279 25775279 EHR INCENTIVE REVENUE 900099 1963865 1963865 OTHER OPERATING REVENUE 900099 22221674 22221674 638428005 6702282 6702282 0 0 3634038 3634038 0 3634038 285088 3348950 402927226 1091097 407277384 127002 -4350158 964095 -3386063 -3386063 0 0 740986 323146 417840 405683 12157 CAFETERIA REVENUE 722514 2440096 2440096 FITNESS CENTERS 713940 1921391 1921391 Vending Machine Revenue 722515 54482 54482 4415969 652751055 638833688 2218636 9159747 X 27555482 27555482 0 0 0 6778147 6181288 596859 27532 25162 2370 156283193 142329561 13953632 7974014 6563861 1410153 16010873 15854077 156796 11522535 9960119 1562416 1345140 268557 1076583 0 0 0 0 367137 97480 269657 132786421 53136016 79650405 19106 19106 2944414 2327338 617076 1234625 238964 995661 0 6237252 6082085 155167 145014 126578 18436 0 284341 203155 81186 7977059 7977059 0 22913312 21643174 1270138 9942669 3183 9939486 MEDICAL SUPPLIES 116508416 116481575 26841 BAD DEBT EXPENSE 43265631 43265631 0 REPAIRS AND MAINTENANCE 8626380 7938777 687603 FOOD 3552425 3540623 11802 9204625 8475787 728838 593505743 480294638 113211105 0 89168491 39775155 6831700 6561307 0 0 60336428 61022470 0 0 0 0 0 0 6362520 6337430 3498209 2617742 631079648 326215482 302660187 304864166 237769064 302110179 3527805 4747805 0 0 2679974 2679974 94516017 129596762 807350395 860312990 68656758 59330887 0 0 81960 1487012 188120099 181261874 0 0 0 0 434872 876514 0 0 90911333 137451637 348205022 380407924 X 459145373 479262111 0 642955 0 0 459145373 479905066 807350395 860312990 X 59245312 3681714 -42167333 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 9405 9405 false SCHEDULE C, PART II-B, LINE 1i OTHER ACTIVITIES: A PERCENTAGE OF AHA DUES WERE EXPENDED FOR SPECIFIC LOBBYING PURPOSES BASED ON MEDICARE DEFINITION OF UNALLOWABLE EXPENSES. 2885950 445000 -118741 26838 3185371 2762072 124878 1000 2885950 2414694 360569 13191 2762072 2408876 163752 157934 2414694 2350337 30875 27664 2408876 0.00000 0.78610 0.21390 false true true 29208000 29208000 227992132 94542382 133449750 114775951 66027486 48748465 251305282 165645614 85659668 7798283 0 7798283 304864166 DUE FROM AFFILIATES 128304978 DEFERRED FINANCING COSTS 1291784 129596762 0 PENSION LIABILITY 73543316 ESTIMATED SELF INSURANCE COSTS 7879143 DUE TO AFFILIATES 37729902 EST. AMOUNTS TO 3RD PARTY PAYERS 18299276 137451637 X 614168640 3681714 -38448893 -34767179 648935819 367137 3448099 3815236 652751055 548162716 -1710259 -1710259 549872975 367137 43265631 43632768 593505743 SCHEDULE D, PART V, LINE 4 INTENDED USE OF THE ORGANIZATION'S 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 XI, LINE 2D RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: Bad debt expense $(43,265,631) Equity in earnings of affiliate 4,816,738 --------------- Total $(38,448,893) SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: Contributions in net assets $1,699,126 Gain on sale of assets 964,095 Other classification differences 784,878 ------------ Total $3,448,099 SCHEDULE D, PART XII, LINE 2D RECONCILIATION OF EXPENSE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: Gain on sale of assets $(964,095) Other classification differences (784,878) Equity in income of consolidated sub 38,714 ----------- Total $(1,710,259) SCHEDULE D, PART XII, LINE 4B RECONCILIATION OF EXPENSE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: Bad debt expense $43,265,631 SCHEDULE D, PART X, LINE 2 LIABILITY FOR UNCERTAIN TAX POSITIONS: The authoritative guidance in Accounting Standards Codification Topic 740, Income Taxes, creates a single model to address uncertainty in tax positions and clarifies the accounting for income taxes by prescribing the minimum recognition threshold a tax position is required to meet before being recognized in the financial statements. Under the requirements of this guidance, tax-exempt organizations could be required to record an obligation as the result of a tax position they have historically taken on various tax exposure items. The Health System has interest in various taxable entities which may give rise to U.S. tax exposures. There are no material unrecorded tax liabilities as of June 30, 2016. Central America and the Caribbean 1 Program Services INSURANCE 38875 1 1 38875 38875 true false true false false false true true X true X true X true true true false true true 22997506 22997506 0.04110 39508924 56066243 1289442 981285 308157 0.00060 63795872 57047528 23305663 0.04170 430861 430861 0.00080 165642 165642 0.00030 1152058 1152058 0.00210 58954 58954 0.00010 27555482 27555482 0.04920 29362997 29362997 0.05250 93158869 57047528 52668660 0.09420 true 43265631 182000991 173521854 8479137 X true true 2 1 Mother Frances Hospital Reg HC Center 1315 Doctors Drive Tyler TX 75701 www.tmfhc.org 000286 X X X 2 Tyler Rehab Associates LP 3131 Troup Highway Tyler TX 75701 www.tmfrehabhospital.com 000692 X Mother Frances Hospital Reg HC Center 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 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 true X false X X X X true X false false Tyler Rehab Associates LP 2 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 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 X X X true X false X X X X false X X false false SCHEDULE H, PART V, SECTION B, FACILITIES 1 & 2, LINE 5 REPRESENTATIVES FROM THE COMMUNITY: BOTH MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER (MFH TYLER) AND TYLER REHAB ASSOCIATES, LP COVER THE SAME COMMUNITY AND ARE WITHIN THE SAME HEALTH CARE SYSTEM; THEREFORE, THEY USED THE SAME COMMUNITY REPRESENTATIVES. THEY 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 CLINIC, ST. PAUL CHILDREN'S FOUNDATION, WHISPERING PINES NURSING HOME, LITERACY COUNCIL OF TYLER, NORTHEAST CHILD ADVOCACY CENTER, BETHESDA HEALTH CLINIC, YOUR PHILANTHROPY, EAST TEXAS HUMAN NEEDS NETWORK (ETHNN), PEOPLE ATTEMPTING TO HELP (PATH), SAMARITAN COUNSELING CENTER, EAST TEXAS COUNCIL OF GOVERNMENTS AREA AGENCY ON AGING, AND VARIOUS OTHERS. ADDITIONALLY, A SURVEY WAS SENT TO A SELECT GROUP OF 940 INDIVIDUALS OR ORGANIZATIONS WHO ARE MEMBERS OF THE ETHNN. OUT OF THE SELECTED GROUP, 120 RESPONSES WERE COLLECTED AND ANALYZED. SURVEY QUESTIONS RELATED TO A VARIETY OF HEALTH PROBLEMS AS WELL AS BARRIERS FOR LOW INCOME RESIDENTS. A PAPER SURVEY WAS ALSO CONDUCTED AT THREE TYLER FAMILY CIRCLE OF CARE CLINIC LOCATIONS. THE SURVEY WAS PROVIDED TO PATIENTS AT CHECK-OUT AND SURVEYED ITEMS SUCH AS LOCATION OF CARE, PROBLEMS SEEING A DOCTOR, AND LIKELINESS OF RETURNING TO CLINICS. SCHEDULE H, PART V, SECTION B, FACILITIES 1 & 2, LINES 7A & 10A CHNA AVAILABLE TO THE PUBLIC: THE CHNAS AND IMPLEMENTATION STRATEGIES FOR EACH ORGANIZATION ARE AVAILABLE UPON REQUEST AND AT THE FOLLOWING WEBSITE: HTTP://WWW.TMFHC.ORG/COMPREHENSIVE-COMMUNITY-HEALTH-NEEDS-ASSESSMENTS SCHEDULE H, PART V, SECTION B, FACILITY 1, LINE 11 NEEDS IDENTIFIED IN CHNA ADDRESSED AND NOT ADDRESSED: MOTHER FRANCES HOSPITAL - TYLER IDENTIFIED AND ADDRESSED THE FOLLOWING PRIORITIES THROUGH ITS IMPLEMENTATION PLAN: - ACCESS TO PRIMARY CARE SERVICES - NEED FOR INCREASED EMPHASIS ON A COLLABORATIVE CONTINUUM OF CARE - PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC DISEASES, PREVENTABLE CONDITIONS AND UNHEALTHY LIFESTYLES - ACCESS TO SPECIALTY CARE SERVICES - ACCESS TO MENTAL AND BEHAVIORAL HEALTH CARE - ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS PROPOSED PROGRAMS TO ADDRESS THE PRIORITIZED NEEDS: - Support development and implementation in Region 1 of the Medicaid Waiver Program in order to accomplish the following: -- Expand Primary Care Access -- Expand Specialty Care Access -- Develop Telemedicine Program for NICU -- Establish and re-certify 19 Medical Homes -- Develop a Palliative Care Project that includes outpatient services -- Develop a Patient Navigation Project for Breast Cancer Patients -- Develop a Care Transition Program - Provide support for the Literacy Council, Alzheimers, Diabetes, American Heart Association, Cancer Foundation For Life, American Cancer Society, Hospice of East Texas, and Health Fitness Programs - Provide support and expand the following programs: -- Tyler Family Circle of Care/Womens Services -- Tyler Family Circle of Care/Primary Care Services -- Trinity Clinic, Pediatric Special Needs Program -- TeleCARE Plus Your Health Information Resource -- Bethesda Clinic Support -- St. Pauls Clinic -- Rural hospital support program through donations -- Health Screening & Preventative Program -- Neonatal Services -- Trauma & Emergency Room Services -- Ross Breast Center Mobile Unit -- MediCab, EMS -- Literacy Council -- Alzheimers Association - Support of a new behavioral health community project - Participation in the Episcopal Foundation Community Health Collaboration Forums - Northeast Texas Public Health District Fit City Challenge Sponsorship - Provide support for the Susan G Komen Race for the Cure - Tyler Junior College Foundation to support Nursing and Health Sciences Center - Texas Health and Human Services Regional Advisory Council MOTHER FRANCES HOSPITAL - TYLER DECIDED NOT TO ADDRESS "ACCESS TO DENTAL SERVICES" LARGELY DUE TO THE FACT THAT IT IS NOT A CORE BUSINESS FUNCTION OF THE HOSPITAL AND THE LIMITED CAPACITY OF THE HOSPITAL TO ADDRESS THIS NEED. HOSPITAL LEADERSHIP FELT THAT RESOURCES AND EFFORTS WOULD BE BETTER SPENT ADDRESSING THE SIX PRIORITIZED NEEDS ABOVE. SCHEDULE H, PART V, SECTION B, FACILITY 2, LINE 11 NEEDS IDENTIFIED IN CHNA ADDRESSED AND NOT ADDRESSED: TYLER REHAB IDENTIFIED AND ADDRESSED THE FOLLOWING PRIORITIES THROUGH ITS IMPLEMENTATION PLAN: - NEED FOR INCREASED EMPHASIS ON A COLLABORATIVE CONTINUUM OF CARE - PREVENTION, EDUCATION AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC DISEASES, PREVENTABLE CONDITIONS AND UNHEALTHY LIFESTYLES - ACCESS TO SPECIALTY CARE SERVICES - ACCESS TO AFFORDABLE CARE AND REDUCING HEALTH DISPARITIES AMONG SPECIFIC POPULATIONS THE REHAB HOSPITAL DECIDED NOT TO ADDRESS "ACCESS TO DENTAL SERVICES", "ACCESS TO PRIMARY CARE SERVICES", AND "ACCESS TO MENTAL AND BEHAVIORAL HEALTHCARE". THIS IS LARGELY DUE TO THE FACT THAT THESE ARE NOT CORE BUSINESS FUNCTIONS OF THE HOSPITAL AND THE LIMITED CAPACITY OF THE HOSPITAL TO ADDRESS THESE NEEDS. HOSPITAL LEADERSHIP FELT THAT RESOURCES AND EFFORTS WOULD BE BETTER SPENT ADDRESSING THE FOUR PRIORITIZED NEEDS ABOVE. SCHEDULE H, PART V, SECTION B, FACILITY 1, LINE 13B INCOME LEVEL USED FOR FAP ELIGIBILITY: MFH REGIONAL PROVIDES CHARITY FOR PATIENTS ABOVE 400% UNDER THE CATASTROPHIC CAP PROVISION. THIS PROVISION ALLOWS MFH REGIONAL TO DISCOUNT THE CARE RECEIVED TO NO MORE THAN 30% OF THE PATIENT'S YEARLY INCOME. SCHEDULE H, PART V, SECTION B, FACILITY 1, LINES 16A, 16B, AND 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, FACILITY 2, LINES 16B & 16C FAP DOCUMENTS AVAILABLE TO THE PUBLIC: THE HOSPITAL'S FAP APPLICATION FORM AND A PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://WWW.TMFREHABHOSPITAL.COM/EN/PATIENTS-AND-FAMILY/FINANCIAL-ASSISTANC E SCHEDULE H, PART V, SECTION B, FACILITIES 1 & 2, LINES 18, 19 & 20 BILLING AND COLLECTIONS: NEITHER MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER, TYLER REHAB, NOR THIRD PARTIES AUTHORIZED BY MFH-REGIONAL HEALTH CARE CENTER, TAKE ANY ACTIONS UPON NON-PAYMENT FROM A PATIENT BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART V, SECTION B, FACILITY 1, LINE 22D DETERMINATION OF FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE: 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 V, SECTION B, FACILITY 2, LINE 22D DETERMINATION OF FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE: PATIENTS WHO'S FAMILY INCOME IS EQUAL TO OR LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES ARE GENERALLY ELIGIBLE FOR FREE EMERGENCY AND MEDICALLY NECESSARY CARE. PATIENTS WHOSE FAMILY INCOME IS BETWEEN 200% AND 400% OF THE FEDERAL POVERTY GUIDELINES ARE GENERALLY ELIGIBLE FOR A SLIDING SCALE DISCOUNT RANGING FROM 50% TO 75% FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE. GOING FORWARED THE REHABILITATION HOSPITAL WILL USE THE PROSPECTIVE MEDICARE METHOD TO DETERMINE AGB. 1 MFH Outpatient Surgery Center 415 South Fleishel Tyler TX 75702 ambulatory surgical center SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT AS A 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, SECTION A, LINE 4 FOOTNOTE TO THE FINANCIAL STATEMENTS DESCRIBING BAD DEBT: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HEALTH SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HEALTH SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). THE HOSPITAL RECORDS AN AUTOMATIC DISCOUNT OF ITS STANDARD CHARGES FOR UNINSURED PATIENTS. FOR THE REMAINING RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE HEALTH SYSTEM RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE. THIS INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE REDUCED STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HEALTH SYSTEM'S ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS APPROXIMATELY 98% OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2016. SCHEDULE H, PART III, SECTION B, LINE 8 COSTING METHODOLOGY: THE MEDICAL CENTER USES MEDICARE COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS (ROOM AND BOARD) BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. SCHEDULE H, PART III, SECTION C, 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 a 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 AN ECA IS APPROPRIATE. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: THE HOSPITAL'S COMMUNITY HEALTH PROFILES PROVIDE A SNAPSHOT OF SUBURBAN, 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 JOINT 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 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-TYLER 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 OBTAINING 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: THE HOSPITAL OWNS AND OPERATES A 476 LICENSED BED GENERAL ACUTE CARE HOSPITAL AND RELATED HEALTHCARE FACILITIES IN TYLER, TEXAS. THE HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF SMITH COUNTY WITH A POPULATION OF APPROXIMATELY 200,000. THE SECONDARY SERVICE AREA OF THE HOSPITAL CONSISTS OF ANDERSON, CHEROKEE, GREGG, HENDERSON, RAINS, RUSK, UPSHUR, WOOD, AND VAN ZANDT COUNTIES WITH A TOTAL POPULATION OF APPROXIMATELY 500,000. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: MOTHER FRANCES HOSPITAL-TYLER PROMOTES HEALTHCARE AND WELLNESS EDUCATION BY OFFERING OUTREACH PROGRAMS AND SPECIAL INITIATIVES THAT IMPROVE THE QUALITY OF LIFE AND HEALTH IN THE COMMUNITIES SERVED. COMMUNITY BENEFIT IS PROVIDED THROUGH MANY REDUCED PRICE SERVICES AND FREE PROGRAMS TO THE COMMUNITY. THESE SERVICES ARE ESSENTIAL TO PROVIDE COMPLETE HEALTHCARE TO THE COMMUNITIES SERVED. SOME OF THESE PROGRAMS INCLUDE THE FOLLOWING: Name: Tyler Family Circle of Care Womens Services Description: The clinic offers prenatal services to all Medicaid patients, self-pay, underinsured, and anyone who presents for prenatal services. Patient education is an integral part of patient care offering classes in English and Spanish. In addition to regular prenatal education, car seat education, and nutritional counseling to non-diabetic patients is also offered. This program receives CHRISTUS Trinity Mother Frances support for these services. Purpose: The primary objective is to reduce the number of women who delivered babies with no prenatal care or childbirth education and reduce the number of sick infants born. Social workers help clients become eligible for Medicaid, WIC, and other financial assistance. Additionally, case management and diabetic counseling, as well as, nutrition counseling to non-diabetic patients is also provided. Name: Tyler Family Circle of Care Childrens Services Description: The Center serves the largest number of Medicaid and CHIP patients in the area. This patient population has a high percentage of at-risk ethnic groups. It is the largest provider of services to Medicaid and CHIP services for children in east Texas. A special reach out and read program with book distribution and mentors is provided. This program receives financial and in-kind from CHRISTUS Trinity Mother Frances for these services. Purpose: This facility provides access to well baby care and sick baby care for new mothers who were provided care at the Tyler Family Circle of Care Womens Service and for the medically underserved children of east Texas. Name: Tyler Family Circle of Care Family Medicine Description: This clinic provides medical care services to all ages of patients. The clinic sees Medicaid, Medicare, CHIP/CHIP Perinatal, self-pay, uninsured/underserved, and serving those without the ability to pay regardless of their county of residence. Purpose: The goal is to ensure that all patients have a primary care home and do not have to use the emergency department for non-urgent issues. The long-term goal is to have all the clinics receive their medical home status. Name: CHRISTUS Trinity Clinic Special Needs Program Description: The Special Needs Program believes that all children should have access to continuous, comprehensive, coordinated, compassionate and culturally competent healthcare services through a medical home. Medical and social services are provided to children with special needs. Purpose: To provide health care services to over 680 patients ranging from neonates to 21 years serving 20 counties. Services offered without charge include MOMS support group, Respite Care Program support, Annual Special Needs Childrens Celebration for families, and other local community activities. Name: Emergency Education Description: Detailed instruction and hands on participation is offered for certification in areas including CPR, first aid, and AED use. Courses are offered to school district and sponsors for UIL programs on an as needed basis. Nearly 650 people were trained across multiple counties, school districts, and churches. Purpose: To improve the ability of people to respond to an emergency regardless of where it occurs. The benefit to the public includes more rapid response by a trained person, which should increase the potential for positive outcomes. Name: TeleCare Plus-Your Health Information Resource Description: TeleCare Plus is a medical call center available FREE to the public 24 hours a day. Examples of the types of calls in 2016 would be: Tyler Family Circle of Care Pediatrics/Obstetrics, cardiac, neuro, endocrinology, geriatric, education calls, and general information and health care questions or nurse triage. Purpose: TeleCare Plus is designed to provide a central, confidential resource for the community to turn to for health information and assist callers in seeking out the appropriate level of medical resources at the appropriate time. Name: Bethesda Clinic Support Description: Bethesda Clinic is a free medical clinic, which is supported financially and by support services from the community. CHRISTUS Mother Frances Hospital-Tyler provides support in all areas and on special projects as requested. Purpose: To provide a site for patients where they can receive acute medical care. Services are paid for on a sliding scale as determined by their board of directors. This provides another access point for vulnerable populations and has bilingual staff. Name: CHRISTUS Trinity Mother Frances Health System Website Description: The CHRISTUS Trinity Mother Frances Health System website at www.christustmf.org provides a large amount of information about the health system, CHRISTUS Trinity Clinic Physicians, upcoming classes and events and a wealth of health information. This now includes the implementation of MYCHART for personal health information directly. Purpose: The website is designed as an access point to CHRISTUS Trinity Mother Frances Health System resources. Using the web people can access information about the many services CHRISTUS Trinity Mother Frances Health System provides, information about physicians, registration for classes or upcoming events, careers and more. The health information module provides a vast amount of information regarding diseases, medications, labs, tests and links to disease communities or support groups and resources. Name: Community Partnerships Description: Assistance was provided both financially and with staffing for groups and organizations to provide collaborative programs, services, and health information. Projects included over 80 opportunities, including school-based programs, youth programs, and general public events. Purpose: To provide assistance and support and to educate the public on programs offered by Komen Foundation, American Heart Association, American Cancer Society, Alzheimer Association, Bethesda Health Clinic, Boy Scouts, Childrens Advocacy Center, nursing programs, and public and private schools. Name: United Way Description: CTMFHS and our employees provided financial support of over $60,000. Purpose: To assist with the design, development, funding, and mission development of over 30 non-profit agencies in the community, and to provide services to children and families at-risk regardless of their ability to pay for those services. Name: Share the Spirit Description: This is an annual fund raising campaign within the health system for designated programs by the employees. It is organized and implemented by employees with all proceeds going to help with health related programs. The amount raised was $207,000. Purpose: To assist with the funding for the following projects: Heart care, Cancer care, Childrens Miracle Network, diabetes education and services, and the employee CrisisCare Fund. Anyone is eligible to receive assistance based on need or program needs. Name: Childrens Miracle Network Description: This is a designation for hospitals that focus on childrens care and their needs. It provides a support system for fundraising benefiting childrens services. Mother Frances Hospital is the only hospital between Dallas and Houston so designated. Purpose: To improve the medical services for pediatric patients and their families. Medical equipment for pediatric services is purchased for both the Tyler and Jacksonville locations. A board oversees the outlay of the funds raised in the community during the year. In 2016, nearly $1.3 million was allocated for services. Name: Health Education /Screening Programs Description: Community education for healthy life styles was offered throughout the region for a variety of conditions. The Fit City Tyler Program and various walks are included as well as stress management, diabetes education, heart health, and cancer awareness screenings. The Women with Heart program also offered education on heart disease in four counties. 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; both were targeted. NAME: School Assistance Description: Over 4,881 high school physicals and pre-participation exams were done at no cost to the schools. Additionally, over 259 student athletes were seen for free in Saturday sports clinics. All programs are open to anyone to participate provided they have parental approval. Support for on-site trainers is also provide SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: TEXAS SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE, TOTALING $43,265,631. SCHEDULE H, PART I, LINE 3C FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING FACTORS IN ITS DETERMINATON: - ASSET LEVEL - MEDICAL INDIGENCY - INSURANCE STATUS - UNDERINSURANCE STATUS - GREATER THAN 400% UNDER THE CATASTROPHIC CAP PROVISION - RESIDENCY SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: MOTHER FRANCES HOSPITAL-TYLER 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-TYLER AND ITS AFFILIATES PROMOTE THE HEALTH OF THE COMMUNITIES SERVED BY PROVIDING ACUTE CARE FACILITIES AND CRITICAL ACCESS FACILITIES WHOSE OPERATIONS CONSIST PRIMARILY OF PROVIDING INPATIENT AND OUTPATIENT ACUTE CARE AND MEDICAL SERVICES TO PATIENTS RESIDING IN EAST TEXAS. true CHRISTUS-TRINITY MOTHER FRANCES FOUNDATION 1315 DOCTORS DRIVE TYLER TX 75701 752028241 501(c)(3) 80000 SPONSORSHIP SERVICE ORGANIZATION OF PINEY WOODS 2950 50TH ST LUBBOCK TX 79314 300630886 501(C)(3) 20226447 COMMUNITY HEALTHCARE SISTERS OF THE HOLY FAMILY OF NAZARETH 800 E DAWSON TYLER TX 75701 205728802 501(C)(3) 250000 DONATION SERVICE ORGANIZATION OF NORTH & EAST TEXAS 2950 50TH STREET LUBBOCK TX 79314 260468622 501(C)(3) 7026660 COMMUNITY HEALTHCARE CANCER FOUNDATION FOR LIFE 218 N COLLEGE AVE TYLER TX 75702 752957440 501(C)(3) 25000 community healthcare AMERICAN CANCER SOCIETY 1301 S BROADWAY AVE TYLER TX 75701 131788491 501(C)(3) 20000 community healthcare ST GREGORY CATHEDRAL SCHOOL 500 S COLLEGE AVE TYLER TX 75702 272769354 501(C)(3) 20000 community healthcare AMERICAN HEART ASSOCIATION PO Box 4002903 Des Moines IA 50340 135613797 501(C)(3) 30000 community healthcare TYLER ECONOMIC DEVELOPMENT COUNCIL INC 315 N BROADWAY AVE 300 TYLER TX 75702 752254467 501(C)(3) 15000 community healthcare TEXAS ROSE FESTIVAL PO BOX 8224 TYLER TX 75711 751171774 501(C)(3) 6000 community healthcare ALZHEIMERS ALLIANCE OF SMITH COUNTY 211 WINCHESTER DR TYLER TX 75701 752486061 501(C)(3) 6000 community healthcare SAMARITAN COUNSELING CENTER OF TYLER 218 N COLLEGE AVE TYLER TX 75702 452047833 501(C)(3) 7500 community healthcare TYLER AREA CHAMBER OF COMMERCE 315 N BROADWAY AVE 100 TYLER TX 75702 750624670 501(C)(3) 11940 community healthcare 13 SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S.: 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 true true X X X X X false true false false false false false false false RAY THOMPSON SYS EXEC VP/DIRECTOR/ASST SEC 256172 384259 441072 661609 61557 92335 6890 10336 6603 9907 772294 1158446 0 0 FAGG SANFORD MD DIRECTOR 0 925371 0 0 0 20040 0 8613 0 7296 0 961320 0 0 ANDY KIRKPATRICK DIRECTOR 0 629516 0 0 0 34162 0 11263 0 8784 0 683725 0 11722 JOHN MCGREEVY SR VP/CEO OF MFH REG 334849 0 138842 0 23806 0 17226 0 16510 0 531233 0 0 0 J LINDSEY BRADLEY SYSTEM PRESIDENT 183011 630373 269854 929498 29550 101783 3876 13350 3715 12795 490006 1687799 0 0 STEVEN KEUER MD SYS PRESIDENT/CMO/DIRECTOR 0 547317 0 384712 0 714773 0 17226 0 2500 0 1666528 0 601460 SCOTT SMITH MD EXECUTIVE VICE PRESIDENT 0 477787 0 152500 0 13300 0 11926 0 2500 0 658013 0 0 JOYCE HESTER SR. VICE PRESIDENT/CFO 94635 283906 51297 153892 3824 11471 4306 12920 3502 10508 157564 472697 0 0 ROBERT ROSE SR. VP, PATIENT CARE SERVICES 246113 0 71651 0 11716 0 8857 0 8211 0 346548 0 0 0 TODD HANCOCK SR. VP/COO 252852 0 72245 0 11404 0 9226 0 6792 0 352519 0 0 0 LEE PORTWOOD VP 227039 0 64658 0 13131 0 9738 0 4495 0 319061 0 0 0 PATRICK SIMONSON VP 173086 0 44666 0 15955 0 3061 0 3882 0 240650 0 0 0 JASON PROCTOR VP 182425 0 50002 0 11052 0 3173 0 6283 0 252935 0 0 0 ELIZABETH PULLIAM VP OF FINANCE/CFO OF MFH REG 89680 149468 28288 47147 4376 7292 2961 4934 1417 2361 126722 211202 0 0 WILLIAM SANDBERG CRNA 274334 0 0 0 1925 0 7928 0 4000 0 288187 0 0 0 ROBERT BIENERT CRNA 362840 0 0 0 270 0 6580 0 2180 0 371870 0 0 0 TAWONDA FELTON CRNA 387278 0 0 0 671 0 8475 0 2606 0 399030 0 0 0 DUSTIN VIDRINE CRNA 280309 0 0 0 219 0 6940 0 9085 0 296553 0 0 0 TIMOTHY CLARK CRNA 272817 0 0 0 253 0 6797 0 8373 0 288240 0 0 0 CHRIS GLENNEY VP OPERATIONS/FORMER OFFICER 0 262024 0 112654 0 19292 0 17226 0 21610 0 432806 0 0 SCOTT FOSSEY VP/FORMER OFFICER 0 208493 0 52000 0 12371 0 5757 0 5419 0 284040 0 0 SCHEDULE J, PART I, LINE 4B PARTICIPATION IN OR PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN SERP REPORTED IN W-2 DEFERRED COMPENSATION -------------------- --------------- --------------------- STEVEN KEUER MD $493,455 NONE PARTICIPANTS IN 457(F) REPORTED IN W-2 --------------------- --------------- STEVEN KEUER MD $108,005 ANDY KIRKPATRICK MD $11,722 SCHEDULE J, PART II COMPENSATION FROM RELATED ORGANIZATIONS: THE GOVERNING BOARD OF CHRISTUS TRINITY MOTHER FRANCES HEALTH SYSTEM UPON ADVICE FROM NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS, WHO PERIODICALLY REVIEW ALL EXECUTIVE COMPENSATION, APPROVED A DEFERRED COMPENSATION PLAN THAT PROVIDES A 65% TOTAL RETIREMENT BENEFIT FOR SENIOR EXECUTIVES THAT SERVE 20 YEARS OR MORE. THIS PROGRAM HAS BOTH RETENTION AND NON-COMPETITION CLAUSES THAT CREATE A RISK OF FORFEITURE. DEFERRED COMPENSATION IS SUBJECT TO A RISK OF FORFEITURE BASED ON RETENTION, NON-COMPETITION AND OTHER CONTRACTUAL FACTORS. ACCRUALS OF DEFERRED COMPENSATION ARE NOT INCLUDIBLE IN W-2 COMPENSATION UNTIL PAID. OTHER EMPLOYEE BENEFITS INCLUDE QUALIFIED PENSION PLANS, HEALTH, DENTAL AND LIFE INSURANCE PLANS, DISABILITY INSURANCE, ETC. TAXABLE EXPENSES ARE INCLUDED IN THE W-2 PAID COMPENSATION SALARY AMOUNT. SCHEDULE J, PART I, LINE 1A DESCRIPTION OF BENEFITS: THE HOUSING ALLOWANCE IS INCLUDED AS TAXABLE COMPENSATION FOR PATRICK SIMONSON. THE COUNTRY CLUB DUES ARE INCLUDED AS TAXABLE COMPENSATION FOR SCOTT FOSSEY. A TYLER HEALTH FACILITIES DEVELOPMENT CORPORATION 521315814 902261HP4 2011-10-12 51735000 CAPITAL DEVELOPMENT false false false B TYLER HEALTH FACILITIES DEVELOPMENT CORPORATION 521315814 902261FP6 2003-05-08 60753954 CAPITAL DEVELOPMENT false false false C TYLER HEALTH FACILITIES DEVELOPMENT CORPORATION 521315814 902261GP5 2007-05-30 23053130 CAPITAL DEVELOPMENT false false false D TYLER HEALTH FACILITIES DEVELOPMENT CORPORATION 521315814 XXXXXXXXX 2012-10-19 57429494 REFINANCING 1992 AND 1997B BONDS false false false A 0 0 51735000 5173500 0 45260090 873700 0 0 0 0 0 2013 false false true true B 25653954 0 60753954 669419 0 40532637 771361 0 0 18780537 0 0 2005 true false true true C 122499 0 23053130 2300000 0 0 386250 0 0 20366880 0 0 2012 false false true true D 43419395 0 57429494 0 0 57170774 258720 0 0 0 0 0 2001 true false true true A false true false false 0.02300 0.00600 0.02900 false false false true B false false false false 0.00000 0.00000 0.00000 false false false true C false false false false 0.00000 0.00000 0.00000 false false false true D false true false false 0.00647 0.00000 0.00647 false false false true A false true false false false false 0 false 0 false true B true false false 0 false 0 false true C true false false 0 false 0 false true D false true false false true false 0 false 0 false true A true B true C true D true SCHEDULE K, PART I REFINANCED BONDS: SERIES 1992 REVENUE BOND ISSUE DATE 05/27/1992 SERIES 1997B REVENUE BOND ISSUE DATE 12/01/1997 SERIES 2001 REVENUE BOND ISSUE DATE 10/30/2001 SERIES 2003 REVENUE BOND ISSUE DATE 05/08/2003 A TYLER HEALTH FACILITIES DEVELOPMENT CORPORATION 521315814 902261gn0 2007-05-16 66789990 CAPITAL DEVELOPMENT false false false A 2028538 0 66789990 288280 0 64699862 1801848 0 0 0 0 0 2003 false true true true A false false false false 0.00000 0.00000 0.00000 false false false true A true false false 0 false 0 false true A true SUSAN RIPPY DAUGHTER OF DIRECTOR 27532 SALARIES/WAGES false FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS: CHRISTUS TRINITY MOTHER FRANCES HEALTH SYSTEM IS THE SOLE MEMBER OF MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS WHO MAY ELECT MEMBERS OF THE GOVERNING BODY: 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, SECTION A, LINE 7B DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY THE MEMBER: THE MEMBER HAS THE RIGHT TO APPROVE OR DISAPPROVE CERTAIN ACTIONS THAT HAVE BEEN PREVIOUSLY APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS AND A COPY IS PROVIDED TO THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C PROCESS TO MONITOR AND ENFORCE CONFLICT OF INTEREST POLICY: THE BOARD REVIEWS AND RESOLVES, IF NECESSARY, ANY TRANSACTIONS AS THEY ARISE THROUGHOUT THE YEAR IN ACCORDANCE WITH POLICY STANDARDS. THE ORGANIZATION'S INTERNAL ACCOUNTANTS DISTRIBUTE AND REVIEW ANNUAL QUESTIONNAIRES TO IDENTIFY ANY POTENTIAL CONFLICTS OF THE BOARD MEMBERS, OFFICERS AND THE HIGHEST COMPENSATED EMPLOYEES. WHEN A CONFLICT OF INTEREST IS IDENTIFIED, THE INDIVIDUAL IS REMOVED FROM DISCUSSIONS AND CANNOT VOTE ON ANY TRANSACTIONS INVOLVING THE CONFLICT. FORM 990, PART VI, SECTION B, LINES 15A & 15B REVIEW OF COMPENSATION OF CEO, OFFICER, OR KEY EMPLOYEE: 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, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1A COMPENSATION FROM RELATED ORGANIZATIONS: THE GOVERNING BOARD OF CHRISTUS TRINITY MOTHER FRANCES HEALTH SYSTEM UPON ADVICE FROM NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS, WHO PERIODICALLY REVIEW ALL EXECUTIVE COMPENSATION, APPROVED A DEFERRED COMPENSATION PLAN THAT PROVIDES A 65% TOTAL RETIREMENT BENEFIT FOR SENIOR EXECUTIVES THAT SERVE 20 YEARS OR MORE. THIS PROGRAM HAS BOTH RETENTION AND NON-COMPETITION CLAUSES THAT CREATE A RISK OF FORFEITURE. DEFERRED COMPENSATION IS SUBJECT TO A RISK OF FORFEITURE BASED ON RETENTION, NON-COMPETITION AND OTHER CONTRACTUAL FACTORS. ACCRUALS OF DEFERRED COMPENSATION ARE NOT INCLUDIBLE IN W-2 COMPENSATION UNTIL PAID. OTHER EMPLOYEE BENEFITS INCLUDE QUALIFIED PENSION PLANS, HEALTH, DENTAL AND LIFE INSURANCE PLANS, DISABILITY INSURANCE, ETC. TAXABLE EXPENSES ARE INCLUDED IN THE W-2 PAID COMPENSATION SALARY AMOUNT. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: CHANGE IN PENSION PLAN LIABILITY $(27,786,785) TRANSFER TO AFFILIATE (18,882,650) EQUITY IN EARNINGS OF AFFILIATE 4,816,738 NET ASSETS RELEASED FROM RESTRICTION (275,922) EQUITY IN INCOME OF CONSOLIDATED SUBSIDIARY (38,714) ------------- TOTAL $(42,167,333) FORM 990, PART VI, SECTION A, LINE 2 RELATIONSHIPS BETWEEN OFFICERS & DIRECTORS: THE MEMBERS OF THE EXECUTIVE TEAM ALL HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER THROUGH THEIR EMPLOYMENT WITH RELATED ORGANIZATIONS. FORM 990 PART IX LINE 11G DESCRIPTION:CORPORATE ALLOCATION EXPENSE TOTAL FEES:63965057 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:36791770 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:24102675 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:7260819 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTING TOTAL FEES:362599 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN ADVISOR TOTAL FEES:69200 FORM 990 PART IX LINE 11G DESCRIPTION:TRANSCRIPTION SERVICES TOTAL FEES:234301 MOTHER FRANCES HOSPITAL - WINNSBORO 1315 DOCTORS DRIVE TYLER TX 75701 752771569 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) 11, TYPE I CTMFHS true REGIONAL MEDICAL SERVICES ASSOCIATION 1315 DOCTORS DRIVE TYLER TX 75701 752511459 HEALTHCARE TX 501(C)(3) 3 MFH REG true CHRISTUS TRINITY MF HEALTH SYSTEM 1315 DOCTORS DRIVE TYLER TX 75701 752616975 SUPPORT TX 501(C)(3) 11, TYPE II CH false TRINITY CLINIC 1315 DOCTORS DRIVE TYLER TX 75701 752616977 HEALTHCARE TX 501(C)(3) 3 CTMFHS true MOTHER FRANCES HOSPITAL - JACKSONVILLE 1315 DOCTORS DRIVE TYLER TX 75701 751976930 HOSPITAL TX 501(C)(3) 3 CTMFHS true ALIGNED PROVIDERS OF EAST TEXAS 1315 DOCTORS DRIVE TYLER TX 75701 465720165 HEALTHCARE TX 501(C)(3) 3 MFH REG true CSFN MISSION AND MINISTRY INC 4001 GRANT AVENUE PHILADELPHIA PA 19114 205728802 SPONSORSHIP PA 501(C)(3) 1 NA false CHRISTUS HEALTH 919 HIDDEN RIDGE IRVING TX 75038 760590551 SPT HLTH SVCS TX 501(C)(3) 9 NA false TYLER RADIATION EQUIPMENT LEASING LLC 10101 WOODLOCH FOREST DRIVE THE WOODLANDS TX 77380 262554738 EQUIPMENT LEASING TX MFH REG UNRELATED 285088 523811 false 285088 false 0.51000 TRI-STATE FINANCIAL LLC 1315 DOCTORS DRIVE TYLER TX 75701 752728318 DORMANT TX CTMFHS C-CORPORATION true TRINCARE INC 1315 DOCTORS DRIVE TYLER TX 75701 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 TEXAS HEALTH FACILITY INSUR CORP LTD PO BOX 1109 BWI CJ 980136025 INSURANCE CJ MFH REG C-CORPORATION -38714 172509 1.00000 true true true true false false false false false false true false true true true true true true true true ALIGNED PROVIDERS OF EAST TEXAS Q 8661989 CASH VALUE ALIGNED PROVIDERS OF EAST TEXAS S 1614336 CASH VALUE ALIGNED PROVIDERS OF EAST TEXAS P 483824 CASH VALUE ALIGNED PROVIDERS OF EAST TEXAS R 10947109 CASH VALUE CHRISTUS-TRINITY MOTHER FRANCES FOUNDATION B 80000 CASH VALUE CHRISTUS-TRINITY MOTHER FRANCES FOUNDATION C 855654 CASH VALUE CHRISTUS-TRINITY MOTHER FRANCES FOUNDATION S 1356114 CASH VALUE CHRISTUS-TRINITY MOTHER FRANCES FOUNDATION P 929470 CASH VALUE CHRISTUS-TRINITY MOTHER FRANCES FOUNDATION R 231904 CASH VALUE MOTHER FRANCES HOSPITAL - JACKSONVILLE Q 130103 CASH VALUE MOTHER FRANCES HOSPITAL - JACKSONVILLE S 40598137 CASH VALUE MOTHER FRANCES HOSPITAL - JACKSONVILLE P 11295525 CASH VALUE MOTHER FRANCES HOSPITAL - JACKSONVILLE R 25097921 CASH VALUE TRINITY CLINIC Q 38571811 CASH VALUE TRINITY CLINIC S 9390707 CASH VALUE TRINITY CLINIC P 10275356 CASH VALUE TRINITY CLINIC R 38802853 CASH VALUE MOTHER FRANCES HOSPITAL - WINNSBORO S 18048338 CASH VALUE MOTHER FRANCES HOSPITAL - WINNSBORO P 6580799 CASH VALUE MOTHER FRANCES HOSPITAL - WINNSBORO R 7582410 CASH VALUE REGIONAL MEDICAL SERVICES ASSOCIATION Q 591133 CASH VALUE REGIONAL MEDICAL SERVICES ASSOCIATION P 390107 CASH VALUE REGIONAL MEDICAL SERVICES ASSOCIATION R 337673 CASH VALUE REGIONAL MEDICAL SERVICES ASSOCIATION L 130228 CASH VALUE TRINCARE INC S 4066756 CASH VALUE TRINCARE INC P 2518483 CASH VALUE TRINCARE INC R 893114 CASH VALUE MOTHER FRANCES HOSPITAL - JACKSONVILLE A 2251235 CASH VALUE SCHEDULE R, PART II, COLUMN F & PART III, COLUMN D DIRECT CONTROLLING ENTITY: CHRISTUS HEALTH ("CH") IS THE TOP LEVEL ORGANIZATION WHICH DIRECTLY OR INDIRECTLY CONTROLS ALL OF THE LOWER TIERED ORGANIZATIONS. THE FOLLOWING RELATED ORGANIZATIONS REPORTABLE IN PART II ARE DIRECTLY CONTROLLED BY CHRISTUS TRINITY MOTHER FRANCES HEALTH SYSTEM ("CTMFHS"): MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER MOTHER FRANCES HOSPITAL - JACKSONVILLE CHRISTUS-TRINITY MOTHER FRANCES FOUNDATION TRINITY CLINIC MOTHER FRANCES HOSPITAL - WINNSBORO REGIONAL MEDICAL SERVICES ASSOCIATION AND ALIGNED PROVIDERS OF EAST TEXAS ARE DIRECTLY CONTROLLED BY MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER ("MFH REG"). THE ABOVE DIRECT CONTROLLING ENTITIES, "CTMFHS"MFH REG", ARE ALSO THE CONTROLLING ENTITIES FOR THE CORPORATIONS LISTED IN PART IV.