MOTHER FRANCES HOSPITAL JACKSONVILLE: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MOTHER FRANCES HOSPITAL JACKSONVILLE (EIN 75-1976930)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-15
- IRS object ID
- 201721359349304017
- Schema version
- 2015v3.0
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-15T10:47:02-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14241 DALLAS PKWY STE 1100 | AddressLine1Txt |
| City | DALLAS | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | 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 | VP of Finance | PersonTitleTxt |
| Phone | 9035315764 | PhoneNum |
| Signature | 2017-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Jeanette Verrelli | PreparerPersonNm |
| PTIN | P00742631 | PTIN |
| Phone | 9727028262 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | 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 | ANNE PILEGGI | 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 | $39,695,634 | 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 |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 2 | VotingMembersIndependentCnt |
| Total Employee | 177 | TotalEmployeeCnt |
| Total Volunteers | 4 | 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 | $38,157,700 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $39,695,631 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,636 | PYInvestmentIncomeAmt |
| CY Investment Income | $3 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $38,159,336 | PYTotalRevenueAmt |
| CY Total Revenue | $39,695,634 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,861,094 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,642,814 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,608,169 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $11,105,652 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $26,658,184 | PYOtherExpensesAmt |
| CY Other Expenses | $23,622,056 | CYOtherExpensesAmt |
| PY Total Expenses | $38,127,447 | PYTotalExpensesAmt |
| CY Total Expenses | $36,370,522 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $31,889 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,325,112 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $25,390,734 | TotalAssetsBOYAmt |
| Total Assets EOY | $31,688,163 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,732,671 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,704,988 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $19,658,063 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $22,983,175 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE THE COMMUNITY WITH A FULL RANGE OF COMPREHENSIVE HEALTHCARE 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 | $31,112,383 | ExpenseAmt |
| Grant | $1,642,814 | GrantAmt |
| Revenue | $39,695,631 | 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 645 INPATIENTS ADMITTED RESULTING IN 2,756 PATIENT DAYS; 51,714 OUTPATIENTS ADMITTED RESULTING IN 25,127 PATIENT DAYS; AND 18,464 EMERGENCY ROOM VISITS RESULTING IN 1,520 PATIENT DAYS. | Desc |
| Total Program Service Expenses | $31,112,383 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | 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 | false | 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 |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 14 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 177 | 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 2 | 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 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 | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| THOMAS N CAMMACK JR | |||||||||
| CEO/SEC/TREAS; TERM:9/2015 | 40.0 | 0.0 | Yes (X) | Yes (X) | $270,315 | $0 | $9,617 | ||
| MATTHEW A VIERKANT MD | |||||||||
| DIRECTOR | 40.0 | 0.0 | Yes (X) | $380,780 | $0 | $21,969 | |||
| RAY THOMPSON | |||||||||
| SYS EXEC/VP/CHAIR | 1.0 | 39.0 | Yes (X) | Yes (X) | $47,425 | $1,849,579 | $33,736 | ||
| GLEN T HAMILTON | |||||||||
| VICE CHAIR | 1.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM MILAWSKI MD | |||||||||
| DIRECTOR | 40.0 | 0.0 | Yes (X) | $255,981 | $0 | $13,836 | |||
| DICK STONE | |||||||||
| DIRECTOR | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| RANDY GORHAM | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| ANNE PILEGGI | |||||||||
| ASSOCIATE VP/SEC; START:9/2015 | 40.0 | 0.0 | Yes (X) | Yes (X) | $0 | $187,333 | $8,459 | ||
| PETER SIRIANNI MD | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $1,298,995 | $17,253 | |||
| SCOTT SMITH MD | |||||||||
| SR VP; START:4/2016 | 1.0 | 39.0 | Yes (X) | Yes (X) | $0 | $643,587 | $14,426 | ||
| J LINDSEY BRADLEY JR | |||||||||
| SYSTEM PRESIDENT | 1.0 | 39.0 | Yes (X) | $53,602 | $2,090,467 | $33,736 | |||
| JOYCE HESTER | |||||||||
| SR. VP/CFO; TERM:4/2016 | 4.0 | 36.0 | Yes (X) | $59,903 | $539,122 | $31,236 | |||
| BARRY L THIBODEAUX | |||||||||
| CRNA | 40.0 | 0.0 | $270,268 | $0 | $10,104 | Yes (X) | |||
| BEN BEATHARD | |||||||||
| RN | 40.0 | 0.0 | $118,766 | $0 | $12,619 | Yes (X) | |||
| ROMAN BAGWELL | |||||||||
| DIRECTOR CRNA | 40.0 | 0.0 | $222,431 | $0 | $13,493 | Yes (X) | |||
| KEITH MARTIN | |||||||||
| RN | 40.0 | 0.0 | $125,650 | $0 | $8,729 | Yes (X) | |||
| KERRY BOLIN | |||||||||
| chief nursing officer | 40.0 | 0.0 | $131,316 | $0 | $9,457 | Yes (X) | |||
| MICHAEL LEWIS SR | |||||||||
| Associate VP/former coo | 0.0 | 40.0 | $0 | $190,722 | $13,638 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,936,437 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $6,799,805 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $252,308 | 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 | Siemens Medical Solutions USA Inc | PersonNm |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 40 Liberty Boulevard | AddressLine1Txt |
| City | MALVERN | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19355 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | Equip Maintenance | ServicesDesc |
| Compensation | $332,683 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 621110 | $33,719,331 | $33,719,331 |
| UPL MEDICAID REVENUE | 900099 | $4,328,707 | $4,328,707 |
| EHR INCENTIVE REVENUE | 900099 | $23,520 | $23,520 |
| PHARMACY REVENUE | 446110 | $1,491,242 | $1,491,242 |
| RELATED RENTAL REVENUE | 532000 | $70,820 | $70,820 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $62,011 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $62,011 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $39,695,631 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3 | TotalRevenueColumnAmt |
| Exclusion | $3 | ExclusionAmt |
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 |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $39,695,634 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $39,695,631 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $3 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,642,814 | TotalAmt |
| Program Services | $1,642,814 | 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 | $1,007,522 | TotalAmt |
| Program Services | $815,522 | ProgramServicesAmt |
| Management And General | $192,000 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,724 | TotalAmt |
| Program Services | $51,351 | ProgramServicesAmt |
| Management And General | $12,373 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,011,754 | TotalAmt |
| Program Services | $6,486,414 | ProgramServicesAmt |
| Management And General | $1,525,340 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $180,630 | TotalAmt |
| Program Services | $160,760 | ProgramServicesAmt |
| Management And General | $19,870 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $736,356 | TotalAmt |
| Program Services | $546,219 | ProgramServicesAmt |
| Management And General | $190,137 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,105,666 | TotalAmt |
| Program Services | $991,237 | ProgramServicesAmt |
| Management And General | $114,429 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $135,508 | TotalAmt |
| Management And General | $135,508 | 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 | $4,800 | TotalAmt |
| Program Services | $4,800 | ProgramServicesAmt |
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 | $10,648,115 | TotalAmt |
| Program Services | $10,413,409 | ProgramServicesAmt |
| Management And General | $234,706 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,490 | TotalAmt |
| Management And General | $37,490 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,222 | TotalAmt |
| Program Services | $41,162 | ProgramServicesAmt |
| Management And General | $141,060 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,100 | TotalAmt |
| Program Services | $9,179 | ProgramServicesAmt |
| Management And General | $14,921 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,587,848 | TotalAmt |
| Program Services | $349,031 | ProgramServicesAmt |
| Management And General | $2,238,817 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,728 | TotalAmt |
| Program Services | $6,624 | ProgramServicesAmt |
| Management And General | $104 | 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 | $9,688 | TotalAmt |
| Program Services | $6,663 | ProgramServicesAmt |
| Management And General | $3,025 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $753 | TotalAmt |
| Management And General | $753 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $300,074 | TotalAmt |
| Program Services | $22,462 | ProgramServicesAmt |
| Management And General | $277,612 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,303 | TotalAmt |
| Management And General | $78,303 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $5,373,450 | $5,373,450 | $0 |
| MEDICAL SUPPLIES | $3,331,173 | $3,315,181 | $15,992 |
| FOOD | $116,321 | $111,321 | $5,000 |
| REPAIRS AND MAINTENANCE | $621,789 | $618,768 | $3,021 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $163,694 | TotalAmt |
| Program Services | $146,016 | ProgramServicesAmt |
| Management And General | $17,678 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,370,522 | TotalAmt |
| Program Services | $31,112,383 | ProgramServicesAmt |
| Management And General | $5,258,139 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$115,427 | BOYAmt |
| EOY | $1,639 | 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 | $3,786,351 | BOYAmt |
| EOY | $3,618,894 | 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 | $132,951 | BOYAmt |
| EOY | $139,580 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,283 | BOYAmt |
| EOY | $76,906 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,129,447 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,938,679 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $930,150 | BOYAmt |
| EOY | $1,190,768 | 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 | $20,600,426 | BOYAmt |
| EOY | $26,660,376 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,390,734 | BOYAmt |
| EOY | $31,688,163 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,300,300 | BOYAmt |
| EOY | $1,490,559 | 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 | $3,432,371 | BOYAmt |
| EOY | $7,214,429 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,732,671 | BOYAmt |
| EOY | $8,704,988 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,658,063 | BOYAmt |
| EOY | $22,983,175 | 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 | $19,658,063 | BOYAmt |
| EOY | $22,983,175 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,390,734 | BOYAmt |
| EOY | $31,688,163 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,325,112 | ReconcilationRevenueExpnssAmt |
| 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 | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $455 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $455 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1i | FormAndLineReferenceDesc |
| Explanation | OTHER ACTIVITIES: A PERCENTAGE OF AHA DUES WERE EXPENDED FOR SPECIFIC LOBBYING PURPOSES BASED ON MEDICARE DEFINITION OF UNALLOWABLE EXPENSES. | ExplanationTxt |
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 | $2,885,950 | BeginningYearBalanceAmt |
| Contributions | $445,000 | ContributionsAmt |
| Investment Earnings Or Losses | -$118,741 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $26,838 | GrantsOrScholarshipsAmt |
| End Year Balance | $3,185,371 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| 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 |
| End Year Balance | $2,885,950 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| 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 |
| End Year Balance | $2,762,072 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| 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 |
| End Year Balance | $2,414,694 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,350,337 | BeginningYearBalanceAmt |
| Contributions | $30,875 | ContributionsAmt |
| Investment Earnings Or Losses | $27,664 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $2,408,876 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.78610 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.21390 | 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 |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $96,200 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,342 | DepreciationAmt |
| Book Value | $93,858 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,033,248 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,936,338 | DepreciationAmt |
| Book Value | $1,096,910 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Land Buildings | OtherLandBuildingsGrp | |
| Total Book Value Land Buildings | $1,190,768 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE FROM AFFILIATES | Desc |
| Book Value | $26,660,376 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $26,660,376 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to third-party payers | $3,726,375 |
| Due To Affiliates | $3,274,304 |
| Est Self-Insurance Costs | $213,750 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $7,214,429 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $38,265,215 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$1,430,419 | OtherRevenueAmt |
| Revenue Not Reported | -$1,430,419 | RevenueNotReportedAmt |
| Revenue Subtotal | $39,695,634 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $39,695,634 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $34,940,103 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $34,940,103 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,430,419 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,430,419 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $36,370,522 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 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 | 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. |
| SCHEDULE D, PART XI, LINE 2D | Reconciliation of revenue per audited financial statements with return: Bad debt expense $(5,373,450) Provider tax $ 3,943,031 ------------- Total $(1,430,419) |
| SCHEDULE D, PART XII, LINE 4B | Reconciliation of expense per audited financial statements with return: Bad debt expense $ 5,373,450 Provider tax $(3,943,031) ------------- Total $ 1,430,419 |
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 | $2,800,446 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,800,446 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09030 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,465,958 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,036,058 | DirectOffsettingRevenueAmt |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $356,256 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,539,649 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,622,660 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,575,707 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,800,446 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09030 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,061 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,061 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $347,638 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $347,638 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01120 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,642,814 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,642,814 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05300 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,000,513 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,000,513 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06450 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,623,173 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,575,707 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,800,959 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15480 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,373,450 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $11,601,742 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,031,746 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,569,996 | 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.thfhc.org/jacksonville | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| 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 |
| Strategy Attached | false | StrategyAttachedInd |
| 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 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. |
| SCHEDULE H, PART V, SECTION B, LINES 7A & 10A | CHNA AVAILABLE TO THE PUBLIC: THE HOSPITAL'S CHNA AND IMPLEMENTATION STRATEGY ARE AVAILABLE UPON REQUEST AND AT THE FOLLOWING WEBSITE: http://www.tmfhc.org/about-us/comprehensive-community-health-needs-assessm ents/ |
| SCHEDULE H, PART V, SECTION B, LINES 18, 19 & 20 | BILLING AND COLLECTIONS: NEITHER MOTHER FRANCES HOSPITAL - JACKSONVILLE, NOR THIRD PARTIES AUTHORIZED BY MFH-J, 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, LINE 22D | DETERMINATION OF FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE: CHRISTUS uses the Prospective Medicare Method to determine amounts generally billed (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, LINES 16A, 16B, & 16C | FAP DOCUMENTS AVAILABLE TO THE PUBLIC: THE HOSPITAL'S FAP, FAP APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT THE FOLLOWING WEBSITE: http://www.tmfhc.org/patients-visitors/financial-assistance/ |
| SCHEDULE H, PART V, SECTION B, LINE 13B | INCOME LEVEL USED FOR FAP ELIGIBILITY: MFH - JACKSONVILLE PROVIDES CHARITY FOR PATIENTS ABOVE 400% UNDER THE CATASTROPHIC CAP PROVISION. THIS PROVISION ALLOWS MFH - JACKSONVILLE TO DISCOUNT THE CARE RECEIVED TO NO MORE THAN 30% OF THE PATIENT'S YEARLY INCOME. |
| 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: - ACCESS TO PRIMARY CARE SERVICES - NEED FOR INCREASED EMPHASIS ON COLLABORATIVE CONTINUUM OF CARE - PREVENTION, EDUCATION, AND SERVICES TO ADDRESS HIGH MORTALITY RATES, CHRONIC 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 COMMUNITY PROGRAMS INCLUDE: - COLLABORATION WITH CHRISTUS MOTHER FRANCES HOSPITAL - TYLER FOR THE CONTINUED MAINTENANCE OF THE MEDICAID WAIVER PROGRAMS - CANCER AWARENESS & PREVENTION ACTIVITIES THROUGH CANCER RELAY FOR LIFE - COLLABORATION WITH LOCAL NON-PROFIT COMMUNITY GROUPS PROVIDING ESSENTIAL SERVICES - PREVENTION SCREENING AND WELLNESS PROGRAMS AT THE COUNTY FAIR - PROVIDING SUPPORT FOR RURAL AREA MEDICAL SERVICES RELATED TO KID'S SAFETY ISSUES AND EMS SERVICES - 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. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART III, SECTION A, LINE 2 | BAD DEBT EXPENSE: THE AMOUNT REPORTED ON LINE 2 IS BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART III, SECTION A, 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, 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-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 AREA. 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 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 FACILITIES, WHOSE OPERATIONS CONSIST PRIMARILY OF PROVIDING INPATIENT AND OUTPATIENT ACUTE CARE AND MEDICAL SERVICES TO PATIENTS RESIDING IN EAST TEXAS. |
| 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 $5,373,450. |
| SCHEDULE H, PART I, LINE 3C | FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING OTHER CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: - INCOME LEVEL - ASSET LEVEL - MEDICAL INDIGENCY - INSURANCE STATUS - UNDERINSURANCE STATUS - RESIDENCY |
| SCHEDULE H, PART VI, LINE 5 | PROMOTION OF COMMUNITY HEALTH: MOTHER FRANCES HOSPITAL-JACKSONVILLE 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: Improving the Fragmented Continuum of Care Description: Implemented the new EHR, EPIC and the updates for the system including "My Chart", cell phone application, bill pay online, and ability to receive texts for appointment notifications. "Health Planet" population health module was implemented. Purpose: The goal is to improve the patients experience as they transition through the continuum of care. This should reduce duplication of testing. Participation in initiatives that improve the patients experience was identified as a need. 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. 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. Name: Fundraising for Not-for-Profits Description: Mother Frances Hospital-Jacksonville supports the United Fund Drive with an in-house program as well as Childrens Miracle Network and American Cancer Society Relay for Life 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. 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. Name: Special Youth Programs Description: Mother Frances Hospital-Jacksonville sponsored Holiday photos with Santa, and Trunk or Treat to provide opportunities for education, safe community events, and promoting physical exercise. Purpose: To provide healthy choices for children during the Halloween Holidays, hosting a healthy snack program for the Christmas season, and supporting a major athletic program to encourage fitness and post-secondary education opportunities. 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 Literacy Council. In FY2016, 4,335 people were served, using 138 staff hours and $6,050 in sponsorships and another $3,500 in expenses. 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 Mother Frances Hospital-Jacksonville, or it may be too far for their patients to travel to receive services at our primary facilities. Name: Miracle on Jackson Street Blood Drive Description: Mother Frances Hospital-Jacksonville hosts several blood drives during the year. An annual blood drive in the community included was thrown in December. There was Participation within the health system, and it was also 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. 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, Jacksonville Literacy Council, and Jacksonville College. Members of the staff serve in leadership positions and as volunteers for programs on various boards and nonprofits in the community. Purpose: These programs benefit 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 public. Name: Health Education Programs Description: Health fair and screenings were done at the Tomato Fest, 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. Name: Community-Wide Disaster Drill Description: Mother Frances Hospital-Jacksonville participated in the Community-Wide Disaster Drill in April 2016. Participants included the Jacksonville Fire/EMS Department, the Jacksonville Police Department, East Texas Medical Center, Champion EMS, the Red Cross, and the Cherokee County Health Department. Purpose: To test the communitys response to a disaster. The drill involved a truck crashing into a local business causing a chemical spill. Mother Frances Hospital-Jacksonville tested readiness for mass casualties and chemical exposure. Name: Access to Mental Health Services Description: Mother Frances Hospital-Jacksonville evaluates, screens, and makes referrals to appropriate facilities when necessary. Additionally, staff developed a list of mental health providers in the community. Staff annually update the list. Purpose: The need to identify access for affordable mental health services was identified, as a community need. Information on referrals for available mental health services/resources is particularly needed in the emergency department. Name: Reducing transportation barriers Description: Mother Frances Hospital-Jacksonville established a list of transportation services available. This included the community and regional GoBus, Jacksonville Taxi Service, Medicab and Medical Transportation. If necessary, assistance for payments can be made by the hospital if the need is within the guidelines. Purpose: The need to provide access and information about available transportation services to community members was identified, as a community need. |
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 Sreet | Lubbock | TX | 79314 | 300630886 | 501(c)(3) | $1,218,560 | COMMUNITY HEALTHCARE |
| Service Organization of North & East Texas | |||||||
| 2950 50th Street | Lubbock | TX | 79314 | 260468622 | 501(c)(3) | $424,253 | COMMUNITY HEALTHCARE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PART I, LINE 2 | FormAndLineReferenceDesc |
| Explanation | PROCESS 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. | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THOMAS N CAMMACK JR | ||||||||||||||
| CEO/SEC/TREAS; TERM:9/2015 | $147,762 | $0 | $0 | $0 | $122,553 | $0 | $6,287 | $0 | $3,330 | $0 | $279,932 | $0 | $0 | $0 |
| MATTHEW A VIERKANT MD | ||||||||||||||
| DIRECTOR | $258,401 | $0 | $94,199 | $0 | $28,180 | $0 | $11,263 | $0 | $10,706 | $0 | $402,749 | $0 | $4,832 | $0 |
| RAY THOMPSON | ||||||||||||||
| SYS EXEC/VP/CHAIR | $16,011 | $624,420 | $27,567 | $1,075,114 | $3,847 | $150,045 | $431 | $16,795 | $413 | $16,097 | $48,269 | $1,882,471 | $0 | $0 |
| WILLIAM MILAWSKI MD | ||||||||||||||
| DIRECTOR | $151,010 | $0 | $100,177 | $0 | $4,794 | $0 | $9,451 | $0 | $4,385 | $0 | $269,817 | $0 | $0 | $0 |
| J LINDSEY BRADLEY JR | ||||||||||||||
| SYSTEM PRESIDENT | $20,335 | $793,049 | $29,984 | $1,169,368 | $3,283 | $128,050 | $431 | $16,795 | $413 | $16,097 | $54,446 | $2,123,359 | $0 | $0 |
| MICHAEL LEWIS SR | ||||||||||||||
| Associate VP/former coo | $0 | $159,902 | $0 | $23,778 | $0 | $7,042 | $0 | $6,892 | $0 | $6,746 | $0 | $204,360 | $0 | $0 |
| JOYCE HESTER | ||||||||||||||
| SR. VP/CFO; TERM:4/2016 | $37,854 | $340,687 | $20,519 | $184,670 | $1,530 | $13,765 | $1,723 | $15,503 | $1,401 | $12,609 | $63,027 | $567,234 | $0 | $0 |
| BARRY L THIBODEAUX | ||||||||||||||
| CRNA | $267,567 | $0 | $0 | $0 | $2,701 | $0 | $9,295 | $0 | $809 | $0 | $280,372 | $0 | $0 | $0 |
| ROMAN BAGWELL | ||||||||||||||
| DIRECTOR CRNA | $200,573 | $0 | $21,600 | $0 | $258 | $0 | $6,979 | $0 | $6,514 | $0 | $235,924 | $0 | $0 | $0 |
| ANNE PILEGGI | ||||||||||||||
| ASSOCIATE VP/SEC; START:9/2015 | $0 | $167,683 | $0 | $14,500 | $0 | $5,150 | $0 | $5,499 | $0 | $2,960 | $0 | $195,792 | $0 | $0 |
| PETER SIRIANNI MD | ||||||||||||||
| DIRECTOR | $0 | $1,294,555 | $0 | $0 | $0 | $4,440 | $0 | $11,263 | $0 | $5,990 | $0 | $1,316,248 | $0 | $0 |
| SCOTT SMITH MD | ||||||||||||||
| SR VP; START:4/2016 | $0 | $477,787 | $0 | $152,500 | $0 | $13,300 | $0 | $11,926 | $0 | $2,500 | $0 | $658,013 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PART I, LINE 4B | PARTICIPATION IN OR PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN 457(F) REPORTED IN W-2 ----------------------- ---------------- MATTHEW A VIERKANT MD $4,832 |
| SCHEDULE J, PART I, LINE 4A | SEVERANCE PAYMENT OR CHANGE-OF-CONTROL PAYMENT: RECIPIENT OF SEVERANCE REPORTED IN W-2 ----------------------- ---------------- THOMAS N CAMMACK JR $111,744 |
| 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 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 | Family member of director | RelationshipDescriptionTxt |
| Transaction | $63,724 | TransactionAmt |
| Transaction | Salaries/wages | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 A, LINE 6 | MEMBERS OR STOCKHOLDERS: CHRISTUS TRINITY MOTHER FRANCES HEALTH SYSTEM IS THE SOLE MEMBER OF MOTHER FRANCES HOSPITAL - JACKSONVILLE. |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS WHO MAY ELECT MEMBERS OF THE GOVERNING BOARD: THE SOLE MEMBER, CHRISTUS TRINITY MOTHER FRANCES HEALTH SYSTEM, APPOINTS 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 APPROVED BY THE BOARD OF DIRECTORS. |
| 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 EMPLOYEES: 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 V, LINE 1A | 1099S REPORTED BY ORGANIZATION: THE ORGANIZATION'S FORMS 1099-MISC ARE ISSUED BY A RELATED ORGANIZATION, MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER, WHICH REPORTS ALL FORMS 1099-MISC FOR THE ENTIRE SYSTEM AND ALLOCATES EXPENSES TO THE APPROPRIATE RELATED ORGANIZATION. THE NUMBER OF 1099S REPORTED ON PART V, LINE 1A IS THE NUMBER OF 1099S RELATED TO THE FILING ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 1A | DELEGATION OF AUTHORITY: THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE GOVERNING BOARD, DURING THE PERIOD BETWEEN THE MEETINGS OF THE GOVERNING BOARD. THE COMMITTEE SHALL BE SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE WILL BE REFERRED TO THE BOARD AT THE NEXT MEETING. |
| 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:CONTRACT LABOR TOTAL FEES:169033 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CORPORATE EXPENSE TOTAL FEES:3018597 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PURCHASED SERVICES TOTAL FEES:1534299 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:5926186 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 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) | 11, Type I | CTMFHS | Yes (true) |
| REGIONAL MEDICAL SERVICES ASSOCIATION | ||||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 752511459 | HEALTHCARE | TX | 501(c)(3) | 3 | MFH REG | Yes (true) |
| CHRISTUS TRINITY MF HEALTH SYSTEM | ||||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 752616975 | HEALTHCARE | 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 | Yes (true) |
| MOTHER FRANCES HOSPITAL - WINNSBORO | ||||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 752771569 | HOSPITAL | TX | 501(c)(3) | 3 | CTMFHS | Yes (true) |
| ALIGNED PROVIDERS OF EAST TEXAS | ||||||||||
| 1315 Doctors Drive | Tyler | TX | 75701 | 465720165 | Healthcare | TX | 501(c)(3) | 3 | MFH REG | Yes (true) |
| CSFN MISSION & 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 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 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 | Address Line1ForeignAddress/AddressLine1Txt | Province Or StateForeignAddress/ProvinceOrStateNm | CountryForeignAddress/CountryCd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TRI-STATE FINANCIAL LLC | |||||||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 752728318 | DORMANT | TX | CTMFHS | C-CORPORATION | Yes (true) | ||||
| TRINCARE INC | |||||||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 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) | ||||
| TEXAS HEALTH FACILITY INSUR CORP LTD | |||||||||||||
| 980136025 | INSURANCE | MFH REG | C-CORPORATION | Yes (true) | PO BOX 1109 BWI | GRAND CAYMAN | CJ | CJ | |||||
| 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 | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (9 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| TRINITY CLINIC | ||
| Q | $5,412,235 | CASH VALUE |
| TRINITY CLINIC | ||
| R | $5,430,067 | CASH VALUE |
| TRINITY CLINIC | ||
| S | $96,200 | CASH VALUE |
| MOTHER FRANCES HOSPITAL REGIONAL HC CENTER | ||
| P | $166,473 | CASH VALUE |
| MOTHER FRANCES HOSPITAL REGIONAL HC CENTER | ||
| Q | $22,371,876 | CASH VALUE |
| MOTHER FRANCES HOSPITAL REGIONAL HC CENTER | ||
| R | $42,691,990 | CASH VALUE |
| MOTHER FRANCES HOSPITAL REGIONAL HC CENTER | ||
| S | $13,900,559 | CASH VALUE |
| MOTHER FRANCES HOSPITAL - WINNSBORO | ||
| Q | $5,689,647 | CASH VALUE |
| MOTHER FRANCES HOSPITAL - WINNSBORO | ||
| R | $2,845,021 | CASH VALUE |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE R, PART II, COLUMN F | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Comments