2017-05-15T10:47:02-05:00 2016-06-30 BKD LLP 14241 DALLAS PKWY STE 1100 DALLAS TX 75254 990 2015-07-01 751976930 Mother Frances Hospital - Jacksonville % 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 MFH - Jacksonville ANNE PILEGGI 2026 South Jackson Jacksonville TX 75766 39695634 false X www.tmfhc.org/jacksonville X 2000 TX TO PROVIDE THE COMMUNITY WITH A FULL RANGE OF COMPREHENSIVE HEALTH CARE SERVICES WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. 10 2 177 4 0 0 0 0 38157700 39695631 1636 3 0 0 38159336 39695634 1861094 1642814 0 0 9608169 11105652 0 0 0 26658184 23622056 38127447 36370522 31889 3325112 25390734 31688163 5732671 8704988 19658063 22983175 X 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. false false 31112383 1642814 39695631 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. 31112383 true false false true false false false false false true true false false true true true false true false false false false false false false false true true true false true false false false false false false true false false false false false false true true true false false true X 14 0 true 177 true false false false false false false false false false false X 10 2 true false false false true true true true true false false true true true true true true true true false X CHRISSY RAMSEY 9036065639 1315 DOCTORS DRIVE TYLER TX 75701 X THOMAS N CAMMACK JR CEO/SEC/TREAS; TERM:9/2015 40.0 0.0 X X 270315 0 9617 MATTHEW A VIERKANT MD DIRECTOR 40.0 0.0 X 380780 0 21969 RAY THOMPSON SYS EXEC/VP/CHAIR 1.0 39.0 X X 47425 1849579 33736 GLEN T HAMILTON VICE CHAIR 1.0 0.0 X X 0 0 0 WILLIAM MILAWSKI MD DIRECTOR 40.0 0.0 X 255981 0 13836 DICK STONE DIRECTOR 1.0 1.0 X 0 0 0 RANDY GORHAM DIRECTOR 1.0 0.0 X 0 0 0 ANNE PILEGGI ASSOCIATE VP/SEC; START:9/2015 40.0 0.0 X X 0 187333 8459 PETER SIRIANNI MD DIRECTOR 1.0 0.0 X 0 1298995 17253 SCOTT SMITH MD SR VP; START:4/2016 1.0 39.0 X X 0 643587 14426 J LINDSEY BRADLEY JR SYSTEM PRESIDENT 1.0 39.0 X 53602 2090467 33736 JOYCE HESTER SR. VP/CFO; TERM:4/2016 4.0 36.0 X 59903 539122 31236 BARRY L THIBODEAUX CRNA 40.0 0.0 X 270268 0 10104 BEN BEATHARD RN 40.0 0.0 X 118766 0 12619 ROMAN BAGWELL DIRECTOR CRNA 40.0 0.0 X 222431 0 13493 KEITH MARTIN RN 40.0 0.0 X 125650 0 8729 KERRY BOLIN chief nursing officer 40.0 0.0 X 131316 0 9457 MICHAEL LEWIS SR Associate VP/former coo 0.0 40.0 X 0 190722 13638 1936437 6799805 252308 8 true true false Siemens Medical Solutions USA Inc 40 Liberty Boulevard MALVERN PA 19355 Equip Maintenance 332683 1 0 NET PATIENT REVENUE 621110 33719331 33719331 UPL MEDICAID REVENUE 900099 4328707 4328707 EHR INCENTIVE REVENUE 900099 23520 23520 PHARMACY REVENUE 446110 1491242 1491242 RELATED RENTAL REVENUE 532000 70820 70820 62011 62011 39695631 3 3 0 0 0 0 0 0 0 0 0 0 39695634 39695631 3 X 1642814 1642814 0 0 0 1007522 815522 192000 63724 51351 12373 8011754 6486414 1525340 180630 160760 19870 736356 546219 190137 1105666 991237 114429 135508 135508 0 4800 4800 0 0 0 10648115 10413409 234706 37490 37490 182222 41162 141060 24100 9179 14921 0 2587848 349031 2238817 6728 6624 104 0 9688 6663 3025 753 753 0 300074 22462 277612 78303 78303 BAD DEBT EXPENSE 5373450 5373450 0 MEDICAL SUPPLIES 3331173 3315181 15992 FOOD 116321 111321 5000 REPAIRS AND MAINTENANCE 621789 618768 3021 163694 146016 17678 36370522 31112383 5258139 0 -115427 1639 0 0 0 0 3786351 3618894 0 0 0 0 0 0 132951 139580 56283 76906 6129447 4938679 930150 1190768 0 0 0 0 0 0 0 0 20600426 26660376 25390734 31688163 2300300 1490559 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3432371 7214429 5732671 8704988 X 19658063 22983175 0 0 0 0 19658063 22983175 25390734 31688163 3325112 X false true X true false X false false false false false false false false true 455 455 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 0 124878 1000 2885950 2414694 0 360569 13191 2762072 2408876 0 163752 157934 2414694 2350337 30875 27664 2408876 0.00000 0.78610 0.21390 false true true 96200 2342 93858 6033248 4936338 1096910 1190768 DUE FROM AFFILIATES 26660376 26660376 0 Due to third-party payers 3726375 Due To Affiliates 3274304 Est Self-Insurance Costs 213750 7214429 X 38265215 -1430419 -1430419 39695634 39695634 34940103 34940103 1430419 1430419 36370522 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 true true X true X true X true true true false true true 2800446 2800446 0.09030 3465958 5036058 356256 1539649 6622660 6575707 2800446 0.09030 10061 10061 0.00030 347638 347638 0.01120 1642814 1642814 0.05300 2000513 2000513 0.06450 8623173 6575707 4800959 0.15480 true 5373450 11601742 10031746 1569996 X true true 1 1 Mother Frances Hospital-Jacksonville 1026 Jackson Street Jacksonville TX 75766 www.thfhc.org/jacksonville 007254 X X X X Mother Frances Hospital-Jacksonville 1 false false true X X X X X X X X X 15 true false false true X See Part V, Section C X true 15 true See Part V, Section C false 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 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. 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. true Service Organization of Piney Woods 2950 50th Sreet Lubbock TX 79314 300630886 501(c)(3) 1218560 COMMUNITY HEALTHCARE Service Organization of North & East Texas 2950 50th Street Lubbock TX 79314 260468622 501(c)(3) 424253 COMMUNITY HEALTHCARE 2 SCHEDULE I, PART I, LINE 2 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. X X X X X true true false false false false false false false THOMAS N CAMMACK JR CEO/SEC/TREAS; TERM:9/2015 147762 0 0 0 122553 0 6287 0 3330 0 279932 0 0 0 MATTHEW A VIERKANT MD DIRECTOR 258401 0 94199 0 28180 0 11263 0 10706 0 402749 0 4832 0 RAY THOMPSON SYS EXEC/VP/CHAIR 16011 624420 27567 1075114 3847 150045 431 16795 413 16097 48269 1882471 0 0 WILLIAM MILAWSKI MD DIRECTOR 151010 0 100177 0 4794 0 9451 0 4385 0 269817 0 0 0 J LINDSEY BRADLEY JR SYSTEM PRESIDENT 20335 793049 29984 1169368 3283 128050 431 16795 413 16097 54446 2123359 0 0 MICHAEL LEWIS SR Associate VP/former coo 0 159902 0 23778 0 7042 0 6892 0 6746 0 204360 0 0 JOYCE HESTER SR. VP/CFO; TERM:4/2016 37854 340687 20519 184670 1530 13765 1723 15503 1401 12609 63027 567234 0 0 BARRY L THIBODEAUX CRNA 267567 0 0 0 2701 0 9295 0 809 0 280372 0 0 0 ROMAN BAGWELL DIRECTOR CRNA 200573 0 21600 0 258 0 6979 0 6514 0 235924 0 0 0 ANNE PILEGGI ASSOCIATE VP/SEC; START:9/2015 0 167683 0 14500 0 5150 0 5499 0 2960 0 195792 0 0 PETER SIRIANNI MD DIRECTOR 0 1294555 0 0 0 4440 0 11263 0 5990 0 1316248 0 0 SCOTT SMITH MD SR VP; START:4/2016 0 477787 0 152500 0 13300 0 11926 0 2500 0 658013 0 0 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. Deanna Hamilton Family member of director 63724 Salaries/wages false 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 MOTHER FRANCES HOSP REGIONAL HC CENTER 1315 DOCTORS DRIVE TYLER TX 75701 750818167 HOSPITAL TX 501(c)(3) 3 CTMFHS true CHRISTUS-TRINITY MOTHER FRANCES FDN 1315 DOCTORS DRIVE TYLER TX 75701 752028241 SUPPORT TX 501(C)(3) 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 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 true MOTHER FRANCES HOSPITAL - WINNSBORO 1315 DOCTORS DRIVE TYLER TX 75701 752771569 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 & 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 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 GRAND CAYMAN CJ 980136025 INSURANCE CJ MFH REG C-CORPORATION true false false false false false false false false false true true false true true true true true true true TRINITY CLINIC Q 5412235 CASH VALUE TRINITY CLINIC R 5430067 CASH VALUE TRINITY CLINIC S 96200 CASH VALUE MOTHER FRANCES HOSPITAL REGIONAL HC CENTER P 166473 CASH VALUE MOTHER FRANCES HOSPITAL REGIONAL HC CENTER Q 22371876 CASH VALUE MOTHER FRANCES HOSPITAL REGIONAL HC CENTER R 42691990 CASH VALUE MOTHER FRANCES HOSPITAL REGIONAL HC CENTER S 13900559 CASH VALUE MOTHER FRANCES HOSPITAL - WINNSBORO Q 5689647 CASH VALUE MOTHER FRANCES HOSPITAL - WINNSBORO R 2845021 CASH VALUE SCHEDULE R, PART II, COLUMN F 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.