2017-08-15T12:11:36-05:00 2016-09-30 ERNST & YOUNG US LLP 425 HOUSTON STREET STE 600 FORT WORTH TX 76102 990 2015-10-01 750818178 Texas Scottish Rite Hospital for Crippled Children % JEAN ALLEN CONTROLLER TEXA 2145595000 2222 WELBORN ST DALLAS TX 75219 WILLIAM R HUSTON SVP & CFO 2017-08-14 true kathleen moseley P00116760 8173351900 2015 2021-01-29 14:40:06Z see schedule o ROBERT WALKER 2222 WELBORN ST DALLAS TX 75219 1874075400 false X WWW.SCOTTISHRITEHOSPITAL.ORG X 1921 TX IMPROVING THE LIVES OF CHILDREN WITH ORTHOPEDIC RELATED CONDITIONS THROUGH PATIENT CARE, RESEARCH AND EDUCATION. 37 35 1199 773 1307005 -876048 22527562 24540940 43357140 64362074 61026772 85199899 144930896 93171018 271842370 267273931 100000 3630000 0 0 97979067 106910883 0 0 7044764 60586736 72106223 158665803 182647106 113176567 84626825 2248339445 2492910685 142370300 167108685 2105969145 2325802000 X TO PROVIDE THE HIGHEST QUALITY CARE TO IMPROVE THE LIVES OF CHILDREN WITH ORTHOPEDIC AND RELATED CONDITIONS AND SPECIFIC LEARNING DISABILITIES. TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN FOCUSES ON PATIENT CARE, RESEARCH AND EDUCATION. false false 139953475 3630000 63947261 PATIENT CARE TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN IS ONE OF THE NATION'S LEADING PEDIATRIC CENTERS FOR THE TREATMENT OF ORTHOPEDIC CONDITIONS, CERTAIN RELATED ARTHRITIC AND NEUROLOGICAL DISORDERS AND LEARNING DISORDERS, SUCH AS DYSLEXIA. PATIENTS RECEIVE TREATMENT REGARDLESS OF THE FAMILY'S ABILITY TO PAY. THE ORTHOPEDICS PROGRAM INCLUDES OUTPATIENT CLINIC VISITS AND INPATIENT STAYS FOR THE DIAGNOSIS AND TREATMENT OF SUCH CONDITIONS AS SCOLIOSIS, CLUBFOOT, DISLOCATED HIP, LEGG-PERTHES, LIMB-LENGTH DIFFERENCES AND LIMB DEFICIENCIES, HAND DIFFERENCES AND SPORTS INJURIES.(CONTINUED ON SCHEDULE O.) 11086071 0 414813 RESEARCH THE HOSPITAL'S DEDICATED RESEARCH CENTER, THE SARAH M. AND CHARLES E. SEAY CENTER FOR MUSCULOSKELETAL RESEARCH, IS MADE UP OF SIX CENTERS FOR EXCELLENCE -SCOLIOSIS AND SPINE DISORDERS, CLUBFOOT AND FOOT DISORDERS, HIP DISORDERS, LIMB LENGTH AND RECONSTRUCTION, HAND DIFFERENCES AND SPORTS MEDICINE - SUPPORTED BY RESEARCH DIVISIONS AND CORE FACILITIES.(CONTINUED ON SCHEDULE O.) 1122447 0 0 EDUCATION TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN FUNCTIONS AS A PREMIER TEACHING INSTITUTION, PROVIDING COMPREHENSIVE EDUCATION AND TRAINING TO ORTHOPEDIC RESIDENTS AND POST-GRADUATE ORTHOPEDIC FELLOWS. IN ADDITION, THE HOSPITAL CONTRIBUTES TO THE EDUCATION OF ALLIED HEALTH PROFESSIONALS BY PROVIDING CLINICAL EXPERIENCE AND DIDACTIC EDUCATION FOR STUDENTS AS WELL AS CONTINUING EDUCATION FOR HEALTH CARE PROFESSIONALS. THE HOSPITAL IS CURRENTLY AFFILIATED WITH 57 INSTITUTIONS, INCLUDING COLLEGES, UNIVERSITIES AND TECHNICAL TRAINING PROGRAMS.(CONTINUED ON SCHEDULE O.) 152161993 true true false true false false false false false true true false false false true true false true false false true false false false true true true true true false true true false false false false false false false false true false true false false false false true true true false false true 361 0 true 1199 true true true false false false false true true false false false true false X 37 35 true false false false false false false true true false false true true true true true true true true false X JEAN ALLEN CONTROLLER 2145597507 2222 WELBORN ST DALLAS TX 75219 M DOUGLAS ADKINS VICE PRESIDENT 4.0 1.0 X X 0 0 0 FRED E ALLEN VICE PRESIDENT(RESIGNED 01/16) 0.0 0.0 X X 0 0 0 W EUGENE BROOKSHIRE TRUSTEE 3.0 0.0 X 0 0 0 RUSSELL C BROWN TRUSTEE 3.0 1.0 X 0 0 0 W VERNON BURKE JR TRUSTEE 3.0 1.0 X 0 0 0 HAROLD D CARTER VICE CHAIRMAN 4.0 1.0 X X 0 0 0 RONALD L CARTER TRUSTEE 4.0 1.0 X 0 0 0 DANIEL H CHAPMAN VICE PRESIDENT 4.0 1.0 X X 0 0 0 GRAHAM H CHILDRESS VICE PRESIDENT 4.0 0.0 X X 0 0 0 DAVID COUNTS JR TRUSTEE (TERM ENDED JAN 2017) 3.0 0.0 X 0 0 0 STEPHEN F CROSS TRUSTEE 3.0 1.0 X 0 0 0 KENNETH C CURRY TRUSTEE 2.0 0.0 X 0 0 0 DAN F DAVIDSON TRUSTEE 4.0 0.0 X 0 0 0 JOSEPH M DEALEY JR TRUSTEE 3.0 0.0 X 0 0 0 LEE DRAIN VICE PRESIDENT 4.0 1.0 X X 0 0 0 CLAUDE O ERVIN TRUSTEE 4.0 0.0 X 0 0 0 JERRY C GILMORE VP & ASSISTANT SECRETARY 4.0 1.0 X X 0 0 0 W M GOWER TRUSTEE 4.0 0.0 X 0 0 0 THOMAS F GRIFFIN TRUSTEE 3.0 0.0 X 0 0 0 TOM GUEST TRUSTEE 3.0 0.0 X 0 0 0 REESE L HARRISON JR TRUSTEE (RESIGNED 12/15) 0.0 0.0 X 0 0 0 LEONARD P HARVEY TRUSTEE 3.0 1.0 X 0 0 0 TOM L HIGGINS TRUSTEE 3.0 0.0 X 0 0 0 VESTER T HUGHES JR VICE PRESIDENT(DECEASED 01/17) 4.0 1.0 X X 0 0 0 BRACK JONES JR TRUSTEE 3.0 0.0 X 0 0 0 JAMES E LANEY TRUSTEE/VICE PRESIDENT 4.0 0.0 X X 0 0 0 LEO G MARTIN JR TRUSTEE (DECEASED 5/16) 0.0 0.0 X 0 0 0 DOUGLAS S MAXEY TRUSTEE 3.0 0.0 X 0 0 0 JOHN C NOBLES TRUSTEE 4.0 0.0 X 0 0 0 ROBERT A NORTHCUTT PHD TRUSTEE 4.0 1.0 X 0 0 0 LYNDON L OLSON JR TRUSTEE/CHAIRMAN OF THE BOARD 6.0 1.0 X X 0 0 0 C CLIFTON ROBINSON TRUSTEE (RESIGNED 1/16) 0.0 0.0 X 0 0 0 FRANK C ROCKABRAND TRUSTEE (DECEASED 8/16) 0.0 0.0 X 0 0 0 RONALD L SKAGGS TRUSTEE/SECRETARY 4.0 1.0 X X 0 0 0 GUY F STOVALL JR TRUSTEE, VP & ASST. TREASURER 4.0 0.0 X X 0 0 0 H FINLAY WATKINS TRUSTEE 3.0 0.0 X 0 0 0 MURRAY WATSON JR TRUSTEE 3.0 0.0 X 0 0 0 RALPH WAYNE TRUSTEE 3.0 0.0 X 0 0 0 BERT MASSEYII TRUSTEE 3.0 0.0 X 0 0 0 JAMES D NYFELER SR TRUSTEE 3.0 0.0 X 0 0 0 JOE H TYDLASKA TRUSTEE 3.0 1.0 X 0 0 0 JAMES M WILLSON VP & TREASURER (DECEASED 4/16) 3.0 0.0 X X 0 0 0 ROBERT L WALKER PRESIDENT/CEO 40.0 1.0 X 722737 0 25071 JC MONTGOMERY JR PRESIDENT EMERITUS 10.0 30.0 X 505200 0 26069 WILLIAM R HUSTON SR VICE PRESIDENT AND CFO 40.0 2.0 X 373402 0 30034 M SCOTT PERRYMAN SR VP (RESIGNED OCT 2015) 0.0 0.0 X 290779 0 46067 LORI DALTON SR VP & GENERAL COUNSEL 40.0 2.0 X 390972 0 50950 MARK BATEMAN SENIOR VICE PRESIDENT 35.0 5.0 X 371480 0 49095 FREDRIC RICHMOND VP/CHIEF INVESTMENT OFFICER 40.0 0.0 X 358029 0 49570 MATT CHANCE SENIOR VP 40.0 1.0 X 139357 0 10861 CONNIE WRIGHT VP 40.0 1.0 X 183112 0 8970 STEPHANIE BRIGGER VICE PRESIDENT 35.0 5.0 X 190959 0 62288 ELLEN HAYNES VICE PRESIDENT 35.0 5.0 X 178655 0 22151 LESLIE CLONCH VICE PRESIDENT 40.0 0.0 X 328611 0 39082 DEBRA SAYLES VICE PRESIDENT 40.0 0.0 X 277352 0 129217 DONALD KATZ VICE PRESIDENT 40.0 0.0 X 240346 0 98640 JEREMY HOWELL VICE PRESIDENT 40.0 0.0 X 198224 0 44563 KRISTINA KEEVER-SMITH INVESTMENT OFFICER 40.0 2.0 X 228553 0 34241 JEAN ALLEN CONTROLLER 40.0 2.0 X 175826 0 29508 B STEPHENS RICHARDS MD CHIEF MEDICAL OFFICER 40.0 1.0 X 835374 21150 37416 LAWSON COPLEY MD CHIEF MEDICAL INFO OFFICER 8.0 35.0 X 0 683257 130764 MOLLY DEMPSEY MD ASST CHIEF MEDICAL INFO OFFICE 40.0 0.0 X 568869 0 128180 DANIEL SUCATO MD CHIEF OF STAFF 40.0 1.0 X 731406 0 192150 J ANTHONY HERRING MD CHIEF OF STAFF EMERITUS 40.0 0.0 X 654509 0 23630 CHARLES JOHNSTON MD ASST CHIEF OF STAFF EMERITUS 40.0 0.0 X 692729 0 23711 PHILIP WILSON MD ASST CHIEF OF STAFF 20.0 20.0 X 2345 703535 93647 KARL RATHJEN MD ASST CHIEF OF STAFF 40.0 2.0 X 632169 40950 128635 LORI KAROL MD ASST CHIEF OF STAFF 40.0 2.0 X 603534 19300 166584 FARANEH SAFAVI MD ANESTHESIOLOGIST (*SEE SCH. J) 40.0 0.0 X 733616 0 165968 DAVID WILKES PEDIATRICIAN(SEE SCH J**) 40.0 0.0 X 921218 0 158355 AMY MCINTOSH ORTHOPEDIC SURGEON 40.0 1.0 X 607896 91350 43853 BRANDON RAMO ORTHOPEDIC SURGEON 40.0 1.0 X 612917 87950 51635 SCOTT OISHI ORTHOPEDIC SURGEON 40.0 0.0 X 573653 0 49191 JAMES STURGIS ADMINISTRATOR (DECEASED 6/17) 0.0 0.0 X 109483 0 8656 JOHN BIRCH MD RETIRED 0.0 0.0 X 443535 0 0 13876847 1647492 2158752 166 true true false HCBECK LTD 1807 ROSS STE 500 DALLAS TX 752018006 CONSTRUCTION 4925663 HKS INC POB 731121 DALLAS TX 753731121 ARCHITECTURAL 2603247 MCKINSEY COMPANY 2711 CENTERVILLE RD WILMINGTON DE 19808 mgmt consulting 1300000 OPTIMUM HEALTHCARE IT LLC 1300 MARSH LANDING PKWY STE 105 JACKSONVILLE BEACH FL 32250 IT CONSULTING 1280491 VAN BERKOM ASSOC 1130 SHERBROOKE ST W STE 1005 MONTREAL QUEBEC CA H3A 2M8 Investment mgmt 1252322 58 2812815 111006 21617119 1192611 24540940 DYSLEXIA PROGRAM 900099 767047 767047 OUTPATIENT REVENUE 622310 87342576 87342576 INPATIENT REVENUE 622310 56802800 56802800 DEDUCTIONS FROM REVENUE 622310 -86617114 -86617114 OTHER PATIENT RELATED REV 622310 6066765 6066765 64362074 53127008 25910 53101098 0 75198456 75198456 593432 341838 251594 0 251594 251594 1635790287 196100 1603775613 137883 32014674 58217 32072891 32072891 911876 2812815 1194358 -282482 -282482 17206 8553 8653 8653 2787894 1343224 1444670 1228129 216541 SURFACE DAMAGE/WATER SALE 110000 4245074 4245074 LEASE BONUS REVENUE 211110 12248288 12248288 HUNTING PERMITS 900099 10900 10900 45865 42066 3799 16550127 267273931 64362074 1307005 177063912 3630000 3630000 0 0 0 10116622 4899068 3741460 1476094 235242 211717 23525 72898860 63622790 6956746 2319324 10464388 9659739 487070 317579 8809013 7703398 767685 337930 4386758 3860661 378881 147216 0 469143 32963 436180 352290 352290 52539 52539 0 5693537 5693537 10635499 8162640 2375380 97479 2994025 2991117 2050 858 5104577 2882280 1087348 1134949 6380973 5304505 794527 281941 0 5292145 4213900 988958 89287 693173 520049 141626 31498 0 238202 167667 63235 7300 619768 546590 59544 13634 0 10257400 9129244 917822 210334 1115818 619840 469636 26342 MEDICAL SUPPLIES 11753858 11746976 5543 1339 MGMT & GENERAL EXP ALLOCATION 4892672 -5444332 551660 RANCH OPERATIONS 2692809 2692809 BAD DEBT EXPENSE 7364177 7364177 396290 396290 182647106 152161993 23440349 7044764 693755 1188013 0 0 0 0 34614713 31185415 0 0 0 0 14112 12555 2138793 4872368 5984097 6419557 295480935 146569247 122937959 148911688 1999418061 2227583318 124709 122613 0 0 0 0 82413246 72615158 2248339445 2492910685 16817607 24512061 0 0 0 0 23000000 23000000 0 0 0 0 0 0 0 0 102552693 119596624 142370300 167108685 X 1996933949 2206363284 45584516 53837148 63450680 65601568 2105969145 2325802000 2248339445 2492910685 X 84626825 140412246 -5206216 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false false true 2706 false true 49833 52539 false PART II-B, LINE 1B AND 1G ROBERT WALKER AND LORI DALTON MET WITH MEMBERS OF CONGRESS AND/OR STAFF AND HAD ASSOCIATED EXPENSES INCLUDING TRAVEL AND ALLOCATED COMPENSATION IN THE AMOUNT OF $2,706. PART II-B, LINE 1I PER TEXAS HOSPITAL ASSOCIATION, CHILDREN'S HOSPITAL ASSOCIATION AND DALLAS REGIONAL CHAMBER, $13,315 OF THE HOSPITAL'S DUES WERE ALLOCATED TO LOBBYING. THE HOSPITAL RETAINED THE SERVICES OF GREENBERG TRAURIG LLP TO MEET WITH VARIOUS FEDERAL LEGISLATORS OR STAFF AND INCURRED EXPENSES IN THE AMOUNT OF $36,518. 112800210 8057633 8144805 3476145 125526503 120595294 6843791 -7546608 7092267 112800210 133897630 2949795 -11210694 5041437 120595294 124107569 4082409 9512276 3804624 133897630 115329338 4378890 7772123 3372782 124107569 0.05000 0.52000 0.43000 true false 46941044 46941044 173733150 88259120 85474030 74622700 58310127 16312573 184041 184041 148911688 0 ACCRUED PENSION COSTS 67618096 MANAGEMENT BENEFIT PLAN 1997053 EMPLOYEE INS BENEFITS PAYABLE 1647421 RESERVE FOR MALPRACTICE INS CL 1088145 CHARITABLE GIFT ANNUITIES 4215969 TRUST OBLIGATIONS 10522514 DEFERRED INCOME 23433 RESERVE FOR RESTORATION PLAN 32481288 RESERVE FOR 3RD PARTY PAYOR SETTLEMENT 2705 119596624 X Intended use of endowment funds Schedule D, Part V, Line 4: THE INCOME FROM THE ORGANIZATION'S PERMANENT ENDOWMENT FUNDS AND THE TEMPORARILY RESTRICTED ENDOWMENT FUNDS ARE USED TO SUPPORT THE OPERATIONS OF THE MEDICAL, RESEARCH AND LEARNING PROGRAMS OF THE HOSPITAL. Audit footnote 16 - Income Taxes Schedule D, Part X, Line 2 GAAP REQUIRES MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINIATION BY THE APPLICABLE TAX AUTHORITY. THE HOSPITAL HAS ANALYZED THE TAX POSITIONS TAKEN AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2016 AND 2015, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING AUTHORITIES; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS, THE HOSPITAL BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE TAX AUTHORITIES FOR YEARS PRIOR TO 2013. East Asia and the Pacific INVESTMENTS 40179526 Europe (Including Iceland and Greenland) INVESTMENTS 49871868 Middle East and North Africa Investments 1051107 North America Investments 9628598 South America Investments 11939 Sub-Saharan Africa Investments 1749 East Asia and the Pacific INVEST MGMT FEES 306779 Europe (Including Iceland and Greenland) INVEST MGMT FEES 18530 Middle East and North Africa INVEST MGMT FEES 45 North America INVEST MGMT FEES 93608 South America INVEST MGMT FEES 21463 Sub-Saharan Africa INVEST MGMT FEES 3144 Central America and the Caribbean Program Services conferences, training 5311 East Asia and the Pacific Program Services conferences, training 4797 Europe (Including Iceland and Greenland) Program Services conferences, training 75021 North America Program Services conferences, training 7148 Russia and the Newly Independent States Program Services conferences, training 11503 South America Program Services conferences, training 4502 101292136 4502 101296638 false false true false false false Part I, Line 3, Column F THESE AMOUNTS REPRESENT $100,744,787 OF INVESTMENTS AND $551,851 IN EXPENDITURES BASED ON AN ACCRUAL METHOD OF ACCOUNTING. SEE DETAIL BY REGION BELOW: INVESTMENTS BY REGION: EAST ASIA AND THE PACIFIC $ 40,179,526 EUROPE $ 49,871,868 MIDDLE EAST AND NORTH AFRICA $ 1,051,107 NORTH AMERICA $ 9,628,598 SOUTH AMERICA $ 11,939 SUB-SAHARAN AFRICA $ 1,749 ---------------- TOTAL $ 100,744,787 EXPENSE BY REGION: CENTRAL AMERICA AND THE CARIBBEAN $ 5,311 EAST ASIA AND THE PACIFIC $ 311,576 EUROPE $ 93,551 MIDDLE EAST AND NORTH AFRICA $ 45 NORTH AMERICA $ 100,756 RUSSIA AND NEIGHBORING STATES $ 11,503 SOUTH AMERICA $ 25,965 SUB-SAHARAN AFRICA $ 3,144 ------------------- TOTAL $ 551,851 auction 743994 641823 102171 226 593 4750 35429 golf tournament 337140 261254 75886 15868 27782 33593 72476 95 2643557 1909738 733819 93620 99242 177460 14500 618819 3724691 2812815 911876 109714 127024 211646 19250 726724 1194358 -282482 false false 17206 8553 false 17206 8553 8553 8653 TX false THE STATE OF TEXAS DOES NOT REQUIRE SUCH A LICENSE FOR OCCASIONAL GAMING ACTIVITIES (UP TO TWO PER YEAR). false true false 0.00000 1.00000 JEAN ALLEN CONTROLLER TSRHC 2222 WELBORN ST DALLAS TX 75219 false NA N/A false true true true X true X 1000. true false true true 9720443 9720443 0.05550 43126226 24846403 18279829 0.10430 52846669 24846403 28000272 0.15980 18387541 18387541 0.10490 1279951 36030 1243921 0.00710 12955574 1014828 11940746 0.06810 3520000 3520000 0.02010 36143066 1050858 35092208 0.20020 88989735 25897261 63092480 0.36000 869690 869690 0.00500 869690 869690 0.00500 true 7364177 63181 55220 7961 X true true 1 1 TEXAS SCOTTISH RITE HOSPITAL 2222 WELBORN ST DALLAS TX 75219 www.scottishritehospital.org 000054 X X X X X ORTHOPEDIC, neurodevelopment & musculoskeletal TX SCOT RITE HOSPITAL FOR CHILDREN 1 false false true X X X X X X X X X 16 true false true true X SEE SCHEDULE H, PART V, SECTION C X true 16 false true false true X 200. 999.999 X true true X X true X www.scottishritehospital.org X www.scottishritehospital.org X www.scottishritehospital.org X X X X X true X false X X X X X true X false false PART V, SECTION B, LINE 5 TSRHC AND BKD CONSULTING COLLABORATED TOGETHER TO CONDUCT AND ASSESS THE NEEDS OF THE COMMUNITY IN PRODUCING THE HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT. BKD CONSULTING, LLP IS ONE OF THE LARGEST CPA AND ADVISORY FIRMS IN THE UNITED STATES, WITH APPROXIMATELY 2,000 PARTNERS AND EMPLOYEES IN 34 OFFICES. BKD SERVES MORE THAN 900 HOSPITALS AND HEALTH CARE SYSTEMS ACROSS THE COUNTRY. PRIMARY DATA WAS OBTAINED FROM PATIENT FAMILIES, PATIENT FOCUS GROUPS AND KEY STAKEHOLDERS. BKD CONDUCTED A HEALTH SURVEY THAT WAS SENT IN ELECTRONIC FORMAT, TO MORE THAN 800 CURRENT TSRHC PATIENTS. THE SURVEY WAS MAILED, IN PAPER FORMAT, TO MORE THAN 2,000 CURRENT AND FORMER TSRHC PATIENT FAMILIES. TWO HUNDRED TWENTY PATIENT FAMILIES PROVIDED INPUT THROUGH THE HEALTH SURVEY, WHICH WAS AVAILABLE IN BOTH ENGLISH AND SPANISH. EIGHTY-FIVE PERCENT OF THE SURVEY RESPONDENTS INDICATED THEY LIVED IN THE CHNA COMMUNITY. IN ADDITION, TSRHC CONDUCTED TWO PATIENT FOCUS GROUPS TO SOLICIT INPUT FROM PATIENTS FAMILIES REGARDING THE HEALTH NEEDS OF THEIR CHILDREN. THE PATIENT FOCUS GROUPS WERE CONDUCTED ON JUNE 13, 2016 AND JUNE 14, 2016 AT TSRHCS MAIN CAMPUS AND NORTH CAMPUS. FOUR QUESTIONS WERE ASKED AND DISCUSSED, THEN UTILIZED TO HELP GATHER DATA FROM THE PARTICIPANTS. INPUT WAS COLLECTED FROM 21 KEY STAKEHOLDERS THROUGH IN-PERSON INTERVIEWS IN JUNE 2016. THESE KEY STAKEHOLDERS WERE DETERMINED BASED ON THEIR SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH, THEIR INVOLVEMENT WITH UNDERSERVED AND MINIORITY POPULATIONS OR THEIR AFFILIATION WITH LOCAL GOVERNMENT, SCHOOLS AND INDUSTRY. THESE INTERVIEWS ARE INTENDED TO ASCERTAIN OPINIONS AMONG INDIVIDUALS WHO ARE LIKELY TO BE KNOWLEDGEABLE ABOUT THE COMMUNITY AND INFLUENTIAL OVER THE OPINIONS OF OTHERS ABOUT HEALTH CONCERNS IN THE COMMUNITY. SECONDARY DATA ASSESSED FACTORS SUCH AS DEMOGRAPHICS, SOCIOECONOMIC INDICATORS (HOUSEHOLD INCOME AND POVERTY, INSURANCE COVERAGE AND CHILDREN LIVING IN SINGLE-PARENT HOUSEHOLDS) AND COMMUNITY HEALTH STATUS INDICATORS RELEVANT TO THE SERVICES PROVIDED BY TSRHC (RATES FOR CONDITIONS TREATED BY TSRHC, NUMBER OF CHILDREN IN TEXAS WITH DISABILITIES AND RATE FOR HEALTH ISSUES IDENTIFIED BY STAKEHOLDERS AND PATIENTS SUCH AS ASTHMA, OBESITY AND PHYSICAL INACTIVITY). SOME OF THE SECONDARY DATA SOURCES, INCLUDED BUT NOT LIMITED TO TEXAS STATE DATA CENTER AND THE OFFICE OF THE STATE DEMOGRAPHER, ANNIE E. CASEY FOUNDATION,TEXAS KIDS COUNT DATA, AND TEXAS DEPARTMENT OF STATE HEALTH SERVICES. USING FINDINGS OBTAINED THROUGH THE COLLECTION OF PRIMARY AND SECONDARY DATA, TSRHC COMPLETED A KEY FINDINGS OVERVIEW FOR EACH IDENTIFIED HEALTH NEED. TO FACILITATE PRIORITIZATION OF IDENTIFIED HEALTH NEEDS, A MODIFIED HANLON METHOD WAS USED BY MEMBERS OF TSRHCS MANAGEMENT TO RANK THE NEEDS. THE FOLLOWING FACTORS WERE USED TO PRIORITIZE THE IDENTIFIED HEALTH NEEDS: SIZE OF THE PROBLEM, SERIOUSNESS OF THE PROBLEM, IMPACT OF THE ISSUES ON VULNERABLE POPULATIONS, HOW IMPORTANT THE ISSUE IS TO THE COMMUNITY, AND THE PREVALENCE OF COMMON THEMES. PART V, SECTION B, LINE 6B TSRHC ENGAGED THE SERVICES OF BKD CONSULTING TO ASSESS THE NEEDS OF THE COMMUNITY AND COLLABORATED WITH TSRHC IN PRODUCING THE HOSPITAL'S CHNA REPORT. PART V, SECTION B, LINE 7A scottishritehospital.org/getattachment/Collapsible-Content-Modules/ABOUT-O UR-FUTURE/2016-Community-Health-Needs-Assessment.pdf?lang=en-US PART V, SECTION B, LINE 11 NEEDS IDENTIFIED IN RECENTLY CONDUCTED CHNA AS PART OF THE CHNA, TSRHC AND BKD CONSULTING CONDUCTED THE ASSESSMENT FROM MAY 2016 TO SEPTEMBER 2016. THE PRIMARY AND SECONDARY DATA GATHERED WAS THEN ANALYZED TO IDENTIFY SIGNIFICANT HEALTH NEEDS FOR THE COMMUNITY SERVED BY TSRHC. AS A RESULT OF THE ANALYSIS, NINE HEALTH NEEDS WERE IDENTIFIED AS BEING SIGNIFICANT TO THE COMMUNITY. THE IDENTIFIED HEALTH NEEDS WERE SUBSEQUENTLY GROUPED AND PRIORITIZED BY HOSPITAL MANAGEMENT INTO THREE PRIORITY AREAS BASED ON THEIR OVERALL ASSESSMENT OF THE QUALITATIVE AND QUANTITATIVE DATA. TSRHC WILL FOCUS ON THE IDENTIFIED AREAS WHERE THE HOSPITAL CAN MOST EFFECTIVELY USE ITS EXPERTISE AND RESOURCES TO HAVE SIGNIFICANT IMPACT. 1. IMPROVE ACCESS TO HEALTH CARE SERVICES 2. IMPROVE CHILD HEALTH STATUS 3. IMPROVE COORDINATION OF CARE TSRHC STRATEGY FOR IMPROVING ACCESS TO HEALTH CARE SERVICES: MORE THAN 200,000 CHILDREN DO NOT HAVE INSURANCE IN THE CHNA COMMUNITY. AFFORDABILITY OF SERVICES AND FINANCIAL STRESS ON THE FAMILY WERE IDENTIFIED AS THE TWO BIGGEST CHALLENGES FOR PATIENT FAMILIES. ANOTHER CHALLENGE IDENTIFIED BY PATIENT FAMILIES WAS THE LACK OF AVAILABILITY OF SERVICES CLOSE TO HOME. KEY STAKEHOLDERS ALSO IDENTIFIED THE NEED TO EXPAND TSRHCS GEOGRAPHIC FOOTPRINT TO MAKE SERVICES MORE ACCESSIBLE. IN ADDITION, THEY NOTED THAT MANY PERSONS IN THE CHNA COMMUNITY ARE UNAWARE OF THE SCOPE OF SERVICES PROVIDED BY TSRHC. OUR OBJECTIVE IS TO INCREASE COMMUNITY AND PUBLIC AWARENESS OF THE AVAILABILITY AND TYPES OF HEALTH CARE SERVICES PROVIDED BY TSRHC. THE ANTICIPATED IMPACT IS TO INCREASE THE NUMBER OF CHILDREN TREATED, ESPECIALLY THOSE IN THE UNDERSERVED COMMUNITY WITHIN OUR SCOPE OF SERVICES, INCLUDING THOSE WITH SPECIAL HEALTH NEEDS. A. INCREASE THE AWARENESS OF OUR FINANCIAL ASSISTANCE PROGRAM: IN AN EFFORT TO ENSURE THAT FAMILIES WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE ARE AWARE OF AND FAMILIAR WITH THE HOSPITALS FINANCIAL ASSISTANCE/CHARITY CARE PROGRAM, CRAYON CARE, TSRHC WILL WIDELY PUBLICIZE INFORMATION REGARDING THE PROGRAM BY HAVING INFORMATION POSTED THROUGHOUT THE BUILDING, ON THE WEBSITE AND THROUGH COMMUNITY AGENCIES THAT MAY ENCOUNTER INDIVIDUALS WITH FINANCIAL NEEDS. FAMILY SERVICES COUNSELORS ARE AVAILABLE TO COMMUNICATE WITH AND ASSIST PATIENTS REGARDING THE PROGRAM. ADDITIONAL COMMUNICATION VEHICLES WILL ALSO BE EXPLORED TO BETTER INFORM PATIENT FAMILIES AND TO REACH OUT TO OTHERS INCLUDING HEALTH CARE PROVIDERS ABOUT TSRHCS FINANCIAL ASSISTANCE PROGRAM, TO ENSURE THAT THE LACK OF FINANCIAL RESOURCES IS NOT AN IMPEDIMENT TO RECEIVING CARE AT TSRHC. B. EXPAND SERVICES THROUGHOUT NORTH TEXAS AND THE SURROUNDING REGION: CONSTRUCTION HAS BEGUN ON A NEW TSRHC CAMPUS IN FRISCO, TEXAS, TO RESPOND TO THIS RAPIDLY GROWING AREAS HEALTH CARE NEEDS AND TO SERVE THE HOSPITALS CURRENT PATIENT POPULATION FROM THIS AREA. THE NEW CAMPUS WILL BE AN AMBULATORY SURGERY CENTER (ASC) THAT OFFERS DAY SURGERIES AND OUTPATIENT CLINIC SERVICES SUCH AS SPORTS MEDICINE, GENERAL ORTHOPEDICS AND A FRACTURE CLINIC AS WELL AS SUPPORT SERVICES LIKE ORTHOTICS AND RADIOLOGY. PLANS ARE TO OPEN THE CAMPUS IN THE FALL OF 2018. C. INCREASE EASE OF ACCESS: TO ADDRESS THE GROWING DEMAND FOR SERVICES, THERE HAVE BEEN CONTINUOUS EFFORTS TO INCREASE ACCESS AND THROUGHPUT IN THE AMBULATORY CARE CLINICS INCLUDING GENERAL ORTHOPEDICS, DYSLEXIA, CEREBRAL PALSY AND RHEUMATOLOGY. THIS WILL BE AN ONGOING COMMITMENT TO FURTHER REDUCE THE TIME BETWEEN PATIENT APPLICATION ACCEPTANCE AND THE FIRST APPOINTMENT. THE ADDITION OF CLINICS AND CLINIC APPOINTMENTS WILL BE POSSIBLE THROUGH CLINIC RENOVATIONS LEADING TO INCREASED SPACE AND WILL RESULT IN IMPROVED ACCESS. THE NORTH TEXAS EXPANSION IN 2018 WILL PROVIDE ADDITIONAL OPPORTUNITIES TO PROVIDE INCREASED ACCESS. D. INCREASE PATIENT ACCESS TO INFORMATION: PATIENT FAMILIES CAN NOW ACCESS PORTIONS OF THEIR CHILDS MEDICAL RECORDS, SCHEDULE APPOINTMENTS AND RECEIVE REFERRALS THROUGH AN ONLINE PORTAL CALLED MYSRH. E. INCREASE AWARENESS OF TSRHC THROUGH COMMUNICATION AND OUTREACH EVENTS/PROGRAMS TO EDUCATE THE COMMUNITY ABOUT ITS SERVICES: TSRHC IS WORKING TO DRIVE BROAD SCALE AWARENESS WITHIN THE COMMUNITY, THE GENERAL PUBLIC AND THE UNDERSERVED. TSRHC WILL CONNECT WITH THE UNDERSERVED IN THE COMMUNITY THROUGH THE USE OF TRADITIONAL BROAD REACHING VEHICLES INCLUDING TELEVISION, RADIO, BILLBOARDS AND PRINT AS WELL AS DIGITAL AND SOCIAL MEDIA CHANNELS. FURTHER, TSRHC WILL CONNECT WITH THESE AUDIENCES THROUGH A WIDE RANGE OF COMMUNITY EVENTS, PHYSICIAN RELATIONS PROGRAMS AND PARTNERSHIP PROGRAMS WITH OTHER COMMUNITY ORGANIZATIONS ALSO INTERESTED IN HEALTH CARE AND WELLNESS OF THE COMMUNITY SUCH AS AGAPE CLINIC, LOS BARRIOS UNIDOS, METROCREST COMMUNITY CLINIC, CATHOLIC CHARITIES, JEWISH FAMILY SERVICES OF GREATER DALLAS, SPINA BIFIDA ASSOCIATION, MASONIC HOME AND SCHOOL OF TEXAS, ORTHOKIDS.ORG/POSNA, TEXAS 211 (TEXAS HEALTH AND HUMAN SERVICES WEBSITE AND TOLL FREE NUMBER TO FIND HEALTH PROVIDERS IN SPECIFIC REGIONS), AND ECI/PPCD/HEAD START PROGRAMS (DALLAS AND FORT WORTH). F. CONTINUE TO MAINTAIN A CULTURALLY APPROPRIATE ENVIRONMENT: TSRHC IS CONTINUOUSLY EVOLVING WITH THE GROWTH OF OUR DIVERSE PATIENT POPULATION. TO MEET THOSE NEEDS, ACCESS TO TSRHC INTERPRETERS ARE AVAILABLE TO TSRHC PATIENTS THROUGH IN-PERSON INTERACTION, VIDEO REMOTE AND TELEPHONE INTERPRETING, OR AN OUTSIDE AGENCY COVERING A BROAD RANGE OF LANGUAGES. G. INCREASE WAY-FINDING SIGNAGE AND INFORMATION BROCHURES IN OTHER PATIENT LANGUAGES: ENHANCEMENTS ARE BEING MADE TO MORE EASILY ACCESS AREAS AND DEPARTMENTS WITHIN THE HOSPITAL, UTILIZING HABLAMOS JUNTOS AND UNIVERSAL HEALTHCARE SYMBOLS FOR WAY-FINDING. TSRHC STRATEGY FOR IMPROVING CHILD HEALTH STATUS: KEY STAKEHOLDERS NOTED THAT THERE IS A SHORTAGE OF HEALTH NUTRITION IN IMPOVERISHED AREAS OF THE COMMUNITY. PATIENT FAMILIES AND KEY STAKEHOLDERS IDENTIFIED OBESITY AS THE BIGGEST HEALTH ISSUE IMPACTING CHILDRENS HEALTH. UNHEALTHY EATING AND LACK OF PHYSICAL ACTIVITY WERE ALSO IDENTIFIED AS HEALTH ISSUES FOR CHILDREN IN THE COMMUNITY. STAKEHOLDERS STRESSED THE IMPORTANCE OF EDUCATION FOR FAMILIES, NOTING MANY FAMILIES ARE UNAWARE OF STATE AND LOCAL PROGRAMS FOR WHICH THEY MAY BE ELIGIBLE. THEY ALSO REPORTED THAT MANY PARENTS IN THE COMMUNITY HAVE A LIMITED UNDERSTANDING OF HEALTHY LIVING AS WELL AS LIMITED KNOWLEDGE REGARDING NAVIGATING TODAYS HEALTH SYSTEM. OUR OBJECTIVE IS TO PROVIDE EDUCATION OPPORTUNITIES FOR FAMILIES AND CHILDREN TO MAKE HEALTHIER CHOICES. THE ANTICIPATED IMPACT IS TO CREATE AN OVERALL HEALTHIER PEDIATRIC COMMUNITY AND DECREASE THE NUMBER OF CHILDREN CATEGORIZED AS "AT RISK E.G., OVERWEIGHT, OBESE, PRE-DIABETIC, ETC. A. INCREASE ACCESS TO SUPPORT GROUPS AND INFORMATION ON WELLNESS/HEALTH EDUCATION: TSRHC DIETICIANS ARE CURRENTLY ACTIVE IN THE DALLAS AREA COALITION FOR THE PREVENTION OF CHILDHOOD OBESITY AND THE MAYORS YOUTH FITNESS INITIATIVE NUTRITION EDUCATION PROGRAM. STAFF ATTEND MONTHLY MEETINGS AND ORGANIZE PARTICIPATION IN THE ANNUAL GET KIDZ FIT FESTIVAL, IN ADDITION TO OTHER PROGRAMS SUCH AS MYFIT. IN THIS PROGRAM, THE DIETICIANS RECRUIT AND ORGANIZE NUTRITION STUDENTS AND DIETETIC INTERNS TO PROVIDE AFTER SCHOOL NUTRITION EDUCATION AT LOCAL PARKS AND RECREATION CENTERS. TSRHC WILL CONTINUE TO INCREASE EFFORTS TO CONNECT PATIENT FAMILIES TO WEIGHT MANAGEMENT AND NUTRITIONAL EDUCATION PROGRAMS OFFERED WITHIN THE COMMUNITY. B. INCREASE AND EXPAND ACCESS TO HEALTH EDUCATION THROUGH EXISTING COMMUNITY PARTNERSHIPS: THROUGH A NUMBER OF NEW PARTNERSHIPS WITH GROUPS SUCH AS DALLAS MAVERICKS, FRISCO ISD, AND FRISCO YMCA, AS WELL AS EXISTING COMMUNITY PARTNERSHIPS LIKE THE ROTARY CLUB, TSRHC PLANS TO EXPAND THE WELLNESS CONTENT CREATED FOR A VARIETY OF AUDIENCES THROUGH A NEW SET OF DISTRIBUTION CHANNELS REACHING A LARGER BASE OF THE POPULATION. C. PARTICIPATE IN THE MAYORS TASK FORCE ON POVERTY: TSRHC WILL PARTICIPATE IN AND SUPPORT THE MAYORS INITIATIVE TO FOCUS ON REDUCING POVERTY IN DALLAS. ACCORDING TO RESEARCH CONDUCTED BY THE TASK FORCE, IN DALLAS, 152,822 FAMILIES ARE LIVING AT OR BELOW THE POVERTY LEVEL AND 184,000 DALLAS CHILDREN WERE LIVING BELOW 150 PERCENT OF THE POVERTY LEVEL. DALLAS STANDS OUT FOR HIGH TEENAGE PREGNANCY RATES, HIGH NUMBER OF HOUSEHOLDS HEADED BY SINGLE MOMS, LOW HIGH SCHOOL GRADUATION RATES AND LIMITED ACCESS TO JOBS VIA MASS TRANSIT FOR MANY "UNDERSERVED". ADDITIONALLY, 43 PERCENT OF DALLAS HOUSEHOLDS DON'T SPEAK ENGLISH AT HOME. THE RESEARCH SHOWS THAT THESE CONTRIBUTING FACTORS ALL MAKE IT MORE LIKELY THAT DALLAS RESIDENTS LIVE IN OR NEAR POVERTY. THE RESEARCH ALSO SHOWS THAT POVERTY IS ONE OF THE LEADING CAUSES OF HUNGER AND THAT ACCESS TO HEALTH CARE IS ONE OF THE MOST IMPORTANT ACTIONS TO TAKE TO REDUCE HUNGER. WORKING WITH THE CITY OF DALLAS AND OTHER ORGANIZATIONS LIKE THE UNITED WAY, DALLAS INDEPENDENT SCHOOL DISTRICT AND CATHOLIC CHARITIES, TSRHC IS COMMITTED TO PLAYING A ROLE IN ADDRESSING THIS CHALLENGE. D. PARTICIPATE IN GROWING LITTLE MINDS: THIS IS A JOI PART V, SECTION B, LINE 22D FAP-ELIGIBLE FINANCIALLY INDIGENT PATIENTS, OR THOSE WHOSE INCOME IS LESS THAN OR EQUAL TO 200% OF THE FPG, RECEIVE A 100% DISCOUNT. PATIENTS DEEMED MEDICALLY INDIGENT WILL QUALIFY FOR A DISCOUNT ON ALL HOSPITAL CHARGES REMAINING AFTER PAYMENT BY THIRD PARTY PAYORS. THE DISCOUNT SHALL BE EQUAL TO THE GREATER OF THE APPLICABLE DISCOUNT SET FORTH ON THE FEE ADJUSTMENT SCALE (please see page 4 for fee adjustment scale: scottishritehospital.org/getattachment/Collapsible-Content-Modules/BECOMIN G-CRAYONCARE/Crayon-Care-Materials-English.pdf?lang=en-US; THE AMOUNT NECESSARY TO ENSURE THAT THE PATIENT'S PAYMENT OBLIGATION TO THE HOSPITAL AFTER APPLICATION OF THE DISCOUNT IS EQUAL TO 1% OF THE PATIENT'S GROSS INCOME, AND THE AMOUNT NECESSARY TO ENSURE THAT THE PATIENT'S PAYMENT OBLIGATION IS NOT GREATER THAN THE AGB. 1 TSRHC SPORTS MEDICINE CENTER 7000 W PLANO PARKWAY PLANO TX 75093 MEDICAL PRACTICE Part I, Line 3c ELIGIBILITY FOR FINANCIAL ASSISTANCE SINCE ITS FOUNDING IN 1921, TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN ("TSRHC") PROVIDED CARE TO PATIENTS WITH NEEDS WITHIN THE HOSPITAL'S SCOPE OF SERVICES AT NO CHARGE. AS THE HOSPITAL BEGAN ACCEPTING REIMBURSEMENT IN OCTOBER 2012, IT IMPLEMENTED A NEW CHARITY CARE/FINANCIAL ASSISTANCE POLICY. FINANCIALLY INDIGENT PATIENTS, OR THOSE WHOSE INCOME IS LESS THAN OR EQUAL TO 200 PERCENT OF THE FPG, RECEIVE A 100% DISCOUNT. FOR DISCOUNTED CARE, FPG AND MEDICAL EXPENSES INCURRED ARE USED TO DETERMINE ELIGIBILITY. Part I, Line 6a COMMUNITY BENEFIT REPORT FOR FISCAL YEAR ENDING SEPTEMBER 30, 2016 A COMMUNITY BENEFIT REPORT HAS BEEN FILED WITH THE STATE OF TEXAS. THE COMMUNITY BENEFIT REPORT IS ALSO AVAILABLE ON THE HOSPITAL'S WEB SITE. Part I, Line 7 COSTING METHODOLOGY LINES 7(A) AND (B) COMMUNITY BENEFIT EXPENSE IN COLUMN (C) WERE CALCULATED USING WORKSHEET 2: RATIO OF PATIENT CARE COST TO CHARGES. LINES 7(E), (F), AND (H) COMMUNITY BENEFIT EXPENSE WERE CALCULATED USING A STEP DOWN ALLOCATION METHOD. PART II, LINE 9 COMMUNITY BUILDING ACTIVITIES TSRHC engages in community building activities such as therapeutic recreation outreach programs, which help connect patients to resources in the community and promote health. For example, TSRHC provides sports and creation camps such as LEARN TO GOLF, A PROGRAM THAT PROVIDES THE TOOLS AND INSTRUCTION NEEDED FOR YOUNG PATIENTS TO EXPERIENCE THE REHABILITATIVE BENEFITS OF THE GAME OF GOLF; SUMMER ALL STARS, WHICH EMPHASIZES FUN, FITNESS, HEALTHY COMPETITION AND TEAM SPIRIT THROUGH INCLUSIVE SPORTS AND ACTIVITIES, SUCH AS BASKETBALL, GOLF AND TENNIS; AND CHANCE TO DANCE, A PROGRAM DESIGNED TO INTRODUCE TSRHC PATIENTS TO VARIOUS TYPES OF DANCE, INCLUDING MODERN, JAZZ, SALSA AND BALLET. EIGHT SPECIALTY CAMPS ARE AVAILABLE FOR CHILDREN UP TO THE AGE OF 17, INCLUDING CAMPS FOR PATIENTS WITH TUBEROUS SCLEROSIS, COMPLEX UPPER LIMB DIFFERENCES, SPINA BIFIDA, JUVENILE ARTHRITIS AND HAND DIFFERENCES. These programs are designed to empower participants in their daily lives and have a positive enduring effect of self-efficacy. The hospital also hosts various peer and parent support groups for the community such as PALS (prosthetics and limb support), etc. In addition, pages 138-141 reference other community building activities that the hospital partakes in. The hospital hosts a few annual events focused on community development. These include Farm & Ranch Day, Bicycle Rodeo and Child Safety Day, which are held at no charge to participants. These events are focused on education and prevention. TSRHC regularly engages with the community, educating young athletes, parents, coaches and school districts about sports safety, injury prevention and concussion management at health fairs and coaching clinics. TSRHC connects with the community through their T.Boone Pickens Training and Conference Center by hosting many events to educate and inform community members on various medical and non-medical topics. We have more than 25,000 people a year who come to the hospital to engage in educational or service opportunities such as various education programs in conjunction with DFWHC (Dallas Fort Worth Hospital Council), Mayor's Task Force on Poverty, Broken Dolls, etc. PART III, SECTION A, LINE 2 METHODOLOGY TO DETERMINE BAD DEBT BAD DEBT EXPENSE IS COMPRISED OF ACTUAL UNCOLLECTIBLE AMOUNTS PLUS AN ALLOWANCE BASED ON HISTORICAL DATA. DISCOUNTS ARE NOT INCLUDED IN BAD DEBT. PART III, SECTION A, LINE 3 BAD DEBT EXCLUSION OF FINANCIAL ASSISTANCE BAD DEBT EXPENSE DOES NOT INCLUDE ANY COSTS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER FINANCIAL ASSISTANCE POLICY. PART III, SECTION A, LINE 4 BAD DEBT THE HOSPITAL MAINTAINS ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS FOR ESTIMATED LOSSES RESULTING FROM A PAYOR'S INABILITY TO MAKE PAYMENTS ON ACCOUNTS. THE HOSPITAL ASSESSES THE REASONABLENESS OF THE ALLOWANCE ACCOUNT BASED ON HISTORICAL WRITE-OFFS, CASH COLLECTIONS, THE AGING OF THE ACCOUNTS, AND OTHER ECONOMIC FACTORS. ACCOUNTS ARE WRITTEN OFF WHEN COLLECTION EFFORTS ARE UNSUCCESSFUL. MANAGEMENT CONTINUALLY MONITORS AND ADJUSTS ITS ALLOWANCES ASSOCIATED WITH ITS RECEIVABLES. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR THE YEARS ENDED SEPTEMBER 30, 2016 AND 2015, WAS APPROXIMATELY $5,255,000 AND $2,460,000 RESPECTIVELY. PART III, SECTION B, LINE 8 MEDICARE ALLOWABLE COSTS THE ESTIMATED COSTS OF PROVIDING CHARITY CARE SERVICES TO MEDICARE PATIENTS ARE BASED ON A CALCULATION WHICH APPLIES A RATIO OF COSTS TO CHARGES AS DETERMINED ON PART I, WORKSHEET 2. THE RATIO OF COSTS TO CHARGES IS CALCULATED BASED ON TOTAL EXPENSES DIVIDED BY GROSS PATIENT SERVICES REVENUE. THE SHORTFALL IS NOT INCLUDED AS A COMMUNITY BENEFIT. PART III, SECTION C, LINE 9B COLLECTION PRACTICES A patient's account will be reviewed for financial assistance eligibility and the appropriate application of any applicable third-party payment, and/or discounts before initiating a statement to the patient. Once a patient qualifies for financial assistance, the patient shall be notified of the amount qualifying under the policy, and no further billing actions shall be taken for amounts qualifying under the policy. After a patient's account balance is reduced by any discounts available under this policy, the patient will be responsible for the remainder of his or her outstanding account balance. TSRHC will send three post-discharge billing statements over a 120 day period. NEEDS ASSESSMENT PART VI, LINE 2 THE HOSPITAL IS PART OF REGIONAL HEALTHCARE PARTNERSHIP 9 (RHP). THESE EFFORTS WERE CONSISTENT WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES TRIPLE AIM TO IMPROVE THE EXPERIENCE OF CARE, IMPROVE THE HEALTH OF POPULATIONS IN OUR RHP, AND TO REDUCE THE COST OF HEALTHCARE WITHOUT COMPROMISING QUALITY. TSRHC EMPLOYS TWO FULL TIME PHYSICIAN RELATIONS STAFF MEMBERS WITHIN OUR PATIENT ACCESS TEAM. THE PRIMARY GOAL OF THE PHYSICIAN RELATIONS DEPARTMENT IS TO BETTER COMMUNICATE AND INTERACT WITH THE PRIMARY CARE PHYSICIANS IN OUR AREA. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, LINE 3 FAMILIES ARE CONTACTED BY FAMILY SERVICES COUNSELORS PRIOR TO SCHEDULED SURGICAL PROCEDURES, INPATIENT VISITS, MRI, CT AND ORTHOTICS AND PROSTHETCS TO INFORM THEM ABOUT THE FINANCIAL ASSISTANCE PROGRAM AND TO ASSESS THEIR POTENTIAL QUALIFICATION FOR FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS. FAMILIES ARE NOTIFIED UPON CHECK-IN FOR OUTPATIENT APPOINTMENTS THAT FAMILY SERVICES COUNSELORS ARE AVAILABLE TO OFFER THE SAME APPLICATION. THE FACILITY HAS ALSO POSTED SPECIFICS ABOUT AVAILABLE FINANCIAL ASSISTANCE AT REGISTRATION, IN MAJOR WAITING AREAS, publication in the hospital magazine, HOSPITAL WEBSITE AND CARDS provided to families upon check-in that is available in English and Spanish. In addition, each post-discharge billing statement will notify the patient that financial assistance is available for eligible individuals, including a phone number for inquiries about financial assistance and a website where additional information can be obtained. Information regarding this policy and how to apply for financial assistance will also be provided during phone conversations with patients regarding financial charges and/or account balances. COMMUNITY INFORMATION PART VI, LINE 4 THE COMMUNITY SERVED BY TSRHC CAN BEST BE DEFINED BY UNDERSTANDING ITS PATIENT POPULATION AND CLINICAL FOCUS. TSRHC IS A 501(C)(3) PEDIATRIC ORTHOPEDIC HOSPITAL IN DALLAS, TEXAS AND OUTPATIENT CLINIC IN PLANO, TEXAS, WHICH TREATS PEDIATRIC ORTHOPEDIC CONDITIONS, SPORTS INJURIES, FRACTURES, AS WELL AS CERTAIN RELATED ARTHRITIC AND NEUROLOGICAL DISORDERS AND DYSLEXIA/LEARNING DISORDERS. TSRHC PROVIDES PREMIER PEDIATRIC ORTHOPEDIC AND DYSLEXIA SERVICES TO PEDIATRIC PATIENTS FOR WHOM THE SERVICES PROVIDED BY THE HOSPITAL OFFER HOPE OF IMPROVEMENT. THOUGH TSRHC IS DEDICATED TO PROVIDING CARE FOR CHILDREN FROM AROUND THE STATE OF TEXAS AND THROUGHOUT THE U.S./COUNTRY, MORE THAN 80 PERCENT OF ITS PATIENTS LIVE IN A 13-COUNTY GEOGRAPHY LOCATED IN NORTHEAST TEXAS. THIS PRIMARY SERVICE AREA INCLUDES THE COUNTIES OF COLLIN, DALLAS, DENTON, ELLIS, GRAYSON, GREGG, HENDERSON, HUNT, JOHNSON, KAUFMAN, ROCKWALL, SMITH, AND TARRANT. DEFINING ITS PRIMARY COMMUNITY WILL ALLOW TSRHC TO MORE EFFECTIVELY FOCUS ITS RESOURCES TO ADDRESS IDENTIFIED SIGNIFICANT HEALTH NEEDS TARGETING AREAS OF GREATEST NEED AND HEALTH DISPARITIES. ACCORDING TO THE CENSUS BUREAU, THE 2016 ESTIMATED POPULATION FOR THE PRIMARY SERVICE AREA, WAS 7,530,966 PEOPLE. BASED ON 2015 CENSUS BUREAU DATA, THE MEDIAN HOUSEHOLD INCOME FOR THE PRIMARY SERVICE AREA WAS $58,685. APPROXIMATELY 25% OF THE PRIMARY SERVICE AREA POPULATION WAS 17 YEARS OR YOUNGER. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 MEDICAL CARE IS PROVIDED TO CHILDREN WITH ORTHOPEDIC AND RELATED CONDITIONS NOT TREATED AT OTHER MEDICAL FACILITIES. MANY PROVIDERS AT TSRHC RECEIVE REFERRALS FROM PHYSICIANS AND CHILDREN'S HOSPITALS IN THE PRIMARY SERVICE AREA BECAUSE THE PATIENT'S CONDITION IS EITHER TOO ACUTE OR IN SOME CASES, SO RARE, THE REFERRING FACILITY DOES NOT HAVE ADEQUATELY TRAINED OR EXPERIENCED STAFF TO PROVIDE THE NECESSARY CARE. THE HOSPITAL HAS A PROCESS TO DETERMINE IF TSRHC IS THE APPROPRIATE FACILITY TO MEET A CHILD'S CLINICAL NEEDS. THE PROCESS BEGINS WITH A REFERRAL OR AN APPLICATION FOR SERVICES, WHICH IS UTILIZED TO DETERMINE IF TSRHC CAN APPROPRIATELY MEET THE NEEDS OF THE PATIENT THROUGH ONE OF ITS SERVICE LINES WHEN THE CHILD'S DIAGNOSIS IS NOT A CLEAR ORTHOPEDIC CONDITION. WHEN TSRHC IS UNABLE TO PROVIDE SERVICES, TSRHC, AS PART OF ITS CARE COORDINATION SERVICES, IDENTIFIES REFERRAL RESOURCES THAT ARE PROVIDED TO THE FAMILY. IN ADDITION TO GENERAL PEDIATRIC ORTHOPEDIC SERVICES, THE PEDIATRIC ORTHOPEDIC SERVICES FOR WHICH PATIENTS ARE PRIMARILY REFERRED TO TSRHC INCLUDE SCOLIOSIS AND SPINE DISORDERS, CLUBFOOT AND OTHER FOOT DISORDERS, REDUCTION DEFICITS (LIMB LENGTHENING), HAND AND UPPER LIMB DISORDERS, HIP DISORDERS, SPORTS MEDICINE AND NEUROLOGIC, RHEUMATOLOGIC AND OTHER PEDIATRIC DEVELOPMENTAL DISABILITIES TREATED IN ADDITION OR RELATED TO OTHER ORTHOPEDIC CONDITIONS. RESEARCH: SINCE OPENING ITS DOORS IN 1921, TSRHC HAS STRIVED TO DISCOVER NEW AND BETTER WAYS TO CARE FOR CHILDREN AFFECTED BY PEDIATRIC ORTHOPEDIC CONDITIONS AND CERTAIN RELATED NEUROLOGICAL DISORDERS. THE HOSPITAL'S DEDICATED RESEARCH CENTER, THE SARAH M. AND CHARLES E. SEAY CENTER FOR MUSCULOSKELETAL RESEARCH, IS MADE UP OF SIX CENTERS FOR EXCELLENCE SUPPORTED BY RESEARCH DIVISIONS AND CORE FACILITIES: SCOLIOSIS AND SPINE; CLUBFOOT AND FOOT DISORDERS; HIP DISORDERS; LIMB LENGTH DISCREPANCIES; HAND DIFFERENCES; AND SPORTS MEDICINE. THROUGH THE YEARS, TSRHC RESEARCHERS AND PHYSICIANS HAVE GENERATED MORE THAN 25 PATENTS AND MADE IMPORTANT DISCOVERIES THAT HAVE HELPED CHILDREN WORLDWIDE. THESE FINDINGS AND INNOVATIONS ALLOW THE MEDICAL COMMUNITY TO FORM NEW HYPOTHESES TO EXPLAIN WHAT CAUSES CERTAIN CONDITIONS WHILE PROVIDING TOOLS FOR FUTURE RESEARCH. THE MAJOR DISCOVERIES AND RESEARCH APPLICATIONS AT TSRHC INCLUDE: THE FIRST GENE ASSOCIATED WITH IDIOPATHIC SCOLIOSIS; TWO MORE GENETIC MARKERS OF THE CONDITION; THE TSRH SILO 5.5 SPINAL SYSTEM; THE TRUE/LOK EXTERNAL FIXATION SYSTEM; AND THE TRUE/LOK HEXAPOD SYSTEM. MEDICAL EDUCATION: FOR 35 YEARS, IN ASSOCIATION WITH THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER, TSRHC HAS PROVIDED AN EXTRAORDINARY EDUCATIONAL EXPERIENCE IN THE FIELD OF PEDIATRIC ORTHOPEDICS TO PROMISING ORTHOPEDIC SURGEONS. MORE THAN 180 PHYSICIANS HAVE BENEFITED FROM THE TSRHC FELLOWSHIP IN PEDIATRIC ORTHOPEDICS AND SCOLIOSIS, GOING ON TO HOLD PRESTIGIOUS MEDICAL POSITIONS ACROSS THE COUNTRY AND AROUND THE WORLD. IN ADDITION TO THE FELLOWSHIP PROGRAM, THE HOSPITAL PARTICIPATES IN RESIDENCY TRAINING PROGRAMS IN NEUROLOGY, RHEUMATOLOGY, ORTHOPEDICS, PSYCHOLOGY, RADIOLOGY AND PEDIATRIC DEVELOPMENT DISABILITIES. THE HOSPITAL HAS VARIOUS AFFILIATION PROGRAMS FOR EDUCATION IN NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, PROSTHETICS AND VARIOUS OTHER DISCIPLINES. FAMILY RESOURCE CENTER: THE CHRISTI CARTER URSCHEL FAMILY RESOURCE CENTER, FOUNDED IN 1988, PROVIDES HEALTH INFORMATION AND SUPPORT RESOURCES TO PATIENTS AND FAMILIES IN ORDER TO HELP THEM MAKE INFORMED HEALTH CARE DECISIONS AND IMPROVE THEIR QUALITY OF LIFE. THE CENTERS STAFF ALSO PROVIDES REFERRALS TO MEDICAL PROVIDERS FOR CONDITIONS NOT TREATED AT TSRHC. THE CENTER SERVES AN AVERAGE OF 2,000 FAMILIES ANNUALLY. FAMILY ROOM AND CHAPEL: THE FAMILY ROOM IS PRIMARILY UTILIZED BY PATIENT FAMILIES AS A COMFORTABLE SURGERY WAITING AREA, WHILE THE CHAPEL LOCATED NEXT DOOR PROVIDES A PLACE OF WORSHIP WITH NONDENOMINATIONAL SERVICES EACH SUNDAY. CHILD LIFE PLAYROOM: THE PLAYROOM FEATURES STAFF SPECIALISTS WHO FOCUS ON EACH PATIENT AND THEIR FAMILY'S SPECIFIC NEEDS BY PROMOTING OPTIMAL PSYCHOSOCIAL DEVELOPMENT. FAMILY SERVICES DEPARTMENT: FAMILY SERVICES SERVES AS A SUPPORT CENTER FOR PATIENTS AND FAMILIES IN FOUR PRIMARY AREAS: MEDICAL SOCIAL WORK FOR RESOURCES AND REFERRALS; COORDINATION OF OFF-SITE MEDICAL SERVICES; FINANCIAL ASSISTANCE PROGRAMS AND FAMILY SERVICES COUNSELING; AND LANGUAGE INTERPRETATION AND TRANSLATION SERVICES. RESOURCES TO ADDRESS CHILD HEALTH STATUS: SOCIAL WORKERS AND MEDICAL CONSULT COORDINATORS HELP FAMILIES ARRANGE TO RECEIVE FOLLOW-UP CARE FOR THE SERVICES ORDERED BY THE MEDICAL STAFF. PATIENT FAMILIES CHOOSE THEIR VENDORS FROM A LIST OF VENDORS PROVIDED BY SOCIAL WORKERS BASED ON LOCATION AND THE PATIENT'S FUNDING SOURCE. THESE SERVICES INCLUDE WEIGHT MANAGEMENT, OUTPATIENT PHYSICAL REHAB, HOME HEALTH SERVICES, DURABLE MEDICAL EQUIPMENT, MEDICAL SUPPLIES, TESTING AND SPECIALISTS AND MENTAL HEALTH. TSRHCS PATIENT EDUCATION IS CREATED AND MAINTAINED BY AN INTERDISCIPLINARY TEAM OF PHYSICIANS, NURSES AND ANCILLARY SERVICES THROUGHOUT THE ORGANIZATION. THESE MATERIALS ARE AVAILABLE TO PATIENTS AND FAMILIES ON SPECIFIC SURGERIES, CONDITIONS AND MEDICAL PROCESSES, ALONG WITH MORE GENERAL AND BASIC HEALTH EDUCATION. REFERRAL TO OTHER PROVIDERS: WHEN TSRHC IS UNABLE TO PROVIDE SERVICES, TSRHC IDENTIFIES REFERRAL RESOURCES THAT ARE PROVIDED TO THE FAMILY. EXAMPLES OF EXISTING HEALTH CARE PROGRAMS WITHIN THE COMMUNITY AVAILABLE TO ADDRESS THE IDENTIFIED NEEDS INCLUDE BUT ARE NOT LIMITED TO: CHILDREN'S MEDICAL CENTER; UT SOUTHWESTERN MEDICAL CENTER; COOK CHILDREN'S MEDICAL CENTER; MEDICAL CITY CHILDREN'S HOSPITAL; BAYLOR INSTITUTE FOR IMMUNOLOGY RESEARCH; TEXAS CHILD NEUROLOGY; AND NORTH TEXAS PEDIATRIC UROLOGY. RESOURCES TO ADDRESS COORDINATION OF CARE: TSRHC TRANSITIONS PATIENTS TO ADULT PROVIDERS AS THEY APPROACH THE AGE OF 18. A GROUP OF TSRHC SOCIAL WORKERS, NURSES, ADMINISTRATORS AND MEDICAL STAFF WORK TO TRANSITION TSRHC PATIENTS TO ENSURE THAT ALL PATIENTS NEEDING ADDITIONAL COORDINATION AS THEY AGE OUT OF SERVICES RECEIVE THE NECESSARY ASSISTANCE. CATEGORIES OF CARE WITH WHICH STAFF HELP TRANSITION PATIENTS TO ADULT CARE INCLUDE LEGAL AND GUARDIANSHIP, PRIMARY AND SPECIALTY CARE, FUNDING, EDUCATION AND/OR VOCATIONAL PROGRAMS. MEDICAID TRANSPORTATION: SOCIAL WORKERS IN FAMILY SERVICES ARE AVAILABLE TO HELP FAMILIES UNDERSTAND AND NAVIGATE THE PROCESSES FOR MEDICAID TRANSPORTATION ASSISTANCE, LODGING AND MEALS, WHEN ELIGIBLE FOR THESE SERVICES. SOUTHWEST AIRLINES TICKET VOUCHERS: TSRHC SOCIAL WORKERS ARE ABLE TO FACILITATE AIRLINE TICKETS FROM SOUTHWEST AIRLINES FOR FAMILIES LIVING OUTSIDE THE DALLAS/FORT WORTH METROPLEX THAT DO NOT HAVE OTHER RESOURCES TO HELP WITH TRAVEL TO THE HOSPITAL FOR APPOINTMENTS. SOUTHWEST AIRLINES DONATES TICKET VOUCHERS TO BE USED BY FAMILIES WITH NO OTHER MEANS OF TRANSPORTATION. IF SUCH FAMILIES CAN GET TO A SOUTHWEST AIRLINES HUB, SOCIAL WORKERS WILL COORDINATE THE TRIP WITH THE FAMILY USING THE VOUCHERS. AFFILIATED HEALTHCARE SYSTEM PART VI, LINE 6 NOT APPLICABLE STATE FILINGS OF COMMUNITY BENEFIT REPORT PART VI, LINE 7 FOR FISCAL YEAR ENDING SEPTEMBER 30, 2016 A COMMUNITY BENEFIT REPORT WAS FILED WITH THE STATE OF TEXAS. true SERVICE ORGANIZATION OF WEST TEXAS 2950 W 50TH LUBBOCK TX 79413 383755079 501(c)(3) 3500000 RURAL TX INDIGENT CARE PEDI-ORTHO HEALTH CORPORATION 2222 WELBORN DALLAS TX 75219 752665759 501(c)(3) 110000 MEDICAL CARE & RESEARCH SERVICE ORGANIZATION OF BIG COUNTRY 2950 W 50TH LUBBOCK TX 79413 260746318 501(c)(3) 20000 RURAL TX INDIGENT CARE 3 0 SCHEDULE I, PART I, LINE 2 USE OF GRANT FUNDS THE GRANT TO PEDI-ORTHO HEALTH CORPORATION, A RELATED MEDICAL ENTITY, IS TO SUPPORT THE MEDICAL SERVICES OF ITS PHYSICIANS. THE HOSPITAL, AS A SOLE MEMBER, MONITORS THE ACTIVITIES OF THE ENTITY WHICH PROVIDES PEDIATRIC ORTHOPAEDIC PHYSICIANS TO LOCAL MEDICAL FACILITIES THAT CARE FOR CHILDREN. THE ENTITY IS INDEPENDENTLY AUDITED ANNUALLY AND THE HOSPITAL RECEIVES A COPY OF THE AUDITED FINANCIAL STATEMENTS. THE HOSPITAL, IN COLLABORATION WITH THE SERVICE ORGANIZATION OF WEST TEXAS, SOLICITED THE PARTICIPATION OF CERTAIN RURAL TEXAS HOSPITAL DISTRICTS IN INDIGENT CARE AFFILIATION AGREEMENTS AS PART OF THE SECTION 1115 DEMONSTRATION WAIVER FOR THE TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM. THE FOLLOWING HOSPITAL DISTRICTS PARTICIPATE UNDER THESE AGREEMENTS: DALLAM & HARTLEY COUNTIES AND DAWSON COUNTY. SIMILARLY, THE HOSPITAL COLLABORATED WITH THE SERVICE ORGANIZATION OF BIG COUNTRY AND ENTERED INTO INDIGENT CARE AFFILIATION AGREEMENTS WITH THE FOLLOWING HOSPITAL DISTRICTS: EASTLAND MEMORIAL, ROLLING PLAINS MEMORIAL AND STONEWALL MEMORIAL. THE SERVICES OF A CONSULTANT WERE UTILIZED IN THE SELECTION OF HOSPITAL DISTRICTS WITH WHICH TO AFFILIATE. THE SERVICE ORGANIZATIONS ARE MONITORED BY MEANS OF THEIR TAX RETURNS, AND UNDER THE TERMS OF THE AFFILIATION AGREEMENTS, THE HOSPITAL DISTRICTS AGREED TO COOPERATE WITH TSRH TO ASSESS THE IMPROVEMENTS IN INDIGENT CARE ACCESS, AVAILABILITY AND DELIVERY IN THEIR COMMUNITIES RESULTING FROM THIS PROGRAM. X X false true X X X X false true false false false false false false false ROBERT L WALKER PRESIDENT/CEO 659887 0 0 0 62850 0 0 0 25071 0 747808 0 16176 0 JC MONTGOMERY JR PRESIDENT EMERITUS 444597 0 0 0 60603 0 0 0 26069 0 531269 0 19057 0 WILLIAM R HUSTON SR VICE PRESIDENT AND CFO 340598 0 0 0 32804 0 10337 0 19697 0 403436 0 0 0 M SCOTT PERRYMAN SR VP (RESIGNED OCT 2015) 268310 0 0 0 22469 0 15900 0 30167 0 336846 0 0 0 LORI DALTON SR VP & GENERAL COUNSEL 358954 0 0 0 32018 0 15900 0 35050 0 441922 0 0 0 MARK BATEMAN SENIOR VICE PRESIDENT 340192 0 0 0 31288 0 15900 0 33195 0 420575 0 0 0 FREDRIC RICHMOND VP/CHIEF INVESTMENT OFFICER 326643 0 0 0 31386 0 15900 0 33670 0 407599 0 0 0 MATT CHANCE SENIOR VP 139158 0 0 0 199 0 0 0 10861 0 150218 0 0 0 CONNIE WRIGHT VP 170053 0 0 0 13059 0 0 0 8970 0 192082 0 0 0 STEPHANIE BRIGGER VICE PRESIDENT 173607 0 0 0 17352 0 42486 0 19802 0 253247 0 0 0 ELLEN HAYNES VICE PRESIDENT 175652 0 0 0 3003 0 10663 0 11488 0 200806 0 0 0 LESLIE CLONCH VICE PRESIDENT 305298 0 0 0 23313 0 4278 0 34804 0 367693 0 0 0 DEBRA SAYLES VICE PRESIDENT 260147 0 0 0 17205 0 115315 0 13902 0 406569 0 0 0 DONALD KATZ VICE PRESIDENT 226879 0 0 0 13467 0 62988 0 35652 0 338986 0 0 0 JEREMY HOWELL VICE PRESIDENT 187324 0 0 0 10900 0 11604 0 32959 0 242787 0 0 0 KRISTINA KEEVER-SMITH INVESTMENT OFFICER 217850 0 0 0 10703 0 30447 0 3794 0 262794 0 0 0 JEAN ALLEN CONTROLLER 166082 0 0 0 9744 0 10292 0 19216 0 205334 0 0 0 JAMES STURGIS ADMINISTRATOR (DECEASED 6/17) 98515 0 0 0 10968 0 0 0 8656 0 118139 0 0 0 LAWSON COPLEY MD CHIEF MEDICAL INFO OFFICER 0 647910 0 0 0 35347 0 94509 0 36255 0 814021 0 0 MOLLY DEMPSEY MD ASST CHIEF MEDICAL INFO OFFICE 542978 0 0 0 25891 0 106310 0 21870 0 697049 0 0 0 DANIEL SUCATO MD CHIEF OF STAFF 690424 0 0 0 40982 0 157395 0 34755 0 923556 0 0 0 J ANTHONY HERRING MD CHIEF OF STAFF EMERITUS 563033 0 0 0 91476 0 0 0 23630 0 678139 0 22040 0 B STEPHENS RICHARDS MD CHIEF MEDICAL OFFICER 606023 21150 0 0 229351 0 30129 0 7287 0 872790 21150 0 0 JOHN BIRCH MD RETIRED 90402 0 0 0 353133 0 0 0 0 0 443535 0 0 0 CHARLES JOHNSTON MD ASST CHIEF OF STAFF EMERITUS 595058 0 0 0 97671 0 0 0 23711 0 716440 0 52163 0 PHILIP WILSON MD ASST CHIEF OF STAFF 0 663173 0 0 2345 40362 0 69992 0 23655 2345 797182 0 0 KARL RATHJEN MD ASST CHIEF OF STAFF 592343 0 0 0 39826 40950 116960 0 11675 0 760804 40950 0 0 FARANEH SAFAVI MD ANESTHESIOLOGIST (*SEE SCH. J) 524414 0 0 0 209202 0 142017 0 23951 0 899584 0 0 0 LORI KAROL MD ASST CHIEF OF STAFF 563651 19300 0 0 39883 0 130569 0 36015 0 770118 19300 0 0 DAVID WILKES PEDIATRICIAN(SEE SCH J**) 424457 0 0 0 496761 0 122600 0 35755 0 1079573 0 0 0 AMY MCINTOSH ORTHOPEDIC SURGEON 564690 91350 0 0 43206 0 10844 0 33009 0 651749 91350 0 0 BRANDON RAMO ORTHOPEDIC SURGEON 561650 87950 0 0 51267 0 15900 0 35735 0 664552 87950 0 0 SCOTT OISHI ORTHOPEDIC SURGEON 550682 0 0 0 22971 0 15900 0 33291 0 622844 0 0 0 FORM 990, PART VII & SCHEDULE J FOOTNOTE *PREVIOUSLY VESTED IN NON-QUALIFIED PENSION PLAN AND ACCRUED ADDITIONAL TAXABLE BENEFITS IN CALENDAR 2015. **VESTED IN NON-QUALIFIED PENSION PLAN IN CALENDAR 2015. SCHEDULE J, PART I, LINE 1A TRAVEL FOR COMPANIONS (INCLUDED ON SCH J, PART II, COL B (III) & W-2, BOX 5) JOHN BIRCH $800 J. ANTHONY HERRING $800 CHARLES JOHNSTON $800 B. STEPHENS RICHARDS $800 DANIEL SUCATO $800 KARL RATHJEN $800 LAWSON COPLEY $153 (EMPLOYED BY RELATED ENTITY) PHILIP WILSON $800 (EMPLOYED BY RELATED ENTITY) BRANDON RAMO $800 SOCIAL CLUB DUES (INCLUDED ON SCH J, PART II, COL B (III) & W-2, BOX 5) JC MONTGOMERY, JR. $2,640 Schedule J, Part I, Line 1b THE CORPORATION DOES NOT HAVE A WRITEN POLICY REGARDING REIMBURSEMENT FOR TRAVEL FOR COMPANIONS. CERTAN EMPLOYEES ARE ALLOWED $800 ANNUALLY FOR TRAVEL FOR COMPANIONS. THE ORGANIZATION PAID A PORTION OF THE SOCIAL CLUB DUES FOR AN EMPLOYEE. SUBSTANTIATION OF EXPENSES WAS REQUIRED PRIOR TO REIMBURSEMENT AND THESE ITEMS WERE INCLUDED AS TAXABLE INCOME ON SCHEDULE J. Schedule J, Part I, Line 4b THE RESTORATION OF RETIREMENT INCOME PLAN (RRIP) IS A NON-QUALIFIED PLAN PROVIDING SUPPLEMENTAL RETIREMENT BENEFITS TO CERTAIN EMPLOYEES OF TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN (TSRHC) AND A RELATED ENTITY, WHOSE BENEFITS UNDER THE TAX-QUALIFIED RETIREMENT PLAN HAVE BEEN LIMITED BY THE MAXIMUM BENEFIT AND MAXIMUM COMPENSATION LIMITATIONS IMPOSED UNDER THE TAX-QUALIFIED RETIREMENT PLAN IN ORDER TO COMPLY WITH THE INTERNAL REVENUE CODE. THE TOTAL ACCUMULATED BENEFIT THAT HAS ACCRUED FOR A PARTICIPANT UNDER THE RRIP NORMALLY BECOMES VESTED AND TAXABLE TO A PARTICIPANT WHEN HE OR SHE EITHER HAS ATTAINED AGE 55 AND COMPLETED 15 YEARS OF SERVICE OR ATTAINS AGE 65. THE BENEFIT ACCRUALS FOR A PARTICIPANT AFTER THE DATE OF INITIAL VESTING ARE TAXABLE TO THE PARTICIPANT WHEN AND AS ACCRUED. RRIP BENEFITS BECOME PAYABLE AFTER TERMINATION OF EMPLOYMENT. UNDER THE TERMS OF THE RRIP, THE FOLLOWING EMPLOYEES ARE NON-VESTED PARTICIPANTS WHO ARE ACCRUING AN ANNUAL BENEFIT IN 2015. (INCLUDED ON SCH J, PART II, COL C) DANIEL SUCATO $117,000 KARL RATHJEN $73,505 LORI KAROL $74,280 MOLLY DEMPSEY $63,204 LAWSON COPLEY $63,204 (EMPLOYED BY A RELATED ENTITY) PHILIP WILSON $37,110 (EMPLOYED BY A RELATED ENTITY) UNDER THE TERMS OF THE RRIP, THE FOLLOWING EMPLOYEE VESTED IN THIS PLAN IN CALENDAR YEAR 2015 AND HIS CUMULATIVE ACCRUED BENEFITS SINCE INCEPTION, AS REFERENCED BELOW, ARE SUBJECT TO TAXATION. (INCLUDED ON SCH J, PART II, COL B (III) & W-2, BOX 5) DAVID WILKES $493,176 UNDER THE TERMS OF THE RRIP, THE FOLLOWING EMPLOYEES HAVE PREVIOUSLY VESTED IN THE RRIP AND ACCRUED ADDITIONAL BENEFITS DURING 2015, WHICH ARE SUBJECT TO TAXATION, IN THE FOLLOWING AMOUNTS. (INCLUDED IN SCH J, PART II, COL B (III) & W-2, BOX 5) B. STEPHENS RICHARDS $186,363 FARZANEH SAFAVI $180,939 THE MANAGEMENT BENEFIT PLAN IS A NON-QUALIFIED PLAN PROVIDING SUPPLEMENTAL RETIREMENT BENEFITS TO CERTAIN ELIBIGLE EMPLOYEES WHO BECAME PARTICIPANTS PRIOR TO 1988. MONTHLY RETIREMENT INCOME BENEFITS BECOME PAYABLE UNDER THE PLAN COMMENCING AT AGE 65 (OR EARLIER DISABILITY), AND ARE TAXABLE TO PARTICIPANT WHEN AND AS PAID. UNDER THE TERM OF THE MANAGEMENT BENEFIT PLAN, THE FOLLOWING EMPLOYEES RECEIVED PAYMENTS IN 2015. (INCLUDED ON SCH J, PART II, COL B (III) AND W-2, BOX 1 AND 5) JC MONTGOMERY, JR. $39,702 J. ANTHONY HERRING $45,917 ROBERT WALKER $32,352 JOHN BIRCH $85,416 CHARLES JOHNSTON $100,848 THE FLEXIBLE BENEFITS PLAN IS A NON-QUALIFIED PLAN PROVIDING LIFE INSURANCE, DISABILITY INSURANCE, LONG-TERM CARE INSURANCE AND/OR RETIREMENT BENEFITS TO ELIGIBLE EMPLOYEES OF TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN (TSRHC) AND A RELATED ENTITY, AT THEIR ELECTION. THE INSURANCE PREMIUM AND RETIREMENT ACCOUNT CONTRIBUTION AMOUNTS ALLOCATED TO A PARTICIPANT UNDER THIS PLAN FOR EACH YEAR ARE TAXABLE TO THE PARTICIPANT FOR SUCH YEAR. THE EARNINGS ON RETIREMENT ACCOUNT CONTRIBUTIONS BECOME TAXABLE TO A PARTICIPANT WHEN PAID OR MADE AVAILABLE TO THE PARTICIPANT. UNDER THE TERMS OF THE FLEXIBLE BENEFITS PLAN, THE FOLLOWING EMPLOYEES WERE TAXED ON THE FOLLOWING AMOUNTS FOR CALENDAR YEAR 2015. (INCLUDED IN SCH J, PART II, COL B (III), AND W-2, BOX 5) JC MONTGOMERY, JR. $18,720 ROBERT WALKER $28,125 M. SCOTT PERRYMAN $11,742 LORI DALTON $15,789 KRISTINA KEEVER-SMITH $9,549 MARK BATEMAN $14,895 STEPHANIE BRIGGER $7,629 JEAN ALLEN $7,384 JAMES STURGIS $9,000 DEBBIE SAYLES $11,280 J. ANTHONY HERRING $23,625 B. STEPHENS RICHARDS $26,066 CHARLES JOHNSTON $24,461 KARL RATHJEN, MD $24,825 DANIEL SUCATO $29,700 LORI KAROL $23,496 FARZANEH SAFAVI $22,755 MOLLIE DEMPSEY $23,584 JEREMY HOWELL $8,325 DONALD KATZ $10,125 BRANDON RAMO $24,234 AMY MCINTOSH $24.234 LESLIE CLONCH $13,500 FREDRICK RICHMOND $14,322 WILLIAM HUSTON $14,832 LAWSON COPLEY $23,496 (EMPLOYED BY RELATED ENTITY) PHILIP WILSON $23,496 (EMPLOYED BY RELATED ENTITY) A CITY OF PARKER TX CULTURAL EDUCATION FACILITIES 270365113 000000000 2010-12-30 23000000 CONSTRUCT & EQUIP POWER PLANT false false false A 0 0 23000000 0 1067432 0 111125 347333 0 22735606 0 0 2012 false false true true A false false false false 0 false false false false A false false true false true true JPMORGAN CHASE 10. false false false 0 false false A false SCHEDULE K, PART IV, LINE 2B: Arbitrage - Exception to rebate Construction fund exempt from rebate based on two year spend down rules. DODGE CARTER GRANDSON TO TRUSTEE 70054 EMPLOYEE/NON-OFFICER OF TSRHC false KAITLYN BROWN DAUGHTER TO TRUSTEE 43218 EMPLOYEE/NON-OFFICER OF TSRHC false SCHEDULE L, PART IV DODGE CARTER IS THE GRANDSON OF HAROLD D. CARTER, TRUSTEE. KAITLYN BROWN IS THE DAUGHTER OF RUSSELL C. BROWN, TRUSTEE. X 7 124118 Market value X 6 205210 Market value X 3 402500 MARKET VALUE X 1 440000 Market Value X 1 20782 MARKET VALUE X Mineral interest 1 1 Market value false false true SCHEDULE M, PART II, LINE 32A TSRHC USES THIRD PARTY BROKERS TO SELL DONATED SECURITIES AND OTHER THIRD PARTY SPECIALISTS TO SELL OTHER NON-CASH DONATIONS OF VEHICLES, REAL ESTATE AND OTHER ASSETS. DOING BUSINESS AS FORM 990, BOX C TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN PROGRAM SERVICES - PATIENT CARE (CONT.) FORM 990, PART III, LINE 4A THE NEUROLOGY PROGRAM PROVIDES CARE IN SPECIALIZED CLINICS FOR ORTHOPEDIC PATIENTS WHO HAVE RELATED NEUROLOGICAL DISORDERS AND NEUROMUSCULAR DISEASES SUCH AS TUBEROUS SCLEROSIS. THE PEDIATRIC DEVELOPMENTAL DISABILITIES PROGRAM INCLUDES OUTPATIENT CLINIC VISITS FOR THE DIAGNOSIS AND TREATMENT OF CONDITIONS SUCH AS SPINA BIFIDA AND CEREBRAL PALSY. ALL PROGRAMS, INCLUDING ORTHOPEDIC, NEUROLOGY AND LEARNING DISORDERS, TAKES AN INTERDISCIPLINARY APPROACH TO PROVIDING THE BEST POSSIBLE FAMILY-CENTERED CARE. Program Services - Research (Cont.) FORM 990, PART III, LINE 4B HOSPITAL RESEARCHERS HAVE STRIVED TO DISCOVER NEW AND BETTER WAYS TO CARE FOR CHILDREN, WHICH HAVE GENERATED MORE THAN 25 PATENTS. THEY HAVE MADE IMPORTANT DISCOVERIES THAT HAVE HELPED CHILDREN WORLDWIDE, INCLUDING DISCOVERING THE FIRST GENE ASSOCIATED WITH IDIOPATHIC SCOLIOSIS AND TWO MORE GENETIC MARKERS OF THE CONDITION. THROUGH RESEARCH, NEW DEVICES AND TREATMENT SYSTEMS HAVE BEEN CREATED, INCLUDING THE TSRH SILO 5.5 SPINAL SYSTEM, THE TRUE/LOK EXTERNAL FIXATION SYSTEM AND THE TRUE/LOK HEXAPOD SYSTEM. Program Services - Education (Cont.) FORM 990, PART III, LINE 4C FOR 35 YEARS, IN ASSOCIATION WITH THE UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER, THE HOSPITAL HAS PROVIDED AN EXTRAORDINARY EDUCATIONAL EXPERIENCE IN THE FIELD OF PEDIATRIC ORTHOPEDICS TO PROMISING ORTHOPEDIC SURGEONS. MORE THAN 180 PHYSICIANS HAVE BENEFITED FROM THE HOSPITAL'S FELLOWSHIP IN PEDIATRIC ORTHOPEDICS AND SCOLIOSIS, WITH MANY GOING ON TO HOLD PRESTIGIOUS MEDICAL POSITIONS ACROSS THE COUNTRY AND AROUND THE WORLD. IN ADDITION, PHYSICIANS FROM SOME OF THE MAJOR HAND CENTERS HAVE TRAINED AT THE HOSPITAL IN THE SUB-SPECIALTY OF PEDIATRIC HAND SURGERY. THE HOSPITAL ALSO PARTICIPATES IN RESIDENCY TRAINING PROGRAMS IN NEUROLOGY, RHEUMATOLOGY, PSYCHOLOGY, RADIOLOGY AND PEDIATRIC DEVELOPMENTAL DISABILITIES. AFFILIATION PROGRAMS IN NURSING, PHYSICAL THERAPY, PROSTHETICS AND OTHER DISCIPLINES ALSO EXIST. FAMILY AND BUSINESS RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2: LYNDON L. OLSON AND RON CARTER HAVE A BUSINESS RELATIONSHIP. J. A. ANTHONY HERRING, MD, JOHN G. BIRCH, MD, CHARLES E. JOHNSTON, MD, LORI A. KAROL, MD, B. STEPHENS RICHARDS, MD, KARL E. RATHJEN, MD, PHILIP L. WILSON, MD, LAWSON A.B. COPLEY, MD, AMY MCINTOSH, MD, BRANDON RAMO, MD, AND DANIEL J. SUCATO, MD, HAVE A BUSINESS RELATIONSHIP WITH ROBERT WALKER, WILLIAM HUSTON AND LORI DALTON IN THAT THE PHYSICIANS ARE DIRECTORS OF PEDI-ORTHO HEALTH CORPORATION, AN ENTITY FOR WHICH TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN IS THE SOLE MEMBER, IN WHICH THE LATTER INDIVIDUALS SERVE AS OFFICERS. LORI DALTON AND KRISTINA KEEVER-SMITH HAVE A BUSINESS RELATIONSHIP IN THAT THEY ARE EMPLOYED BY TEXAS SCOTTISH HOSPITAL FOR CHILDREN AND ALSO SERVE AS OFFICERS OF LEGACY SCHOLARSHIP FUND, A RELATED ENTITY. J.C. MONTGOMERY, JR., LORI DALTON, WILLIAM HUSTON AND KARL RATHJEN HAVE A BUSINESS RELATIONSHIP IN THAT THEY ARE EMPLOYED BY TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN AND ALSO SERVE AS OFFICERS OF TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN FOUNDATION, AN ENTITY FOR WHICH TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN IS THE SOLE MEMBER. PROCESS USED TO REVIEW 990 Form 990, Part VI , Section B, Line 11b: THE FORM 990 IS PREPARED INTERNALLY IN CONJUNCTION WITH OUTSIDE ACCOUNTANTS AND THEN REVIEWED BY MANAGEMENT. A COPY OF THE FORM 990 IS PROVIDED TO THE AUDIT COMMITTEE FOR REVIEW AND DISCUSSION. THE FORM 990 IS PROVIDED TO THE BOARD THROUGH ACCESS TO A SECURE PORTAL FOR REVIEW BEFORE IT IS FILED. COMPLIANCE WITH WRITTEN CONFLICT OF INTEREST POLICY Form 990, Part VI, Section B, Line 12c: THE ORGANIZATION ANNUALLY REQUIRES OFFICERS, KEY EMPLOYEES AND TRUSTEES TO COMPLETE A CONFLICTS OF INTEREST FORM DISCLOSING ACTUAL OR POTENTIAL CONFLICTS OF INTEREST IN COMPLIANCE WITH THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY. ADDITIONALLY, THESE INDIVIDUALS ARE TO REPORT ANY NEW MATTERS THAT ARISE DURING THE YEAR IF THEY BECOME AWARE OF A TRANSACTION THAT IS UNDER CONSIDERATION THAT PRESENTS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST. ANNUALLY THE GENERAL COUNSEL PREPARES AND SUBMITS A SUMMARY OF THE DISCLOSED POTENTIAL CONFLICTS TO THE AUDIT COMMITTEE OF THE BOARD OF TRUSTEES. ADDITIONALLY, AT THE TIME A KEY STAFF MEMBER IS HIRED OR PROMOTED TO A POSITION WITH ADMINISTRATIVE OR MANAGEMENT RESPONSIBILITIES, THE ORGANIZATION PROVIDES THE INDIVIDUAL WITH A COPY OF THE CONFLICTS OF INTEREST POLICY AND THE INDIVIDUAL IS REQUIRED TO COMPLETE A CONFLICTS OF INTEREST DISCLOSURE FORM. ALL MATERIAL FACTS SURROUNDING CONTRACTS, TRANSACTIONS, OR ARRANGEMENTS INVOLVING A CONFLICT OF INTEREST ARE TO BE DISCLOSED TO ENSURE THAT THE CONTRACT, TRANSACTION OR ARRANGEMENT IS FAIR TO THE HOSPITAL AT THE TIME IT IS AUTHORIZED, APPROVED, OR RATIFIED. PROCESS FOR DETERMINING COMPENSATION Form 990, Part VI, Section B, Line 15a and 15b: THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES ANNUALLY REVIEWS AND APPROVES SALARIES AND BENEFITS FOR OFFICERS, MEMBERS OF THE MEDICAL STAFF AND KEY EMPLOYEES OF THE ORGANIZATION. THE HOSPITAL REVIEWS VARIOUS EXECUTIVE/PHYSICIAN COMPENSATION SURVEYS, INCLUDING DATA FROM PEDIATRIC HOSPITALS AND PHYSICIAN PRACTICES ON BOTH A LOCAL AND NATIONAL BASIS. BI-ANNUALLY, AN INDEPENDENT CONSULTANT REVIEWS SALARIES AND BENEFITS OF OFFICERS, PHYSICIANS AND KEY EMPLOYEES. THIS REVIEW WAS LAST UNDERTAKEN IN FISCAL YEAR 2016 FOR OFFICERS AND MEDICAL STAFF. Governing Document, Conflict of Interest Policy and Financial Statements Form 990, Part VI, Section C, Line 19: GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MAINTAINED BY THE HOSPITAL AND ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. RECONCILIATION OF NET ASSETS FORM 990, PART XI, LINE 9: PENSION LIABILITY ADJUSTMENT $ (6,690,261) CHANGE IN BENEFICIAL INTEREST IN TRUSTS $ 1,484,045 ------------- TOTAL $ (5,206,216) Pedi-Ortho Health Corporation 2222 Welborn St Dallas TX 75219 752665759 Physicians TX 501(c)(3) 9 TSRH true TSRH SCHOLRSHP FND (DBA LEGACY SCHLRSHP) 2222 Welborn St Dallas TX 75219 752106637 Scholarships TX 501(c)(3) 7 NA false Texas Scottish Rite Hospital Trust C/O JPMorgan Chase POB 3038 Milwaukee WI 53201 756013875 Support org WI 501(c)(3) 11d-III-O NA false TSRH for Children Foundation 2222 Welborn St Dallas TX 75219 460683787 Support org TX 501(c)(3) 7 TSRH true false true false false false false false false false false false true true true true true true true true Pedi-Ortho Health Corporation b 110000 Market Pedi-Ortho Health Corporation l 821064 Market Pedi-Ortho Health Corporation m 1923048 Market Pedi-Ortho Health Corporation o 55096 Market Pedi-Ortho Health Corporation p 3219485 Market PEDI-ORTHO HEALTH Corporation q 1269850 Market PEDI-ORTHO HEALTH CORPORATION r 750000 Market PEDI-ORTHO HEALTH CORPORATION s 700500 Market