2016-11-11T15:56:00-06:00 2015-12-31 990 2015-01-01 751748586 Texas Health Harris Methodist Hospital Azle % DAVID JACKSON TEXA 8174448600 108 Denver Trail Azle TX 76020 RICK MCWHORTER Asst Secretary 6822367900 2016-11-11 2015 2017-02-10 21:41:12Z Texas Health Azle Bob Ellzey 108 Denver Trail Azle TX 76020 34809339 false X www.texashealth.org X 1954 TX A faith-based organization whose mission is to improve the health of the people in the communities it serves regardless of one's ability to pay. 11 10 315 51 0 426272 162264 31951259 34410992 -35169 -21900 203134 236083 32545496 34787439 8025 938259 0 0 17608996 18338753 0 0 0 13167392 13599121 30784413 32876133 1761083 1911306 12467083 13223184 16247169 15091964 -3780086 -1868780 X A FAITH-BASED ORGANIZATION WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE IN THE COMMUNITIES IT SERVES REGARDLESS OF ONE'S ABILITY TO PAY. false false 27433198 938259 34410992 Texas Health Harris Methodist Hospital Azle (THAZ) is a 31 bed community based hospital serving Azle, Lake Worth, Springtown and the surrounding areas. Since 1954, THAZ has provided quality health care services to the northwest Tarrant County community. Located in Azle, the hospital offers many services such as cardiovascular, imaging, inpatient/outpatient surgery, Outpatient Sports and Rehabilitation Center and an intensive care unit. During the year, THAZ had 4,879 patient days, 1,549 discharges, 31,554 outpatient encounters, 0 births and 23,385 emergency room visits. THAZ provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. The hospital provides care to persons covered by governmental programs including Medicare and Medicaid for reimbursement that does not always cover the cost of providing the care. Recognizing its mission to the community, services are provided to both financially indigent and medically indigent patients. 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: Various health screenings were offered to the community free of charge or for a nominal charge such as diabetes and breast cancer. THAZ participated in community education regarding good hand hygiene to promote awareness of proper hand washing in an effort to slow the spread of infection and disease. In the Better Living through Improved Fitness and Education (L.I.F.E.) program senior adults are encouraged to focus on improving their health with a range of physical activities, health education and screenings. THAZ provided healthy eating for children classes, smoking cessation classes and community health support groups. 27433198 true true false true false false false false false false true false false false true false false true false false false false false false false false true true true false true false false false false false false false false false false false false false true false false false true 39 0 true 315 true false false false false false false false false false false X 11 10 true false true false true true true true true false false true true true true true true false false false X X DAVID JACKSON 6822367900 612 E LAMAR BLVD Arlington TX 76011 X Anderson Tanya Layne Vice Chairman 2.0 0.0 X 0 0 0 Braudis Russell Paul Chairman 2.0 0.0 X 0 0 0 Briggs Frank W Member 2.0 0.0 X 0 0 0 Galindo Graciela Member 2.0 0.0 X 0 0 0 Haas Anthony J Member 2.0 0.0 X 0 0 0 Kuenstler MD Kristi M Ex Officio 2.0 0.0 X 0 0 0 Miller DO Keegan Ex Officio 2.0 0.0 X 0 0 0 Niles MD Richard Ex Officio 2.0 0.0 X 0 339124 41449 Reger Kristie D Member 2.0 0.0 X 0 0 0 Robbins Frankie Member 2.0 0.0 X 0 0 0 Standefer Thomas Bishop Member 2.0 0.0 X 0 0 0 Berenzweig MD Harold THR Corporate Officer 0.5 40.0 X 0 758494 124731 Boes Charles W Assistant Secretary 0.5 40.0 X 0 764506 59480 King Kirk THR Corporate Officer 0.5 40.0 X 0 689597 229313 Kramer Kenneth Assistant Secretary 0.5 40.0 X 0 669825 109536 Krejci Jacque Assistant Secretary 0.5 40.0 X 0 124885 26330 McWhorter Rick E Assistant Secretary 0.5 40.0 X 0 517956 161844 Stout Luanne R Corporate Secretary 0.5 40.0 X 0 260435 94686 Wossum Marian Assistant Secretary 0.5 40.0 X 0 113155 22024 EllzeyBob S PRESIDENT THAZ 40.0 0.0 X 291902 0 66205 GilbertValarie G CHIEF NURSING OFFICER THAZ 40.0 0.0 X 198602 0 57670 LavioletteJudy D CHIEF MEDICAL OFFR THAZ & THC 8.0 32.0 X 81977 327908 37120 MilandStephanie GRP FIN OFF THFW-THC-THAZ-THSH 0.5 40.0 X 0 301896 59885 WardVanessa PHARMACIST 40.0 0.0 X 151902 0 25232 FonvilleMary V DIR SR QUAL/PT SF/RSK/SPRT SVC 40.0 0.0 X 134486 0 46869 EdwardsConnie Beck DIR REHAB SVC 40.0 0.0 X 126506 0 24969 OwensRobyn L DIR QUALITY/PT SAFETY/RISK 40.0 0.0 X 121711 0 27095 SosebeeTonya A ASSOC CNO THAZ 40.0 0.0 X 120349 0 24791 BerdanBarclay E Former Officer 0.0 40.0 X 0 1690376 220980 MitchellJohn D Former Officer 0.0 40.0 X 0 417466 90554 CanoseJeffrey L Former Officer 0.0 40.0 X 0 1018371 363705 HumphreyRichard I Former Officer 0.0 40.0 X 0 475895 91806 MiaoWinjie Tang Former Officer 0.0 40.0 X 0 354318 66718 DeSioTerri Alice Former Officer 0.0 40.0 X 0 217031 33193 1227435 9041238 2106185 22 true true false Texas Health Resources 612 E Lamar Blvd Ste 900 ARLINGTON TX 76011 Management Fee 3818554 TEXAS HEALTH PHYSICIANS GROUP 9229 LBJ FREEWAY DALLAS TX 75243 PHYSICIAN SERVICES 971788 Northstar Anesthesia PA 6225 North State Hwy 161 200 IRVING TX 75038 Anesthesia Coverage 159932 Hutcherson Construction INC PO Box 650638 DALLAS TX 75265 Construction Service 121459 North Texas Healthcare Laundry Coop PO Box 535849 GRAND PRAIRIE TX 75050 Laundry Services 104542 6 60938 101326 162264 PATIENT SERVICE REVENUE 622110 31423300 31423300 DSRP REVENUE 622110 2133425 2133425 MEDICARE/MEDICAID ADJUSTMENT 622110 839037 839037 EDUCATION 611430 15230 15230 34410992 0 0 0 75285 75285 0 75285 75285 21900 -21900 -21900 -21900 0 0 0 CAFETERIA REVENUE 722212 125896 125896 REBATES & INCENTIVES 454210 16521 16521 VENDING 454210 7914 7914 10467 10467 160798 34787439 34410992 214183 938259 938259 0 0 0 696824 696824 0 14022175 13683293 338882 647635 647635 1987551 1964413 23138 984568 984568 3818554 3818554 1384 1384 0 0 0 0 2514949 2466368 48581 168136 168136 269203 222140 47063 334942 334942 0 419094 266670 152424 35286 32209 3077 0 15129 13230 1899 262244 5688 256556 0 1129001 1129001 66794 66794 SUPPLIES 3099445 3083007 16438 PATIENT SERVICES 726779 726779 FURNITURE & EQUIPMENT 364770 346919 17851 REPAIRS & MAINTENANCE 207294 207294 166117 144469 21648 32876133 27433198 5442935 0 -8856 57327 0 0 0 0 4356079 4338318 0 0 0 0 0 0 455157 543684 55258 37696 20830667 12584508 7609445 8246159 0 0 0 0 0 0 0 0 0 0 12467083 13223184 2878245 2750457 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13368924 12341507 16247169 15091964 X -3780086 -1868780 0 0 0 0 -3780086 -1868780 12467083 13223184 1911306 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true true false true false false false false false false Lobbying Activities Officers and/or Board Members of the corporation may, to an insubstantial degree, make comments or statements concerning legislation that may affect either the healthcare industry or the health status of the communities the Corporation serves. In pursuing this activity, Officers and/or Board Members may engage in conversations and/or write letters to various federal, state, and local officials regarding such matters. The amount of time and money involved in these activities is negligible. In no case has either the Corporation, or any person acting on behalf of the Corporation, intervened in any political campaign. 145334 145334 12999331 8066557 4932775 229289 133888 95401 7353718 4384063 2969654 102995 102995 8246159 0 INTERCOMPANY PAYABLE 12072678 ASSET RETIREMENT OBLIGATIONS 268829 12341507 true true X true X true X 900. true true true false true true 4647376 78357 4569019 0.13900 2939093 2720677 218416 0.00660 10923 3836 7087 0.00020 7597392 2802870 4794522 0.14580 551951 91671 460280 0.01400 927709 927709 0.02820 1479660 91671 1387989 0.04220 9077052 2894541 6182511 0.18800 56663 28262 28401 0.00090 56663 28262 28401 0.00090 false 3650933 6704968 7115961 -410993 X true true 1 1 Texas Health Azle 108 Denver Trail Azle TX 76020 www.texashealth.org TDH #469 X X X Texas Health Azle 1 false false true X X X X X X X X X 13 true false false true X www/texashealth.org/chna X X true 15 true www.texashealth.org/chna false false true X 200. 900. X X X true true X X X true X See Section C X See Section C X See Section C X X X X X true X false X X X X X true X false false Texas Health Azle Part V. Section B, Line 5 Texas Health Azles (THAZ) CHNA was a six-month collaborative process which utilized vast amounts of qualitative and quantitative data to assess the health needs of the persons in the communities served by the hospital. As a means to further understand the needs from those engaged in the community, THAZ conducted a series of community feedback sessions through surveys, interviews, and a community stakeholder meeting. Multiple interviews were conducted between December 2012 and January 2013. Participants of the community feedback interviews included, but were not limited to: political leaders, faith community representatives, public health officials, lay community members, school officials, and city administration. Nine persons with interests specific to the health of THAZs community completed a survey, and sixteen individuals participated in an in-person discussion. These methods for gathering community feedback were aimed at soliciting input from participants for community health resources, as well as the health needs of the community. Responses were divided into four sections (acknowledged strengths, gaps in services/care, community concerns, suggestions and opportunities), analyzed against secondary data, and assessed using criteria designed to rank or prioritize the issues. Participants of the stakeholder meeting represented both hospital staff and persons who represent the broad interests of the community, including members of medically underserved, low-income, and minority populations. Organizations represented in the in-person community stakeholder meeting included: Tarrant County Public Health, Tarrant County Safe Kids Coalition, City of Azle, and Azle Independent School District. Part V. Section B, Line 7d The hospital produced executive summaries of the completed CHNA along with other information that is of benefit to community members as well as a comparison between the health needs of the community and the state of Texas statistics. This information is widely available throughout the facility and given out at various community coalition and partnership meetings in an effort to disseminate the information through various community-based outlets. Part V. Section B, Line 11 CHNA 2013 revealed a vast number of community health issues that require collective action to improve the health of the community. In order to assist the organization in determining which health needs should be addressed, Texas Health Azle (THAZ) categorized the community needs in alignment with the national objectives of Healthy People 2020 categories. By using a strategic prioritization method to determine the top needs within the community aligned with the ability to address the issues, two areas were chosen and are being addressed through the 2014-2016 implementation plans. 2015 was the second year of implementation, and the focus was to deploy the systems, structures, and interventions that were chosen in 2014. The two priority areas from the 2013 CHNA were Awareness, Literacy, and Navigation and Chronic Disease. In addition, in 2015 THAZ worked to align and coordinate services and interventions with community partners for a collective impact to meet the two priority areas defined. Below are some ways in which the priority areas were addressed by THAZ. 1. Awareness, Literacy, and Navigation (ALN) 1a. Community Health Improvement strategies include collaboration to develop an area resource guide of key services available to the local community, individuals, and non-profit partners that address the social determinants of health. In 2015, Community Connect, a website database of free and reduced-cost social services that is available to both external and internal audiences, was launched as a result of this collaboration. 1b. The Texas Health Grant and Sponsorship Program provides community benefit grants, sponsorships, and other in-kind resources to improve the health status of the communities served. Grants are limited to the specific areas of health disparities, disease management, wellness, disease prevention and health promotion programs, clinics, charitable care, and community health collaborations. 1c. Sponsorship and partnering with area collaborations working to address ALN continued. Texas Health Azle has maintained and supported relationships with key partners, such as the Long Live Parker County Collaboration and Cook Childrens Community Coalition. 1d. For the past 15 years, THAZ has partnered with the Azle Independent School District to improve the health of the students. Over the years, many health issues have been addressed, such as hand hygiene, texting and drive, and childhood obesity. 1e. The Child Automobile Safety Initiative (CASI) strives to educate and raise community awareness about child passenger safety and the risk of unintentional injury from motor vehicle collisions. CASI's program model, based on the ecological perspective, includes four main components: child passenger restraint checks, community-based education, school-based education, and training. In 2015, Texas Health Azle held two car seat fitting stations. 2. Chronic Disease 2a. Community Health Improvement strategies include implementing new evidence-based programs and maintaining existing chronic disease programs provided at the hospital with a focus on self-management programs. Active partnerships and sponsorships aligned with the strategic efforts to address chronic diseases remains a top priority. 2b. The Chronic Disease Self-Management Program (CDSMP) is a program offered by the hospital and local community partners with the goal of enabling individuals to build the self-confidence and motivation they need to manage the challenges of living with a chronic health condition. Participants are adults experiencing chronic health conditions such as hypertension, arthritis, heart disease, stroke, lung disease, and diabetes. Their family members, friends, and caregivers also participate. The program provides information and teaches practical skills on managing chronic health problems through the use of lay leaders. 2c. Recognizing the need to engage older adults in the community, THAZ developed a fitness program called the Better Living through Improved Fitness and Education Program (Better L.I.F.E.) in 1997. The program is designed to improve the health and quality of life in older Americans. Healthy lifestyles and injury prevention are included with free exercise classes ranging from chair exercise for beginners to line dancing for the more active. Currently, there are four yoga classes, two line dancing sessions, a walking club, and senior mixers, a chair-based exercise program. Free screenings, flu vaccines, and classes stress the importance of early detection and self-management. 2d. In 2015 alone, 1,040 hospital staff hours were devoted to provide medically supervised exercise for patients with heart and/or lung problems who do not qualify for pulmonary or physical therapy through the Better Breathers Club. 2e. Texas Health Azles HELP Clinic provides access to routine healthcare and education for patients with chronic conditions who do not have access to primary care and are forced to utilize the hospitals emergency department as a way to manage their conditions. Patients are connected to local resources such as prescription assistance and eye exams. HELP care plans are assigned based on the individuals health care needs and include non-physician health professionals; nurses providing care outside of the clinic setting via phone, email, and other electronic support; health coaches offering culturally and linguistically appropriate education; and social workers helping patients to navigate the health care system. 2f. In 2011, Texas Health Azle reached out to several community partners and created the Healthy Eating Initiative, a strategic approach to address the issue of the lack of accessible and affordable produce as an obstacle to healthy eating in the community. The goal of the Healthy Eating Initiative is to increase the amount of fruits and vegetables consumed by improving the availability and affordability of healthy food options with a multi-pronged approach including community gardens, a farmers market, and food hubs. In the 2012 baseline survey, the number of servings of fruit was reported as just under 4 servings per week. By 2015, this number had doubled to 8 servings per week. The average number of servings of all fruit and vegetables increased 27 percent over the baseline survey. Texas Health Azle will not adopt new strategies for the following identified needs in the community for the reasons listed. 1. Access: Provider Supply Resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 2. Cancer - This need is currently being addressed by multiple outside organizations in the community. The facility will continue to address the need at its curren Texas Health Azle Part I, Line 3c - Patient Eligibility Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income, as determined on a sliding scale based on FPG, may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income in relation to FPG. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's financial assistance application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a Financial Assistance application. Part I, Line 7 - Cost to Charge Ratio A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Part II - Community Building The organization participates in community building activities that aim to address the socio-economic factors that influence the overall health of individuals in the communities served. As identified in the community health needs assessment, there are areas of need that are not in alignment with the operations of a hospital system. Our volunteerism, collaborations and partnerships with various aid organizations and various area coalitions aid in addressing the socio-economic factors that are the backbone for many underlying health concerns. Part III, Lines 2, 3 & 4 - Bad Debts Bad debt expense is not included as a community benefit for purposes of reporting community benefits. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THR's annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts that reads as follows: Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the balance sheets. The allowance and resulting provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators for each of its major payor sources of revenue. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. For receivables associated with services provided to patients who have third-party coverage, the System analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For 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 System records a significant provision for bad debts in the period of service on the basis of its past experience, which 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 billed rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The Systems allowance for doubtful accounts for self-pay patients (including allowances for charity care) remained constant at 96.1% of self-pay accounts receivable at December 31, 2015 and 2014. In addition, the Systems self-pay write-offs for bad debts decreased from approximately $310,000,000 for fiscal year 2014 to approximately $250,000,000 for fiscal year 2015. The decrease in write offs was the result of a decrease in uninsured patients in fiscal year 2015, as well as a financial assistance policy change. The System does not maintain a material allowance for doubtful accounts from third-party payors, nor did it have significant write-offs from third-party payors. Pt III, Line 8 - Medicare Shortfall The state of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care & community benefit. For state purposes, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost-to-charge ratio (with costs determined in accordance with generally accepted accounting principles) to billed charges. The shortfall amount reported to the state of Texas for 2015 is $3,933,090. Sch H requires a different method of calculating the Medicare shortfall shown on Part III, Lines 5-7. Part III, Line 9b - Debt Collection During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Financial Assistance Policy. Part VI, Line 2 - Needs Assessment The organization is part of the Texas Health Resources (THR) Healthcare System. In addition to the organizations Community Health Needs Assessment (CHNA), THR developed and implemented, as a healthcare system, a Community Benefit Framework (CBF), based on the Public Health Institutes Best Practices ASACB Program. The CBF systematically integrates internal practices into the community to improve the efficiency and effectiveness of THRs Community Health Improvement (CHI) Strategy, to address disproportionate unmet health needs (DUHN), to address primary prevention, and to improve community capacity. The CBF provides a quantitative approach to parallel the CHNA in identifying key communities within THRs service area and the means to align them with a THR entity. The CBF contains five phases: assessment/profile, infrastructure, community health council, programmatic review, and strategy development. THR works with each entitys Community Health Advocate to examine the entitys structure and programs for gaps, needs, strengths, and alignment with the CBF, CHNA, and ASACB standards. Part VI, Line 3 - Patient Education A description of the Financial Assistance Policy (FAP), the Plain Language Summary of the FAP (PLS) and the FAP application are available on the THR website at www.TexasHealth.org in English and other languages. The PLS is included in the patients admission packets. Signs alerting patients of financial assistance and related contact information are posted in various areas of the hospital including admissions & registration and the emergency room. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms necessary to apply for the assistance. At the same time, patients are provided with a financial assistance application. The patient is informed that the hospital is a non-profit organization offering financial assistance to patients deemed medically or financia true Tarrant County Indigent Care Corporation 612 E LAMAR BLVD Arlington TX 76011 260648532 501(c)(3) 926806 Indigent Health Care 1 Monitor Grants Texas Health Azle (THAZ) is a member of the Texas Health Resources (THR) healthcare system. The majority of the grants distributed by the system are to related tax exempt organizations. The hospital does not specifically monitor the use of grants paid to related organizations since THR administration monitors the use of these grants on a system basis for all members of the THR healthcare system. Grants to non-related tax exempt organizations are generally given to entities that are in the hospitals community and/or service area or to certain organizations which will specifically impact the hospitals community. These grants are typically monitored by hospital personnel who are working closely with the non-related nonprofit organization. X X true true false true false false false false false false false Niles MD Richard Ex Officio 0 224203 0 114921 0 0 9480 0 31969 0 380573 0 0 Berenzweig MD Harold THR Corporate Officer 0 511183 0 164509 0 82802 0 84227 0 40504 0 883225 0 24136 Boes Charles W Assistant Secretary 0 493855 0 157708 0 112943 0 19875 0 39605 0 823986 0 25860 King Kirk THR Corporate Officer 0 461755 0 122904 0 104938 0 181515 0 47798 0 918910 0 25734 Kramer Kenneth Assistant Secretary 0 306934 0 288282 0 74609 0 59034 0 50502 0 779361 0 213851 Krejci Jacque Assistant Secretary 0 123495 0 540 0 850 0 7484 0 18846 0 151215 0 0 McWhorter Rick E Assistant Secretary 0 361032 0 94454 0 62470 0 129475 0 32369 0 679800 0 11875 Stout Luanne R Corporate Secretary 0 190958 0 41692 0 27785 0 65856 0 28830 0 355121 0 0 EllzeyBob S PRESIDENT THAZ 196801 0 61949 0 33152 0 27115 0 39090 0 358107 0 5355 0 GilbertValarie G CHIEF NURSING OFFICER THAZ 162560 0 26620 0 9422 0 22483 0 35187 0 256272 0 1496 0 LavioletteJudy D CHIEF MEDICAL OFFR THAZ & THC 61596 246383 13516 54063 6865 27462 5703 22810 1721 6886 89401 357604 56 225 MilandStephanie GRP FIN OFF THFW-THC-THAZ-THSH 0 211976 0 42395 0 47525 0 18555 0 41330 0 361781 0 0 BerdanBarclay E Former Officer 0 1073202 0 417182 0 199992 0 181176 0 39804 0 1911356 0 49442 MitchellJohn D Former Officer 0 274141 0 79766 0 63559 0 44435 0 46119 0 508020 0 10605 CanoseJeffrey L Former Officer 0 687287 0 220259 0 110825 0 322467 0 41238 0 1382076 0 29378 HumphreyRichard I Former Officer 0 333384 0 74205 0 68306 0 43414 0 48392 0 567701 0 0 MiaoWinjie Tang Former Officer 0 240920 0 67293 0 46105 0 40880 0 25838 0 421036 0 8373 DeSioTerri Alice Former Officer 0 195058 0 14091 0 7882 0 12264 0 20929 0 250224 0 0 WardVanessa PHARMACIST 148226 0 2360 0 1316 0 9013 0 16219 0 177134 0 0 0 FonvilleMary V DIR SR QUAL/PT SF/RSK/SPRT SVC 121470 0 10002 0 3014 0 9856 0 37013 0 181355 0 0 0 EdwardsConnie Beck DIR REHAB SVC 119944 0 5584 0 978 0 9173 0 15796 0 151475 0 0 0 Schedule J, Part I, Line 1A - Gross-Up Payments Certain imputed income is grossed-up to include employment taxes paid on the listed persons behalf. All tax indemnification payments provided to employees are included in the taxable compensation of the employee. Schedule J, Part I, Line 1a - Discretionary Spending Account EACH EXECUTIVE AT THE VICE PRESIDENT LEVEL AND ABOVE RECEIVES A PERK ALLOWANCE WHICH IS INCLUDED IN THE TAXABLE COMPENSATION OF THE EMPLOYEE. This allowance covers costs such as business use of their personal vehicles in lieu of reimbursement for auto mileage. Schedule J, Part I, Line 3 - CEO Compensation THE ORGANIZATIONS RELIED ON TEXAS HEALTH RESOURCES (THR), A RELATED 501(C)(3) ORGANIZATION WITH CENTRALIZED COMPENSATION PROFESSIONALS TO USE THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT. * THR HAS A Governance Committee COMPRISED OF EXTERNAL BOARD MEMBERS THAT REVIEW COMPENSATION PHILOSOPHY AND DESIGN. One function of the governance committee is to serve as a compensation committee for the THR system. * THR BOARD HIRED INDEPENDENT COMPENSATION CONSULTANTS. * THR & THE INDEPENDENT COMPENSATION CONSULTANTS UTILIZE PUBLISHED THIRD-PARTY COMPENSATION SURVEYS. AN INDEPENDENT THIRD PARTY COMPENSATION CONSULTANT IS HIRED BY THE THR BOARD OF TRUSTEES (BOARD) TO REVIEW BASE PAY ANNUALLY AS COMPARED TO A PEER GROUP OF EMPLOYERS SIMILAR IN SIZE AND SCOPE TO THR. EVERY THREE YEARS THE INDEPENDENT COMPENSATION CONSULTANT REVIEWS ALL ASPECTS OF EXECUTIVE COMPENSATION (BASE, INCENTIVES, BENEFITS, ETC.) WHICH INCLUDES: * REVIEW AND CONFIRMATION OF THE EXECUTIVE COMPENSATION PHILOSOPHY. * MARKET REVIEW OF BASE AND INCENTIVE PAY FOR ALL POSITIONS. NATIONAL, REGIONAL, AND LOCAL DATA IS REVIEWED WHEN AVAILABLE. * MARKET REVIEW OF BENEFITS AND PERQUISITES, * INTERVIEW OF SELECTED OFFICERS AND MEMBERS OF THE GOVERNANCE COMMITTEE (COMPENSATION COMMITTEE) OF THE THR BOARD OF TRUSTEES, AND * REVIEW OF FINANCIAL REPORTS, JOB DESCRIPTIONS, ORGANIZATIONAL CHARTS, CURRENT SALARIES, INCENTIVE OPPORTUNITIES, INCENTIVE PAYMENTS, BENEFITS, PERQUISITES AND PLAN DOCUMENTS. THE INDEPENDENT COMPENSATION CONSULTANT MEETS DIRECTLY WITH THE GOVERNANCE COMMITTEE TO REPORT THE RESULTS OF THE TOTAL COMPENSATION STUDY. AT THE BEGINNING OF EACH YEAR, THE GOVERNANCE COMMITTEE REVIEWs A DETAILED REPORT CONTAINING THE BELOW INFORMATION. THE BOARD REVIEWS AN EXECUTIVE SUMMARY OF THE DETAILED REPORT. * MARKET ANALYSIS BASED ON THE RESULTS OF THE OUTSIDE CONSULTANT'S REVIEW * OFFICER BASE SALARY ADJUSTMENTS INCLUDING MERIT AND MARKET/EQUITY ADJUSTMENTS * PRIOR YEAR EXECUTIVE ANNUAL INCENTIVE AWARDS * CURRENT YEAR EXECUTIVE ANNUAL INCENTIVE PLAN TARGETS, KEY PERFORMANCE INDICATORS AND POTENTIAL PAYOUT AMOUNTS. Schedule J, Part I, Line 4b - Nonqualified Retirement Plan PARTICIPATION IN THE PLAN IS MADE AVAILABLE TO A SELECT GROUP OF MANAGEMENT AND HIGHLY COMPENSATED EMPLOYEES, AS DETERMINED BY THE THR BOARD OF TRUSTEES, WHO ARE PROVIDING SERVICES IN KEY POSITIONS OF MANAGEMENT AND RESPONSIBILITY. FOR THE ACTIVE RESTORATION ACCOUNT (ACCOUNT BALANCES AFTER 12/31/2009), SERP BENEFITS VEST WHILE THE PARTICIPANT IS EMPLOYED IF THE PARTICIPANT: * REACHES AGE 65, * BECOMES DISABLED or DIES, * REACHES THE FOLLOWING YEARS OF SERVICE: 2 YEARS - 25%; 3 YEARS -50%; 4 YEARS - 75%; AND 5 OR MORE - 100%. PARTICIPANTS MUST BE EMPLOYED ON DEC 1 TO QUALIFY FOR THE CURRENT YEAR'S SERP benefit UNLESS SEPARATION IS DUE TO DEATH, DISABILITY, RETIREMENT (AGE 65) OR EARLY RETIREMENT (SEPARATION FROM SERVICE AT OR AFTER AGE 55 WITH 75 YEARS OF COMBINED AGE AND CONTINUOUS SERVICE WITH THE SYSTEM). SERP benefits ARE CALCULATED EACH DEC 1. VESTED BALANCES ARE TAXED to the employee AND THE NET BALANCES BEGIN ACCRUING EARNINGS. VESTED BALANCES ARE PAID IN a CASH LUMP SUM WITHIN a 90 DAY PERIOD COMMENCING ON THE EARLIER OF DEATH, DISABILITY, OR SEPARATION FROM SERVICE. The deferred portion is included in Schedule J, Part II, column c. In FROZEN RESTORATION ACCOUNTS (ACCOUNT BALANCES PRIOR TO 1/1/2010), THE PARTICIPANT OR BENEFICIARY SHALL BE TAXED ON HIS OR HER VESTED SERP BENEFITS UPON THE EARLIEST OF: * Continued employment in THR until AGE 68 * TERMINATION OF EMPLOYMENT FOR DISABILITY OR DEATH * INVOLUNTARY TERMINATION OF EMPLOYMENT WITHOUT REASONABLE CAUSE; OR * SATISFYING A 24 MONTH NON-COMPETE PERIOD FOLLOWING HIS/HER TERMINATION OF EMPLOYMENT. PAYMENT follow THE BEFORE MENTIONED EVENTS, EXCEPT IN THE CASE OF INVOLUNTARY SEPARATIONS FOR WHICH THE PARTICIPANT MUST WAIT 24 MONTHS TO RECEIVE THE PREVIOUSLY TAXED BENEFIT. Payouts TO THE FOLLOWING EMPLOYEES WERE MADE DURING THE YEAR. THE AMOUNTS BELOW ARE INCLUDED IN THE AMOUNT REPORTED ON SCH J, PART II, COLUMN B(III) AND COLUMN (F). Berdan, Barclay $9,819 Laviolette, Judy $ 281 Business Relationship-Part VI, Section A, Line 2 Texas Health Resources (THR) and its related organizations included in the THR healthcare system encourage employees to become involved in philanthropic endeavors in their communities. As a result, THR healthcare system employees who are serving as officers, board members, or key employees may, from time to time, also serve on the boards of various community organizations such as church boards, United Way, etc. There may be a business relationship as a result of multiple THR employees serving on the same community boards. THR employees serve as the corporate officers of each subsidiary organization. As THR system employees, all officers have a business relationship within the organizations of the THR healthcare system. THR also appoints system officers to the boards of various controlled joint ventures. As THR system employees, various officers of the organization may have a business relationship through serving on THR controlled joint venture boards. Governing Documents Part VI, Section A, Line 4 The governing documents were amended with an effective date of 1/1/15 with the following significant changes: *The reserved powers were transferred from the Founding Members to Texas Health Resources (THR). All authority pertaining to governance of the organization now resides entirely with the THR Board. *The definition of Community Representative changed in order to allow one primary care or specialty physician employed by Texas Health Physicians Group (THPG) to fill one Community Representative position on the board, provided the percentage of physicians on the board does not exceed 40%. *The requirement to state the purpose of a specially called meeting in the notice has been removed. *The medical staff leader positions on the board were changed. The Chief/President of the medical staff will continue to serve ex officio with vote; however, the other two positions may continue to be the Vice Chief/President-Elect and/or Immediate Past Chief/President. These positions may also be other medical staff leaders selected by the board. The terms for the latter two positions will be one year, eligible for re-election for up to a total of nine years. *The board officer position of Secretary was changed to a corporate officer position. Members-Part VI, Section A, Lines 6&7a Texas Health Resources (THR) is the sole member of the organization. Governance Decisions Reserved-Part VI, Section A, Line 7b The following actions require the approval of Texas Health Resources (THR): (a) Amendment, restatement or repeal of the Certificate of Formation or these Bylaws. (b) Any action that would adversely affect the religious or church practices or religious affiliation of the Corporation. (c) Sale, exchange, lease or other transfer of all or substantially all of the assets of the Corporation. (d) Merger or consolidation of the Corporation. (e) Dissolution of the Corporation. (f) Election of members of the Board of Trustees (g) Removal of a member of the Board of Trustees (h) Creation of affiliates or subsidiaries and approval of the initial governing documents. (i) Incurrence of debt not included in the budgets. (j) Discontinuing the operations of a licensed health care facility controlled by the corporation. (k) Activities involving winding up, distribution, conversion or exchange under Chapter 11 Form 990 Filing-Part VI, Section B, Line 11b A full copy of the Form 990 is provided to members of the governing board before filing. In addition, the Audit & Compliance Committee of the Texas Health Resources (THR) Board of trustees is given the opportunity to review, comment, and ask questions regarding the Form 990s filed for THR and each of its wholly controlled affiliates. Conflict of Interest- Part VI, Section B, Line 12c Texas Health Resources (THR) has adopted a Conflict of Interest Policy that applies to THR and all of its wholly owned or wholly controlled affiliates. During the first quarter of each fiscal year, a Duality and Conflict Statement Form is distributed by the THR Chief Compliance Officer to all board members, officers, contracted medical directors, employees with a title of manager or above, employed physicians, and certain committee members and other employees based upon function. All disclosed conflicts are reviewed by the THR Chief Compliance Officer. A report, listing each reported Duality of Interest or Conflict of Interest is given to both the Chair of the Governing body and the President of the Corporation with which the reporting person is affiliated. The THR Board of Trustees receives a report when the Annual Disclosure process is complete. Progressive corrective action is taken for any identified noncompliance which may include removal from a board or committee or physician/employee counseling if the person fails to provide the disclosure. In addition, THR monitors through a public database recently implemented by CMS. Management plans are executed as needed based upon disclosures. THR also educates the Boards and workforce annually through either a web based or live compliance training. Compensation Determination-Part VI, Section B, Line 15 a&b The organization relied on Texas Health Resources (THR) with centralized compensation professionals to review and establish the compensation of the organizations officers. A more in depth discussion of executive compensation review can be found on Schedule J, Part III. Public Disclosure-Part VI, Section C, Line 19 The organization does not make its governing documents or conflict of interest policy available to the public. The consolidated financial statements of Texas Health Resources (THR) are made available to the public on the website www.dacbond.com. Consolidated financial statements are posted to this website quarterly and the audited financial statements are posted annually. The financial statements of the wholly controlled affiliates of THR are not posted to the website nor are they generally made available to the public in any other manner. Consolidated Financial Statements-Part XII, Line 2c Texas Health Resources (THR) prepares consolidated financial statements with its related entities. The THR Board appoints an audit and compliance sub-committee that assumes responsibility for oversight of the consolidated audit for all related entities. The related entities do not have a separate audit committee, but abide by the THR committee's oversight. There has been no change during the year in the organizations oversight selection process. Johnson County Community Care Corp 612 E Lamar Blvd Arlington TX 76011 452793120 Support Org. TX 501(c)(3) 11a TH Cleburne false North Texas Healthy Communities 612 E Lamar Blvd Arlington TX 76011 464513182 Comm Support TX 501(c)(3) 7 TH Resources false Texas Health Arlington Memorial Hospital 800 West Randol Mill Rd Arlington TX 76011 750972805 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Back Care 9229 LBJ Freeway Dallas TX 75243 474724257 Phys. Clinic TX 501(c)(3) 9 TH Phys Grou false Texas Health Alliance 10864 Texas Health Trail Fort Worth TX 76244 451502252 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Azle 108 Denver Trail Azle TX 76020 751748586 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Cleburne 201 Walls Dr Cleburne TX 76033 751977850 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Fort Worth 1301 Pennsylvania Ave Fort Worth TX 76104 756001743 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Hurst-Euless-Bedford 1600 Hospital Parkway Bedford TX 76022 751438726 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Southwest Fort Worth 6100 Harris Parkway Fort Worth TX 76132 752678857 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Stephenville 411 Belknap Stephenville TX 76401 751752253 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Huguley Inc 11801 S Freeway Burleson TX 76028 452694620 Hospital FL 501(c)(3) 3 TH Resources false TX Health Outpatient Surg Ctr Alliance 10840 Texas Health Trail Fort Worth TX 76244 800800294 Hospital TX 501(c)(3) 3 TH Alliance false Texas Health Physicians Group 9229 LBJ Freeway Dallas TX 75243 752613493 Phys. Clinic TX 501(c)(3) 9 TH Resources false Texas Health Resources Foundation 612 E Lamar Blvd Arlington TX 76011 752022128 Fundraising TX 501(c)(3) 7 TH Resources false Texas Health Allen 1105 Central Expressway N Allen TX 75013 752890358 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Dallas 8200 Walnut Hill Ln Dallas TX 75231 751047527 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Denton 3000 North Interstate 35 Denton TX 76201 432008974 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Kaufman 850 Ed Hall Drive Kaufman TX 75142 752771437 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Plano 6200 W Parker Rd Plano TX 75093 752770738 Hospital TX 501(c)(3) 3 TH Resources false TX Health Research & Education Institute 612 E Lamar Blvd Arlington TX 76011 752562191 Edu& Research TX 501(c)(3) 4 TH Resources false Texas Health Resources 612 E Lamar Blvd Arlington TX 76011 752702388 Mgmt Supp Org TX 501(c)(3) 11c NA false TX Health Resources Self-Insurance Trust 612 E Lamar Blvd Arlington TX 76011 756335902 Insur Trust TX 501(c)(3) 11c TH Resources false TH Specialty Hospital Fort Worth 1301 Pennsylvania Ave Fort Worth TX 76104 751648589 LT Hospital TX 501(c)(3) 3 TH Resources false WW Ward Endowment Fund Trust 612 E Lamar Blvd Arlington TX 76011 756196065 Support Org. TX 501(c)(3) 11a TH Foundatio false Healthy Tarrant County Collaboration PO Box 8040 Fort Worth TX 76124 432087946 Support Org TX 501(c)(3) 11a TH Resources false AMH Cath Labs LLC 811 Wright St Arlington TX 76012 203003947 Hospital TX NA N/A Cleburne Imaging LLC PO Box 820519 Dallas TX 75382 460767278 Outpatient Diagno TX NA N/A Cleburne Surgical Center LLC 2010 W Katherine P Raines Blvd St Cleburne TX 76033 203742012 Amb Surg Ctr TX NA N/A Denton Surgery Center LLC 207 North Bonnie Brea Denton TX 76201 470926556 Amb Surg Ctr TX NA N/A Flower Mound Hospital Partners LLC 612 E Lamar Blvd Ste 600 Arlington TX 76011 260684968 Hospital TX NA N/A Fort Worth Endoscopy Centers LLC 900 W Magnolia Ave 101 Fort Worth TX 76104 770368346 Endoscopy Center TX NA N/A Greenville Surgery Center LLC 7150 Greenville Ave Ste 200 Dallas TX 75231 742411643 Amb Surg Ctr TX NA N/A Health Imaging Partners LLC 8610 Explorer Drive Ste 300 Colorado Springs CO 80920 271385885 Outpatient Diagno TX NA N/A North Dallas Surgical Center LLC 17980 Dallas Parkway Ste 100 Dallas TX 75287 272248103 Amb Surg Ctr TX NA N/A Physician Medical Center LLC 612 E Lamar Blvd 6th Flr Arlington TX 76011 481281376 Hospital TX NA N/A Presbyterian Cancer Center-Dallas LLC 1220 Senlac Drive 2nd Flr Carrollton TX 75006 260422749 Cancer Treatment TX NA N/A Rockwall Regional Hospital LLC 612 E Lamar Blvd 6th Flr Arlington TX 76011 202848116 Hospital TX NA N/A Southlake Specialty Hospital LLC 612 E Lamar Blvd 6th Flr Arlington TX 76011 020555370 Hospital TX NA N/A Surgical Caregivers of Fort Worth LLC 2001 W Rosedale Street Fort Worth TX 76104 751925497 Amb Surg Ctr TX NA N/A Texas Health Craig Ranch Surgery Center 8080 State Hwy 121 Ste 100 McKinney TX 75070 383897811 Amb Surg Ctr TX NA N/A Texas Health Flower Mound Orthopedic Sur 5000 Long Prairie Road Flower Mound TX 75028 800866449 Amb Surg Ctr TX NA N/A Texas Health MedSynergies LLC 909 Hidden Ridge Ste 300 Irving TX 75038 800272951 Mgmt Services TX NA N/A Texas Health Spine Center Arlington 1545 E Southlake Blvd Ste 100 Southlake TX 76092 464143686 Inactive TX NA N/A Texas Health Surgery Center Preston Plaz 17950 Preston Road Ste 75 Dallas TX 75252 203991622 Amb Surg Ctr TX NA N/A Texas Health Surgery Center Rockwall LL 569 Brookwood Village Ste 901 Birmingham AL 35209 474425996 Inactive TX NA N/A Texas Institute for Surgery LLP 7715 Greenville Ave Ste 100 Dallas TX 75231 770628004 Hospital TX NA N/A THR-STT Rockwall ASC LLC 1545 E Southlake Blvd Southlake TX 76092 262429878 Amb Surg Ctr TX NA N/A THR-STT Southlake ASC LLC 1545 E Southlake Blvd Southlake TX 76092 201728912 Amb Surg Ctr TX NA N/A USMD Hospital at Arlington LP 801 I -20 West Arlington TX 76017 731662763 Hospital TX NA N/A USMD Hospital at Fort Worth LP 6333 North State Hwy 161 Ste 200 Irving TX 75038 203571243 Hospital TX NA N/A Wilson Creek Surigcal Center LLC 569 Brookwood Village Ste 901 Birmingham AL 35209 274816583 Amb Surg Ctr TX NA N/A Women's Specialty Surgery Center 8230 Walnut Hill Ln Ste 101 Dallas TX 75231 262310072 Amb Surg Ctr TX NA N/A Grace Indemnity Company Ltd 1159 Caribean Plaza Grand Cayman CJ KY 1-1102 981209573 Captive Insurance CJ NA C Corp false Huguley Medical Associates Inc 11801 South Freeway Burleson TX 76028 752547668 Phys Clinics TX NA C Corp false Magnum Health Holdings Inc 612 E Lamar Blvd Ste 600 Arlington TX 76011 475486814 Inactive TX NA C Corp false Magnum Health Plan Inc 612 E Lamar Blvd Ste 600 Arlington TX 76011 475548221 Inactive TX NA C Corp false Texas Health Biomedical Advancement Cent 612 E Lamar Blvd Arlington TX 76011 752636884 Research TX NA C Corp false Texas Health Resources Casualty Company 612 E Lamar Blvd Arlington TX 76011 030310676 Insurance VT NA C Corp false Texas Health Resources Bundled Products 612 E Lamar Blvd Arlington TX 76011 465588632 Inactive TX NA C Corp false TH Resources Primary Care Ext Physcian N 612 E Lamar Blvd Arlington TX 76011 465365421 Inactive TX NA C Corp false Texas Health Resources Spine Services 612 E Lamar Blvd Arlington TX 76011 465347751 Inactive TX NA C Corp false Texas Health Resources Women's Services 612 E Lamar Blvd Arlington TX 76011 465330487 Inactive TX NA C Corp false Charitable Remainder Trusts (4) 612 E Lamar Blvd Arlington TX 76011 CR Trust TX NA Trust false true false true false false false false false false true true false true false false true true true true Related Transactions- Part V, Line 2 Texas Health Resources (THR) is the parent organization in a large healthcare system made up of both wholly owned entities as well as related controlled joint ventures as listed on Schedule R. THR's role is to plan, manage and coordinate the activities of the affiliated healthcare system in order to maximize opportunities to deliver cost effective quality medical care to residents of north central Texas. THR provides direction and oversight to its wholly owned affiliates through centralized services. They also provide oversight for the controlled joint ventures. As an integral part of providing centralized services to the affiliates, THR maintains intercompany receivable/payable accounts, most of which do not fall within the scope of IRC Section 512(b)(13). The range of centralized services provided by THR include information services, managed care contracting, Human resources, revenue cycle, billing and collections, patient access/admissions, legal, tax, compliance, supply chain, quality, business development, insurance, treasury, marketing, general accounting, real estate services, coding, transcription and strategic planning. In addition, THR does daily cash sweeps of all controlled tax exempt entity cash accounts. As a result, THR has numerous daily transactions with controlled tax exempt entities, none of which fall within the scope of IRC Section 512(b)(13). A management fee is charged for the centralized services and reported on Form 990, Part VII, Section B as a professional services fee. Transactions with related tax exempt organizations falling within the meaning of centralized services as described above, are not listed on Schedule R, Part V, Line 2.