2015-08-17T18:09:41-05:00 2014-09-30 440160260 BKD LLP 2800 POST OAK BLVD STE 3200 HOUSTON TX 77056 990 2013-10-01 750974351 HARRISON COUNTY HOSPITAL ASSOCIATION HARR 9039276703 811 SOUTH WASHINGTON AVE MARSHALL TX 75670 TIM PILEGGI CFO 9033152440 2015-08-17 1 PAIGE GERICH P00226776 7134994600 2013 2016-03-07 17:11:31Z GOOD SHEPHERD MEDICAL CENTER-MARSHALL RUSS COLLIER 811 SOUTH WASHINGTON AVE MARSHALL TX 75670 101344642 0 X HTTP://WWW.GSMCMARSHALL.ORG/ X 1954 TX TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION REGARDLESS OF RACE, SEX, CREED, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. 18 13 619 75 0 0 55884 0 97839440 100135649 218015 151833 1072174 1011730 99185513 101299212 0 0 0 0 27191280 25582882 0 0 97834 66069417 70964670 93260697 96547552 5924816 4751660 67440941 42115512 47584110 44109258 19856831 -1993746 X TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION REGARDLESS OF RACE, SEX, CREED, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. 0 0 78539846 100135649 GOOD SHEPHERD MEDICAL CENTER-MARSHALL EXISTS TO IDENTIFY AND DELIVER QUALITY HEALTHCARE SERVICES IN A SAFE & CARING ENVIRONMENT TO THE PEOPLE OF THIS REGION.GOOD SHEPHERD MEDICAL CENTER - MARSHALL IS A NOT-FOR-PROFIT FACILITY LOCATED IN NORTHEAST TEXAS, APPROXIMATELY 150 MILES EAST OF DALLAS, TEXAS AND 35 MILES WEST OF SHREVEPORT, LOUISIANA. GOOD SHEPHERD MEDICAL CENTER - MARSHALL IS THE ONLY HOSPITAL LOCATED IN HARRISON AND MARION COUNTIES. ESTABLISHED IN 1954 BY SEVERAL HARRISON COUNTY PHYSICIANS, GOOD SHEPHERD MEDICAL CENTER - MARSHALL HAS GROWN TO A 149 BED FACILITY WITH AN INTENSIVE CARE UNIT AND A 24-HOUR LEVEL III TRAUMA CENTER. GOOD SHEPHERD MEDICAL CENTER - MARSHALL IS ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION FOR HEALTHCARE ORGANIZATIONS. 78539846 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 88 0 1 619 1 0 0 0 0 0 0 0 0 0 0 X 18 13 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X JANET ANDERSEN 9033155177 700 E MARSHALL AVE LONGVIEW TX 75601 ALLEN STAGGERS DIRECTOR 1.00 X 0 0 0 BRENDA BROWN DIRECTOR 1.00 X 0 0 0 BUCK BIRDSONG DESIGNATED SYSTEM REP 1.00 X 0 0 0 CHASE PALMER BOARD TREASURER 1.00 X X 0 0 0 DAVID BATES DIRECTOR 1.00 X 0 0 0 DEAN SEARLE BOARD SECRETARY 1.00 X X 0 0 0 GEORGE MEISENHEIMER DIRECTOR 1.00 X 0 0 0 GLENN BICKERDIKE BOARD CHAIRMAN 1.00 X X 0 0 0 JULIE SIMMONS DIRECTOR 1.00 X 0 0 0 LEROY FISHER DIRECTOR 1.00 X 0 0 0 R BLAIR ABNEY BOARD VICE CHAIRMAN 1.00 X X 0 0 0 RICKY PAUL MD PRESIDENT OF MEDICAL STAFF 1.00 40.00 X X 0 541875 23601 RUSS COLLIER PRESIDENT/CEO 40.00 X X 360692 0 22773 STEVE ALTMILLER GSHS PRESIDENT/CEO 1.00 40.00 X X 0 254153 4391 TED HUFFHINES DIRECTOR 1.00 X 0 0 0 MITTIE HUTCHINS DIRECTOR 1.00 X 0 0 0 LUIS BALBUENA MD MEDICAL STAFF REP TO BOARD 1.00 40.00 X X 0 365836 24878 GORDEN GREEN MD VP MEDICAL STAFF 1.00 40.00 X X 0 294438 9884 PAT KEEL CFO END 5/14/14 2.00 40.00 X 0 428336 10255 TIM PILEGGI INTERIM CFO BEGIN 5-15-14 2.00 40.00 X 0 0 0 JOYCE EGLI CHARGE NURSE 40.00 X 127397 0 11058 TONYA HENRY STAFF PHARMACIST 40.00 X 118970 0 16249 DANA HADEN DIRECTOR OF PHARMACY 40.00 X 128050 0 5067 KEITH KIRBOW CHIEF NURSING OFFICER 40.00 X 137615 0 23085 GEORGE NOEL PHYSICIAN ASSISTANT 40.00 X 115179 0 17557 JOHN MCDONALD DO FORMER MEDICAL STAFF 1.00 40.00 X 0 186936 18173 VALARIE ALLMAN MD FORMER VP MEDICAL STAFF 1.00 40.00 X 0 351487 19624 PAULA BRANDON FORMER -SR VP PCS 1.00 40.00 X 0 208601 19628 RAY DELK FORMER - VP OPERATIONS 1.00 40.00 X 0 201205 19143 ED BANOS FORMER CEO 0.00 0.00 X 0 668219 0 987903 3501086 245366 14 1 1 0 MORRIS AND DICKSON CO LLC PO BOX 51367 SHREVEPORT LA 711351367 PHARMACY MANAGEMENT SERVICES 2104134 ALLEGIANCE HEALTH MANAGEMENT INC 504 TEXAS STREET SHREVEPORT LA 71101 MEDICAL SERVICES 600476 CARTER BLOODCARE 2205 HIGHWAY 121 BEDFORD TX 76021 MEDICAL SERVICES 350141 EXECUTIVE HEALTH RESOURCES INC PO BOX 822688 PHILADELPHIA PA 191822688 MEDICAL SERVICES 297825 RENAL TREATMENT CENTERS SE LP PO BOX 403008 ATLANTA GA 303843008 MEDICAL SERVICES 267394 13 NET PATIENT REVENUES 621110 94332067 94332067 DISPRO RECEIPTS 621110 3237503 3237503 LIFE WELLNESS CENTER 624200 311700 311700 GOVERNMENT FUNDS-TRAUMA AND TERRO 624200 95211 95211 2159168 2159168 100135649 151833 151833 753353 45430 707923 707923 707923 CAFETERIA REVENUE 722210 287080 287080 VENDING MACHINES 722210 16727 16727 303807 101299212 100135649 0 1163563 352127 352127 21043148 17056557 3920045 66546 380982 282593 98389 2195007 1643705 551302 1611618 1204847 401616 5155 3674778 3674778 10040 4187 5853 397878 397878 3057 3057 6747929 5443131 1300728 4070 28217 21163 7054 763850 557477 185826 20547 1923244 1923244 1936506 1499887 435989 630 134872 134872 1949772 1949772 3489919 2617439 872480 400759 300569 100190 BAD DEBT 35206559 35206559 NON-MEDICAL SUPPLIES 7759811 5819858 1939953 MEDICAL SUPPLIES AND EQ 5465698 5465698 PLANT OPERATIONS AND MA 566874 425156 141718 504907 504021 886 96547552 78539846 17909872 97834 2349 1102 5770209 3790736 13388033 13680547 1248608 1403529 308116 195936 75499671 55018595 23166647 20481076 1049198 108509 1294360 1207100 21213421 1246977 67440941 42115512 4976469 4862890 39156504 36966334 340668 336117 3110469 1943917 47584110 44109258 X 18920788 -3014793 936043 1021047 19856831 -1993746 67440941 42115512 X 4751660 11752 -26613989 X 0 1 X 1 0 X 0 0 0 0 0 1 3057 0 0 0 3057 0 PART II-B, LINE 1: THE AMOUNT REPRESENTS THE PERCENTAGE OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION THAT THE AHA DETERMINED WAS FOR LOBBYING EXPENSES. 602390 602390 44505422 29760032 14745390 157149 91140 66009 29833379 24792233 5041146 401331 375190 26141 20481076 INTERCOMPANY PAYABLES 1208270 BOND INTEREST PAYABLE 460885 OTHER NON CURRENT LIABILITIES 274762 1943917 X 66149837 11752 45430 57182 66092655 35206557 35206557 101299212 61386425 45430 45430 61340995 35206557 35206557 96547552 PART X, LINE 2: THE SYSTEM, GSHS ASO, THE MEDICAL CENTER, GSMC LINDEN, GSMC MARSHALL, THE GSMC FOUNDATION AND THE GSMC - LINDEN FOUNDATION ARE EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. THESE ENTITIES ARE SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. ENTERPRISES IS A TAXABLE CORPORATION. CSC IS TAXED AS A PARTNERSHIP. DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR ENTERPRISES FOR THE TAX EFFECTS OF DIFFERENCES BETWEEN THE FINANCIAL STATEMENTS AND TAX BASES OF ASSETS AND LIABILITIES. A VALUATION ALLOWANCE IS ESTABLISHED TO REDUCE DEFERRED TAX ASSETS IF IT IS MORE LIKELY THAN NOT THAT A DEFERRED TAX ASSET WILL NOT BE REALIZED. THE SYSTEM FILES TAX RETURNS IN THE U.S. FEDERAL JURISDICTION. WITH A FEW EXCEPTIONS, THE SYSTEM IS NO LONGER SUBJECT TO U.S. FEDERAL EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2011. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 45,430. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 35,206,559. ROUNDING -2. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 45,430. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 35,206,559. ROUNDING -2. 1 1 1 X 1 X 500.000000000000 1 1 1 0 1 1 2191957 702627 1489330 0.02430 8694502 6591689 2102813 0.03430 709743 99415 610328 0.00990 11596202 7393731 4202471 0.06850 119052 119052 0.00190 341027 341027 0.00560 460079 460079 0.00750 12056281 7393731 4662550 0.07600 1 33838179 20732339 17712183 3020156 X 1 1 1 1 HARRISON COUNTY HOSPITAL ASSOCIATION 811 SOUTH WASHINGTON AVE MARSHALL TX 75670 WWW.GSMCMARSHALL.ORG 000020 X X X HARRISON COUNTY HOSPITAL ASSOCIATION 1 1 X X X X X X X X X 13 1 0 1 X WWW.GSMCMARSHALL.ORG X X X X X 1 0 1 1 100.000000000000 1 500.000000000000 1 X X X X X 1 1 X 1 0 X X X 1 X 0 0 HARRISON COUNTY HOSPITAL ASSOCIATION PART V, SECTION B, LINE 3: GSMC MARSHALL RECEIVED INPUT FROM REPRESENTATIVES OF THE COMMUNITY WHICH INCLUDES THE FOLLOWING INDIVIDUALS WITH; A.)SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH B.)AFFILIATION WITH LOCAL GOVERNMENT,SCHOOLS AND INDUSTRYC.)INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS.INTERVIEWS WERE CONDUCTED BOTH AT THE MEDICAL CENTER AND IN LOCATIONS MORE CONVENIENT FOR THE INFORMANT. ALL INTERVIEWS WERE CONDUCTED BY BKD PERSONNEL USING A STANDARD QUESTIONNAIRE.THE FOLLOWING INDIVIDUALS PARTICIPATED IN OUR KEY INFORMANT INTERVIEW PROCESS:HARRISON COUNTY UNITED WAY, DIRECTORCITY OF MARSHALL, EMS COORDINATORGSMC, DIRECTOR OF PATIENT FINANCIAL SERVICESHARRISON COUNTY, JUDGEGSMC, DIRECTOR OF RADIOLOGYGSMC, DIRECTOR OF ENDOSCOPYGSMC, ACUTE REHABILITATION PROGRAM DIRECTORGSMC, TRAUMA COORDINATORGSMC, DIRECTOR OF MEDICAL AND INPATIENT SURGICAL UNITSGSMC, PHYSICIAN OFFICES OPERATIONS MANAGERGSMC, EXECUTIVE DIRECTOR OF ANCILLARY SERVICESGSMC, CHIEF NURSING OFFICERGSMC, DIRECTOR OF QUALITYGSMC, CLINICAL DIRECTOR OF CAREGSMC, CLINICAL OF FAMILY CARE SERVICESDIRECTOR OF LABORATORY SERVICESGSMC-MARSHALL, CEOGSMC, DIRECTOR OF INTENSIVE CARE UNITHARRISON COUNTY SHERRIFF'S DEPARTMENT, SHERRIFFGSMC, EMERGENCY DEPARTMENT DIRECTOR HARRISON COUNTY HOSPITAL ASSOCIATION PART V, SECTION B, LINE 20D: THE FINANCIAL ASSISTANCE ELIGIBILITY DISCOUNT GUIDELINES STATES ALL UNINSURED PATIENTS WHO QUALIFY FOR LESS THAN 68% FINANCIAL ASSISTANCE AND COMPLETE THE NECESSARY APPLICATION PROCESS, WILL RECEIVE THE DISCOUNT UNDER THE UNINSURED ADJUSTMENT. THIS AMOUNT IS BASED ON AN AVERAGE OF GSHS MANAGED CARE CONTRACTS DEEPEST DISCOUNTS. THIS AMOUNT WILL BE REVIEWED ANNUALLY BY THE FAP COMMITTEE TO ADJUST FOR CHANGES AS APPROPRIATE. PART I, LINE 3C: TO QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY THE FOLLOWING MUST BE MET:(1) A RATIO IS DEVELOPED BY DIVIDING THE PATIENT'S INCOME BY THE FEDERAL POVERTY GUIDELINES.(2) THIS RATIO IS MATCHED TO THE FOLLOWING CHART TO DETERMINE AMOUNT ELIGIBLE FOR FINANCIAL ASSISTANCE. RATIO ASSISTANCE0% - 100% 100%101%-200% 80%201%-300% 60%301%-400% 40%401%-500% 20%501%-1000% 0% PART I, LINE 7: ALLOCATION OF MEDICAID SUPPLEMENTAL PAYMENTSDURING THE CURRENT REPORTING PERIOD , THE STATE OF TEXAS PARTICIPATED IN A SPECIAL 1115 MEDICAID WAIVER WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS). VARIOUS SUPPLEMENTAL HOSPITAL PAYMENTS UNDER THE WAIVER ARE INTENDED TO HELP HOSPITALS OFFSET MEDICAID AND UNINSURED LOSSES AND/OR CREATE NEW PROGRAMS DESIGNED TO IMPROVE THE PATIENT CARE EXPERIENCE, ENHANCE HEALTH OUTCOMES AND REDUCE COSTS FOR THESE SAME PATIENT POPULATIONS. SUPPLEMENTAL PAYMENTS ARE CAPPED BY MEDICAID AND UNINSURED LOSSES DETERMINED FROM A SPECIAL UNCOMPENSATED CARE (UC) TOOL DESIGNED BY THE TEXAS HEALTH AND HUMAN SERVICES COMMISSION (HHSC). IN FISCAL YEAR 2014, THE HOSPITAL RECEIVED $3,237,503 OF SUPPLEMENTAL PAYMENTS UNDER THE MEDICAID WAIVER. FOR PURPOSES OF IRS FORM 990 SCHEDULE H REPORTING, THESE PAYMENTS HAVE BEEN ALLOCATED BETWEEN FINANCIAL ASSISTANCE (CHARITY), MEDICAID AND BAD DEBT USING RATIOS DERIVED FROM THE UC TOOL AND OTHER INTERNAL DOCUMENTS USED FOR PURPOSES OF PREPARING MEDICARE COST REPORT WORKSHEET S-10 "HOSPITAL UNCOMPENSATED AND INDIGENT CARE DATA".MORE INFORMATION ON THE MEDICAID WAIVER MAY BE FOUND AT HTTP://WWW.HHSC.STATE.TX.US/WAIVER-1115-PROPOSAL.PDF. PART I, LN 7 COL(F): BAD DEBT EXPENSE IN THE AMOUNT OF $35,206,559 WAS NOT INCLUDED IN TOTAL EXPENSE USED TO COMPUTE THE PERCENTAGE REPORTED IN PART I, LINE 7, COL(F). PART III, LINE 4: THE INFORMATION IS PROVIDED IN THE ATTACHED AUDITED FINANCIAL STATEMENT ON PAGES 10 AND 11 TITLED PATIENT ACCOUNTS RECEIVABLE.PART III, LINE 2 AND LINE 3: BAD DEBT FROM THE AUDITED FINANCIAL STATEMENT REDUCED BY MEDICAID SUPPLEMENTAL PAYMENTS OF $ 1,368,380. WE DID NOT INCLUDE ANY BAD DEBT AMOUNTS IN COMMUNITY BENEFITS. PART III, LINE 8: SOURCE OF INFORMATION ON LINE 6 IS THE FYE 09/30/14 MEDICARE COST REPORT. THE SUM OF MEDICARE PART A ALLOWABLE COSTS REPORTED ON WORKSHEET D-1, PART II (FOR BOTH INPATIENT ACUTE PPS AND INPATIENT REHAB FACILITY)AND WORKSHEET DV, COLUMN 9 FOR MEDICARE OUTPATIENT PPS SERVICES. SINCE ALLOWABLE COSTS ARE NOT DETERMINED FOR SERVICES RENDERED TO MEDICARE PATIENTS ENROLLED IN MEDICARE ADVANTAGE (MEDICARE PART C) OR FOR PHYSICIAN SERVICES (SUCH AS EMERGENCY ROOM DOCTORS) BILLED UNDER MEDICARE PART B, NEITHER THE REVENUES OR COSTS RELATED TO THESE SERVICES HAVE BEEN INCLUDED ON LINES 5 OR 6.PART III, LINE 6: MEDICARE ALLOWABLE COSTS WERE DERIVED FROM FYE 9/30/2014 FILED COST REPORT FOR FINANCIAL AND STATISTICAL DATA TO DEVELOP PER DIEMS AND COST TO CHARGE RATIOS FOR ALLOWABLE COST AND REIMBURSEMENT. PART III, LINE 9B: ALL PATIENTS WHO ARE UNDERINSURED OR UNINSURED WILL BE EVALUATED FOR GOVERNMENT PROGRAMS,PAYMENT PLANS, AND FINANCIAL ASSISTANCE. IF ALL ATTEMPTS FAIL, WE WILL CONSIDER EACH ACCOUNT MEETING CERTAIN CRITERIA FOR FINANCIAL ASSISTANCE. ANY ACCOUNT THAT HAS A BALANCE GREATER THAN $10,000 AND HAS NOT QUALIFIED FOR MEDICAID OR COUNTY PROGRAMS WILL BE REVIEWED ON A CASE BY CASE BASIS FOR CHARITY CONSIDERATION. CREDIT REPORTS WILL BE RUN AND SUBMITTED FOR REVIEW. IF THE PATIENT HAS A CREDIT SCORE BELOW 650, AND THE BALANCE IS COMPLETELY OWED BY THE GUARANTOR/PATIENT ON ANY ONE ACCOUNT, CHARITY WILL BE CONSIDERED AT 100%. WRITE-OFFS WILL BE MONITORED THROUGH A SPECIFIC CODE, TO MONITOR AND EVALUATE AS NEEDED FOR CHANGES OR UPDATES. IF AT ANYTIME RECOVERIES ARE OBTAINED AFTER WRITE-OFF, THE CHARITY ADJUSTMENT WILL BE REVERSED AND ADDITIONAL REVIEW OF THE ACCOUNT WILL BE REQUIRED. PART VI, LINE 2: THE BOARD OF DIRECTORS IS A NON-PAID COMMUNITY BASED BOARD WHO REPRESENTS A BROAD SPECTRUM OF OUR COMMUNITY. THEY GUIDE THE DIRECTION OF THE ORGANIZATION BASED ON THE INFORMATION THEY RECEIVE FROM THEIR CONSTITUENTS, THE PROGRAM CAPABILITIES OF THE ORGANIZATION, AVAILABILITY OF PHYSICIANS AND THE PERFORMANCE OUTCOMES OF THE ORGANIZATION. IN ADDITION, THE GOOD SHEPHERD MEDICAL CENTER-MARSHALL EXECUTIVES AND MID-LEVEL MANAGERS LIVE AND WORK IN THIS COMMUNITY, SURROUNDING COMMUNITIES AND ALL THREE COUNTIES WHICH WE SERVE, AS WELL AS PARTICIPATE IN COMMUNITY ORGANIZATION AT ALL LEVELS. GOOD SHEPHERD MEDICAL CENTER-MARSHALL HAS A GROUP OF OVER 1,100 SENIORS WHO ARE A PART OF OUR EXTRA STEPS PROGRAM WHO PROVIDE US FEEDBACK MONTHLY AT THEIR MEETING WHERE MORE THAN 500 SENIORS ATTEND. IN ADDITION, GOOD SHEPHERD MEDICAL CENTER-MARSHALL HAS A WELLNESS CENTER SERVING 2,900 MEMBERS CALLED THE LIFECENTER WHERE POPULATIONS OF ALL AGES COME TO WORK OUT AND PARTICIPATE IN WELLNESS PROGRAMS. THE CENTER HAS A BOX FOR IDEAS REGARDING IMPROVEMENTS, PROGRAMS, AND SUGGESTIONS. IN ADDITION, LOCAL AND INDIVIDUAL MEETINGS ARE HELD WITH LOCAL BUSINESSES WHERE WE HAVE AN OPEN FORUM/FOCUS GROUP THAT SHARES INFORMATION REGARDING IMPROVEMENT AND PROGRAMS THEY WOULD LIKE TO SEE OUR ORGANIZATION OFFER TO ASSIST IN MEETING THEIR EMPLOYEE'S HEALTHCARE NEEDS. THE CEO PARTICIPATES IN A TASK FORCE TO POTENTIATE GROWTH AND DEVELOPMENT OF OUR COMMUNITY AND THE ASSOCIATED NEEDS REQUIRED TO OBTAIN SUCH GROWTH AND DEVELOPMENT. WE TYPICALLY CONDUCT A FORMAL COMMUNITY ASSESSMENT THROUGH OUR MARKETING DEPARTMENT EVERY 2 YEARS. PART VI, LINE 3: ANY PATIENT WITH A BALANCE OWED IS PROVIDED A FINANCIAL ASSISTANCE APPLICATION WITH INSTRUCTIONS WHICH LIST THE DOCUMENTS REQUIRED TO PROCESS THE FINANCIAL ASSISTANCE APPLICATION. A CONTACT PERSON IS LISTED FOR ANY QUESTIONS OR CONCERNS AND A FINANCIAL COUNSELOR IS AVAILABLE IF NEEDED. THE FINANCIAL COUNSELOR ALSO GOES TO PATIENT ROOMS TO PERSONALLY ASSIST WHO HAVE BEEN IDENTIFIED AS HAVING NO METHOD OF PAYMENT OR HARDSHIP FOR THE PURPOSE OF ASSISTING PATIENTS WITH THEIR FINANCIAL NEEDS. PART VI, LINE 4: GOOD SHEPHERD MEDICAL CENTER-MARSHALL IS LOCATED IN THE PINEY WOODS OF EAST TEXAS AND SERVES A RURAL AREA WHICH INCLUDES HARRISON, NORTHERN PANOLA, AND SOUTHERN MARION COUNTIES. THE POPULATION IN EACH OF THESE COUNTIES IS DIVERSE IN INCOME AND ETHNICITY AS INDICATED BELOW. HARRISON COUNTY IS LOCATED IN NORTHEASTERN TEXAS ALONG THE LOUISIANA BORDER. MARSHALL, THE COUNTY SEAT, IS 152 MILES EAST OF DALLAS AND 39 MILES WEST OF SHREVEPORT. THE COUNTY SEAT IS MARSHALL, TEXAS. HARRISON COUNY WAS OFFICIALLY ESTABLISHED IN 1839 AND COMPRISES 984 SQUARE MILES. ACCORDING TO THE 2014 CENSUS ESTIMATES, 16% OF THE HARRISON COUNTY POPULATION LIVES IN POVERTY. 14.5% OF HARRISON COUNTY RESIDENTS ARE AGE 65 OR OLDER. THE CENSUS BUREAU REPORTS THAT ONLY 17.8% OF ADULTS HOLD A COLLEGE DEGREE OR HIGHER LEVEL OF EDUCATION. THIS OFTEN IMPACTS THE AVAILABLE JOBS THAT CAN BE OBTAINED AND WHETHER BENEFITS SUCH AS HEALTHCARE ARE PROVIDED. IN OTHER AREAS OF OUR SERVICE REGION, MARION COUNTY HAS A MEDIAN ANNUAL HOUSEHOLD INCOME OF $31,967, AND 23.2% OF ITS RESIDENTS LIVE IN POVERTY. PANOLA COUNTY HAS A MEDIAN ANNUAL HOUSEHOLD INCOME OF $52,453, AND 12.7% OF ITS RESIDENTS LIVE IN POVERTY. UNEMPLOYMENT IN HARRISON, PANOLA, AND MARION COUNTIES IS CURRENTLY LISTED BETWEEN 4.5-5.9%. IT IS CLEAR THAT WITHIN THE AREA SERVED THERE ARE OBSTACLES TO OVERCOME. MANY FIND IT VERY DIFFICULT TO AFFORD THE COST OF HEALTHCARE SUCH AS IT IS TODAY-BOTH IN BASIC PREVENTION AND IN TREATMENT OF EXISTING AND CHRONIC ILLNESS. PART VI, LINE 5: THE COMMUNITY BUILDING ACTIVITIES INCLUDE OUR WELLNESS CENTER AND THE PROGRAMS WE OFFER IN AN ATTEMPT TO KEEP OUR COMMUNITY HEALTHY. THE WELLNESS CENTER IS THE HUB OF OUR PROGRAM OFFERING FITNESS AND WELLNESS PROGRAMS FOR INDIVIDUALS, FAMILIES AND BUSINESSES IN OUR COMMUNITY, INCLUDING OUR OWN EMPLOYEES AND THEIR FAMILIES. WE ALSO OFFER A VARIETY OF WATER AEROBICS, ADULT AEROBIC CLASSES, SENIOR EXERCISE CLASSES, SPECIALTY CLASSES, SUCH AS ZUMBA CARDIAC REHAB CLASSES, ETC. WE ALSO OFFER ACUTE, CHRONIC, AND PREVENTATIVE EDUCATIONAL PROGRAMS TO OUR COMMUNITY. WE ARE INVOLVED IN THE SCHOOLS WITH PRENATAL CLASSES FOR PREGNANT TEENS AT THE SCHOOL AND HAVE WORKED WITH THE SCHOOLS ON OBESITY PROGRAMS. IN ADDITION, WE PROVIDE COMMUNITY EDUCATIONAL SERVICES AND PROGRAMS, SUCH AS CPR, CERTIFIED DIABETIC EDUCATION PROGRAMS, WOUND CARE EDUCATION AND PREVENTION, SEATBELT AWARENESS, HARD HATS FOR LITTLE HEADS BICYCLE RODEO PROGRAMS, AND SHOPPING CLASSES FOR THOSE TRYING TO MODIFY THEIR DIET FOR CARDIAC REASONS OR WEIGHT LOSS. WE ALSO OFFER HEALTH FAIRS THROUGHOUT THE YEAR, PROVIDING BASIC SCREENING EXAMS AT NO COST TO OUR COMMUNITY. OUR CASE MANAGEMENT AND SOCIAL SERVICES PROGRAM OFFER THE AVAILABILITY OF EXTERNAL RESOURCES AND PROGRAMS TO ASSIST PATIENTS AND THEIR FAMILIES, SUCH AS WIC AND OTHER GOVERNMENT AND PRIVATE PROGRAMS. THESE ARE JUST SOME EXAMPLES OF THE MANY EDUCATIONAL AND DEVELOPMENTAL PROGRAMS WE HAVE PROVIDED TO OUR COMMUNITY. PART VI, LINE 6: WE ARE A PART OF GOOD SHEPHERD HEALTH SYSTEM WHICH HAS ALLOWED US TO BETTER OUTREACH AND SERVE OUR CATCHMENT AREA. LINE 7 TEXAS X X 1 0 0 0 0 0 0 0 0 RICKY PAUL MD PRESIDENT OF MEDICAL STAFF 0 515092 0 26783 0 0 0 8351 0 15250 0 565476 0 0 RUSS COLLIER PRESIDENT/CEO 360692 0 0 0 0 0 10200 0 12573 0 383465 0 0 0 STEVE ALTMILLER GSHS PRESIDENT/CEO 0 254153 0 0 0 0 0 0 0 4391 0 258544 0 0 LUIS BALBUENA MD MEDICAL STAFF REP TO BOARD 0 365836 0 0 0 0 0 9291 0 15587 0 390714 0 0 GORDEN GREEN MD VP MEDICAL STAFF 0 294438 0 0 0 0 0 0 0 9884 0 304322 0 0 PAT KEEL CFO END 5/14/14 0 428336 0 0 0 0 0 5100 0 5155 0 438591 0 0 KEITH KIRBOW CHIEF NURSING OFFICER 136530 0 1085 0 0 0 5679 0 17406 0 160700 0 0 0 JOHN MCDONALD DO FORMER MEDICAL STAFF 0 184397 0 2539 0 0 0 6274 0 11899 0 205109 0 0 VALARIE ALLMAN MD FORMER VP MEDICAL STAFF 0 301341 0 50146 0 0 0 7628 0 11996 0 371111 0 0 PAULA BRANDON FORMER -SR VP PCS 0 208601 0 0 0 0 0 8393 0 11235 0 228229 0 0 RAY DELK FORMER - VP OPERATIONS 0 201205 0 0 0 0 0 8016 0 11127 0 220348 0 0 ED BANOS FORMER CEO 0 0 0 0 0 668219 0 0 0 0 0 668219 0 0 PART I, LINE 4A ED BANOS SEVERANCE PAYMENT OF $668,219 A HARRISON COUNTY HEALTH FACILITIES DEVELOPMENT CORPORATION 752740093 415221AW0 2010-09-22 43980049 REFUND ESCROWS, CAPITAL PROJECTS AND IMPROVEMENTS 0 0 0 A 43980049 3077293 31331629 879600 8691527 2013 1 0 0 1 A 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 6 GSHS,INC. IS THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE MEMBER, GSHS, INC. HAS THE POWER TO APPOINT ONE MEMBER TO THE CORPORATION'S BOARD OF DIRECTORS AND THE POWER TO APPROVE THE REMAINING DIRECTORS NOMINATED TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B A NUMBER OF DECISIONS OF THE ORGANIZATION ARE SUBJECT TO APPROVAL OF THE MEMBER OF THE ORGANIZATION. THESE RESERVED POWERS ARE STATED BELOW: A) THE APPOINTMENT OF ONE MEMBER OF THE ORGANIZATION'S BOARD OF DIRECTORS, AND THE APPROVAL OF THE REMAINING DIRECTORS FOLLOWING THE NOMINATION PROCESS AND SUBJECT TO THE PROVISIONS GOVERNING STAFF DIRECTORS; B) THE REMOVAL OF A MEMBER OF THE ORGANIZATION'S BOARD AND ALSO THE APPROVAL OF REMOVAL AND APPOINTMENTS TO FILL VACANCIES ON THE BOARD AND SET SIZE OF BOARD; C) APPROVE ELECTION AND REMOVAL OF OFFICES OF THE ORGANIZATION AND ESTABLISH, TERMINATE, AND/OR REVISE ALL EMPLOYMENT CONTRACTS, COMPENSATION, AND BENEFIT PACKAGES OF THE OFFICERS OF THE ORGANIZATION REGARDLESS OF WHICH ENTITY ACTUALLY PAYS SUCH COMPENSATION OR BENEFITS; D) DESIGNATE THE FISCAL YEAR; E) APPROVE THE SELECTION AND REMOVAL OF INDEPENDENT AUDITORS, OUTSIDE GENERAL LEGAL COUNSEL, AND OUTSIDE INVESTMENT ADVISORS; F) AMEND THE ARTICLES OF INCORPORATION; G) APPROVE ALL MERGERS ACQUISITIONS, CONSOLIDATIONS, OR AFFILIATIONS WITH OHTER ENTITIES, THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION, OR THE SALE, MORTGAGE, OR ENCUMBRANCE OF ANY PROPERTY OWNED BY THE ORGANIZATION; H) APPROVE THE DISSOLUTION OR LIQUIDATION OF THE ORGANIZATION; I) APPROVE CAPITAL PLANS, STRATEGIC PLANS, AND ANNUAL OPERATING AND CAPITAL BUDGETS; J) APPROVE ANY EXCEPTION TO THE CAPITAL BUDGET FOR A SINGLE ITEM OR RELATED ITEM THAT EXCEEDS $100,000 AND/OR APPROVE ANY AGGREGATE ANNUAL EXPENDITURES THAT EXCEED THE BUDGET BY $50,000; K) SELECT OFFICIAL DEPOSITORIES FOR THE ORGANIZATION'S FUNDS; L) CREATE OR INVEST IN ANY SUBSIDIARY ENTITY OR ENTER INTO ANY PARTNERSHIP OR JOINT VENTURE; M) AUTHORIZE ANY LOANS, GUARANTEES, OR INCURRENCE OF DEBT; N) AUTHORIZE THE COMMENCEMENT OF ANY LITIGATION OR OTHER LEGAL PROCEEDING, OR THE SETTLEMENT, DISPOSITION, OR TERMINATION OF ANY SUCH LITIGATION OR OTHER LEGAL PROCEEDING OR OF ANY CLAIM OR THREAT OF LITIGATION OR OTHER LEGAL PROCEEDING NOT FULLY COVERED BY INSURANCE; AND O) APPROVE THE ADMISSION OF ADDITIONAL MEMBERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION HAS AN EXTERNAL ACCOUNTING FIRM AUDIT ON A CONSOLIDATED BASIS. INTERNAL ACCOUNTING PREPARES THE 990. THE 990 IS REVIEWED BY AN EXTERNAL ACCOUNTING FIRM. THE RETURN IS THEN REVIEWED BY INTERNAL ACCOUNTANTS AND EXECUTIVES PRIOR TO FILING. THE BOARD OF DIRECTORS WILL REVIEW AFTER THE SUBMISSION DATE. FORM 990, PART VI, SECTION B, LINE 12C DISCLOSURES ARE OBTAINED ANNUALLY. THE BOARD REVIEWS AND APPROVES THE BOARD MEMBERS' DISCLOSURES, AND THE CEO REVIEWS AND APPROVES THE EMPLOYEES' DISCLOSURES. BOARD MINUTES REFLECT WHEN A BOARD MEMBER DECLARES A CONFLICT AND DOES NOT VOTE. FORM 990, PART VI, SECTION B, LINE 15 A COMPENSATION SUBCOMMITTEE OF THE BOARD NEGOTIATES CONTRACTS WITH EXECUTIVES THROUGH LONGNECKER & ASSOCIATES. THIS SUBCOMMITTEE OF THE BOARD REVIEWS AND APPROVES COMPENSATION AND BONUSES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. PART VI SECTION A LINE 1A THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE FOUNDATION BETWEEN MEETINGS OF THE BOARD. FORM 990, PART XI, LINE 9: CONTRIBUTED CAPITAL -5,574,776. INVESTMENT IN MARSHALL FOUNDATION 92,171. MHS RECEIVABLE RESERVE -21,131,384. GSHS INC 700 E MARSHALL AVE LONGVIEW TX 75601 752027157 SUPPORT GSMC TX 501(C)(3) LINE 11B, II N/A 0 MARSHALL HEALTH SERVICES INC 811 SOUTH WASHINGTON AVE MARSHALL TX 75670 752580686 HEALTHCARE TX 501(C)(3) LINE 3 HARRISON COUNTY HOSPITAL ASSOCIATION 1 MARSHALL HOSPITAL FOUNDATION INC 811 SOUTH WASHINGTON AVE MARSHALL TX 75670 752605699 SUPPORT TX 501(C)(3) LINE 7 HARRISON COUNTY HOSPITAL ASSOCIATION 1 THE GOOD SHEPHERD HOSPITAL INC 700 E MARSHALL AVE LONGVIEW TX 75601 751041154 HEALTHCARE TX 501(C)(3) LINE 3 GSHS INC 0 GSHS ADMINISTRATIVE SERVICES ORG INC 700 E MARSHALL AVE LONGVIEW TX 75601 861132471 ADMIN SUPPORT TX 501(C)(3) LINE 11A, I GSHS INC 0 GOOD SHEPHERD MEDICAL CENTER - LINDEN 404 N KAUFMAN STREET LINDEN TX 75563 010829282 HEALTHCARE TX 501(C)(3) LINE 3 GSHS INC 0 GSMC - LINDEN FOUNDATION INC 404 N KAUFMAN STREET LINDEN TX 75563 200845127 SUPPORT TX 501(C)(3) LINE 11A, I GOOD SHEPHERD MEDICAL CENTER - LINDEN INC 0 GOOD SHEPHERD HOSPITAL AUXILIARY 700 E MARSHALL AVE LONGVIEW TX 75601 237203364 SUPPORT TX 501(C)(3) LINE 9 THE GOOD SHEPHERD HOSPITAL INC 0 GOOD SHEPHERD FOUNDATION INC 700 E MARSHALL AVE LONGVIEW TX 75601 752056700 SUPPORT TX 501(C)(3) LINE 11A, I GSHS INC 0 GOOD SHEPHERD AMBULATORY SURGICAL 700 E MARSHALL AVE LONGVIEW TX 75601 900259782 SURGERY TX GSHS ENTERPRISES OPERATING #2 RELATED 0 0 GSHS ENTERPRISES INC 700 E MARSHALL AVE LONGVIEW TX 75601 752027162 HEALTHCARE TX GSHS INC C 0 GOOD SHEPHERD HEALTH NETWORK 700 E MARSHALL AVE LONGVIEW TX 75601 752554695 INACTIVE TX THE GOOD SHEPHERD HOSPTIAL INC C 0 NORTHEAST TEXAS PHYSICIAN SERVICES 700 E MARSHALL AVE LONGVIEW TX 75601 752712245 MGMT SERVICES TX GSHS ENTERPRISES INC C 0 GOOD SHEPHERD PHYSICIAN SERVICES INC 700 E MARSHALL AVE LONGVIEW TX 75601 752762417 MEDICAL SERVICES TX GSHS ENTERPRISES INC C 0 GSHS ENTERPRISES HOLDING INC 700 E MARSHALL AVE LONGVIEW TX 75601 510412465 HOLDING COMPANY DE GSHS ENTERPRISES INC C 0 GSHS ENTERPRISES OPERATING 1 700 E MARSHALL AVE LONGVIEW TX 75601 752954772 HEALTHCARE DE GSHS ENTERPRISES INC C 0 GSHS ENTERPRISES OPERATING 2 700 E MARSHALL AVE LONGVIEW TX 75601 752954777 HEALTHCARE DE GSHS ENTERPRISES INC C 0 1 0 0 1 1 0 0 0 0 1 1 0 1 0 0 1 1 1 0 MARSHALL HEALTH SERVICES M 1230598 CASH PAID MARSHALL HEALTH SERVICES A 652746 CASH PAID MARSHALL HEALTH SERVICES K 152963 CASH PAID