2015-11-12T18:07:21-06:00 2014-12-31 BKD LLP 2800 POST OAK BLVD STE 3200 HOUSTON TX 77056 990 2014-01-01 746083124 Hill Country Memorial Hospital % JANICE MENKING HILL 8309974353 PO Box 835 Fredericksburg TX 78624 Mark Jones Hosp CFO 9727028262 2015-11-16 true AMANDA MAYA P01067777 7134994600 2014 2016-02-25 16:41:14Z MARK JONES PO BOX 835 FREDERICKSBURG TX 78624 93280606 false X WWW.HILLCOUNTRYMEMORIAL.ORG X 1966 TX TO PROVIDE REMARKABLE HEALTH CARE SERVICES TO THE HILL COUNTRY AREA THROUGH THE OPERATION AND MAINTENANCE OF A COMMUNITY HOSPITAL. 13 13 767 130 0 0 1565765 2525355 81040677 89210693 171463 104036 611735 608936 83389640 92449020 997 83345 0 0 32216451 32788597 0 0 0 38134292 40573885 70351740 73445827 13037900 19003193 108612289 118447445 24477345 14602678 84134944 103844767 X HILL COUNTRY MEMORIAL HOSPITAL'S VISION IS EMPOWER OTHERS, CREATE HEALTHY. THE HOSPITAL'S VALUES ARE: OTHERS FIRST, COMPASSION, INNOVATION, ACCOUNTABILITY, AND STEWARDSHIP. false false 59475990 83345 85426724 MEDICAL CARE SERVICES - PROVIDED HEALTH CARE SERVICES TO LOCAL RESIDENTS. DAYS OF CARE INCLUDED: ROUTINE - 7,839; INTENSIVE AND CRITICAL CARE UNITS - 1,008; NURSERY - 756; EMERGENCY ROOM CARE WAS PROVIDED FOR 15,343 VISITS; 161,432 LABORATORY TESTS WERE PERFORMED; 41,302 IMAGING PROCEDURES WERE PERFORMED; 35,531 PHYSICAL/OCCUPATIONAL/SPEECH THERAPY VISITS WERE PROVIDED; 4,544 OPERATIONS WERE PERFORMED, AND 472 BABIES WERE DELIVERED. 2349309 2200897 HOME CARE SERVICES - PROVIDE NURSES AND THERAPISTS TO ASSIST PATIENTS IN THEIR HOMES WITH EDUCATION, ASSESSMENT AND OBSERVATION OF WOUNDS, RESPIRATORY STATUS, CARDIAC STATUS AND OTHER BODY SYSTEMS. NURSES ALSO ADMINISTER IVS, WOUND CARE, COLOSTOMY CARE, AND CATHETER CARE. 870406 1016955 WELLNESS CENTER - PROMOTES HEALTH AND WELLNESS BY PROVIDING PHYSICA REHABILITATION FACILITIES AND FITNESS EQUIPMENT; CONDUCTING HEALTH SEMINARS AND CPR/FIRST AID CLASSES; PROVIDING NUTRITION INFORMATION THROUGH EDUCATION CLASSES AND DIETARY CONSULTATIONS; CONDUCTING HEALTH AND FITNESS SCREENINGS, FREE BLOOD PRESSURE CHECKS AND COUNSELING SEMINARS; AND OFFERING BREAST FEEDING SUPPLIES AND BREAST PUMP RENTALS, CHILDCARE AND YOUTH DAY CAMPS AS WELL AS MASSAGE THERAPY. DURING 2014 THERE WERE 38,579 PARTICIPANTS IN WELLNESS CENTER PROGRAMS. 328117 373585 WIC PROGRAM 299526 192532 CLINIC RENT INCOME 183096 OTHER RELATED ACTIVITIES 627643 749213 63323348 true true false true false false false false false false true true false true 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 true true true true false false true 286 0 true 767 true false false false false false false false false false false X 13 13 false false false false false false false true true false false true true true true false true true true true true X JANICE MENKING 8309971339 822 REUBEN ST FREDERICKSBURG TX 78624 X LAURA COOK CHAIRMAN 0.25 1.0 X X 0 0 0 MARK DELEON DIRECTOR 0.25 1.0 X 0 0 0 RICHARD ESTENSON DIRECTOR 0.25 1.0 X 0 0 0 JAMES LINDLEY DIRECTOR 0.25 1.0 X 0 0 0 DAN MITTEL DIRECTOR 0.25 1.0 X 0 0 0 ROBERT MURRAY DIRECTOR 0.25 1.0 X 0 0 0 BRAD HARDIN VICE-CHAIRMAN 0.25 1.0 X X 0 0 0 ANNE PLUENNEKE DIRECTOR 0.25 1.0 X 0 0 0 GORDON SAUER DIRECTOR 0.25 1.0 X 0 0 0 CRISTOL SCHOESSOW DIRECTOR 0.25 1.0 X 0 0 0 PAUL URBAN SECRETARY 0.25 1.0 X X 0 0 0 MARC WILLIAMSON DIRECTOR 0.25 1.0 X 0 0 0 PENNY MCBRIDE DIRECTOR 0.25 1.0 X 0 0 0 JAYNE POPE CEO 39.0 1.0 X 387222 0 24466 MARK JONES CFO 39.0 1.0 X 312529 0 18802 MIKE RENO COO 40.0 0.0 X 267442 0 28215 JAMES R PARTIN CMO 39.0 1.0 X 308657 0 27390 MAUREEN POLIVKA CNO 40.0 0.0 X 201511 0 0 DEBRA DOOLEY EXECUTIVE DIRECTOR 40.0 0.0 X 247059 0 22900 MICHAEL BROWN LEAN SPECIALIST 40.0 0.0 X 261693 0 0 JEFF DARNABY LEAN SPECIALIST 40.0 0.0 X 222573 0 1959 HOLLY SCHMIDT EXECUTIVE DIRECTOR 40.0 0.0 X 162955 0 22662 EMILY PADULA EXECUTIVE DIRECTOR 39.0 1.0 X 161032 0 0 2532673 0 146394 25 false true false ROGERS O'BRIEN CONSTRUCTION 1901 REGAL ROW DALLAS TX 75235 CONSTRUCTION 528189 FREDERICKSBURG ANESTHESIA 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 ANESTHESIA SERVICES 431106 LEIDOS HEALTH HOLDINGS INC 11951 FREEDOM DRIVE RESTON VA 20190 TECHNOLOGY SERVICES 404802 KENDNEL KASPER CONSTRUCTION INC 162 LINDA DRIVE FREDERICKSBURG TX 78624 CONSTRUCTION 370878 BKD LLP 910 E ST LOUIS STREET STE 400 SPRINGFIELD MO 65801 ACCOUNTING SERVICES 303084 20 X 2525355 2525355 NET PATIENT HOSPITAL REVENUE 621110 85426724 85426724 HOME HEALTHCARE REVENUE 621610 2200897 2200897 WELLNESS CTR SERVICE REVENUE 624100 1016955 1016955 WIC PROGRAM REVENUE 624100 373585 373585 CLINIC RENT REVENUE 621110 192532 192532 89210693 270124 270124 0 0 0 0 0 161818 207705 535611 161818 -327906 -166088 -166088 0 0 479071 295975 183096 183096 CAFETERIA REVENUE 722320 209495 209495 MEDICAL RECORDS 621990 9674 9674 MISCELLANEOUS REVENUE 900099 206671 206671 425840 92449020 89393789 529876 83345 83345 0 0 0 1576232 1576232 0 25427743 21240253 4187490 863106 712158 150948 3076195 2620045 456150 1845321 1511406 333915 0 98731 98731 225424 225424 0 0 0 5779897 4320737 1459160 277883 8519 269364 1815129 1285234 529895 0 0 7936261 7608951 327310 221990 172758 49232 0 330059 162155 167904 245653 245653 0 3836294 3836294 916498 916498 MEDICAL SUPPLIES 12893569 12893569 BAD DEBT EXPENSE 5135075 5135075 DUES & SUBSCRIPTIONS 136602 44161 92441 LICENSE & PERMITS 64230 62200 2030 660590 464337 196253 73445827 63323348 10122479 0 11843076 12191858 12004693 12306048 0 0 10014437 9955326 0 0 0 0 0 0 1449572 1362808 7618346 8082182 83289148 46448986 36384451 36840162 0 0 21031611 21780736 0 0 0 0 8266103 15928325 108612289 118447445 7601738 6432054 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16875607 8170624 24477345 14602678 X 63103333 82064031 12454258 13082424 8577353 8698312 84134944 103844767 108612289 118447445 X 19003193 -42495 749125 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 3767 false false false 3767 false LOBBYING EXPENSES LOBBYING EXPENSES: HILL COUNTRY MEMORIAL HOSPITAL PAID DUES TO ORGANIZATIONS, A PORTION OF WHICH IS DESIGNATED FOR LOBBYING EXPENSES. DUES LOBBYING % LOBBYING $ THA $19,328 19.49% $3,767 --------------------------------------------------- TOTAL $19,328 $3,767 4960017 4960017 41871352 20132979 21738373 1174293 1174293 34565925 26316007 8249918 717561 717561 36840162 INTEREST IN FOUNDATION 21780736 F 21780736 OTHER INVESTMENTS 11564 Due From Affiliates 9349951 EHR Receivable 6566810 15928325 0 HCM REFUNDABLE ADVANCE 300000 ESTIMATED SELF INSURANCE COSTS 1235750 HCM FINANCING 6634874 8170624 X 84940389 -42495 -5218420 -5260915 90201304 2247716 2247716 92449020 68505046 277639 277639 68227407 5218420 5218420 73445827 SCHEDULE D, PART XI, LINE 2D RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS TO RETURN: BAD DEBT EXPENSE $(5,135,075) AUXILIARY TRANSFER TO FDN (83,345) ---------------------------------------------- TOTAL $(5,218,420) SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS TO RETURN: THRIFT SHOP EXPENSES $(295,975) CONTRIBUTION FROM FDN 2,525,355 OTHER CLASSIFICATION DIFFERENCE 18,336 ---------------------------------------------- TOTAL $ 2,247,716 SCHEDULE D, PART XII, LINE 2D RECONCILIATION OF EXPENSE PER AUDITED FINANCIAL STATEMENTS TO RETURN: THRIFT SHOP EXPENSES $ 295,975 OTHER CLASSIFICATION DIFFERENCES (18,336) --------------------------------------------- TOTAL $ 277,639 SCHEDULE D, PART XII, LINE 4B RECONCILIATION OF EXPENSE PER AUDITED FINANCIAL STATEMENTS TO RETURN: BAD DEBT EXPENSE $ 5,135,075 AUXILIARY TRANSFER TO FDN 83,345 ---------------------------------------------- TOTAL $ 5,218,345 schedule d, part x, line 2 liability for uncertain tax positions: The Hospital and its wholly owned subsidiaries have been recognized as exempt from income taxes under Section 501 of the Internal Revenue Code and a similar provision of state law. However, these entities are subject to federal income tax on any unrelated business taxable income. HCMSC is taxed as a partnership. With few exceptions, the Hospital and its wholly owned subsidiaries are no longer subject to U.S. federal examinations by tax authorities for years before 2011. true true true X true X true true true false true true 2973862 2973862 0.04350 3781600 3498749 282851 0.00410 125160 116647 8513 0.00010 6880622 3615396 3265226 0.04770 302764 302764 0.00440 302764 302764 0.00440 7183386 3615396 3567990 0.05210 false 5135075 22817607 24929437 -2111830 X true true HILL COUNTRY SURGERY CENTER 0.51000 0.07000 0.03500 MEMORIAL SURGERY CTR 1 1 HILL COUNTRY MEMORIAL HOSPITAL 1020 KERRVILLE HWY FREDERICKSBURG TX 78624 www.hillcountrymemorial.org 00219 X X X HILL COUNTRY MEMORIAL HOSPITAL 1 false false true X X X X X X X X X X 13 true false false true X SEE PART V, SECTION C X X true 13 true SEE PART V, SECTION C false false true X 200. 300. X X true true X X true X X X X X X X X X X true false X X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 3J ABOUT HILL COUNTRY MEMORIAL: MISSION: REMARKABLE ALWAYS. HILL COUNTRY MEMORIAL IS AN 88 BED, NOT-FOR-PROFIT HOSPITAL, FULLY ACCREDITED BY THE JOINT COMMISSION. WHILE THIS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS WAS UNDERTAKEN BECAUSE OF AN INTERNAL REVENUE SERVICE (IRS) REQUIREMENT, HILL COUNTRY MEMORIAL SEES ITSELF AS BEING THE HEALTHCARE PROVIDER OF CHOICE FOR THE CITIZENS OF GILLESPIE COUNTY AND THE MARKET SHARE CONFIRMS THIS TO BE TRUE. AS SUCH, HILL COUNTRY MEMORIAL ACCEPTS RESPONSIBILITY FOR EMPOWERING OTHERS AND IMPROVING THE HEALTH OF THE COMMUNITY. THE VISION STATEMENT IS: EMPOWER OTHERS. CREATE HEALTHY. HCM WANTS TO FULFILL THE HEALTH CARE NEEDS OF HILL COUNTRY PATIENTS. WE HAVE STUDIED AND ANALYZED THOUSANDS OF DATA POINTS IN A COMPREHENSIVE AND STRATEGIC MANNER TO GUIDE THE COMMUNITY AND HOSPITAL DECISIONS REGARDING THE HEALTH OF THE COMMUNITY AND TO PROVIDE A DOCUMENT OF THE ENTIRE PROCESS AND RESULTS. HCM CONDUCTED A FIVE STAGE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS: STAGE 1 - MARKET BRIEF: DEMOGRAPHIC/PSYCHOGRAPHIC ANALYSIS/PATIENT MAPPING - REVIEW ALL DEMOGRAPHIC INFORMATION ON THE REGION - MAP PERTINENT DEMOGRAPHIC SUB-POPULATIONS - DOCUMENT ALL OTHER HEALTHCARE AND NON-PROFIT GROUPS IN THE COMMUNITY - ANALYZE PSYCHOGRAPHICS - COMMUTER PROFILES (DAYTIME VERSUS NIGHTTIME POPULATION) - HEALTH SERVICE DEMAND REPORTS AND MAPS (INPATIENT, OUTPATIENT, EMERGENCY DEPARTMENT, AND PHYSICIAN OFFICE VISITS) - HCM PATIENT ORIGIN, INPATIENT, OUTPATIENT, ED - TEXAS DISCHARGES AND MARKET SHARE STAGE 2 - COMMUNITY HEALTH NEEDS ANALYSIS - DETERMINE NEEDS OF THE POPULATION THROUGH DATA ANALYSIS - DETERMINE HEALTH NEEDS THROUGH COMMUNITY FOCUS GROUP (20 PEOPLE PARTICIPATING) - PUBLIC EDUCATION/HEALTH EDUCATION - ACCESS TO HEALTHCARE STAGE 3 - VALIDATION/SURVEY - A TELEPHONE SURVEY WAS CONDUCTED JULY 29-AUGUST 6, AND SEPTEMBER 5 2013 TO 502 CITIZENS OF GILLESPIE COUNTY TO BETTER UNDERSTAND THE NEEDS OF THE COMMUNITY - AN ON-LINE MEDICAL STAFF SURVEY ABOUT HEALTH AND PHYSICIAN NEEDS FROM THE PHYSICIAN'S POINT OF VIEW WAS RECEIVED FROM 22 PHYSICIANS. - AN ON-LINE SURVEY OF HOSPITAL STAFF ABOUT HEALTH NEEDS WAS RECEIVED FROM 273 EMPLOYEES. STAGE 4 - ENGAGE COMMUNITY PARTNERS AND BUILD CONSENSUS VIA A COMMUNITY HEALTH SUMMIT - 70 COMMUNITY REPRESENTATIVES: DEPARTMENT OF HEALTH, NOT-FOR-PROFIT AGENCIES, SCHOOLS AND CITY/COUNTY GOVERNMENT, BUSINESS AND COMMUNITY LEADERS STAGE 5 - FINAL REPORTS - A COMPREHENSIVE REPORT TO INCLUDE SUMMARY OF ALL RESEARCH, FINDINGS, AND RECOMMENDATIONS - A REPORT TO THE COMMUNITY SUMMARIZING THE HEALTH NEEDS AND WORK OF THE SUMMIT SUITABLE FOR DISPLAY ON WEBSITES OVER THE PAST THREE MONTHS, THE FOLLOWING INTERACTION POINTS OCCURRED: - FOCUS GROUP WITH 20 BUSINESSES, GOVERNMENT DEPARTMENTS, NOT-FOR-PROFIT AGENCIES, AND CITIZENS - 22 PHYSICIANS AND 273 HCM EMPLOYEES SURVEYED - 70 LEADERS ATTENDED THE COMMUNITY HEALTH SUMMIT - MORE THAN 1,000 COMMUNITY DATA POINTS ANALYZED - MULTIPLE PRESENTATIONS (MARKET BRIEF, SURVEYS, COMMUNITY HEALTH SUMMIT) SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY: HILL COUNTRY MEMORIAL HOSPITAL SOLICITED INPUT FROM HUNDREDS OF COMMUNITY MEMBERS AND THOSE WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH. - 20 COMMUNITY MEMBERS, EMPLOYERS, NOT-FOR-PROFIT ORGANIZATIONS, CLERGY, SCHOOL AND GOVERNMENT REPRESENTATIVES PARTICIPATED IN A FOCUS GROUP FOR THEIR PERSPECTIVES ON COMMUNITY HEALTH NEEDS AND ISSUES ON JULY 26, 2013. - INFORMATION GATHERING, USING PUBLIC HEALTH SOURCES AND HOSPITAL-SPECIFIC DATA, OCCURRED JUNE THROUGH AUGUST. - A TELEPHONE SURVEY OF 502 RESIDENTS OF GILLESPIE COUNTY TO DETERMINE HEALTH STATUS WAS CONDUCTED FROM JULY 29-AUGUST 6 AND SEPTEMBER 5. - 22 PHYSICIANS AND 283 EMPLOYEES WERE SURVEYED ON-LINE REGARDING THEIR PERSPECTIVES ON COMMUNITY HEALTH STATUS AND NEEDS FROM JULY 30-AUGUST 23. - A COMMUNITY SUMMIT WAS CONDUCTED ON SEPTEMBER 5 WITH 70 COMMUNITY LEADERS AND CITIZENS. THE AUDIENCE CONSISTED OF HEALTHCARE WORKERS, BUSINESS LEADERS, SCHOOL SYSTEMS, GOVERNMENT REPRESENTATIVES, CLERGY AND OTHER COMMUNITY MEMBERS. - THIS REPORT TO THE COMMUNITY WAS COMPLETED AND PUBLISHED IN OCTOBER 2013. BELOW IS A LIST OF ALL THE ORGANIZATIONS THAT GAVE INPUT INTO THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPROVEMENT PLAN: - HILL COUNTRY MEMORIAL BOARD OF TRUSTEES AND STAFF, HILL COUNTY MEMORIAL HOSPITAL FOUNDATION, STRATASAN, GILLESPIE COUNTY HEALTH DIVISION, FREDERICKSBURG POLICE DEPARTMENT, METHODIST HEALTHCARE MINISTRIES, ALAMO AREA AGENCY ON AGING, HEB, FRANTZEN, KADERLI AND KLIER INSURANCE, GILLESPIE COUNTY, FREDERICKSBURG CHAMBER OF COMMERCE, GILLESPIE COUNTY ECONOMIC DEVELOPMENT, HILL COUNTY COMMUNITY NEEDS COUNCIL, GOOD SAMARITAN CENTER, GILLESPIE COUNTY MINISTERIAL ALLIANCE, FREDERICKSBURG INDEPENDENT SCHOOL DISTRICT, CITY OF FREDERICKSBURG, TEXAS DEPARTMENT OF STATE HEALTH SERVICES, BOYS AND GIRLS CLUB OF FREDERICKSBURG, TEXAS A&M AGRILIFE-GILLESPIE COUNTY, GOLDEN HUB, ENCHANTED ROCK STATE PARK-TEXAS PARKS & WILDLIFE, ADMIRAL NIMITZ FOUNDATION, HILL COUNTRY COMMUNITY FOUNDATION, HCM SENIOR SERVICES, SOCIAL WORK, BUSINESS DEVELOPMENT, MARKETING AND WELLNESS CENTER. AGRILIFE-GILLESPIE COUNTY, GOLDEN HUB, ENCHANTED ROCK STATE PARK-TEXAS PARKS & WILDLIFE, ADMIRAL NIMITZ FOUNDATION, HILL COUNTRY COMMUNITY FOUNDATION, HCM SENIOR SERVICES, SOCIAL WORK, BUSINESS DEVELOPMENT, MARKETING AND WELLNESS CENTER. SCHEDULE H, PART V, SECTION B, LINES 7A, 7D & 10A AVAILABILITY TO THE PUBLIC: THE CHNA AND IMPLEMENTATION STRATEGY IS AVAILABLE ON THE HOSPITAL'S WEBSITE AND WAS MADE AVAILABLE TO THE FREDERICKSBURG STANDARD TO PUBLISH. IN ADDITION, WE HAVE MADE COPIES AVAILABLE BY CALLING OR EMAILING THE HOSPITAL. THE WEBSITE IS HTTP://WWW2.HILLCOUNTRYMEMORIAL.ORG/STATIC/FILES/GILLESPIE_COUNTY_CHNA_V1. PDF. SCHEDULE H, PART V, SECTION B, LINE 11 ADDRESS OF NEEDS IDENTIFIED IN CHNA & NEEDS NOT ADDRESSED IN CHNA: THE STRATEGY TO ADDRESS THE NEEDS IDENTIFIED IS INCLUDED IN THE CHNA WHICH IS POSTED ON THE HOSPITAL'S WEBSITE. THE HOSPITAL COMPLETED THE COMMUNITY NEEDS ASSESSMENT IN OCTOBER 2013. HOSPITAL LEADERSHIP SELECTED THREE PRIORITIES TO ADDRESS (TWO IN THE SAME CATEGORY OF CHRONIC DISEASE), LEAVING FIVE CATEGORIES THE HOSPITAL DID NOT ADDRESS. FIVE PRIORITIES ARE NOT BEING ADDRESSED BY THE HOSPITAL: - OBESITY AND LIFESTYLE (NUTRITION AND ACTIVITY) - SUBSTANCE ABUSE - BEHAVIORAL HEALTH - TEEN PREGNANCY - SOCIOECONOMICS ACCESS TO CARE AND CHRONIC DISEASES ARE AREAS WHERE HOSPITALS CAN MAKE A POSITIVE IMPACT IN A COMMUNITY. THE OTHER FIVE ISSUES, THE HOSPITAL FELT THAT OTHER ORGANIZATIONS WERE MORE APPROPRIATE TO MAKE THE BIGGEST IMPACT. SCHEDULE H, PART V, SECTION B, LINE 13H OTHER FACTORS USED IN DETERMINING AMOUNTS CHARGED TO PATIENTS: THE NUMBER OF MEMBERS OF A HOUSEHOLD ARE ALSO CONSIDERED IN CALCULATING AMOUNTS CHARGED TO PATIENTS. SCHEDULE H, PART V, SECTION B, LINE 16 MEANS BY WHICH HOSPITAL PUBLICIZED POLICY: THE HOSPITALS FINANCIAL ASSISTANCE POLICY AND APPLICATION CAN BE FOUND AT THIS WEBSITE: http://hillcountrymemorial.org/page/patient-information/financial-assistan ce-forms/ THE FINANCIAL ASSISTANCE POLICY IS ALSO PUBLICIZED THROUGH AREA PHYSICIAN PRACTICES. SCHEDULE H, PART V, SECTION B, LINE 18 & 19 BILLING AND COLLECTIONS UNDER FACILITY'S FAP: NEITHER HILL COUNTRY MEMORIAL HOSPITAL, NOR THIRD PARTIES AUTHORIZED BY HILL COUNTRY MEMORIAL HOSPITAL, TAKE ANY ACTIONS UPON NON-PAYMENT FROM A PATIENT BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART V, SECTION B, LINE 20E OTHER ACTIONS TAKEN BEFORE ANY COLLECTION ACTIONS: PATIENT ACCOUNT REPRESENTATIVES CONTACT PATIENTS BY PHONE BEFORE INITIATING COLLECTION ACTIONS. SCHEDULE H, PART V, SECTION B, LINE 22D OTHER BILLING DETERMINATION OF THOSE ELIGIBLE FOR FINANCIAL ASSISTANCE: THE HOSPITAL CHARGE MASTER BILLS A STANDARD AMOUNT FOR ALL PATIENTS, THEREBY INSURING THAT THOSE THAT QUALIFY FOR FINANCIAL ASSISTANCE AND THE INSURED ARE BILLED THE SAME AMOUNT. ADDITIONALLY, PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE ARE OFFERED DISCOUNTS BASED ON THEIR INCOME LEVELS COMPARED TO FEDERAL POVERTY GUIDELINES (FPG). PATIENTS WITH INCOME AT OR BELOW 200% FPG HAVE 100% OF THE BALANCE ADJUSTED. PATIENTS WITH ABOVE 200% AND UNDER 225% OF FPG HAVE 80% OF THE BALANCE ADJUSTED. PATIENTS WITH INCOME OVER 225% AND UNDER 250% OF FPG HAVE 60% OF THE BALANCE ADJUSTED. PATIENTS WITH INCOME OVER 250% AND UNDER 275% OF FPG HAVE 40% OF THE BALANCE ADJUSTED. PATIENTS WITH INCOME OVER 275% AND UNDER 300% OF FPG HAVE 20% OF THE BALANCE ADJUSTED. THOSE WITH INCOME OVER 300% OF FPG DO NOT QUALIFY AS FINANCIALLY INDIGENT. SCHEDULE H, PART I, LINE 7, COLUMN F FINANCIAL ASSISTANCE & CERTAIN OTHER COMMUNITY BENEFITS AT COST: THE AMOUNT OF BAD DEBT EXPENSES REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT PERCENTAGE WAS $5,135,075. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT: THE AMOUNT ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION A, LINE 3 Bad Debt Attributable to patients eligible under Financial Assistance Policy: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT FOOTNOTE: Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for uncollectible accounts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for uncollectible accounts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). 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 Hospital records a significant provision for uncollectible accounts 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 standard rates (or the discounted rates if negotiated or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The Hospitals allowance for uncollectible accounts for self-pay patients was approximately 95% of self-pay accounts receivable at December 31, 2014 and December 31, 2013. Patient write-offs decreased from approximately $6,520,000 in 2013 to approximately $5,645,000 in 2014. The decrease in write-offs is the result of positive trends experienced in collections of amounts from self-pay patients in 2014. SCHEDULE H, PART III, SECTION B, LINE 8a COSTING METHODOLOGY: THE HOSPITAL USES COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. THE ORGANIZATION HAD A MEDICARE SHORTFALL IN THE AMOUNT OF $2,111,830. THE STATE OF TEXAS TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT FOR MEETING STATUTORY REQUIREMENTS FOR CHARITY CARE AND COMMUNITY BENEFIT. SCHEDULE H, PART III, SECTION B, LINE 9B PROVISIONS ON COLLECTION PRACTICES FOR QUALIFIED PATIENTS: HILL COUNTRY MEMORIAL HOSPITAL'S COLLECTION POLICY EXCLUDES PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. OTHER FACTORS ARE USED IN DETERMINING AMOUNTS CHARGED TO PATIENTS. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: HILL COUNTRY MEMORIAL ASSESSES THE NEEDS OF THE COMMUNITY THROUGH PATIENT SURVEYS. PATIENTS RECEIVING CARE IN THE FOLLOWING SERVICE LINES ARE RANDOMLY SURVEYED BY PRESS GANEY, AN INDEPENDENT HOSPITAL AUDITING FIRM WHICH AUDITS 1800 HOSPITALS IN THE UNITED STATES: IN-PATIENT CARE, OUT-PATIENT CARE, ER, AND HOME HEALTH. THE FOLLOWING SERVICE LINES ARE SURVEYED IN AN HCM PAPER-GENERATED SURVEY DISSEMINATED AT THE POINT OF DISMISSAL: HILL COUNTRY MEMORIAL BREAST CENTER AND HILL COUNTRY MEMORIAL SLEEP LAB. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: HILL COUNTRY MEMORIAL PATIENTS SPEAK WITH A HILL COUNTRY MEMORIAL BUSINESS OFFICE REPRESENTATIVE BEFORE CARE TO DETERMINE IF THEY ARE ELIGIBLE FOR ASSISTANCE UNDER THE FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS OR THE ORGANIZATION'S CHARITY CARE POLICY. THE PATIENT'S ELIGIBILITY IS ASSESSED AND CAREFULLY MANAGED, SO THAT IF HE/SHE OVERPAYS, HE/SHE IS REIMBURSED THE RECONCILING AMOUNT. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: THE ORGANIZATION SERVES EIGHT COUNTIES IN THE HILL COUNTRY: GILLESPIE, BLANCO, BURNET, KENDALL, KERR, KIMBLE, MASON, AND LLANO. THE PRIMARY SERVICE AREA OF GILLESPIE COUNTY (POP. 25,753) ACCOUNTS FOR ABOUT 59% OF HILL COUNTRY MEMORIAL PATIENTS. THE TOTAL SERVICE AREA POPULATION IS 191,806, AND THE AVERAGE PATIENT AGE IS 69 YEARS OLD. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: THE ORGANIZATION FURTHERS ITS EXEMPT PURPOSE THROUGH UP TO 40 PUBLIC HEALTH EVENTS AND SCREENINGS A YEAR WHICH ARE ADVERTISED AND WELL ATTENDED. THE HILL COUNTRY MEMORIAL WELLNESS CENTER OFFERS REMOTE IMMUNIZATION "DRIVE-THRUS" TO INCREASE IMMUNIZATION VOLUMES. EMPLOYEES DEVOTE TIME AND MONEY TO THE COMMUNITY NEEDS COUNCIL TO FURNISH SCHOOL SUPPLIES TO ELIGIBLE CHILDREN, TO THE AREA FOOD BANK FOR THE HUNGRY, AND TO THE LOCAL BOYS AND GIRLS CLUB FOR COMMUNITY CHILDREN ACTIVITIES. THE AUXILLARY, HOSPITAL VOLUNTEER ORGANIZATION, RAISES FUNDS TO FURTHER EMPLOYEE HEALTH CARE EDUCATION, WHICH NURTURES THE AVAILABLE WORKFORCE. THE ORGANIZATION HAS THE LARGEST VOLUNTEER BASE IN FREDERICKSBURG. ALSO, FUNDS WERE DONATED TO RELAY FOR LIFE, HEALTH OCCUPATION STUDENT ASSOCIATION (HOSA), AND EISHBAHN. EMPLOYEES ALSO SERVED IN LEADERSHIP ROLES FOR COMMUNITY ORGANIZATIONS. HILL COUNTRY MEMORIAL ALSO COLLABORATES WITH CITY AND COUNTY OFFICIALS TO PREPARE FOR EMERGENCY SCENARIOS. HILL COUNTRY MEMORIAL INVITES CITY AND COUNTY EMERGENCY OFFICIALS TO PARTICIPATE IN MOCK EMERGENCY SITUATIONS TO PREPARE FOR AN ACTUAL, LIKELY EMERGENCY BASED ON THE GEOGRAPHIC PROXIMITY OF THE HOSPITAL, SUCH AS A TORNADO OR MAJOR CHEMICAL SPILL. COLLABORATING WITH THE CITY OF FREDERICKSBURG, PHYSICIANS AND THE FREDERICKSBURG CHAMBER OF COMMERCE, HILL COUNTRY MEMORIAL FUNDED THE CREATION OF AN ARCHITECTURAL PLAN FOR THE CENTER. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: THE HOSPITAL IS PART OF A SYSTEM WHICH INCLUDES TEN ORGANIZATIONS. HILL COUNTRY MEMORIAL HOSPITAL PROVIDES HEALTHCARE; HILL COUNTRY MEMORIAL FOUNDATION PROVIDES FUNDRAISING; HILL COUNTRY PHYSICIAN ASSOCIATES PROVIDES HEALTHCARE; HILL COUNTRY PRIMARY CARE PHYSICIANS PROVIDES HEALTHCARE; AND GREATER HILL COUNTRY HOSPICE PROVIDES HOSPICE SERVICE. IN ADDITION, THE AFFILIATED HEALTH CARE SYSTEM INCLUDES THE FOLLOWING INACTIVE ENTITIES: HILL COUNTRY MEMORIAL HEALTH SYSTEM, HILL COUNTRY COMMUNITY SERVICES, HILL COUNTRY MEMORIAL OFFICE BUILDING, AND HILL COUNTRY WELLNESS CENTER. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: TEXAS false hill country memorial foundation 1020 kerrville hwy fredericksburg TX 78624 450599888 501(C)(3) 83345 FMV CHARITABLE SUPPORT 1 SCHEDULE I, PART I, LINE 2 PROCEDURE FOR MONITORING THE USE OF GRANTS IN THE U.S.: THE ORGANIZATION DOES NOT USUALLY GIVE GRANTS TO OTHER ORGANIZATIONS OR INDIVIDUALS. THE GRANT LISTED ABOVE IS TRANSFER OF CASH IN SUPPORT OF THE HILL COUNTRY MEMORIAL FOUNDATION, A RELATED ORGANIZATION, FROM THE HILL COUNTRY MEMORIAL AUXILIARY. X X X false false false false false false false false false JAYNE POPE CEO 319722 0 67500 0 0 0 0 0 24466 0 411688 0 0 0 MARK JONES CFO 266029 0 39000 0 7500 0 0 0 18802 0 331331 0 0 0 DEBRA DOOLEY EXECUTIVE DIRECTOR 215559 0 31500 0 0 0 0 0 22900 0 269959 0 0 0 MICHAEL BROWN LEAN SPECIALIST 261693 0 0 0 0 0 0 0 0 0 261693 0 0 0 JEFF DARNABY LEAN SPECIALIST 211474 0 1536 0 9563 0 0 0 1959 0 224532 0 0 0 HOLLY SCHMIDT EXECUTIVE DIRECTOR 140935 0 18000 0 4020 0 0 0 22662 0 185617 0 0 0 EMILY PADULA EXECUTIVE DIRECTOR 146519 0 14513 0 0 0 0 0 0 0 161032 0 0 0 MIKE RENO COO 253379 0 14063 0 0 0 0 0 28215 0 295657 0 0 0 JAMES R PARTIN CMO 268907 0 39750 0 0 0 0 0 27390 0 336047 0 0 0 MAUREEN POLIVKA CNO 180261 0 21250 0 0 0 0 0 0 0 201511 0 0 0 FORM 990, PART III, LINE 4D DESCRIPTION OF OTHER PROGRAM SERVICES: WIC PROGRAM - PROVIDE NUTRITIONAL EDUCATION, BREAST FEEDING SUPPORT, WIC FOODS AND SOCIAL SERVICE REFERRALS FOR WOMEN AND CHILDREN MEETING WIC ELIGIBILITY REQUIREMENTS; AND COMMUNITY HEALTH PROGRAMS SUCH AS IMMUNIZATIONS FOR CHILDREN. FORM 990, PART VI, SECTION A, LINE 1 DELEGATION OF AUTHORITY: THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRMAN, VICE-CHAIRMAN, SECRETARY AND ONE AT-LARGE TRUSTEE. THE CEO AND CHIEF OF THE HOSPITAL'S MEDICAL STAFF SHALL BE EX-OFFICIO, NON-VOTING MEMBERS OF THE EXECUTIVE COMMITTEE. THE COMMITTEE SHALL HAVE THE POWER TO TRANSACT BUSINESS OF THE CORPORATION AND THE HOSPITAL SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD. THE EXECUTIVE COMMITTEE SHALL HAVE SUCH ADDITIONAL DUTIES AND RESPONSIBILITIES AS MAY BE SET FORTH IN THE BYLAWS. ACTIONS OF THE EXECUTIVE COMMITTEE SHALL BE BROUGHT TO THE BOARD AT THE NEXT REGULAR MEETING FOR RATIFICATION. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION REVIEW & APPROVAL PROCESS FOR CEO: THE EXECUTIVE COMMITTEE OF THE BOARD REVIEWS RELEVANT WAGE SURVEY AND DATA TO DETERMINE CEO COMPENSATION. DATA AND SURVEYS SUPPLIED BY THE HUMAN RESOURCE DIRECTOR. AND REPORTED TO THE HOSPITAL BOARD. BOARD MEMBERS MUST RECUSE THEMSELVES FROM VOTING ON ISSUES RELATED TO THEIR CONFLICT. FORM 990, PART VI, SECTION B, LINE 15B COMPENSATION REVIEW & APPROVAL PROCESS FOR OTHER OFFICERS: THE CEO REVIEWS WAGE DATA AND SURVEYS SUPPLIED BY THE HUMAN RESOURCE DIRECTOR. DATA TO DETERMINE CEO COMPENSATION. DATA AND SURVEYS SUPPLIED BY THE HUMAN RESOURCE DIRECTOR. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 9 OTHER CHANGES IN NET ASSETS: CHANGE IN TEMPORARILY RESTRICTED NET ASSETS $ 3,153,521 CHANGE IN PERMANENTLY RESTRICTED NET ASSETS 120,959 FOUNDATION CONTRIBUTION (2,525,355) --------------------- TOTAL $ 749,125 FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: THE HOSPITAL BOARD HAS GIVEN THE AUDIT COMMITTEE THE RESPONSIBILITY TO REVIEW THE FORM 990. THE CFO DISCUSSES EACH SECTION WITH THE COMMITTEE AND DISCUSSES ANY ISSUES TO BE ADDRESSED FOR FUTURE YEARS. ALL BOARD MEMBERS ARE ALSO PROVIDED A LINK TO ACCESS THE 990 FOR REVIEW BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: CONFLICT OF INTEREST FORMS ARE COMPLETED BY BOARD MEMBERS ON AN ANNUAL BASIS. ALL DISCLOSURES ARE REVIEWED BY THE BOARD GOVERNANCE COMMITTEE AND REPORTED TO THE HOSPITAL BOARD. BOARD MEMBERS MUST RECUSE THEMSELVES FROM VOTING ON ISSUES RELATED TO THEIR CONFLICT. HILL COUNTRY MEMORIAL AUXILIARY 1020 KERRVILLE HWY FREDERICKSBURG TX 78624 SUPPORT TX -83345 0 HCMH HILL COUNTRY MEMORIAL HOSPITAL SYSTEM 1020 KERRVILLE HWY FREDERICKSBURG TX 78624 742858904 SUPPORT TX 501(C)(3) 11A HCMH true HILL COUNTRY MEMORIAL FOUNDATION 1020 KERRVILLE HWY FREDERICKSBURG TX 78624 742557105 FUNDRAISING TX 501(C)(3) 11C NA false HILL COUNTRY MEMORIAL COMMUNITY SERVICES 1020 KERRVILLE HWY FREDERICKSBURG TX 78624 742858907 HOME CARE SRV TX 501(C)(3) 11C HCMH true HILL COUNTRY MEM MEDICAL OFFICE BLDG 1020 KERRVILLE HWY FREDERICKSBURG TX 79624 742858909 OFFICE BLDG TX 501(C)(3) 11C HCMH true HILL COUNTRY WELLNESS CENTER 1020 KERRVILLE HWY FREDERICKSBURG TX 78624 742858905 HEALTH ED TX 501(C)(3) 11C HCMH true HILL COUNTRY PHYSICIAN ASSOCIATES 1020 KERRVILLE HWY FREDERICKSBURG TX 78624 262553196 HEALTHCARE TX 501(C)(3) 11A HCMH true HILL COUNTRY PRIMARY CARE PHYSICIANS 1020 KERRVILLE HWY FREDERICKSBURG TX 78624 272860109 HEALTHCARE TX 501(C)(3) 3 HCMH true GREATER HILL COUNTRY HOSPICE P O BOX 835 FREDERICKSBURG TX 78624 742912643 HOSPICE TX 501(C)(3) 3 HCMH true HEALTHCARE PARTNERSHIP OF GREATER SAN AN 551 HILL COUNTRY DRIVE KERRVILLE TX 78028 450599888 HEALTHCARE TX 501(C)(3) 7 NA false HILL COUNTRY MEMORIAL SURGERY CENTER 204 GATEWAY CIRCLE A MARBLE FALLS TX 78654 331039828 SURGERY CENTER TX HCMH RELATED -267647 227010 false 0 false 0.51000 false false true false false false false false false true false false true true true false true true false GREATER HILL COUNTRY HOSPICE Q 3039332 FMV HILL COUNTRY PHYSICIAN ASSOCIATES r 160739 FMV HILL COUNTRY PRIMARY CARE PHYSICIANS R 2039656 FMV HILL COUNTRY MEMORIAL SURGERY CENTER R 450151 FMV