2015-05-14T10:45:57-05:00 2014-06-30 BKD LLP 14241 DALLAS PKWY STE 1100 DALLAS TX 75254 990 2013-07-01 751976930 Mother Frances Hospital - Jacksonville % MOTHER FRANCES HOSP ACCT DEP MOTH 9036065783 1315 Doctors Drive Suite Tyler TX 75701 JOYCE HESTER CFO 9036065783 2015-05-15 true Jeanette Verrelli P00742631 9036065783 2013 2016-02-25 16:41:14Z THOMAS N CAMMACK JR 2026 SOUTH JACKSON JACKSONVILLE TX 75766 46642153 false X WWW.TMFHc.ORG/JACKSONVILLE X 2000 TX TO PROVIDE THE COMMUNITY WITH A FULL range of comprehensive healthcare services without regard to race, creed, sex, national origin, handicap, age or ability to pay. 7 2 173 8 0 0 5109 0 40092036 46642153 0 0 2434 0 40099579 46642153 1133785 3501907 0 0 10110064 9933345 0 0 0 27225733 29292962 38469582 42728214 1629997 3913939 18821914 24763091 3109679 5136917 15712235 19626174 TO PROVIDE THE COMMUNITY WITH A FULL RANGE OF COMPREHENSIVE HEALTHCARE SERVICES WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. false false 37693904 3501907 46642153 THE HOSPITAL'S OPERATING PLAN INCORPORATES PROVISIONS FOR INDIVIDUALS WHO DO NOT POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. OUR COMMITMENT TO OUR COMMUNITY EXTENDS TO FREE OR SUBSIDIZED INDIVIDUAL CARE, SUBSIDIZED EDUCATION OF HEALTHCARE PROFESSIONALS, DISCOUNTED FEES FOR PARTICIPANTS IN GOVERNMENT PROGRAMS, COMMUNITY HEALTH EDUCATION AND DONATIONS TO OTHER COMMUNITY AGENCIES. SPECIFIC COMMUNITY SERVICES AND PROGRAMS INCLUDE: WELLNESS AND PREVENTION EDUCATION PROGRAMS, COMMUNITY dIAGNOSTIC SCREENING PROGRAMS, SENIOR CITIZEN HEALTH AWARENESS PROGRAMS, AWARENESS PROGRAMS FOR YOUTH AT RISK, AND AWARENESS PROGRAMS FOR PERSONS WITH SPECIAL PHYSICAL OR MENTAL NEEDS. 37693904 true false false true false false false false false true true false 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 true false false false false false false true false false false true X 29 0 true 173 true false false false false false false false false false false X 7 2 false false false false true true true true true false false true true true true true true true true false X MOTHER FRANCES HOSP ACCT DEP 9036065783 1315 DOCTORS DRIVE TYLER TX 75701 X THOMAS N CAMMACK JR CEO/DIRECTOR/SECRETARY/TREAS 40.0 0.0 X X 282666 0 22843 MATTHEW A VIERKANT MD DIRECTOR 10.0 30.0 X 0 494736 30781 RAY THOMPSON SYS EXEC/VP/DIRECTOR/CHAIR 1.0 39.0 X X 36966 1441703 25752 GLEN T HAMILTON DIRECTOR/VICE CHAIR 10.0 0.0 X X 0 0 WILLIAM MILAWSKI MD DIRECTOR 40.0 0.0 X 0 223539 26046 DICK STONE DIRECTOR 1.0 1.0 X RANDY GORHAM DIRECTOR 1.0 0.0 X J LINDSEY BRADLEY JR SYSTEM PRESIDENT 1.0 39.0 X 42408 1653906 25752 MICHAEL LEWIS COO 40.0 0.0 X 132085 0 18233 JOYCE HESTER SR. VICE PRESIDENT/CFO 5.0 35.0 X 54709 382961 23252 BARRY L THIBODEAUX CRNA 40.0 0.0 X 255073 0 10754 JACK CAPPS CRNA 40.0 0.0 X 250069 0 26128 BEN BEATHARD RN 40.0 0.0 X 103650 22457 KLEANTHE CARUSO CNO 40.0 0.0 X 140324 0 2878 WILLIAM BELLENFANT SR SR VP/CFO/DIRECTOR/TREASURER 0.0 0.0 X 0 213528 0 1297950 4410373 234876 6 true true false 0 0 NET PATIENT REVENUE 621110 40978334 40978334 UPL MEDICAID REVENUE 900099 3373592 3373592 EHR INCENTIVE REVENUE 900099 354629 354629 PHARMACY REVENUE 446110 1812973 1812973 RELATED RENTAL REVENUE 532000 73404 73404 49221 49221 46642153 0 0 0 0 0 0 0 0 0 0 0 46642153 46642153 X 3501907 3501907 0 0 0 615031 501806 113225 62837 50977 11860 7484847 6099664 1385183 120939 107636 13303 1138507 884422 254085 511184 454954 56230 42177 42177 0 0 0 0 0 13057222 12811133 246089 33646 33646 134452 40975 93477 94839 81453 13386 0 2705303 438854 2266449 7104 6226 878 0 5655 3246 2409 0 0 378624 378624 59124 59124 BAD DEBT EXPENSE 8864106 8864106 MEDICAL SUPPLIES 3157326 3133422 23904 FOOD 108209 105761 2448 REPAIRS AND MAINTENANCE 506116 491343 14773 139059 116019 23040 42728214 37693904 5034310 0 -302033 1849 0 0 0 0 7096065 4282611 0 0 0 0 0 0 147465 167997 74805 83193 6604666 5463739 1469963 1140927 0 0 0 0 0 0 0 0 10335649 19086514 18821914 24763091 1919135 1440221 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1190544 3696696 3109679 5136917 X 15712235 19626174 0 0 0 0 15712235 19626174 18821914 24763091 3913939 X false true X true false X X true false false false false false true 624 false false false 624 false GRANTS FOR LOBBYING PURPOSES: 23.65% OF AHA DUES WERE EXPENDED FOR SPECIFIC LOBBYING PURPOSES BASED ON MEDICARE DEFINITION OF UNALLOWABLE EXPENSES. 2414694 360569 13191 2762072 2408876 163752 157934 2414694 2350337 30875 27664 2408876 2209013 50 141274 2350337 414414 1790794 4305 500 2209013 0.74260 0.25740 false true true 6604666 5463739 1140927 1140927 DUE FROM AFFILIATES 17541036 DUE FROM THIRD-PARTY PAYERS 1545478 19086514 0 DUE TO THIRD PARTY PAYERS 3397006 EST SELF-INSURANCE COSTS 299690 3696696 X 37778047 -8864106 -8864106 46642153 46642153 33864108 33864108 8864106 8864106 42728214 schedule d, part x, line 2 liability for uncertain tax positions: The System, the Hospital, RMSA, the Clinic, Jacksonville and Winnsboro have been recognized as exempt from income taxes under Section 501 of the Internal Revenue Code (IRC) and a similar provision of state law. However, these entities are subject to federal income tax on any unrelated business taxable income. THFIC is not considered to be engaged in a United States trade or business and, therefore, is not subject to United States income taxes. If THFIC were to be considered engaged in a United States trade or business, it could be subject to federal income tax. THFIC is currently exempt from income taxes in the Cayman Islands. Accordingly, no provision for taxes has been made. With a few exceptions, the Health System is no longer subject to U.S. federal examinations by tax authorities for years before 2011. schedule d, part xi, line 2d reconciliation of revenue per audited financial statements with return: bad debt expense $(8,864,106) schedule d, part xii, line 4b reconciliation of expense per audited financial statements with return: bad debt expense $ 8,864,106 schedule d, part v, line 4 intended use of endowment funds: THE ORGANIZATION HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR THE ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS AND ITEMS SUPPORTED BY THE ENDOWMENT WHILE SEEKING TO MAINTAIN ITS PURCHASING POWER. true true X true X true X true true true false true true 1409747 1409747 0.04160 4531592 6043133 -1511541 2086747 1281379 805368 0.02380 8028086 7324512 703574 0.06540 7598 7598 0.00020 103187 103187 0.00300 3501907 3501907 0.10340 3612692 3612692 0.10660 11640778 7324512 4316266 0.17200 false 8864106 0 9157887 8469154 688733 X true true 1 1 mother frances hospital-jacksonville 1026 jackson street jacksonville TX 75766 www.tmfhc.org/jacksonville 007254 X X X X mother frances hospital-jacksonville 1 true X X X X X X X X X 12 true false true X see part v, section c X X X false false true true 200. true 400. true X X X X X X X X true true X X X X X X true false X X X true X false false schedule h, part v, section b, line 3 representatives from the community: MOTHER FRANCES HOSPITAL - JACKSONVILLE CONDUCTED 8 INTERVIEWS WITH THE THREE GROUPS OUTLINED IN IRS NOTICE 2011-52. DURING THESE iNTERVIEWS THE HOSPITAL DISCUSSED THE HEALTH NEEDS OF THE COMMUNITY, ACCESS ISSUES, BARRIERS AND ISSUES RELATED TO SPECIFIC POPULATIONS. THE INTERVIEWEES WERE INDIVIDUALS FROM THE FOLLOWING GROUPS: BEN AND MAYTEE FISCH FOUNDATION, SENIOR CARE JACKSONVILLE, TEXAS DEPARTMENT OF STATE HEALTH SERVICES, ETCOG AREA AGENCY ON AGING, CHEROKEE COUNTY FAMILY SERVICES BOARD, NORTHEAST TEXAS PUBLIC HEALTH DISTRICT, UNITED FUND OF CHEROKEE COUNTY, AND CHEROKEE COUNTY PUBLIC HEALTH DEPARTMENT. schedule h, part v, section b, line 5 chna available to the public: The hospital's chna and implementation strategy is available upon request and at the following website: http://www.tmfhc.org/comprehensive-community-health-needs-assessments schedule h, part v, section b, line 7 needs identified in chna not addressed: MOTHER FRANCES HOSPITAL - JACKSONVILLE DECIDED NOT TO SPECIFICALLY ADDRESS THE NEED FOR "ACCESS TO DENTAL SERVICES," LARGELY DUE TO ITS POSITION (LAST) ON THE PRIORITIZED LIST AND THE HOSPITAL'S CAPACITY TO ADDRESS THAT NEED. DENTAL SERVICES ARE NOT A CORE BUSINESS FUNCTION OF THE HOSPITAL AND THE LEADERSHIP TEAM FELT THAT RESOURCES AND EFFORTS WOULD BE BETTER SPENT ADDRESSING THE FIRST SIX PRIORITIZED NEEDS. FURTHERMORE, AT LEAST ONE LOCAL DENTAL PROVIDER ACCEPTS MEDICAID AND CHIP. schedule h, part v, section b, lines 16, 17, & 18 billing and collections: NEITHER MOTHER FRANCES HOSPITAL - JACKSONVILLE, NOR THIRD PARTIES AUTHORIZED BY MFH-J, TAKE ANY ACTIONS UPON NON-PAYMENT FROM A PATIENT BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY. schedule h, part v, section b, line 20d Determination of FAP-Eligible individuals for emergency and other medical care: For selfpay patients that show to be FAP Eligible, we discount based upon their proven FPL percentage (100%, 75% or 50%). These amounts combined with the auto-Selfpay discount of 45% gets us to a rate comparable to lowest managed care or Medicare rates. schedule h, part i, line 7, column f percent of total expense: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE, TOTALING $8,864,106. schedule h, part iii, section a, line 2 bad debt expense: the amount reported on line 2 is bad debt expense per the audited financial statements. schedule h, part iii, section a, line 3 bad debt as community benefit: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. BAD DEBT EXPENSE SHOULD BE CONSIDERED COMMUNITY BENEFIT BECAUSE THIS IS UNCOMPENSATED HEALTHCARE PROVIDED TO RESIDENTS OF THE COMMUNITY. schedule h, part iii, section a, line 4 footnote to the financial statements describing bad debt: Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectibility of accounts receivable, the Health System analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and the provision for uncollectible accounts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Health System analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for uncollectible accounts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). The Hospital records an automatic discount of its standard charges for uninsured patients. For the remaining receivables associated with self-pay patients, which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill, the Health System records a significant provision for uncollectible accounts in the period of service on the basis of its past experience. This indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the reduced standard rates (or the discounted rates if negotiated or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The Health Systems allowance for doubtful accounts was approximately 98% of self-pay accounts receivable at June 30, 2014 and 2013. The current year decrease in allowance for doubtful accounts is primarily the result of a reduction in gross accounts receivable and changes in the age and payer mix of accounts receivable at June 30, 2014, as compared to 2013. schedule h, part iii, section b, line 8 costing methodology: THE MEDICAL CENTER USES MEDICARE COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS (ROOM AND BOARD) BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. schedule h, part iii, section c, line 9b collection policy: THE ORGANIZATION HAS A WRITTEN POLICY COVERING PROCEDURES FOR COLLECTING AND WRITING OFF BAD DEBTS. ACCORDING TO THE POLICY, IF A PATIENT APPEARS TO BE INDIGENT, ACCOUNTS SHOULD BE REVIEWED, AT ANY TIME DURING THE COLLECTION PROCESS, FOR POSSIBLE CONSIDERATION AS A CHARITY CASE IN ACCORDANCE WITH THE ORGANIZATION'S CHARITY CARE POLICY. schedule h, part vi, line 2 needs assessment: THE HOSPITAL'S COMMUNITY HEALTH PROFILES PROVIDE A SNAPSHOT OF SUBURBAN, URBAN, AND RURAL SERVICE AREAS WITHIN TEXAS USING KEY HEALTH INDICATORS, WHICH FACILITATE COMPARISONS LOCALLY, REGIONALLY, AND OVER TIME. COMMUNITY HEALTH PROFILES ARE INTENDED TO ASSIST INTERNAL STAKEHOLDERS, COMMUNITY HEALTH COUNCIL MEMBERS, AND THE COMMUNITY HEALTH IMPROVEMENT DEPARTMENT IN DECIDING WHERE TO ALLOCATE RESOURCES AND ADDRESS HEALTH INEQUALITIES. ALL ENTITY ADVOCATES USE NATIONAL, STATE, AND LOCAL SECONDARY AND PRIMARY DATA SOURCES TO PROVIDE A CURRENT OVERVIEW OF LOCAL HEALTH NEEDS, FACTORS IMPACTING DISEASE AND INJURY BURDEN, SOCIOECONOMIC STATUS, ACCESS TO HEALTH CARE, AGE DISTRIBUTION, INDICATORS AND LIFESTYLE BEHAVIORS. THIS DATA IS USED TO GALVANIZE JOINT COMMUNITY HEALTH EFFORTS TO IMPROVE HEALTH AND REDUCE HEALTH INEQUALITIES AND TO EMPOWER THE greater community. schedule h, part vi, line 3 patient education of eligibility for assistance: THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND CONTACT INFORMATION IS POSTED IN VARIOUS AREAS OF THE HOSPITAL INCLUDING ADMISSIONS & REGISTRATION, EMERGENCY, AND OUTPATIENT DEPARTMENTS. ADDITIONALLY, FINANCIAL ASSISTANCE INFORMATION IS PROVIDED, VERBALLY AND IN WRITTEN BROCHURES, TO ALL SELF PAY PATIENTS BY FINANCIAL COUNSELORS. FINANCIAL ASSISTANCE INFORMATION IS ALSO INCLUDED IN EVERY PATIENT BILL. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO THE PATIENT BY FINANCIAL COUNSELORS WHO ALSO SCREEN SELF PAY PATIENTS FOR POTENTIAL ELIGIBILITY FOR OTHER GOVERNMENTAL ASSISTANCE PROGRAMS. IF IT IS DETERMINED THAT THE PATIENT IS POTENTIALLY ELIGIBLE FOR GOVERNMENTAL ASSISTANCE, THE FINANCIAL COUNSELOR WILL ASSIST THE PATIENT IN COMPLETING ANY FORMS NECESSARY TO APPLY FOR THE ASSISTANCE. AT THE SAME TIME, THE PATIENTS ARE PROVIDED WITH A CHARITY CARE APPLICATION AND INFORMATIONAL FLYER. THE PATIENT IS INFORMED THAT MOTHER FRANCES HOSPITAL-JACKSONVILLE IS A NON-PROFIT CHARITABLE ORGANIZATION OFFERING FINANCIAL ASSISTANCE TO PATIENTS WHO ARE DEEMED MEDICALLY OR FINANCIALLY INDIGENT. THE FINANCIAL COUNSELORS WILL THEN ASSIST THE PATIENT IN COMPLETING THE CHARITY CARE APPLICATION AND OBTAIN ANY AVAILABLE VERIFICATIONS. ONCE THE PATIENT IS DISCHARGED, THE FINANCIAL COUNSELORS WILL CONTINUE TO CONTACT THE PATIENT TO ENSURE ALL NEEDED FORMS AND VERIFICATIONS NEEDED TO FILE AN APPLICATION FOR GOVERNMENTAL ASSISTANCE AND CHARITY CARE HAVE BEEN PROVIDED. schedule h, part vi, line 4 community information: MOTHER FRANCES HOSPITAL-JACKSONVILLE IS A 25-BED ACUTE CARE MEDICARE CERTIFIED CRITICAL ACCESS HOSPITAL. CHEROKEE COUNTY, THE PRIMARY SERVICE AREA FOR MFH-JACKSONVILLE, HAS A POPULATION OF APPROXIMATELY 57,000 AND IS PRIMARILY 48,000 IN A 1,052 SQUARE MILE AREA. THE SECONDARY SERVICE AREA INCLUDES THE SOUTHERN PART OF SMITH COUNTY. schedule h, part vi, line 5 promotion of community health: MOTHER FRANCES HOSPITAL-JACKSONVILLE PROMOTES HEALTHCARE AND WELLNESS EDUCATION BY OFFERING OUTREACH PROGRAMS AND SPECIAL INITIATIVES THAT IMPROVE THE QUALITY OF LIFE AND HEALTH IN THE COMMUNITIES SERVED. COMMUNITY BENEFIT IS PROVIDED THROUGH MANY REDUCED PRICE SERVICES AND FREE PROGRAMS TO THE COMMUNITY. THESE SERVICES ARE ESSENTIAL TO PROVIDE COMPLETE HEALTHCARE TO THE COMMUNITIES SERVED, SOME OF THESE PROGRAMS INCLUDE THE FOLLOWING: Cherokee County Relay for Life - Provided sponsorship and staffing support for Cherokee County Relay for Life. Staff planned activities for the all - night event and manned the event. Staff (40 individuals) volunteers. The purpose of the program is To increase awareness about cancer and to help in fundraising efforts for a county that has an above average rate of cancer. Educational programs targeted the community at large but efforts were made to reach the uninsured. Jacksonville Chamber of Commerce - Job Shadowing - Students participated in job shadowing projects and heard from health care professionals about their jobs. They spent time in the areas to see firsthand what the jobs entailed. The purpose of the program is To provide young high school students the opportunity to learn more about health care professional and the healthcare work environment. Information was given on job opportunities and projected shortages of workers. To improve the opportunities for future employees who may also be bilingual to understand the health care opportunities. Jacksonville Rodeo - DHanded out fans and water to participants and spectators at the rodeo. Provided volunteers to interact on issues for 3 hours each of 3 nights. The purpose of the program is To help educate participants about the dangers of heat and injuries caused by extensive heat. Reached over 1,000 people with heat prevention information and medical support on site. Jacksonville Rotary, Access, and others - Provided sponsorship, staffing, and development of programs and events for the local community. Organizations included Lions Club, Rotary, Kiwanis, Access, Hope Center, United Fund, and American Cancer Society, Jacksonville Chamber of Commerce, Jacksonville Literacy Council. Members of the staff serve in leadership positions and as volunteers for programs on various boards and nonprofits in the community. These programs benefit the residents of the area and organizations that provide services which are not provided by the hospital but impact the health of the residents in Anderson/Cherokee Counties. Finding leadership talent for volunteer positions is an ever growing problem for all communities. Target population for services is the general public. Health Education Programs - Community education for healthy life styles focused to Women with Heart Disease was provided. Dinner and recognition for women across the region who were selected as champions for women affected by heart disease were recognized. Three (3) physicians gave health education presentations. 75 people were reached. Additionally screenings and education were offered through the Tomato Fest and Cherokee County Coop Health Fair. East Texas has an extremely high rate for diabetes, stroke, heart disease, and pulmonary disease. This east Texas region of the state has one of the fastest growing aging groups and high risk for ethnic minorities. The need to educate women on heart disease was targeted. Community Non Profits and Rural Hospital Support Programs - Mother Frances Hospital - Jacksonville provides direct financial support to not-for-profit organizations including the Chamber of Commerce, American Cancer Society, and Literacy Council. These organizations or agencies provide services that otherwise would have to be provided by Mother Frances Hospital - Jacksonville or could be preventing patients from entering our facilities, particularly the emergency room. Many provide education or research programs which are not available at MFH - J or it may be too far for their patients to travel to receive services at our primary facilities. This helps to improve access for vulnerable populations. Community Leadership Programs - Mother Frances Hospital-Jacksonville and the senior management team host and serve on key boards that encourage, and train leaders for the community. These boards also have the potential to direct and raise the awareness of healthcare needs of the area. The support and participation in these programs is to assist and lead in developing the future leaders of the community and region and to help them understand the crisis of access to health care in the region and the influence of governmental officials on healthcare services. Community Disaster Preparedness - Mother Frances Hospital - Jacksonville participated in the countywide disaster drill. It required staff to leave their regular job tasks and take on a community need and interact with law enforcement, fire departments, governmental agencies and EMS services. Over 500 people participated. The goal of the drill was to ensure community safety and readiness in the event a disaster occurs that requires direct or indirect medical services. How patients would appear and be triaged as well as transferred or admitted was included. Fundraising for not-for-profits - MFH - Jacksonville supports the United Fund Drive with an in-house program as well as Children's Miracle Network by raising money through direct financial donations, bake sales, jean days, special lunch offerings, etc. The goal is to raise money for services that otherwise would not be available for the community unless these monies were raised. The programs often target those less fortunate or have an open door policies for all those who need the care. Additionally, these programs provide new leadership opportunities for the staff. Improving the fragmented continuum of care - Implemented the new EHR, EPIC and the updates for the system including "My Chart" and the cell phone application. Achieved Stage 6 HIMSS Analytics HER adoption Model which recognizes an organization's accomplishments to implement technology solutions that have the ability to improve patient safety and quality of care. Additionally, recertified the MFH - Jacksonville Trinity Clinic as Medical homes. The goal is to improve the patient's experience as they transition through the continuum of care. This should reduce duplication of testing. Participation in initiatives that improve the patient's experience was identified as a need. Improving Access to specialty providers and services - Eight (8) specialty services came to Jacksonville at a significant cost to improve access to care to an aging population. Services included cardiology, pulmonology, oncology, urology, gastroenterology, podiatry, gynecology, and endocrinology. This also provided support for a critical access hospital and their patients. The objective is to increase access to additional specialist services and providers in the community. The 340B program continues to provide a much needed service to a vulnerable population to lower costs, and having students from the local high school have access to pre-participation physicals at no costs helps the families and the school. Access to mental health services - MFH - Jacksonville established a list of mental health providers in Cherokee County. While there are only two that provide services to vulnerable populations this information is made available. Additionally, the needs for more services in the area was identified and work within the larger health system was promoted. The need to identify access for affordable mental health services was identified as a community need. Information on referrals for available mental health services/resources is particularly needed in the emergency department. Reducing transportation barriers - MFH - Jacksonville established a list of transportation services available. This included the GoBus, medical transportation, and Jacksonville taxi service. Patients who need transportation are provided with these options. If necessary, assistance for payments can be made by the hospital if the needs is within the guidelines. The need to provide access and information about available transportation services to community members was identified as a community need. Blood Drives - TMF - Jacksonville hosted blood drives on two occasions targeted at the employees of the hospital and clinic. The events provided much needed blood for area patients. The major blood bank serving the area is always low on blood and this helps to increase the supply from a rural area. This is another way of supporting the emergency room and maintaining the needs of the CAH for local services to vulnerable populations to continue. schedule h, part vi, line 6 affiliated health care system: MOTHER FRANCES HOSPITAL - JACKSONVILLE IS PART OF AN AFFILIATED HEALTH CARE SYSTEM CALLED TRINITY MOTHER FRANCES HEALTH SYSTEM. TRINITY MOTHER FRANCES IS A FAITH-BASED ORGANIZATION DEDICATED TO CREATING HEALTHY LIVES FOR PEOPLE AND COMMUNITIES. MFH-JACKSONVILLE AND ITS AFFILIATES PROMOTE THE HEALTH OF THE COMMUNITIES SERVED BY PROVIDING ACUTE CARE FACILITIES AND CRITICAL ACCESS FACILITIES, WHOSE OPERATIONS CONSIST PRIMARILY OF PROVIDING INPATIENT AND OUTPATIENT ACUTE CARE AND MEDICAL SERVICES TO PATIENTS RESIDING IN EAST TEXAS. schedule h, part vi, line 7 state filing of community benefit report: texas true SERVICE ORGANIZATION OF PINEY WOODS 2950 50TH STREET LUBBOCK TX 79314 300630886 501(C)(3) 2418300 community HEALTHCARE SERVICE ORGANIZATION OF NORTH & EAST TEXAS 2950 50TH STREET LUBBOCK TX 79314 260468622 501(C)(3) 1083607 COMMUNITY HEALTHCARE 2 schedule i, part i, line 2 PROCESS FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S.: GRANT RECIPIENTS ARE REQUIRED TO ACKNOWLEDGE PRIOR TO THE ISSUANCE OF GRANT FUNDS THAT THE GRANT WILL BE USED IN ACCORDANCE WITH THE STATED PURPOSE OF THE GRANT APPLICATION AND ANY UNUSED FUNDS RELATED TO THE SPECIFIC PURPOSE OF THE GRANT WILL BE RETURNED TO THE ORGANIZATION. THE ORGANIZATION MONITORS AND REVIEWS THE FINANCIAL DATA OF RECIPIENTS TO ENSURE THAT THE GRANTED FUNDS ARE BEING USED PROPERLY. X true true X X X X X true true false false false false false false false THOMAS N CAMMACK JR CEO/DIRECTOR/SECRETARY/TREAS 233564 0 36937 0 12165 0 9493 0 13350 0 305509 0 0 0 MATTHEW A VIERKANT MD DIRECTOR 0 382034 0 81035 0 31667 0 10837 0 19944 0 525517 0 5629 RAY THOMPSON SYS EXEC/VP/DIRECTOR/CHAIR 18481 720769 18485 720934 0 0 271 10567 373 14541 37610 1466811 0 0 WILLIAM MILAWSKI MD DIRECTOR 0 145896 0 72766 0 4877 0 9453 0 16593 0 249585 0 0 J LINDSEY BRADLEY JR SYSTEM PRESIDENT 21876 853169 20532 800737 0 0 271 10567 373 14541 43052 1679014 0 0 MICHAEL LEWIS COO 130725 0 0 0 1360 0 5594 0 12639 0 150318 0 0 0 JOYCE HESTER SR. VICE PRESIDENT/CFO 40225 281571 14484 101390 0 0 1355 9483 1552 10862 57616 403306 0 0 BARRY L THIBODEAUX CRNA 255058 0 0 0 15 0 8771 0 1983 0 265827 0 0 0 JACK CAPPS CRNA 249474 0 0 0 595 0 9364 0 16764 0 276197 0 0 0 WILLIAM BELLENFANT SR SR VP/CFO/DIRECTOR/TREASURER 0 0 0 0 0 213528 0 0 0 0 0 213528 0 0 SCHEDULE J, PART I, LINE 1A TAX INDEMNIFICATION & GROSS UP PAYMENTS: AMOUNTS PAID FOR "GROSSED UP" GIFT CARDS ARE INCLUDED AS TAXABLE COMPENSATION FOR THE FOLLOWING individuals: BEN BEATHARD, BARRY L THIBODEAUX, MICHAEL LEWIS, AND THOMAS N CAMMACK JR. SCHEDULE J, PART I, LINE 4A SEVERANCE & Change of control payments: KLEANTHe CARUSO $60,299 william bellenfant sr $213,528 SCHEDULE J, PART I, LINE 4B PARTICIPATION IN OR PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PARTICIPANTS IN 457(F) REPORTED IN W-2 ---------------------- --------------- MATTHEW A VIERKANT MD $ 5,629 Deanna Hamilton family member of director 62837 salaries/wages false form 990, part vi, section a, line 1a delegation of authority: the executive committee shall have the power to transact all regular business of the governing board, during the period between the meetings of the governing board. The committee shall be subject to any prior limitation imposed by the board and with the understanding that all matters of major importance will be referred to the board at the next meeting. form 990, part vi, section a, line 6 MEMBERS OR STOCKHOLDERS: TRINITY MOTHER FRANCES HEALTH SYSTEM IS THE SOLE MEMBER OF MOTHER FRANCES HOSPITAL - JACKSONVILLE. form 990, part vi, section a, line 7a MEMBERS WHO MAY ELECT MEMBERS OF THE GOVERNING BOARD: THE SOLE MEMBER, TRINITY MOTHER FRANCES HEALTH SYSTEM, APPOINTS ALL DIRECTORS AND THEIR SUCCESSORS TO THE GOVERNING BOARD. form 990, part vi, section a, line 7b DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY THE MEMBER: THE MEMBER HAS THE RIGHT TO APPROVE OR DISAPPROVE CERTAIN ACTIONS THAT HAVE BEEN APPROVED BY THE BOARD OF DIRECTORS. form 990, part vi, section b, line 11b PROCESS TO REVIEW THE FORM 990: THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS AND A COPY IS PROVIDED TO THE BOARD PRIOR TO FILING. form 990, part vi, section b, line 12c PROCESS TO MONITOR AND ENFORCE CONFLICT OF INTEREST POLICY: THE BOARD REVIEWS AND RESOLVES, IF NECESSARY, ANY TRANSACTIONS AS THEY ARISE THROUGHOUT THE YEAR IN ACCORDANCE WITH POLICY STANDARDS. form 990, part vi, section b, lines 15a & 15b REVIEW OF COMPENSATION OF CEO, OFFICER, OR KEY EMPLOYEES: THE ORGANIZATION USES COMPENSATION CONSULTANTS AND NATIONAL COMPENSATION SURVEYS TO DETERMINE COMPENSATION OF EMPLOYEES. COMPENSATION IS APPROVED BY THE ORGANIZATION'S GOVERNING BODY. form 990, part vi, section c, line 19 availability of documents: the organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. FORM 990, PART V, LINE 1A 1099s reported by organization: THE ORGANIZATION'S 1099S ARE ISSUED BY A RELATED ORGANIZATION, MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER, WHO REPORTS ALL 1099S FOR THE ENTIRE SYSTEM AND ALLOCATES EXPENSES TO THE APPROPRIATE RELATED ORGANIZATION. FORM 990, PART VII, SECTION A, LINE 1A & sCHEDULE J, PART II compensation from related organizations: THE GOVERNING BOARD OF TRINITY MOTHER FRANCES HEALTH SYSTEM, UPON ADVICE FROM NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS, WHO PERIODICALLY REVIEW ALL EXECUTIVE COMPENSATION, APPROVED A DEFERRED COMPENSATION PLAN THAT PROVIDES A 65% TOTAL RETIREMENT BENEFIT FOR SENIOR EXECUTIVES THAT SERVE 20 YEARS OR MORE. THIS PROGRAM HAS BOTH RETENTION AND non-competition clauses that create a risk of forfeiture. DEFERRED COMPENSATION IS SUBJECT TO A RISK OF FORFEITURE BASED ON RETENTION, NON-COMPETITION AND OTHER CONTRACTUAL FACTORS. ACCRUALS OF DEFERRED COMPENSATION ARE NOT INCLUDIBLE IN W-2 COMPENSATION UNTIL PAID. OTHER EMPLOYEE BENEFITS INCLUDE QUALIFIED PENSION PLANS, HEALTH, DENTAL, AND LIFE INSURANCE PLANS, DISABILITY INSURANCE, ETC. TAXABLE EXPENSES ARE INCLUDED IN THE W-2 PAID COMPENSATION SALARY AMOUNT. form 990, part ix, line 11g other fees for services: professional fees $ 7,190,562 corporate expense 3,882,797 purchased services 1,911,037 contract labor 72,826 ------------------- total $ 13,057,222 MOTHER FRANCES HOSPITAL - WINNSBORO 1315 DOCTORS DRIVE TYLER TX 75701 752771569 HOSPITAL TX 501(C)(3) 3 TMFHS false TRINITY MOTHER FRANCES HEALTH SYSTEM FDN 1315 DOCTORS DRIVE TYLER TX 75701 752028241 SUPPORT TX 501(C)(3) 11, TYPE I TMFHS false REGIONAL MEDICAL SERVICES ASSOCIATION 1315 DOCTORS DRIVE TYLER TX 75701 752511459 HEALTHCARE TX 501(C)(3) 3 MFH REG false TRINITY MOTHER FRANCES HEALTH SYSTEM 1315 DOCTORS DRIVE TYLER TX 75701 752616975 SUPPORT TX 501(C)(3) 11, TYPE I NA false TRINITY CLINIC 1315 DOCTORS DRIVE TYLER TX 75701 752616977 HEALTHCARE TX 501(C)(3) 3 TMFHS false MOTHER FRANCES HOSPITAL REGIONAL HC CTR 1315 DOCTORS DRIVE TYLER TX 75701 750818167 HOSPITAL TX 501(C)(3) 3 TMFHS false TRI-STATE FINANCIAL LLC 1315 DOCTORS DRIVE TYLER TX 75701 752728318 DORMANT TX TMFHS C-corporation false TRINCARE INC 1315 DOCTORS DRIVE TYLER TX 75701 752161369 RETAIL HEALTH SVC TX TMFHS C-corporation false HEALTHPLAN OF TEXAS INC 1315 DOCTORS DRIVE TYLER TX 75701 752636832 THIRD PARTY ADMIN TX TMFHS C-corporation false THE REGIONAL HEALTHCARE ALLIANCE 1315 DOCTORS DRIVE TYLER TX 75701 752484109 PREFER PROVIDER TX TMFHS C-corporation false TEXAS HEALTH FACILITIES INSUR CORP LTD PO BOX 1109 BWI GRAND CAYMAN CJ 980136025 INSURANCE CJ MFH REG C-corporation false CONCORDIUM HEALTH LLC 1315 DOCTORS DRIVE TYLER TX 75701 702811022 INACTIVE TX NA C-corporation false false false false false false false false false false false true false true true true true true false false SCHEDULE R, PART II, COLUMN F direct controlling entity: THE FOLLOWING RELATED ORGANIZATIONS REPORTABLE IN PART II ARE DIRECTLY CONTROLLED BY TRINITY MOTHER FRANCES HEALTH SYSTEM ("TMFHS"): MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER TRINITY MOTHER FRANCES HEALTH SYSTEM FOUNDATION TRINITY CLINIC MOTHER FRANCES HOSPITAL - WINNSBORO REGIONAL MEDICAL SERVICES ASSOCIATION IS DIRECTLY CONTROLLED BY MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER ("MFH REG").