MOTHER FRANCES HOSPITAL JACKSONVILLE: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MOTHER FRANCES HOSPITAL JACKSONVILLE (EIN 75-1976930)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-15
- IRS object ID
- 201401359349306635
- Schema version
- 2012v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-15T14:03:07-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2800 Post Oak Blvd Ste 3200 | AddressLine1 |
| City | HOUSTON | City |
| State | TX | State |
| ZIP Code | 77056 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 751976930 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOTHER FRANCES HOSPITAL - JACKSONVILLE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % MFH ACCOUNTING DEPARTMENT | InCareOfName |
| Name Control | MOTH | NameControl |
| Phone | 9035315764 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1315 DOCTORS DRIVE | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | TYLER | City |
| State | TX | State |
| ZIP Code | 75701 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOYCE HESTER | Name |
| Title | CFO | Title |
| Phone | 9035314542 | Phone |
| Date Signed | 2014-05-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Amanda Maya | Name |
| Phone | 7134994600 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | RAY THOMPSON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 910 E HOUSTON SUITE 500 | AddressLine1 |
| City | TYLER | City |
| State | TX | State |
| ZIP Code | 75702 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 40099579 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.TMFHS.ORG/JACKSONVILLE | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2000 | YearFormation |
| State Legal Domicile | TX | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 3 | NbrIndependentVotingMembers |
| Total Nbr Employees | 179 | TotalNbrEmployees |
| Total Nbr Volunteers | 3 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 5109 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 37803399 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 40092036 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 10 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2434 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 37803409 | TotalRevenuePriorYear |
| Total Revenue Current Year | 40099579 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 1010437 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 1133785 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 9802949 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 10110064 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 25418456 | OtherExpensePriorYear |
| Other Expenses Current Year | 27225733 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 36231842 | TotalExpensesPriorYear |
| Total Expenses Current Year | 38469582 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1571567 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1629997 | RevenuesLessExpensesCY |
| Total Assets BOY | 34548586 | TotalAssetsBOY |
| Total Assets EOY | 18821914 | TotalAssetsEOY |
| Total Liabilities BOY | 20466348 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3109679 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 14082238 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 15712235 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 33435852 | Expense |
| Grants | 1133785 | Grants |
| Revenue | 40092036 | Revenue |
| Description | 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. | Description |
| Total Program Service Expense | 33435852 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Number Forms Transmitted With1096 | 34 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 179 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 3 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MFH ACCOUNTING DEPARTMENT | NamePerson |
| Telephone Number | 9035315764 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1315 DOCTORS DRIVE | AddressLine1 |
| City | TYLER | City |
| State | TX | State |
| ZIP Code | 75701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| THOMAS N CAMMACK JR | ||||||||
| CEO/DIRECTOR/SECRETARY/TREAS | 40.0 | 0.0 | X | X | 273507 | 0 | 20707 | |
| MATTHEW A VIERKANT MD | ||||||||
| DIRECTOR | 10.0 | 30.0 | X | 0 | 497339 | 13125 | ||
| RAY THOMPSON | ||||||||
| SYS EXEC/VP/DIRECTOR/CHAIR | 1.0 | 42.0 | X | X | 221425 | 1360188 | 21049 | |
| GLEN T HAMILTON | ||||||||
| DIRECTOR/VICE CHAIR | 10.0 | 0.0 | X | X | 0 | 0 | 0 | |
| WILLIAM MILAWSKI MD | ||||||||
| DIRECTOR | 40.0 | 0.0 | X | 0 | 257372 | 13025 | ||
| DICK STONE | ||||||||
| DIRECTOR | 1.0 | 1.0 | X | 0 | 0 | 0 | ||
| RANDY GORHAM | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| J LINDSEY BRADLEY JR | ||||||||
| SYSTEM PRESIDENT | 1.0 | 42.0 | X | 34500 | 1690480 | 21049 | ||
| MICHAEL LEWIS | ||||||||
| COO | 40.0 | 0.0 | X | 131213 | 0 | 20719 | ||
| JOYCE HESTER | ||||||||
| SR. VICE PRESIDENT/CFO | 5.0 | 37.0 | X | 54214 | 397573 | 14147 | ||
| KLEANTHE CARUSO | ||||||||
| CNO | 40.0 | 0.0 | X | 121167 | 0 | 4407 | ||
| BARRY L THIBODEAUX | ||||||||
| CRNA | 40.0 | 0.0 | 247825 | 0 | 9388 | X | ||
| JACK CAPPS | ||||||||
| CRNA | 40.0 | 0.0 | 241330 | 0 | 26047 | X | ||
| BEN BEATHARD | ||||||||
| RN | 40.0 | 0.0 | 115398 | 0 | 21205 | X | ||
| MICHAEL BENTOSKI | ||||||||
| RN | 40.0 | 0.0 | 107105 | 0 | 16014 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1547684 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 4202952 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 200882 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| COMPLETE RX LTD | |||||
| 3100 S GESSNER RD | HOUSTON | TX | 77063 | PHARMACY SERVICES | 759328 |
| CARDIAC IMAGING SERVICES | |||||
| 1737 DOMINION PLAZA | TYLER | TX | 75703 | IMAGING SERVICES | 229663 |
| CAPSTONE PERSONNEL SERVICES INC | |||||
| PO BOX 5744 | TYLER | TX | 75711 | CONTRACT STAFFING | 191005 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| All Other Contributions | 5109 | AllOtherContributions |
| Total Contributions | 5109 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT REVENUE | 621110 | 36002176 | 36002176 |
| UPL MEDICAID REVENUE | 900099 | 1800942 | 1800942 |
| EHR INCENTIVE REVENUE | 900099 | 886977 | 886977 |
| PHARMACY REVENUE | 446110 | 1277801 | 1277801 |
| RELATED RENTAL REVENUE | 532000 | 104685 | 104685 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 19455 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19455 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 40092036 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | REBATE INCOME | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 2434 | TotalRevenueColumn |
| Exclusion | $2,434 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2434 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 40099579 | TotalRevenueColumn |
| Related Or Exempt Function Income | 40092036 | RelatedOrExemptFunctionIncome |
| Exclusion | $2,434 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1133785 | Total |
| Program Services | 1133785 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1454340 | Total |
| Program Services | 1211916 | ProgramServices |
| Management And General | 242424 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6764626 | Total |
| Program Services | 5611050 | ProgramServices |
| Management And General | 1153576 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 205862 | Total |
| Program Services | 183217 | ProgramServices |
| Management And General | 22645 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1128364 | Total |
| Program Services | 1004244 | ProgramServices |
| Management And General | 124120 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 556872 | Total |
| Program Services | 495616 | ProgramServices |
| Management And General | 61256 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 81433 | Total |
| Management And General | 81433 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12701608 | Total |
| Program Services | 12335378 | ProgramServices |
| Management And General | 366230 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24725 | Total |
| Management And General | 24725 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 116603 | Total |
| Program Services | 46591 | ProgramServices |
| Management And General | 70012 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26213 | Total |
| Program Services | 11095 | ProgramServices |
| Management And General | 15118 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2697308 | Total |
| Program Services | 420781 | ProgramServices |
| Management And General | 2276527 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6905 | Total |
| Program Services | 6160 | ProgramServices |
| Management And General | 745 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6221 | Total |
| Program Services | 5929 | ProgramServices |
| Management And General | 292 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 491933 | Total |
| Management And General | 491933 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40477 | Total |
| Management And General | 40477 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 7573744 | 7573744 | |
| MEDICAL SUPPLIES | 2651055 | 2620381 | 30674 |
| FOOD | 113048 | 109130 | 3918 |
| REPAIRS AND MAINTENANCE | 576931 | 572815 | 4116 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 117529 | Total |
| Program Services | 94020 | ProgramServices |
| Management And General | 23509 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38469582 | Total |
| Program Services | 33435852 | ProgramServices |
| Management And General | 5033730 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38333 | BOY |
| EOY | -302033 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4588047 | BOY |
| EOY | 7096065 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 170953 | BOY |
| EOY | 147465 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 197308 | BOY |
| EOY | 74805 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 6557575 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 5087612 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1440472 | BOY |
| EOY | 1469963 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28113473 | BOY |
| EOY | 10335649 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34548586 | BOY |
| EOY | 18821914 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2137460 | BOY |
| EOY | 1919135 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18328888 | BOY |
| EOY | 1190544 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20466348 | BOY |
| EOY | 3109679 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14082238 | BOY |
| EOY | 15712235 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14082238 | BOY |
| EOY | 15712235 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34548586 | BOY |
| EOY | 18821914 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 1629997 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $1,873 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 1873 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | grants for lobbying purposes | Identifier |
| Return Reference | SCHEDULE C, PART II-B, LINE 1F | ReturnReference |
| Explanation | 23.98% of AHA dues were expended for specific lobbying purposes based on Medicare definition of unallowable expenses. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years | |
| Land | Land | |
| Buildings | Buildings | |
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6557575 | OtherCostOrOtherBasis |
| Depreciation | 5087612 | Depreciation |
| Book Value | 1469963 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Land Buildings | OtherLandBuildings | |
| Total Of Book Value Land Buildings | 1469963 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE FROM AFFILIATES | Description |
| Book Value | 10335649 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 10335649 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| THIRD PARTY PAYOR LIABILITIES | $911,844 |
| ESTIMATED SELF INSURANCE COSTS | $278,700 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1190544 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 32524080 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | -7573744 | OtherRevenues |
| Revenue Not Rptd F990 | -7573744 | RevenueNotRptdF990 |
| Revenue Subtotal | 40097824 | RevenueSubtotal |
| Other Revenues Not Included | 1755 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 1755 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 40099579 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 30894083 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | -1755 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | -1755 | ExpensesNotRptdF990 |
| Expenses Subtotal | 30895838 | ExpensesSubtotal |
| Other Expenses Not Included | 7573744 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 7573744 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 38469582 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| REVENUE INCLUDED ON BOOKS, NOT ON RETURN: | SCHEDULE D, PART XI, LINE 2D | BAD DEBT EXPENSE IN AUDIT REVENUE ($7,573,744) REVENUE INCLUDED ON RETURN, NOT ON BOOKS: SCHEDULE D, PART XI, LINE 4B REBATES IN AUDIT EXPENSE $ 1,755 |
| EXPENSES INCLUDED ON BOOKS, NOT ON RETURN: | SCHEDULE D, PART XII, LINE 2D | REBATES IN AUDIT EXPENSE ($ 1,755) EXPENSES INCLUDED ON RETURN, NOT ON BOOKS: SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSE IN AUDIT REVENUE $7,573,744 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1387960 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1387960 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04490 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3784276 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4988848 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1204572 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1880516 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1037954 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 842562 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02730 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7052752 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6026802 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1025950 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07220 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7237 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7237 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 601690 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 601690 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01950 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1133785 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1133785 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03670 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1742712 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1742712 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05640 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8795464 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6026802 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2768662 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12860 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $7,573,744 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 11943766 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11363196 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 580570 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOTHER FRANCES HOSPITAL-JACKSONVILLE | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1026 JACKSON STREET | AddressLine1 |
| City | JACKSONVILLE | City |
| State | TX | State |
| ZIP Code | 75766 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOTHER FRANCES HOSPITAL-JACKSONVILLE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | false | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| All Needs Addressed | false | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 200. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Provided On Admission | X | ProvidedOnAdmission |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Lowest Negotiated Rates | X | LowestNegotiatedRates |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| BAD DEBT EXPENSE | SCHEDULE H, PART III, SECTION A, LINE 2 | THE AMOUNT REPORTED ON LINE 2 IS BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS. |
| COSTING METHODOLOGY | SCHEDULE H, PART III, SECTION B, LINE 8 | 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. |
| COLLECTION POLICY | SCHEDULE H, PART III, SECTION C, LINE 9B | 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. |
| NEEDS ASSESSMENT | SCHEDULE H, PART VI, LINE 2 | 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. |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | SCHEDULE H, PART VI, LINE 3 | 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. |
| COMMUNITY INFORMATION | SCHEDULE H, PART VI, LINE 4 | 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. |
| PROMOTION OF COMMUNITY HEALTH | SCHEDULE H, PART VI, LINE 5 | 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. THE PURPOSE 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 - Over 40 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 IS To provide young high school students the opportunity to learn more about health care professionals and the healthcare work environment. Information was given on job opportunities and projected shortages of workers. JACKSONVILLE RODEO - Handed out fans and water to participants and spectators at the rodeo. Provided volunteers to interact on issues for 3 hours each of 4 nights. MFH jacksonville received an annual sponsorship to assist with the program. THE PURPOSE 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, American Cancer Society, Jacksonville Chamber of Commerce, and Jacksonville Literacy Council. Members of the staff serve in leadership positions and as volunteers for programs on various boards and non profits 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 these services is the general public. HEALTH EDUCATION PROGRAMS - Community education for healthy life styles were offered throughout the region for a variety of conditions including cancer, cholesterol, diabetes, smoking cessation, stress, weight management, and healthy hearts. Over 1,000 people were reached. 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; both were targeted. COMMUNITY NON PROFITS AND RURAL HOSPITAL SUPPORT PROGRAMS - Mother Frances Hospital - Jacksonville provides direct financial support to not-for-profit organizations and community supported rural hospitals within the region to help provide needed services to the community. Priority is given to agencies or organizations that provide support or direct health related services or benefits and have a mission to serve the underinsured and uninsured. New programs included are Cherokee Health Advisory Board and EMS, Fire Department and Public Safety offices. 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 physician services, 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. 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 open door policies for all those who need the care. Additionally, these programs provide new leadership opportunities for the staff. |
| AFFILIATED HEALTH CARE SYSTEM | SCHEDULE H, PART VI, LINE 6 | 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. |
| PERCENT OF TOTAL EXPENSE | SCHEDULE H, PART I, LINE 7, COLUMN F | 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 $7,573,744. |
| BILLING AND COLLECTIONS | SCHEDULE H, PART V, LINES 16, 17, & 18 | 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. |
| STATE OF FILING COMMUNITY BENEFIT REPORT | SCHEDULE H, PART VI, LINE 7 | TEXAS |
| NEEDS IDENTIFIED IN CHNA NOT ADDRESSED | SCHEDULE H, PART V, SECTION B, LINE 7 | 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. |
| REPRESENTATIVES FROM THE COMMUNITY | SCHEDULE H, PART V, SECTION B, LINE 3 | 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. |
| BAD DEBT AS COMMUNITY BENEFIT | SCHEDULE H, PART III, SECTION A, LINE 3 | 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. |
| FOOTNOTE TO THE FINANCIAL STATEMENTS DESCRIBING BAD DEBT EXPENSE | SCHEDULE H, PART III, SECTION A, LINE 4 | ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY 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). |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| SERVICE ORGANIZATION OF PINEY WOODS | |||||||
| 2950 50TH STREET | LUBBOCK | TX | 79314 | 300630886 | 501(C)(3) | 993310 | COMMUNITY HEALTHCARE |
| SERVICE ORGANIZATION OF NORTH EAST TEXAS | |||||||
| 2950 50TH STREET | LUBBOCK | TX | 79314 | 260468622 | 501(C)(3) | 140475 | COMMUNITY HEALTHCARE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S. | Identifier |
| Return Reference | SCHEDULE I, PART I, LINE 2 | ReturnReference |
| Explanation | 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | false | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| THOMAS N CAMMACK JR | ||||||||||||||
| CEO/DIRECTOR/SECRETARY/TREAS | 226210 | 0 | 35297 | 0 | 12000 | 0 | 9329 | 0 | 11378 | 0 | 294214 | 0 | 0 | 0 |
| MATTHEW A VIERKANT MD | ||||||||||||||
| DIRECTOR | 0 | 321208 | 0 | 167487 | 0 | 8644 | 0 | 10625 | 0 | 2500 | 0 | 510464 | 0 | 0 |
| RAY THOMPSON | ||||||||||||||
| SYS EXEC/VP/DIRECTOR/CHAIR | 101011 | 620498 | 46462 | 285410 | 73952 | 454280 | 1487 | 9138 | 1459 | 8965 | 224371 | 1378291 | 73952 | 454280 |
| WILLIAM MILAWSKI MD | ||||||||||||||
| DIRECTOR | 0 | 175678 | 0 | 73945 | 0 | 7749 | 0 | 10625 | 0 | 2400 | 0 | 270397 | 0 | 0 |
| J LINDSEY BRADLEY JR | ||||||||||||||
| SYSTEM PRESIDENT | 17075 | 836657 | 17425 | 853823 | 0 | 0 | 212 | 10413 | 208 | 10216 | 34920 | 1711109 | 0 | 0 |
| MICHAEL LEWIS | ||||||||||||||
| COO | 130762 | 0 | 101 | 0 | 350 | 0 | 5649 | 0 | 15070 | 0 | 151932 | 0 | 0 | 0 |
| JOYCE HESTER | ||||||||||||||
| SR. VICE PRESIDENT/CFO | 36574 | 268214 | 17640 | 129359 | 0 | 0 | 1301 | 9537 | 397 | 2912 | 55912 | 410022 | 0 | 0 |
| BARRY L THIBODEAUX | ||||||||||||||
| CRNA | 247724 | 0 | 101 | 0 | 0 | 0 | 7448 | 0 | 1940 | 0 | 257213 | 0 | 0 | 0 |
| JACK CAPPS | ||||||||||||||
| CRNA | 241229 | 0 | 101 | 0 | 0 | 0 | 8130 | 0 | 17917 | 0 | 267377 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PARTICIPATION IN OR PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN | SCHEDULE J, PART I, LINE 4B | PARTICIPANTS IN SERP REPORTED IN W-2 DEFERRED COMPENSATION -------------------- ---------------- --------------------- RAY THOMPSON $528,232 NONE |
| TAX INDEMNIFICATION & GROSS UP PAYMENTS | SCHEDULE J, PART I, LINE 1A | Amounts paid for "grossed up" gift cards are included as taxable compensation for the following directors: THOMAS CAMMACK, MATTHEW VIERKANT, MICHAEL LEWIS, KLEANTHE CARUSO, BARRY THIBODEAUX, JACK CAPPS, BEN BETHARD, AND MICHAEL BENTOSKI |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 1099S REPORTED BY ORGANIZATION | FORM 990, PART V, LINE 1A | 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. |
| DESCRIBE THE ORGANIZATION'S MEMBERS OR STOCKHOLDERS | FROM 990, PART VI, SECTION A, LINE 6 | TRINITY MOTHER FRANCES HEALTH SYSTEM IS THE SOLE MEMBER OF MOTHER FRANCES HOSPITAL - JACKSONVILLE. |
| MEMBERS OR STOCKHOLDERS WHO MAY ELECT MEMBERS OF THE GOVERNING BOARD | FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER, TRINITY MOTHER FRANCES HEALTH SYSTEM, APPOINTS ALL DIRECTORS AND THEIR SUCCESSORS TO THE GOVERNING BOARD. |
| DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBER | FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBER HAS THE RIGHT TO APPROVE OR DISAPPROVE CERTAIN ACTIONS THAT HAVE BEEN APPROVED BY THE BOARD OF DIRECTORS. |
| DESCRIBE REVIEW PROCESS OF FORM 990 | FORM 990, PART VI, SECTION B, LINE 11B | 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. |
| HOW DOES THE ORGANIZATION MONITOR AND ENFORCE COMPLIANCE WITH POLICY | FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD REVIEWS AND RESOLVES, IF NECESSARY, ANY TRANSACTIONS AS THEY ARISE THROUGHOUT THE YEAR IN ACCORDANCE WITH POLICY STANDARDS. |
| PROCESS FOR DETERMINING COMPENSATION OF CEO, OFFICERS, OR KEY EMPLOYEES | FORM 990, PART VI, SECTION B, LINES 15A & 15B | THE ORGANIZATION USES COMPENSATION CONSULTANTS AND NATIONAL COMPENSATION SURVEYS TO DETERMINE COMPENSATION OF EMPLOYEES. COMPENSATION IS APPROVED BY THE ORGANIZATION'S GOVERNING BODY. |
| DESCRIBE WHETHER THE ORGANIZATION MAKES ITS DOCUMENTS AVAILABLE TO PUBLIC | FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| COMPENSATION FROM RELATED ORGANIZATIONS | FORM 990, PART VII, SECTION A & SCHEDULE J, PART II | 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. |
| other fees for services | form 990, part ix, line 11g | Purchased Services $3,798,118 Professional Fees $6,985,172 Contract Labor $282,389 Corporate Expense $1,623,125 Overhead Fees $12,804 ---------------- Total $12,701,608 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| MOTHER FRANCES HOSP REGIONAL HC CENTER | ||||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 750818167 | 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 - WINNSBORO | ||||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 752771569 | HOSPITAL | TX | 501(C)(3) | 3 | TMFHS | false |
Form990 Schedule R Part IV Form990ScheduleRPartIV (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg | Address Line1AddressForeign/AddressLine1 | Province Or StateAddressForeign/ProvinceOrState | CountryAddressForeign/Country | Legal Domicile Foreign CountryLegalDomicileForeignCountry |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| tri-state financial llc | |||||||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 752728318 | COLLECTION AGENCY | 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 | ||||
| REGIONAL HEALTHCARE ALLIANCE | |||||||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 752484109 | PREFER PROVIDER | TX | TMFHS | C-CORPORATION | false | ||||
| TEXAS HEALTH FACILITIES INSUR CORP LTD | |||||||||||||
| 980136025 | INSURANCE | MFH REG | C-CORPORATION | false | PO BOX 1109 BWI | GRAND CAYMAN | CJ | CJ | |||||
| CONCORDIUM HEALTH LLC | |||||||||||||
| 1315 DOCTORS DRIVE | TYLER | TX | 75701 | 702811022 | INACTIVE | TX | NA | C-CORPORATION | false | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DIRECT CONTROLLING ENTITY | Identifier |
| Return Reference | SCHEDULE R, PART II, COLUMN F | ReturnReference |
| Explanation | 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"). | Explanation |
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