2014-05-15T14:08:07-05:00 2013-06-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2012-07-01 752616977 TRINITY CLINIC % MOTHER FRANCES HOSP ACCTG DE TRIN 9035315764 1315 DOCTORS DRIVE Suite TYLER TX 75701 JOYCE HESTER 9035315764 2014-05-15 true Amanda Maya 7134994600 2012 2015-11-30 17:44:51Z STEVEN KEUER 910 E HOUSTON TYLER TX 75701 165066338 false X WWW.TMFHS.ORG/TRINITYCLINIC X 1995 TX TO PROVIDE PHYSICIAN SERVICES WITH A FULL RANGE OF COMPREHENSIVE HEALTH CARE SERVICES WITHOUT REGARD TO THE PATIENT'S RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. 14 0 680 33 -308532 -308532 0 0 127491339 161528332 4592 1678504 -1721912 -182669 125774019 163024167 0 0 0 0 17276516 43571561 0 0 0 132837119 151639641 150113635 195211202 -24339616 -32187035 135889145 50748541 157671418 80503891 -21782273 -29755350 TO PROVIDE PHYSICIAN SERVICES WITH A FULL RANGE OF COMPREHENSIVE HEALTH CARE SERVICES WITHOUT REGARD TO THE PATIENT'S RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. false false 176410223 161528332 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, AWARENESS PROGRAMS FOR PERSONS WITH SPECIAL PHYSICAL OR MENTAL NEEDS, CHILDREN WITH DIABETES SUMMER CAMP, SPORTS CARE PROGRAMS, SAFETY TRAINING FOR LOCAL BUSINESSES, AND RESEARCH PROGRAMS. 176410223 true false false false false false false false false true true false false true true false false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true X 110 0 true 680 true true true false false false false false false false false false X 14 0 false false false false true false true true true false false true true true true true true true true true true X MOTHER FRANCES HOSP ACCTG DE 9035315764 1315 DOCTORS DRIVE TYLER TX 75701 X STEVEN KEUER MD 18.0 23.0 X X 569669 725033 28146 ROBERT MCKINNEY MD 40.0 0.0 X 524395 0 30474 GIFFORD ECKHOUT MD 15.0 26.0 X X 297151 505960 25449 MARK ANDERSON MD 40.0 1.0 X X 478804 0 29974 ROGER FOWLER MD 40.0 1.0 X X 443266 0 21991 KENT WEBB MD 40.0 0.0 X 690952 0 27474 WILLIAM HOBBS MD 40.0 0.0 X 789970 0 27474 JAMES STANFORD MD 40.0 0.0 X X 351360 0 27474 GREGORY STOVALL 40.0 0.0 X X 757653 0 27474 KAI XIA MD 40.0 0.0 X 1606153 0 24297 JAMES CACCITOLO MD 40.0 1.0 X X 819712 0 27424 HAMPTON WILLIAMS MD 40.0 0.0 X 550750 0 26697 OLADIMEJI AKIODE MD 40.0 0.0 X 430093 0 29724 BARBARA ALLEN MD 35.0 5.0 X 372994 0 24974 BRYAN LOWERY MD 40.0 0.0 X 722927 0 9375 JANET HURLEY MD 40.0 0.0 X 141749 0 16849 MEG REITMEYER MD 40.0 1.0 X 289920 0 6760 JOSEPH ZASIK DO 40.0 0.0 X 544350 0 5885 ORAN FERRELL 40.0 0.0 X 790195 0 21258 LORETTA SWAN 40.0 0.0 X 182312 0 21067 JOYCE HESTER 10.0 32.0 X 108429 343358 14147 THOMAS HARGROVE 40.0 0.0 X 431135 0 19249 WILLIAM MCCRADY 40.0 0.0 X 334448 0 12522 MARTIN HOLLAND MD 40.0 0.0 X 1475163 0 23570 LAURA O'HALLORAN MD 40.0 0.0 X 1631808 0 26224 WAYNE GLUF MD 40.0 0.0 X 1653828 0 20647 PETER SIRIANNI MD 40.0 0.0 X 1772526 0 26224 SAUYU LIN MD 40.0 0.0 X 1268877 0 28224 DAVID TEEGARDEN MD 0.0 0.0 X 0 202767 19772 20030589 1777118 650819 326 true true false HOSPITALIST CONNECTIONS LLC 16000 NORTH DALLAS PKWAY SUITE 450 DALLAS TX 75248 PHYSICIAN SERVICES 1496023 EAGLE HOSPITAL PHYSICIANS 16000 NORTH DALLAS PKWAY SUITE 450 DALLAS TX 75248 PHYSICIAN SERVICES 924164 PROFESSIONAL SERVICES EMPLOYERS PO BOX 3629 SALT LAKE CITY UT 84110 PHYSICIAN SERVICES 815681 HURON CONSULTING SERVICES LLC 4795 PAYSHERE CIRCLE CHICAGO IL 60674 CONSULTING SERVICES 736066 JASON G HOLMAN MD 6938 PARK SLOPE TYLER TX 75703 PHYSICIAN SERVICES 426910 13 0 NET PATIENT SERVICE REVENUE 621500 114276457 114276457 OTHER OPERATING REVENUE 900099 44993184 44993184 EHR INCENTIVE REVENUE 900099 2258691 2258691 161528332 1600220 1600220 0 0 520407 703076 -182669 0 -182669 -56079 -126590 1417379 1339095 78284 78284 -252453 330737 0 0 0 0 163024167 161528332 -308532 1804367 X 0 0 0 0 0 0 0 0 14465115 12971059 1494056 0 0 13911332 12021444 1889888 0 2869391 2869391 0 8459076 7692678 766398 0 3866647 3821264 45383 0 3590251 3588564 1687 0 0 0 0 0 2518 0 2518 0 0 0 0 0 0 0 150 0 150 0 126292482 112976317 13316165 0 52141 42448 9693 0 704195 380186 324009 0 7660 6216 1444 0 0 0 0 0 1325503 1059793 265710 0 67838 18902 48936 0 0 0 0 0 1008227 1008182 45 0 885690 137101 748589 0 0 0 0 0 354189 267133 87056 0 -24692 -41554 16862 0 MEDICAL SUPPLIES 2711789 2711789 BAD DEBT EXPENSE 7091030 7091030 REPAIRS AND MAINTENANCE 83475 66671 16804 PERFORMANCE STANDARDS 1964115 2258197 -294082 5523080 5463412 59668 195211202 176410223 18800979 0 3980108 701164 0 0 0 0 10469530 14719532 0 0 0 0 1490266 1196280 300494 230612 521553 432590 3895480 2275826 4213464 1619654 22354194 24749645 90634 86710 0 0 427625 373209 92041277 6639145 135889145 50748541 17291328 23809430 0 0 0 0 0 0 0 0 0 0 1631813 0 0 0 138748277 56694461 157671418 80503891 X -21782273 -29755350 0 0 0 0 -21782273 -29755350 135889145 50748541 X -32187035 24213958 X false true X true false X 2408876 163752 157934 2414694 2350337 30875 27664 2408876 2209013 50 141274 2350337 414414 1790794 4305 500 2209013 413932 239 243 414414 0.84944 0.15057 false true true 1178605 260463 918142 2703464 2015363 688101 13411 0 13411 1619654 DUE FROM AFFILIATES 6582111 OTHER ASSETS 57034 6639145 0 DUE TO AFFILIATES 30200368 ACCRUED PENSION LIABILITY 14370318 ESTIMATED SELF INSURANCE COSTS 3174800 DEFERRED COMPENSATION 8948975 56694461 154889947 -7091030 -7091030 161980977 1043190 1043190 163024167 187076982 -1043190 -1043190 188120172 7091030 7091030 195211202 RECONCILIATION OF REVENUE PER FINANCIAL STATEMENTS TO FORM 990 SCHEDULE D, PART XI, LINE 2D BAD DEBT $ (7,091,030) RECONCILIATION OF REVENUE PER FINANCIAL STATEMENTS TO FORM 990 SCHEDULE D, PART XI, LINE 4B SEQUESTER REDUCTION REVENUE $ 108,824 REBATE INCOME 40,363 RENT EXPENSE (703,076) INTEREST INCOME 1,597,079 ------------- $ 1,043,190 RECONCILIATION OF EXPENSES PER FINANCIAL STATEMENTS TO FORM 990 SCHEDULE D, PART XII, LINE 2D SEQUESTER REDUCTION REVENUE $ (108,824) REBATE INCOME (40,363) RENT EXPENSE 703,076 INTEREST INCOME (1,597,079) ------------- $ (1,043,190) RECONCILIATION OF EXPENSES PER FINANCIAL STATEMENTS TO FORM 990 SCHEDULE D, PART XII, LINE 4B BAD DEBT $ 7,091,030 INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS SCHEDULE D, PART V, QUESTION 4 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. X true false X X X X X true true false false false true false false false STEVEN KEUER MD 254304 323659 129800 165200 185565 236174 4675 5950 7709 9812 582053 740795 173977 221426 ROBERT MCKINNEY MD 514450 0 0 0 9945 0 10625 0 19849 0 554869 0 0 0 GIFFORD ECKHOUT MD 266267 453374 28913 49229 1971 3357 1332 2268 8084 13765 306567 521993 0 0 MARK ANDERSON MD 473476 0 0 0 5328 0 8125 0 21849 0 508778 0 0 0 ROGER FOWLER MD 355261 0 63153 0 24852 0 10625 0 11366 0 465257 0 0 0 KENT WEBB MD 435211 0 247878 0 7863 0 10625 0 16849 0 718426 0 0 0 WILLIAM HOBBS MD 630879 0 134066 0 25025 0 10625 0 16849 0 817444 0 0 0 JAMES STANFORD MD 183510 0 160430 0 7420 0 10625 0 16849 0 378834 0 0 0 GREGORY STOVALL 356429 0 56523 0 344701 0 10625 0 16849 0 785127 0 0 0 KAI XIA MD 695483 0 888342 0 22328 0 9375 0 14922 0 1630450 0 0 0 JAMES CACCITOLO MD 798800 0 15584 0 5328 0 9375 0 18049 0 847136 0 0 0 HAMPTON WILLIAMS MD 545422 0 0 0 5328 0 9375 0 17322 0 577447 0 0 0 ORAN FERRELL 243750 0 0 0 546445 0 9050 0 12208 0 811453 0 0 0 LORETTA SWAN 154565 0 24947 0 2800 0 6657 0 14410 0 203379 0 0 0 MARTIN HOLLAND MD 1455153 0 0 0 20010 0 8125 0 15445 0 1498733 0 0 0 LAURA O'HALLORAN MD 961933 0 664547 0 5328 0 9375 0 16849 0 1658032 0 0 0 WAYNE GLUF MD 1631500 0 0 0 22328 0 8125 0 12522 0 1674475 0 0 0 PETER SIRIANNI MD 1759448 0 7750 0 5328 0 9375 0 16849 0 1798750 0 0 0 SAUYU LIN MD 670728 0 576321 0 21828 0 9375 0 18849 0 1297101 0 0 0 OLADIMEJI AKIODE MD 221860 0 186405 0 21828 0 9375 0 20349 0 459817 0 0 0 BARBARA ALLEN MD 327297 0 23869 0 21828 0 8125 0 16849 0 397968 0 0 0 BRYAN LOWERY MD 359874 0 341225 0 21828 0 9375 0 0 0 732302 0 0 0 JOYCE HESTER 73149 231639 35280 111719 0 0 2601 8237 794 2515 111824 354110 0 0 JANET HURLEY MD 115271 0 22213 0 4265 0 0 0 16849 0 158598 0 0 0 MEG REITMEYER MD 267592 0 0 0 22328 0 0 0 6760 0 296680 0 0 0 JOSEPH ZASIK DO 539022 0 0 0 5328 0 0 0 5885 0 550235 0 0 0 THOMAS HARGROVE 353591 0 72216 0 5328 0 0 0 19249 0 450384 0 0 0 WILLIAM MCCRADY 309947 0 0 0 24501 0 0 0 12522 0 346970 0 0 0 DAVID TEEGARDEN MD 0 197563 0 0 0 5204 0 2250 0 17522 0 222539 0 0 PARTICIPATION IN OR PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B PARTICIPANTS IN SERP REPORTED IN W-2 DEFERRED COMPENSATION ---------------------- ----------------- --------------------- STEVEN KEUER MD $394,866 NONE DAVID TEEGARDEN MD NONE NONE PARTICIPANTS IN 457(F) REPORTED IN W-2 ---------------------- ----------------- STEVEN KEUER MD $537 DAVID TEEGARDEN MD NONE COMPENSATION CONTINGENT ON THE NET EARNINGS OF THE ORGANIZATION SCHEDULE J, PART I, LINE 6A SOME PHYSICIANS ARE PAID BASED ON THE COMPENSATION FORMULA OF THEIR INDIVIDUAL RESPECTIVE DEPARTMENTS. SEVERANCE PAYMENTS SCHEDULE J, PART I, LINE 4A SEVERANCE PAID ---------------- GREGORY STOVALL $308,212 ORAN FERRELL $541,045 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: MARK ANDERSON, ROGER FOWLER, KENT WEBB, WILLIAM HOBBS, GREGORY STOVALL, KAI XIA, JAMES CACCITOLO, BARBARA ALLEN, LORETTA SWAN, WILLIAM MCCRADY, MARTIN HOLLAND, AND PETER SIRIANNI 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. DESCRIBE THE ORGANIZATION'S MEMBERS OR STOCKHOLDERS FORM 990, PART VI, SECTION A, LINE 6 TRINITY MOTHER FRANCES HEALTH SYSTEM IS THE SOLE MEMBER OF TRINITY CLINIC. DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBER FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER HAS THE AUTHORITY TO APPROVE OR DISAPPROVE CERTAIN MATTERS PREVIOUSLY APPROVED BY THE BOARD OF DIRECTORS. HOW DOES THE ORGANIZATION MONITOR AND ENFORCE COMPLIANCE WITH THE 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. 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. 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 AND ULTIMATELY APPROVED BY TRINITY MOTHER FRANCES HEALTH SYSTEM. COMPENSATION FROM RELATED ORGANIZATIONS FORM 990, PART VII & SCHEDULE J 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. 1099S REPORTED BY ORGANIZATION FORM 990, PART V, LINE 1A FORMS 1099-INT ARE ISSUED BY THE FILING ORGANIZATION. HOWEVER, THE ORGANIZATION'S FORMS 1099-MISC ARE ISSUED BY A RELATED ORGANIZATION, MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER, WHICH REPORTS ALL FORMS 1099-MISC FOR THE ENTIRE SYSTEM AND ALLOCATES EXPENSES TO THE APPROPRIATE RELATED ORGANIZATION. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 9 TRANSFERS FROM AFFILIATE $ 24,213,958 Other fees for services Form 990, part ix, line 11g Professional Fees $112,875,260 Corporate Expenses $7,133,954 Consulting $2,313,534 Purchased Services $1,591,512 Director Fees $1,938,282 Direct Care Fees $261,955 Physician Advisor Fees $83,190 Contract Labor $94,795 ---------------- Total $126,292,482 MOTHER FRANCES HOSPITAL REGIONAL HC CTR 1315 DOCTORS DRIVE TYLER TX 75701 750818167 HOSPITAL TX 501(C)(3) 3 TMFHS false MOTHER FRANCES HOSPITAL - JACKSONVILLE 1315 DOCTORS DRIVE TYLER TX 75701 751976930 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 MOTHER FRANCES HOSPITAL - WINNSBORO 1315 DOCTORS DRIVE TYLER TX 75701 752771569 HOSPITAL TX 501(C)(3) 3 TMFHS false 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 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 CAYMAN ISLANDS 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 true false false true false false true true true true true true true false true DIRECT CONTROLLING ENTITY SCHEDULE R, PART II, COLUMN F THE FOLLOWING RELATED ORGANIZATIONS REPORTABLE IN PART II ARE DIRECTLY CONTROLLED BY TRINITY MOTHER FRANCES HEALTH SYSTEM ("TMFHS"): MOTHER FRANCES HOSPITAL REGIONAL HEALTHCARE CENTER MOTHER FRANCES HOSPITAL - JACKSONVILLE MOTHER FRANCES HOSPITAL - WINNSBORO TRINITY MOTHER FRANCES HEALTH SYSTEM FOUNDATION REGIONAL MEDICAL SERVICES ASSOCIATION IS DIRECTLY CONTROLLED BY MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER ("MFH REG").