2014-05-15T10:27:29-05:00 2013-06-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2012-07-01 203069241 Walker County Hospital Corporation % SHANNON L BROWN WALK 9362913411 PO Box 4001 Suite Huntsville TX 773424001 SHANNON L BROWN 9364352230 2014-05-15 true Amanda Maya 7134994600 2012 2015-11-30 17:44:51Z SHANNON L BROWN 110 Memorial Hospital Drive Huntsville TX 77340 114948252 false X www.huntsvillememorial.com X 2005 TX TO PROVIDE BENEVOLENT AND CHARITABLE SERVICES FOR THE SICK, INFIRM, AND AFFLICTED RESIDENTS OF WALKER COUNTY THROUGH THE ESTABLISHMENT, MAINTENANCE, SUPPORT, AND OPERATION OF A HOSPITAL. 14 14 759 75 0 0 5155830 63515 79167808 88086935 680283 647282 390222 414122 85394143 89211854 931986 1073484 0 0 37386059 37317086 0 0 0 48710271 54876864 87028316 93267434 -1634173 -4055580 68233293 65047220 30812147 28824182 37421146 36223038 THE PURPOSE OF HUNSTVILLE MEMORIAL HOSPITAL IS TO PROVIDE BENEVOLENT AND CHARITABLE SERVICES FOR THE SICK, INFIRM, AND AFFLICTED RESIDENTS OF WALKER COUNTY THROUGH THE ESTABLISHMENT, MAINTENANCE, SUPPORT, AND OPERATION OF A HOSPITAL. false false 79594557 1073484 88086935 TO PROVIDE BENEVOLENT AND CHARITABLE SERVICES FOR THE SICK, INFIRM, AND AFFLICTED RESIDENTS OF WALKER COUNTY THROUGH THE ESTABLISHMENT, MAINTENANCE, SUPPORT, AND OPERATION OF A HOSPITAL. 79594557 true true false true false false false false false false true false false false 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 true true false false true 151 1 true 759 true false true CJ false false false false false false false false X 14 14 false true false false false false false true true false false true true true true true true true true false X SHANNON L BROWN 9364352230 110 MEMORIAL HOSPITAL DRIVE Huntsville TX 77340 X DANA GIBSON PHD CPA 1.0 0.0 X 0 0 0 DAVID ALLEN PRIER MD 1.0 1.0 X X NANCY GAERTNER 1.0 0.0 X DON JOHNSON 1.0 0.0 X ROSA VALLES 1.0 0.0 X WAYNE SCOTT 1.0 0.0 X MORRIS JOHNSON 1.0 0.0 X X TIMOTHY DEAHL MD 1.0 0.0 X JOHN KNIGHT MD 1.0 0.0 X URMIL SHULKA MD 1.0 0.0 X SAM BURRIS 1.0 1.0 X WILLIAM DURHAM 1.0 0.0 X HELEN WATKINS MD 1.0 0.0 X JACK CHOATE 1.0 0.0 X SALLY I NELSON 40.0 2.0 X GUY GROS 40.0 1.0 X DONNA STEWART 40.0 0.0 X SHANNON BROWN 40.0 1.0 X DAVID FICKLEN MD 40.0 0.0 X JOHN A HEEMANN JR 40.0 0.0 X 118640 16191 LENETH S ROZIER 40.0 0.0 X 143598 19023 SHEILA HOGUE 40.0 0.0 X 122322 7988 ELIZABETH ROGERS 40.0 0.0 X 124420 630 CHEYENNE ASHMORE 40.0 0.0 X 155916 9 664896 0 43841 18 false true false Memorial Hermann Hospital System 9301 Southwest Fwy HOUSTON TX 770741425 Management 1213092 Comprehensive Pharmacy Services PO Box 1000 Dept 176 MEMPHIS TN 381480176 Pharmacy 1002539 Premier Anesthesia of Huntsville 2655 Northwinds Parkway ALPHARETTA GA 30009 Anesthesia 972362 Diversified Clinical Services 4500 Salisbury Road JACKSONVILLE FL 32216 Wound Care 528847 HMH Clinical Management LLC PO Box 4001 HUNTSVILLE TX 77342 Management 280839 18 25000 36056 2459 63515 ROUTINE & ANCILLARY SERVICES 621990 87893760 87893760 EDUCATION NURSING REVENUE 621990 193175 193175 88086935 367716 367716 0 29333 29333 30418 30418 0 30418 30418 25356832 100000 25482134 254264 -125302 -154264 279566 279566 0 0 0 CAFETERIA 900099 253722 253722 EDUCATION CLASSES 900099 8790 8790 MEDICAL RECORDS REVENUE 900099 37215 37215 54644 54644 354371 89211854 88086935 1061404 1069584 1069584 3900 3900 0 0 0 0 0 0 0 0 0 0 0 0 30110418 22582814 7527604 0 1396754 1047566 349188 0 3652009 2739007 913002 0 2157905 1618429 539476 0 536673 0 536673 0 1300713 0 1300713 0 137683 0 137683 0 0 0 0 0 0 0 0 0 0 0 10158611 9686502 472109 0 109915 109915 0 0 796226 796214 12 0 402393 384856 17537 0 0 0 0 0 877687 658265 219422 0 73824 73011 813 0 0 0 0 0 73095 92 73003 0 300868 0 300868 0 0 0 0 0 3100718 3100718 0 0 433163 0 433163 0 BAD DEBT EXPENSE 21441801 21441801 0 0 DUES & SUBSCRIPTIONS 358440 54645 303795 0 MEDICAL SUPPLIES & EQUIPMENT 12035304 12035304 0 0 REPAIRS & MAINTENANCE 1988829 1491622 497207 0 750921 700312 50609 93267434 79594557 13672877 0 2383797 240413 16543035 10433549 0 0 11504846 9750692 0 0 0 0 -211686 -288769 1644141 1689539 977782 587387 63655152 41419268 20466542 22235884 2632201 7767108 0 0 0 0 10558686 10544648 1733949 2086769 68233293 65047220 11885206 13447783 0 0 81048 0 0 0 0 0 0 0 9782915 11549218 0 0 9062978 3827181 30812147 28824182 X 37295509 36095940 125637 127098 0 0 37421146 36223038 68233293 65047220 X -4055580 597679 2259793 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 2612 false false false 2612 false false GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES PART II-B, QUESTION 1F AMOUNT REPORTED IN PART II-B, QUESTION 1F REPRESENTS PORTION OF DUES PAID TO TRADE ASSOCIATIONS THAT IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 699139 699139 16473028 9836050 6636978 1670628 1274292 396336 43446279 30308926 13137353 1366078 1366078 22235884 0 PENSION LIABILITY 5455709 ESTIMATED DUE TO THIRD PARTIES -1740892 ASSET RETIREMENT OBLIGATION 112364 3827181 68370621 597679 -21437451 -20839772 89210393 1461 1461 89211854 71829983 71829983 21437451 21437451 93267434 RECONCILIATION OF AUDITED FINANCIAL STATEMENTS TO FORM 990 PART XI, LINE 2D BAD DEBT EXPENSE IN AUDIT REVENUE $ (21,441,801) INTEREST EXPENSE CREDIT IN AUDIT REVENUE $ 4,350 --------------- $ (21,437,451) RECONCILIATION OF AUDITED FINANCIAL STATEMENTS TO FORM 990 PART XII, LINE 4B INTEREST EXPENSE CREDIT IN AUDIT REVENUE $ (4,350) BAD DEBT EXPENSE IN AUDIT REVENUE $ 21,441,801 --------------- $ 21,437,451 RECONCILIATION OF AUDITED FINANCIAL STATEMENTS TO FORM 990 PART XI, LINE 2D INVESTMENT INCOME RECORDED TO NET ASSETS $ 1,461 true true X true X true X 500. true true true false true true 2818740 2818740 0.03920 5680648 4371065 1309583 0.01820 92763 82065 10698 0.00010 8592151 4453130 4139021 0.05750 42727 42727 0.00060 625564 201220 424344 0.00590 1348617 1348617 0.01880 2016908 201220 1815688 0.02530 10609059 4654350 5954709 0.08280 true 21441801 5360450 18149497 19945762 -1796265 X true true 1 1 WALKER COUNTY HOSPITAL CORPORATION

110 MEMORIAL HOSPITAL DRIVE HUNTSVILLE TX 77340

X X X WALKER COUNTY HOSPITAL CORPORATION 1 true X X X X X X X X X 12 true false true X X X X X X true false true true 100 true 500. true X X X X X X X true true X X X true false X X true X false false ANNUAL COMMUNITY BENEFIT REPORT PART I, QUESTION 6A HUNTSVILLE MEMORIAL HOSPITAL AND THE MATTHEWS GROUP WORK TOGETHER TO PREPARE THE ANNUAL COMMUNITY BENEFIT REPORT. HUNTSVILLE MEMORIAL HOSPITAL'S COMMITMENT TO CHARITABLE CARE GOES BACK TO OUR 1927 HOSPITAL CHARTER PROMISING "BENEVOLENT AND CHARITABLE" SERVICES FOR THE "SICK, INFIRM AND AFFLICTED." WE KEPT THIS PROMISE EVERY YEAR BY HELPING OUR COMMUNITY THROUGH EDUCATIONAL PROGRAMS AND SUPPORT GROUPS. IN ADDITION, HMH PROVIDES OVER $10 MILLION IN CHARITY CARE AND OVER $6 MILLION IN UNREIMBURSED MEDICARE AND STATE MEDICAID CARE. ALL INFORMATION REGARDING HUNTSVILLE MEMORIAL HOSPITAL'S COMMUNITY BENEFIT REPORT CAN BE LOCATED ON THE EXTERNAL WEBSITE. PERCENTAGE OF TOTAL EXPENSE PART I, QUESTION 7, COLUMN F BAD DEBT EXPENSE OF $21,441,801 WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT WAS SUBTRACTED FROM TOTAL EXPENSE FOR THE CALCULATION OF "PERCENT OF TOTAL EXPENSE" IN THIS COLUMN. IN ADDITION TO CHARITY CARE PROVIDED BY THE HOSPITAL TO RESIDENTS OF WALKER COUNTY, THE WALKER COUNTY HOSPITAL DISTRICT HAS A SPECIFIC INDIGENT CARE PROGRAM FOR WALKER COUNTY RESIDENTS THAT PROVIDES ADDITIONAL CHARITY CARE RESOURCES TO THE COMMUNITY OUTSIDE HOSPITAL CARE. THE HOSPITAL PROVIDES CARE TO PATIENTS QUALIFYING UNDER THE COUNTY'S INDIGENT CARE PROGRAM. IF PATIENTS DO NOT QUALIFY FOR THE COUNTY'S PROGRAM, THEY ARE THEN ABLE TO APPLY TO THE HOSPITAL'S CHARITY CARE PROGRAM. THE COUNTY'S INDIGENT CARE PROGRAM PROVIDES ADDITIONAL CHARITY CARE RESOURCES TO THE COMMUNITY FOR NON-HOSPITAL RELATED HEALTHCARE SERVICES REDUCING THE OVERALL COMMUNITY BENEFIT PERCENTAGE OF THE HOSPITAL FOR SERVICES IT WOULD HAVE PROVIDED WERE THE PROGRAM NOT IN PLACE. THE ORGANIZATION BELIEVES THE COMMUNITY BENEFIT AS A PERCENTAGE OF EXPENSES REPORTED IN SCHEDULE H, PART I, LINE 7 IS REASONABLE GIVEN THE ADDITIONAL CHARITY CARE RESOURCES TO THE COMMUNITY PROVIDED BY THE WALKER COUNTY HOSPITAL DISTRICT. METHODOLOGY TO ESTIMATE BAD DEBT EXPENSE PART III, LINE 2 THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. METHODOLOGY TO ESTIMATE THE AMOUNT REPORTED ON LINE 3 PART III, LINE 3 AMOUNTS REPORTED ON LINE 3 ARE THE ORGANIZATION'S ESTIMATE OF THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO CHARITY CARE PATIENTS, ESTIMATED AT 25%. FINANCIAL STATEMENTS FOOTNOTE ON BAD DEBT EXPENSE PART III, LINE 4 Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectibility of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for uncollectible accounts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. CALCULATION OF MEDICARE SHORTFALL PART III, QUESTION 8 THE MEDICARE SHORTFALL WAS COMPUTED USING THE ANNUAL MEDICARE COST REPORT FOR THE PERIOD 11/01/11 THRU 10/31/12. THE MEDICAL CENTER USES COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. THE SHORTFALL BENEFITS THE COMMUNITY BY LESSENING THE BURDEN OF GOVERNMENT. IN ADDITION, THE STATE OF TEXAS TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT FOR MEETING STATUTORY REQUIREMENTS FOR CHARITY CARE AND COMMUNITY BENEFIT. COLLECTION POLICY PART III, QUESTION 9B THE HOSPITAL SHALL CONTRIBUTE APPROPRIATE RESOURCES, ADVOCACY AND COMMUNITY SUPPORT TO PROMOTE THE HEALTH STATUS OF THE COMMUNITY, WHICH IT SERVES, WITHIN ITS ECONOMIC ABILITY TO DO SO. CHARITY CARE WILL BE PROVIDED TO PATIENTS WITH A DEMONSTRATED INABILITY TO PAY. THE PURPOSE OF THIS POLICY IS TO ESTABLISH CRITERIA FOR DETERMINING IF A PATIENT'S ACCOUNT QUALIFIES FOR A CHARITY CARE DISCOUNT. THE AMOUNT OF CHARITY CARE TO BE MADE AVAILABLE, AS WELL AS ANY OTHER CHANGES TO THIS POLICY SHALL BE ASSESSED AND DETERMINED BY THE HOSPITAL'S CHIEF EXECUTIVE OFFICER ON AN ANNUAL BASIS, AND WILL ADHERE TO STATE GUIDELINES FOR NON-PROFIT FACILITIES, IF APPLICABLE. THE AMOUNT OF CHARITY CARE AS WELL AS THE OTHER TERMS OF THIS POLICY MAY BE CHANGED BY THE HOSPITAL'S CHIEF EXECUTIVE OFFICER. FACILITIES PART V WALKER COUNTY HOSPITAL CORPORATION HAS ONE FACILITY THAT INCLUDES THE ACUTE CARE HOSPITAL, I/P REHAB, AMBULATORY SURGERY CENTER, O/P IMAGING CENTER, AND RURAL HEALTH CARE CLINIC. NEEDS ASSESSMENT In the past, Huntsville Memorial Hospital has contracted with a 3rd party vendor to conduct a Community Needs Assessment and Market Analysis. The Community Assessment is evaluated and reported every three (3) years and the Market Analysis every 1-2 years as needed. After data is gathered and a full assessment completed, this information is reported to the Hospital Leadership Team and Board of Directors. Hospital leaders utilize the information gathered in both these report to format our strategic plan for the next fiscal year, as well as a five year plan. Huntsville Memorial Hospital has completed our contractual relationship with the 3rd party vendor previously used for these reports and is actively working to identify a new contract. That decision will be postponed until the Hospital can complete our Request for Proposal (RFP) process for management of the organization, as that decision plays a key role in all vendor selections moving forward. PATIENT EDUCATION OF ELIGIBILITY OF ASSISTANCE THE PATIENT IS ENCOURAGED TO APPLY FOR CHARITY AS EARLY AS POSSIBLE IN THE ACCOUNT MANAGEMENT PROCESS. CHARITY APPLICATION AND QUALIFICATIONS GUIDELINES ARE GIVEN UP FRONT IN REGISTRATION. THE SELF PAY BALANCES ARE SENT TO A MEDICAID ELIGIBILITY COMPANY, WHO SCREENS PATIENTS FROM DAY 1 TO DAY 60. THE SELF PAY BALANCES ARE RETURNED IF THE COMPANY IS UNABLE TO REACH THE PATIENT OR THE PATIENT DOES NOT QUALIFY. SELF PAY BALANCES THAT ARE RETURNED ARE SENT TO AN EARLY OUT COMPANY, WHO HAS OUR CHARITY GUIDELINES, IF THE PATIENT EXPRESSES AN INABILITY TO PAY, THEY ARE REFERRED TO THE HOSPITAL FOR SCREENING. ONCE A COMPLETED APPLICATION IS RECEIVED AND APPROVED, ANY ACCOUNT BALANCES ARE ADJUSTED ACCORDING TO THE LEVEL OF CHARITY THE PATIENT HAS QUALIFIED FOR. IF THE ACCOUNT IS WITH A COLLECTION AGENCY, IT IS RETURNED TO THE HOSPITAL. COMMUNITY INFORMATION HUNTSVILLE MEMORIAL HOSPITAL IS A JOINT COMMISSION-ACCREDITED, NOT-FOR-PROFIT ACUTE CARE COMMUNITY HOSPITAL. SINCE 1927, WE HAVE PROVIDED CHARITABLE HEALTH CARE SERVICES, DELIVERING QUALITY HEALTHCARE TO THE RESIDENTS OF WALKER COUNTY AND THE SURROUNDING COMMUNITIES. FOUNDED IN 1835, HUNTSVILLE IS ONE OF TEXAS' OLDEST CITIES AND THE HOME OF SAM HOUSTON, THE FIRST AND THIRD PRESIDENT OF THE REPUBLIC OF TEXAS. WE ARE HOME TO SAM HOUSTON STATE UNIVERSITY AND THE TEXAS DEPARTMENT OF CRIMINAL JUSTICE (THE ONLY STATE AGENCY WITH HEADQUARTERS OUTSIDE OF AUSTIN,). THE CITY OF HUNTSVILLE IS PART OF WALKER COUNTY IN EAST TEXAS, APPROXIMATELY 70 MILES NORTH OF HOUSTON AND 170 MILES SOUTH OF DALLAS VIA INTERSTATE 45. IT IS ON TEXAS HIGHWAY 30 (WEST TO BRYAN-COLLEGE STATION) AND HIGHWAY 190 (EAST TO LIVINGSTON). OTHER CITIES IN WALKER COUNTY INCLUDE NEW WAVERLY AND RIVERSIDE. HUNTSVILLE COVERS 31 SQUARE MILES, WHILE WALKER COUNTY INCLUDES 790 SQUARE MILES. THE POPULATION OF HUNTSVILLE IS 35,078, NEW WAVERLY IS 950, AND RIVERSIDE IS 425. THE POPULATION IN WALKER COUNTY IS 61,758. WALKER COUNTY IS LOCATED NEAR LAKE LIVINGSTON AND LAKE CONROE AND IS SURROUNDED BY THE SAM HOUSTON NATIONAL FOREST. WALKER COUNTY IS PROUD TO HOST A CULTURALLY DIVERSE COMMUNITY. THE POPULATION DENSITY IS 78 PEOPLE PER SQUARE MILE (30/KM). THERE ARE 21,099 HOUSING UNITS AT AN AVERAGE DENSITY OF 27 PER SQUARE MILE (10/KM). THE RACIAL MAKEUP OF THE COUNTY IS 67.9% WHITE, 23.88% BLACK OR AFRICAN AMERICAN, 0.35% NATIVE AMERICAN, 0.77% ASIAN, 0.05% PACIFIC ISLANDER, 4.42% FROM OTHER RACES, AND 1.41% FROM TWO OR MORE RACES. 14.11% OF THE POPULATION ARE HISPANIC OR LATINO OF ANY RACE. PROMOTION OF COMMUNITY HEALTH HUNTSVILLE MEMORIAL HOSPITAL'S COMMITMENT TO CHARITABLE CARE GOES BACK TO THE 1927 HOSPITAL CHARTER PROMISING "BENEVOLENT AND CHARITABLE" SERVICES FOR THE "SICK AND INFIRM." OUR GOAL IS TO EDUCATE AND BUILD AWARENESS, PROMOTING HEALTHY LIFESTYLES IN WALKER COUNTY. WE BELIEVE IN GIVING BACK TO THE COMMUNITY THROUGH A NUMBER OF VALUABLE HEALTH RESOURCES SUCH AS EDUCATIONAL MATERIALS, HANDS-ON CLASSES AND INFORMATIVE EVENTS. ON A MONTHLY BASIS, THE HOSPITAL HOLDS FREE COMMUNITY EDUCATION SESSIONS THAT ARE OPEN TO THE PUBLIC. THESE FORUMS PROVIDE CITIZENS A CHANCE TO DETECT A HEALTH THREAT AT ITS EARLIEST, MOST TREATABLE STAGE OR A WAY TO LEARN MORE ABOUT A LOVED ONE'S ILLNESS. EACH SESSION FEATURES A LOCAL PHYSICIAN AS THE KEY SPEAKER AND IS ALSO ASSOCIATED WITH A MEDICAL SCREENING. NOT ONLY DO WE PROVIDE ADVANCED CARE WITH A FRIENDLY TOUCH, WE ALSO FOCUS ON GIVING BACK TO THE GREAT COMMUNITY OF WALKER COUNTY EACH AND EVERY YEAR. WE PROVIDE REDUCED- OR NO-COST CARE FOR THOSE WITH FINANCIAL CHALLENGES. WE EDUCATE AND PRODUCE TOP-NOTCH NURSES THROUGH OUR ACCREDITED JOE G. DAVIS SCHOOL OF VOCATIONAL NURSING. WE RECRUIT EXPERT PHYSICIANS INTO OUR OPEN MEDICAL STAFF. UNDER THE LEADERSHIP OF OUR BOARD OF DIRECTORS, AND THROUGH THE DEDICATION OF OUR PROFESSIONAL HEALTH CARE STAFF, HUNTSVILLE MEMORIAL HOSPITAL IS SETTING THE STANDARD IN QUALITY HEALTH CARE TODAY. HUNTSVILLE MEMORIAL HOSPITAL IS ALSO ABLE TO GAIN VALUABLE INSIGHT FROM LOCAL COMMUNITY LEADERS WHO SERVE ON OUR FOUNDATION BOARD AND COMMUNITY ADVISORY BOARD. THE HUNTSVILLE MEMORIAL HOSPITAL MEDICAL CLINIC WAS ESTABLISHED IN 1992 TO MEET THE PRIMARY HEALTH CARE NEEDS OF THE RESIDENTS OF WALKER COUNTY. IT IS AN AMBULATORY ACUTE CARE CLINIC THAT PROVIDES CARE FOR PATIENTS OF ALL AGES. SERVICES INCLUDE PEDIATRIC CARE, ADOLESCENT MEDICINE AND ADULT MEDICINE. AFFILIATED HEALTH CARE SYSTEM ROLES AS A TESTAMENT TO THE QUALITY HEALTH CARE SERVICES THAT HUNTSVILLE MEMORIAL HOSPITAL PROVIDES, WE ARE RECOGNIZED AS AN AFFILIATE OF MEMORIAL HERMANN, A HEALTH CARE NETWORK SERVING THE GREATER HOUSTON AREA. HUNTSVILLE MEMORIAL OPERATES UNDER A CLOSE TEAM OF LEADERS KNOWN AS THE EXECUTIVE TEAM, WHICH ARE ALL EMPLOYEES OF MEMORIAL HERMANN. LED BY CHIEF EXECUTIVE OFFICER SALLY NELSON, THE TEAM PHILOSOPHY IS "TO PROVIDE FRIENDLY HEALTH CARE SERVICES, WHILE CONTINUING TO EXCEED THE EXPECTATIONS OF THE COMMUNITY." ELIGIBILITY FOR FREE OR DISCOUNTED CARE PART I, QUESTION 3C GRADUATED SCALE UP TO 500% OF FPG TO DETERMINE DISCOUNT. BILLINGS AND COLLECTIONS SCHEDULE H, PART V, LINE 16, 17, & 18 NEITHER HUNTSVILLE MEMORIAL HOSPITAL, NOR THIRD PARTIES AUTHORIZED BY HMH, 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. INDIVIDUAL ELIGIBLE FOR FINANCIAL ASSISTANCE PART V, SECTION B, LINE 20D THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE CALCULATED USING A SLIDING SCALE BASED UPON FEDERAL POVERTY GUIDELINES. IN ALL CASES, AMOUNTS CHARGED TO PATIENTS WILL BE BELOW THE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE, THE AVERAGE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE, AND MEDICARE RATES. INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY PART V, SECTION B, LINE 3 THE ORGANIZATION GATHERED INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY BY TELEPHONE INTERVIEWS WITH KEY ORGANIZATIONS AND INSTITUTIONS WITHIN THE COMMUNITY. GATHERED DATA WAS REVIEWED TO IDENTIFY HEALTH NEEDS OF THE COMMUNITY. COMMUNITY NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY PART V, SECTION B, LINE 6A THE IMPLEMENTATION STRATEGY IS INCLUDED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IS POSTED ONLINE AT THE FOLLOWING WEBSITE ADDRESS: http://www.huntsvillememorial.com/res/files/12/HMH%20FY2014%20Community%20 Benefit%20Plan.pdf true HMH Physicians Organization 110 Memorial Hospital Drive Hunstville TX 77340 760500960 501(C)(3) 1049384 Contribution 1 PROCEDURES TO MONITOR THE USE OF GRANT FUNDS IN THE U.S. PART I, QUESTION 2 THE ORGANIZATION EVALUATES AND MONITORS DONEES BASED ON PUBLIC AND PRIVATE DATA. X X X X false false false false false true true false false LENETH S ROZIER 143598 0 0 2872 16151 162621 CHEYENNE ASHMORE 155916 0 0 0 9 155925 PAYMENT OF SALARIES SCHEDULE J, PART I Memorial Hermann Hospital System (MHHS), also a Texas nonprofit corporation, managed the operations of the Hospital through an operating agreement. Under the operating agreement, MHHS provided day-to-day operations management of the Hospital. The management agreement between MHHS and the Hospital expired on April 30, 2013. Management fees, expense reimbursements, and other amounts paid pursuant to this agreement for the years ended June 30, 2013 and 2012, was approximately $1,401,000 and $1,562,000, respectively. THE FOLLOWING INDIVIDUALS WERE REPORTED IN FORM 990, PART VII BUT SHOWN WITH NO COMPENSATION PER IRS GUIDANCE. THEIR COMPENSATION UNDER THEIR EMPLOYMENT WITH MHHS, AN UNRELATED ENTITY, FOR SERVICES TO THE HOSPITAL ARE AS FOLLOWS: SALLY I NELSON, CEO $ 442,311 ROBERT E GRAY JR, CFO $ 145,715 DONNA STEWART, CNO $ 215,465 SHANNON BROWN, CFO $ 161,114 DAVID FICKLEN, MD, CMO $ 251,374 MANAGEMENT INCENTIVE PROGRAM SCHEDULE J, PART I, QUESTION 6A ELIGIBLE MANAGEMENT IS PAID A "DIPG" PAYMENT IN 2011, OR A MANAGEMENT INCENTIVE PROGRAM. THE DIPG PROGRAM CONSISTED OF HMH GOALS BASED ON HOSPITAL WIDE INITIATIVES IN OPERATIONAL EXCELLENCE, QUALITY, PATIENT SATISFACTION, EMPLOYEE SATISFACTION AND GROWTH. UNDER THE DIPG PROGRAM, EACH DEPARTMENT DIRECTOR WAS ASSIGNED THREE INDIVIDUAL GOALS AGREED UPON WITH THEIR SENIOR MANAGER. THE HOSPITAL ALSO HAD TO MEET EARNINGS BEFORE INTEREST, DEPRECIATION & AMORTIZATION EARNINGS LEVEL FOR THE DEPARTMENT DIRECTORS TO BE ELIGIBLE FOR PAYOUT AND THE TOTAL PAYOUT TO THEM WAS BASED ON THEIR FINAL ACHIEVEMENT LEVEL. MANAGEMENT INCENTIVE PROGRAM SCHEDULE J, PART I, QUESTION 6B A PORTION OF THE DISCRETIONARY INCENTIVE COMPENSATION PROGRAM WAS BASED ON THE CONSOLIDATED EBITDA OF CHC. JUDY BURRIS WIFE OF MEMBER 61786 EMPLOYMENT false DESCRIPTION OF MANAGEMENT ARRANGEMENT FORM 990, PART VI, QUESTION 3 Memorial Hermann Hospital System (MHHS), also a Texas nonprofit corporation, managed the operations of the Hospital through an operating agreement. Under the operating agreement, MHHS provided day-to-day operations management of the Hospital. The management agreement between MHHS and the Hospital expired on April 30, 2013. Management fees, expense reimbursements, and other amounts paid pursuant to this agreement for the years ended June 30, 2013 and 2012, was approximately $1,401,000 and $1,562,000, respectively. THE FOLLOWING INDIVIDUALS WERE REPORTED IN FORM 990, PART VII BUT SHOWN WITH NO COMPENSATION PER IRS GUIDANCE. THEIR COMPENSATION UNDER THEIR EMPLOYMENT WITH MHHS, AN UNRELATED ENTITY, FOR SERVICES TO THE HOSPITAL ARE AS FOLLOWS: SALLY I NELSON, CEO $ 442,311 ROBERT E GRAY JR, CFO $ 145,715 DONNA STEWART, CNO $ 215,465 SHANNON BROWN, CFO $ 161,114 DAVID FICKLEN, MD, CMO $ 251,374 PROCESS TO REVIEW THE 990 FORM 990, PART VI, QUESTION 11B THE DETAILED REVIEW OF THE FORM 990 IS CONDUCTED BY THE CFO FOLLOWING THE PREPARATION AND REVIEW OF THE RETURN BY THE ORGANIZATION'S PAID PREPARER. AN ELECTRONIC COPY OF THE FINAL FORM 990 IS EMAILED TO EACH BOARD MEMBER PRIOR TO FILING WITH THE IRS. PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 12C THE ORGANIZATION FOLLOWS A CONFLICT OF INTEREST DISCLOSURE PROCESS WHICH REQUIRES ALL OFFICERS, DIRECTORS, KEY EMPLOYEES, HIGHLY COMPENSATED EMPLOYEES AND OTHER MANAGEMENT OFFICIALS ("COVERED PERSONS") TO DISCLOSE POTENTIAL CONFLICTS. PURSUANT TO THE POLICY, A DISCLOSURE STATEMENT IS CIRCULATED ANNUALLY TO COVERED PERSONS IN WHICH THE INDIVIDUAL MUST DISCLOSE TRANSACTIONS THAT MAY RESULT IN A CONFLICT. COVERED PERSONS ARE ALSO ENCOURAGED TO NOTIFY THE BOARD, APPROPRIATE MANAGEMENT PERSONNEL, CHIEF COMPLIANCE OFFICE, GENERAL COUNSEL, OR THE AUDIT AND COMPLIANCE COMMITTEE OF THE GOVERNING BODY AS NECESSARY. WHEN NECESSARY, THE BOARD CHAIR OR APPROPRIATE BOARD COMMITTEE MAY APPOINT A DISINTERESTED PERSON(S) OR COMMITTEE TO INVESTIGATE THE POTENTIAL CONFLICT OF INTEREST AND RECOMMEND ALTERNATIVES TO THE APPLICABLE TRANSACTION OR ARRANGEMENT OR OTHERWISE DETERMINE IF THE CONFLICT CAN BE RESOLVED. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLY UNDER THE CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF THE ORGANIZATION, AND WHETHER IT IS REASONABLE. THE GOVERNING BOARD OR COMMITTEE MAKES THE DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. ANY MEMBER OF THE BOARD OPERATING UNDER A CONFLICT IS NOT PERMITTED TO BE PRESENT OR OTHERWISE PARTICIPATE IN THE VOTE ON ANY MATTER TO WHICH THE CONFLICT RELATES. IF THE GOVERNING BOARD OR COMMITTEE OF THE ORGANIZATION HAS REASONABLE CAUSE TO BELIEVE THAT A COVERED PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST AND AFTER INVESTIGATION THE BOARD OR COMMITTEE DETERMINES THAT THE COVERED PERSON FAILED TO DISCLOSE A CONFLICT OF INTEREST, THE ORGANIZATION TAKES APPROPRIATE DISCIPLINARY OR CORRECTIVE ACTION, WHICH MAY INCLUDE, TERMINATION OF THE INDIVIDUAL'S MEMBERSHIP, EMPLOYMENT, OR CONTRACT. PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, QUESTIONS 15A AND 15B THE ORGANIZATION USED AON HEWITT TO DEVELOP THE COMPENSATION PLAN AND AON HEWITT UTILIZED NUMEROUS MARKET SURVEYS TO ESTABLISH THE PLAN. THE PLAN WAS DEVELOPED BY AN INDEPENDENT PERSON AND APPROVED BY THE FINANCE COMMITTEE AND BOARD. HMH ALSO UTILIZES SALARY REVIEWS AND SURVEYS FOR COMPARISON WHEN DETERMINING COMPENSATION OF HIGHLY COMPENSATED EMPLOYEES. GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990, PART VI, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTERET POLICY AVAILABLE AT ITS BUSINESS OFFICE UPON REQUEST. PAYMENT OF SALARIES SCHEDULE J PART I PURSUANT TO THE MANAGEMENT AGREEMENT BETWEEN WALKER COUNTY HOSPITAL CORPORATION D/B/A HUNTSVILLE MEMORIAL HOSPITAL ("HMH") AND MEMORIAL HERMANN HOSPITAL SERVICES ("MHHS"), THE SALARIES OF SALLY I NELSON, ROBERT E GRAY, JR, AND SUSAN WHITE ARE PAID BY MHHS. HMH PAYS MHHS A MANAGEMENT FEE TO COVER THE SALARIES OF THESE INDIVIDUALS FOR SERVING AS OFFICERS OF HMH. RECONCILIATION OF OTHER CHANGES IN NET ASSETS FORM 990, PART XI, QUESTION 5 THA PENSION ADJUSTMENT $ 2,259,793 HMH PHYSICIAN ORGANIZATION 110 MEMORIAL HOSPITAL DRIVE HUNTSVILLE TX 77340 760500960 HOSPITAL TX 501(c)(3) 3 HMH true HUNSTVILLE MEMORIAL HOSPITAL AUXILIARY 110 MEMORIAL HOSPITAL DRIVE HUNSTVILLE TX 77340 741508450 SUPPORT ORG TX 501(C)(3) 9 NA false HUNTSVILLE MEMORIAL HOSPITAL FOUNDATION 110 MEMORIAL HOSPITAL DRIVE HUNTSVILLE TX 77340 273311765 SUPPORT ORG TX 501(C)(3) 11a NA false false true true false false false false false false false false false false false true true true false false HMH PHYSICIAN ORGANIZATION INC B 1049384 BOOK BASIS