MEMORIAL MEDICAL CENTER-SAN AUGUSTINE: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL MEDICAL CENTER-SAN AUGUSTINE (EIN 75-2663904)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-17
- IRS object ID
- 201443219349300909
- Schema version
- 2013v3.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-17T05:54:08-08:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Axley & Rode LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1307 S 1st St | AddressLine1 |
| City | Lufkin | City |
| State | TX | State |
| ZIP Code | 759014717 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 752663904 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Medical Center - San Augustine | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEMO | BusinessNameControlTxt |
| Phone | 9366348111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 1447 | AddressLine1 |
| City | Lufkin | City |
| State | TX | State |
| ZIP Code | 75902 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GARY N LOOPER | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Signature | 2014-11-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | J LEON MANNING CPA | PreparerPersonNm |
| PTIN | P00045819 | PTIN |
| Phone | 9366346621 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DARLENE WILLIAMS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 321 NEAL ROAD | AddressLine1 |
| City | HUNTINGTON | City |
| State | TX | State |
| ZIP Code | 75949 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $6,398,774 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| All Affiliates Included | false | AllAffiliatesIncludedInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | TX | LegalDomicileStateCd |
| Activity Or Mission | THE MISSION IS TO SUPPORT, MANAGE, & FURNISH FACILITIES TO PROVIDE QUALITY CRITICAL ACCESS HEALTHCARE SERVICES FOR THE CITIZENS OF SAN AUGUSTINE & SURROUNDING COUNTIES AND TO FACILITATE & ENCOURAGE EDUCATION & TRAINING ACTIVITIES TO PROMOTE THE HEALTH & WELFARE OF THOSE CITIZENS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 67 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $56,441 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $6,068,885 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $6,342,342 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$2,263 | PYInvestmentIncomeAmt |
| CY Investment Income | -$9 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $6,066,622 | PYTotalRevenueAmt |
| CY Total Revenue | $6,398,774 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,882,485 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,829,020 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,830,058 | PYOtherExpensesAmt |
| CY Other Expenses | $2,919,991 | CYOtherExpensesAmt |
| PY Total Expenses | $5,712,543 | PYTotalExpensesAmt |
| CY Total Expenses | $5,749,011 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $354,079 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $649,763 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,519,445 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,176,540 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,155,968 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,163,300 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$3,636,523 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$2,986,760 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE MISSION IS TO SUPPORT, MANAGE, & FURNISH FACILITIES TO PROVIDE QUALITY CRITICAL ACCESS HEALTHCARE SERVICES FOR THE CITIZENS OF SAN AUGUSTINE & SURROUNDING COUNTIES AND TO FACILITATE & ENCOURAGE EDUCATION & TRAINING ACTIVITIES TO PROMOTE THE HEALTH & WELFARE OF THOSE CITIZENS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $4,595,811 | ExpenseAmt |
| Revenue | $6,334,586 | RevenueAmt |
| Desc | HOSPITAL SERVICES PROVIDED TO PATIENTS IN SAN AUGUSTINE AND SURROUNDING AREA, INCLUDING 342 ADMISSIONS, 8,245 OUTPATIENT VISITS, 6,299 EMERGENCY ROOM VISITS AND 1,312 PATIENT DAYS. | Desc |
| Total Program Service Expenses | $4,595,811 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | false | BackupWthldComplianceInd |
| Employee | 67 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | false | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Excess Business Holdings | false | ExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Org Filed In Lieu Of Form1041 | false | OrgFiledInLieuOfForm1041Ind |
| Licensed More Than One State | false | LicensedMoreThanOneStateInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GARY N LOOPER | PersonNm |
| Phone | 9366348111 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 W FRANK | AddressLine1 |
| City | LUFKIN | City |
| State | TX | State |
| ZIP Code | 75901 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| CAROLYN LADNER | |||||||
| CHAIRMAN | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| NORRELL THOMAS | |||||||
| VICE CHAIRMAN | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| BARBARA MITCHELL | |||||||
| SEC/TREAS | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ALFRED BRODEN | |||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN MATHEWS | |||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JEANETTE DAVIDSON | |||||||
| DIRECTOR | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| THARASA N THOMAS | |||||||
| Director | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| PATRICIA MCKENZIE EdD | |||||||
| Director | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| HUGH MIXON | |||||||
| Director | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JEFF WATSON M D | |||||||
| CHIEF OF STAFF | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MARSHALL MCMILLAN | |||||||
| Director | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CHARLES BOYETTE | |||||||
| EX-OFFICIO | 0.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DARLENE WILLIAMS | |||||||
| ADMINISTRATOR | 40.00 | 0.00 | $145,170 | $0 | $17,278 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $145,170 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $17,278 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| EMCARE | |||||
| 7032 COLLECTION CENTER DR | CHICAGO | IL | 60693 | ER PHYSICIANS | $351,951 |
| WILLIAM BASSUKCLINICAL ENGINEERING | |||||
| 1606 DOE CREST | SAN ANTONIO | TX | 78248 | EQUIPMNT MAINTENANCE | $451,337 |
| SNG LUFKIN DIALYSIS CENTER LP | |||||
| 4425 W AIRPORT FWY STE 450 | IRVING | TX | 75062 | RENAL DIALYSIS | $178,889 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $56,441 | AllOtherContributionsAmt |
| Total Contributions | $56,441 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA SERVICES | 621990 | $7,756 | $7,756 | |
| COPY MACHINE INCOME | 621990 | $5,114 | $5,114 | |
| ELECTRONIC HEALTH RECORDS | 621990 | $792,883 | $792,883 | |
| PATIENT SERVICE REVENUE | 621990 | $5,523,390 | $5,523,390 | |
| RENTAL INCOME - AFFILIATE | 621990 | $8,964 | $8,964 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,235 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,235 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $6,342,342 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$9 | TotalRevenueColumnAmt |
| Exclusion | -$9 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,398,774 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,334,586 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $7,747 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,430 | TotalAmt |
| Management And General | $131,430 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,263,344 | TotalAmt |
| Program Services | $2,096,245 | ProgramServicesAmt |
| Management And General | $167,099 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,950 | TotalAmt |
| Program Services | $28,836 | ProgramServicesAmt |
| Management And General | $4,114 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $232,631 | TotalAmt |
| Program Services | $203,757 | ProgramServicesAmt |
| Management And General | $28,874 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $168,665 | TotalAmt |
| Program Services | $147,607 | ProgramServicesAmt |
| Management And General | $21,058 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,919 | TotalAmt |
| Management And General | $6,919 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,149,318 | TotalAmt |
| Program Services | $1,015,586 | ProgramServicesAmt |
| Management And General | $133,732 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,704 | TotalAmt |
| Management And General | $3,704 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,953 | TotalAmt |
| Program Services | $172,461 | ProgramServicesAmt |
| Management And General | $18,492 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $135,757 | TotalAmt |
| Program Services | $135,757 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,720 | TotalAmt |
| Program Services | $3,698 | ProgramServicesAmt |
| Management And General | $5,022 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $317,118 | TotalAmt |
| Program Services | $317,118 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,702 | TotalAmt |
| Management And General | $100,702 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| HOME OFFICE COST ALLOCATION | $482,519 | $482,519 | |
| PATIENT CARE SUPPLIES | $374,265 | $374,265 | |
| OTHER EXPENSES | $67,074 | $40,978 | $26,096 |
| REPAIRS & MAINTENANCE | $64,829 | $3,047 | $61,782 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,113 | TotalAmt |
| Program Services | $12,603 | ProgramServicesAmt |
| Management And General | $5,510 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,749,011 | TotalAmt |
| Program Services | $4,595,811 | ProgramServicesAmt |
| Management And General | $1,153,200 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,096 | BOYAmt |
| EOY | $11,267 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $375,537 | BOYAmt |
| EOY | $531,869 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $127,346 | BOYAmt |
| EOY | $112,332 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,309 | BOYAmt |
| EOY | $23,326 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,912,191 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,967,690 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,964,744 | BOYAmt |
| EOY | $2,944,501 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,413 | BOYAmt |
| EOY | $553,245 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,519,445 | BOYAmt |
| EOY | $4,176,540 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $764,177 | BOYAmt |
| EOY | $454,188 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,391,791 | BOYAmt |
| EOY | $6,709,112 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,155,968 | BOYAmt |
| EOY | $7,163,300 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$3,636,523 | BOYAmt |
| EOY | -$2,986,760 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$3,636,523 | BOYAmt |
| EOY | -$2,986,760 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,519,445 | BOYAmt |
| EOY | $4,176,540 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $649,763 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | false | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,845,884 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,365,200 | DepreciationAmt |
| Book Value | $1,480,684 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,465 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,111 | DepreciationAmt |
| Book Value | $6,354 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,056,842 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,599,379 | DepreciationAmt |
| Book Value | $1,457,463 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,944,501 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due from Affiliates | $26,747 |
| Electronic Health Records Receivable | $526,832 |
| Miscellaneous Receivables | -$334 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $553,245 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATE | $6,395,977 |
| Insurance Reserve Payable | $255,392 |
| PENSION PLAN PAYABLE | $36,327 |
| SICK TIME PAYABLE | $21,416 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,709,112 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $118,921 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $118,921 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02070 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $836,421 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $483,559 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $352,862 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06140 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $955,342 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $483,559 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $471,783 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08210 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,510 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,510 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,510 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,510 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $960,852 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $483,559 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $477,293 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08310 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,080,463 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $540,231 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $2,655,204 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,661,070 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$5,866 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MMC-SAN AUGUSTINE | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 511 E HOSPITAL ST | AddressLine1 |
| City | SAN AUGUSTINE | City |
| State | TX | State |
| ZIP Code | 75972 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MMC-SAN AUGUSTINE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | MEMORIALHEALTH.ORG | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Include Operational Plan | Yes (X) | IncludeOperationalPlanInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | false | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Form4720 Filed | false | Form4720FiledInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.0000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 250.0000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | false | FAPActionsOnNonpaymentInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| Other Actions | Yes (X) | OtherActionsInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | Yes (true) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 3 - Account Input from Person Who Represent the Community | Interview Methodology- Memorial Health System of East Texas provided CHC Consulting with a list of people with special knowledge of Angelina, Polk and San Augustine Counties including public health representatives, not-for-profit organization professionals, charities and other individuals who focus specifically on underrepresented groups.- From that list, 21 in depth interviews were conducted using a structured interview guide. In order to further quantify the data, a follow up survey was sent to the list of 21 with the option to forward the survey on to others.- Extensive notes were taken during each interview and then quantified based on responses, communities and populations (minority, elderly, un/underinsured, etc.)served, and priorities identified by respondents. Qualitative data from the interviews was also analyzed and reported. Survey Construction, Distribution, and Collection- An electronic survey was constructed using Survey Monkey(TM) software in order to gather opinions and input of those with special knowledge regarding the health needs and priorities of the study area.- The survey was restricted so that respondents could only complete the survey once per computer to protect the integrity of the data.- The survey was initially distributed to the 21 interviewees. Recipients were allowed to forward the survey to other stakeholders in the community. The survey remained open for approximately one month.- Responses were quantified and analyzed for reporting purposes, including any free-form comments. Interviewee list- Tina Battise, Deputy Administrator, Alabama-Coushatta Tribe- Deborah Walters, RN, Director, Case Management and Social Work, MHSET- Marilyn Kegler, Director of Nurses, Lufkin ISD- Marshall McMillan, Member, MMC-San Augustine Board of Directors, Chair, Boys and Girls Club of San Augustine- John L. Brink, RN, Nurse Manager, Cardiac Cath Lab/Cardiac Rehab, MHSET/Member of the Angelina County Heart Alliance- Dr. Sid Roberts, Radiation Oncologist- Jean Hines, SAN Augustine County Hospital District Board member- Carla Hight, Director, United Way - Angelina County- Judge Sammye Johnson, San Augustine County Judge- Brittney Johnson, Project Manager, San Augustine County- Sharon Shaw, Administrator, Angelina County and Cities Health District- Dr. Robert Fayle, Neurologist- Jerry Hathorne, Chairman, Polk County Advisory Committee- Susan Rushing, CEO, Burke Center- Letha Tullos, Regional Vice President for the East Texas Region, American Cancer Society- Carrie Yocum, Administrator, Twin Lakes Rehabilitation and Care Center- Ray Polk, Diabetes Activist and former Board Member, Memorial Medical Center- Lufkin- Phyllis Grandgeorge, Executive Director, Alcohol and Drug Abuse Council- Heather Kartye, Executive Director, Family Crisis Center of East Texas- Minerva Palomino, Social Worker, MHSET- Judge John Thompson, Judge, Polk County |
| Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment | The Community Health Needs Assessment was conducted to include all four (4) facilities which comprise Memorial Health System of East Texas: (1) Memorial Medical Center of East Texas (Lufkin), (2) Memorial Medical Center Livingston, (3) Memorial Medical Center San Augustine, and (4) Memorial Specialty Hospital. |
| Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why | Following the completion of thorough process designed to comply with the requirements of Patient Protection and Affordable Care Act, including research, individual interviews with stakeholders, and receipt of the survey results, a Community Health Needs Assessment Team consisting of hospital representatives and the Executive Director of the local Health District reviewed all results identified and prioritized eight (8) specific health needs. Working with the consultants from Community Hospital Consulting, the team identified actions to address those needs and developed implementation plans FOR Seven (7) of the eight (8) needs identified. The eighth identified need, increasing access to affordable dental care, was not addressed as it was deemed not a core business function of the health system. |
| Part V, Line 17e - Other Collection Actions by Facility or Third Party Engaged | THE ONLY CASE IN WHICH THE SYSTEM TAKES ANY ACTION TO COLLECT PRIOR TO DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE IS WHEN A PATIENT IS INJURED IN AN ACCIDENT AND A THIRD-PARTY MAY BE RESPONSIBLE. IN THAT CASE, ACCIDENT LIABILITY CASE LIENS ARE FILED AGAINST FUTURE SETTLEMENTS TO COLLECT UNPAID AMOUNTS. IF THE FUTURE SETTLEMENT DOES NOT COVER THE ENTIRE ACCOUNT BALANCE, THE REMAINING AMOUNT IS WRITTEN OFF. |
| Part V, Line 20d - Other Billing Determination of Individuals Without Insurance | PATIENTS WITHOUT INSURANCE ARE BILLED USING THE SAME RATES FOR SERVICE AS ALL OTHER PATIENTS. |
| Part V, Line 22 - Charge Patients Amount Equal Gross Charge for Services | ALL PATIENTS ARE EQUALLY CHARGED. PATIENTS WHO FILE AN APPLICATION FOR FINANCIAL ASSISTANCE ARE NOT BILLED UNLESS IT IS LATER DETERMINED THAT THEY DO NOT QUALIFY FOR ASSISTANCE. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a - Related Organization Community Benefit Report | INFORMATION ABOUT THE ORGANIZATION IS INCLUDED IN THE "REPORT TO THE COMMUNITY" PREPARED ANNUALLY BY MEMORIAL HEALTH SYSTEM OF EAST TEXAS. AS THE HOSPITAL IS IN A COUNTY WITH LESS THAN 50,000 POPULATION AND IS IN A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA, IT IS NOT REQUIRED TO PREPARE AND FILE AN ANNUAL COMMUNITY BENEFIT REPORT WITH THE STATE OF TEXAS. |
| Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense | THE AMOUNT SHOWN ON LINE 2 WAS DETERMINED BY USING THE COSTING METHODOLOGY DERIVED FROM WORKSHEET 2 - "RATIO OF PATIENT CARE COST-TO-CHARGES". THE HOSPITAL ACCOUNTS FOR DISCOUNTS AS DEDUCTIONS FROM GROSS PATIENT REVENUE AND WHERE APPLICABLE, PAYMENT OF PATIENTS ACCOUNTS AS DEDUCTIONS FROM UNCOLLECTIBLE (BAD DEBTS EXPENSE) ACCOUNTS. |
| Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit | THE AMOUNT SHOWN ON LINE 3 IS BASED ON THE HOSPITAL'S ESTIMATE THAT 50% OF THE ACCOUNTS RECORDED AS BAD DEBT EXPENSE WOULD HAVE BEEN CLASSIFIED AS CHARITY (COMMUNITY BENEFIT) HAD THE APPROPRIATE INFORMATION BEEN OBTAINED. THIS ESTIMATE IS PRIMARILY BASED ON THE POPULATION'S MEDIAN HOUSEHOLD INCOME ($26,841), THAT 27.2% OF COMMUNITY RESIDENTS HAD INCOME BELOW THE FEDERAL POVERTY LEVEL, THAT 76% OF GROSS PATIENT REVENUE WAS FROM OUTPATIENTS AND THAT THE HOSPITAL DID NOT EMPLOY ADEQUATE PERSONNEL TO IDENTIFY AND FOLLOW UP ON PATIENT ACCOUNTS THAT WOULD HAVE QUALIFIED FOR CHARITY STATUS. THERE ARE ALSO VARIOUS OTHER REASONS WHY ADEQUATE INFORMATION WAS NOT OBTAINED. THESE REASONS INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: LANGUAGE BARRIERS WITH THE SPANISH SPEAKING POPULATION THE PATIENT'S LACK OF UNDERSTANDING ABOUT THE PROCESS AND WHERE TO FIND THE INFORMATION REQUESTED SOME PATIENT'S ARE UNABLE OR UNWILLING TO SUPPLY SUPPORTING DOCUMENTATION LACK OF UNDERSTANDING BY THE PATIENT OF HOW A CHARITY CLASSIFICATION RATHER THAN A BAD DEBT CLASSIFICATION MAY BENEFIT THEM |
| Part III, Line 4 - Bad Debt Expense | THE HOSPITAL DOES NOT REPORT BAD DEBTS EXPENSE (UNCOLLECTIBLE ACCOUNTS) IN ACCORDANCE WITH HFMA STATEMENT NO. 15. THE HOSPITAL ACCOUNTS FOR ANY LOSSES ON ACCOUNTS RECEIVABLE USING THE ALLOWANCE METHOD. THE HOSPITAL IS A MEMBER OF A SYSTEM WITH CONSOLIDATED FINANCIAL STATEMENTS AUDITED BY BKD, LLP. THE CONSOLIDATED FINANCIAL STATEMENTS FOOTNOTE TO PATIENT ACCOUNTS RECEIVABLE INCLUDES THE FOLLOWING:"ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE 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 PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS." |
| Part III, Line 9b - Provisions On Collection Practices For Qualified Patients | AS SOON AS SUFFICIENT INFORMATION IS AVAILABLE CONCERNING THE PATIENT'S FINANCIAL RESOURCES AND ELIGIBILITY FOR GOVERNMENT ASSISTANCE, A DETERMINATION IS MADE CONCERNING THE PATIENT'S ELIGIBILITY FOR CHARITY. NO COLLECTION EFFORTS WILL BE PURSUED ON A CHARITY ACCOUNT AFTER SUCH DETERMINATION IS MADE. |
| Part VI - Needs Assessment | IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT REQUIRED BY LAW, THE HOSPITAL HAS A BOARD OF DIRECTORS MADE UP OF COMMUNITY MEMBERS WHO PROVIDE INPUT ABOUT NEEDS IN THE COMMUNITY. OUR PHYSICIANS HAVE NUMEROUS COMMITTEES AT THE HOSPITAL, IN PART TO KEEP US INFORMED ABOUT COMMUNITY MEDICAL NEEDS. |
| Part VI - Patient Education of Eligibility for Assistance | THE HOSPITAL INFORMS AND EDUCATES PATIENTS BY PROVIDING PATIENT HANDBOOKS WHICH CONTAIN INFORMATION FOR UNINSURED PATIENTS AS WELL AS FINANCIAL COUNSELOR INFORMATION. PATIENT BILLS HAVE INFORMATION AND WORDING IN THEM WHICH STATES FOR THEM TO CALL THE BUSINESS OFFICE FOR POSSIBLE DISOUNTS OF UP TO 50%. WE USE A CALCULATION SHEET FOR INCOME LEVELS WHICH TAKES INTO ACCOUNT THE NUMBER OF FAMILY MEMBERS IN THE HOUSEHOLD AND THEIR TOTAL INCOME, WHICH TRANSLATES INTO THEIR TOTAL DISCOUNT AMOUNT AND DISCOUNT PERCENTAGE.THE ADMISSION SUPERVISOR MAILS APPLICATIONS FOR FINANCIAL ASSISTANCE TO PATIENTS MONDAY - FRIDAY FROM THE EMERGENCY DEPARTMENT VISITS THAT ARE LISTED AS SELF PAY; ADDITIONALLY SHE ASSISTS PATIENTS DURING WORKING HOURS WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS; SHE ALSO DISCUSSES THE COUNTY INDIGENT PROGRAM WITH THEM AND GIVES REFERRALS TO THE ON-SITE COUNTY INDIGENT INTAKE COORDINATOR. IN 2011, THE HOSPITAL ADDED A PERSON TO ASSIST WITH APPLICATIONS AND RESOURCES AND A SOCIAL WORKER MONDAY-FRIDAY. |
| Part VI - Community Information | SAN AUGUSTINE COUNTY WITH AN APPROXIMATE POPULATION OF 8,769, IS CONSIDERED A RURAL COUNTY. IT IS A FEDERALLY DESIGNATED MEDICALLY UNDER SERVED AREA; HEALTH PROFESSIONAL SHORTAGE AREA AND MENTAL HEALTH PROFESSIONAL SHORTAGE AREA PER A RECENT HRSA SHORTAGE AREA REVIEW AND PER THE 2000 TEXAS TECH UNIVERSITY HEALTH SCIENCE CENTER'S RURAL HEALTH STUDY, WE ARE ALSO A FRONTIER AREA. THE POPULATION'S AVERAGE INCOME IS $27,580; 25.8% OF COMMUNITY RESIDENTS WITH INCOME BELOW THE FEDERAL POVERTY GUIDELINE. IN 2011 WE HAD AN AVERAGE UNEMPLOYMENT RATE OF 12.4%. APPROXIMATELY 18 - 20% OF OUR PATIENT BASE IS UNINSURED, APPROXIMATELY 20% OF OUR PATIENT BASE IS MEDICAID RECIPIENTS, AND APPROXIMATELY 55% OF OUR PATIENT BASE IS MEDICARE RECIPIENTS. THE HOSPITAL IS THE ONLY HEALTH CARE FACILITY IN SAN AUGUSTINE COUNTY, AND IS THEREFORE THE ONLY HOSPITAL WHICH DIRECTLY SERVES OUR COMMUNITY. WE ARE A MEDICARE DESIGNATED CRITICAL ACCESS FACILITY.THE CITY OF SAN AUGUSTINE IS THE COUNTY SEAT AND THE HOSPITAL SERVES AS THE MEDICAL HUB OF SAN AUGUSTINE COUNTY. WE HAVE MISSION DELORES VISITOR CENTER AND RV PARK LOCATED ONE MILE FROM THE HOSPITAL. WE ARE WITHIN 20 MINUTES OF LAKE SAM RAYBURN AND TOLEDO BEND RESERVOIR AND THE BIG THICKET NATIONAL PRESERVE. WE ARE A CERTIFIED RETIREMENT COMMUNITY SO THE HOSPITAL SERVES A LARGE POPULATION OF RETIREES, VACATIONERS, HUNTERS AND NATURE LOVERS. |
| Part VI - Explanation Of How Organization Furthers Its Exempt Purpose | THE HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY THROUGH PARTICIPATION IN VARIOUS EDUCATIONAL ACTIVITIES WITH FOCUS ON CPR, DIABETIC EDUCATION AND SUPPORT GROUPS AS 12.6% OF OUR POPULATION IS DIABETIC. THE HOSPITAL PARTICIPATES IN HEALTH FAIRS AT THE HOSPITAL, HEALTH FAIRS AT THE SASSAFRAS FESTIVAL, SPEAKING/HEALTH EDUCATION AT ROTARY, LIONS CLUB AND OTHER AREA ORGANIZATIONS, PARTICIPATING IN BUSINESS AFTER HOURS, RELAY FOR LIFE, AND RURAL EAST TEXAS HEALTH NETWORK OF MENTAL HEALTH. THERE WAS A FOCUS ON STROKE WARNING SIGNS IN SOME OF THE PROGRAMS OFFERED IN 2012. ANNUALLY, WE PARTICIPATE IN A HEALTH FAIR AT THE LOCAL ELECTRIC CO-OP, PROVIDING HEALTH SCREENINGS AND FREE BLOOD PRESSURES. THE HOSPITAL HOSTS A COMMUNICATION/EDUCATION MEETING WITH LOCAL NURSING HOMES, ASSISTED LIVING AND DEVELOPMENT CENTER ON A QUARTERLY BASIS. THE HOSPITAL ALSO PARTNERS WITH THE FOLLOWING COMMUNITY GROUPS: CANCER SUPPORT GROUP, PANOLA COLLEGE LVN NURSING PROGRAMS AND PHLEBOTOMY PROGRAMS, AND WITH AREA HIGH SCHOOLS HEALTH CAREERS PROGRAMS WHICH ALLOW HIGH SCHOOL STUDENTS TO PARTICIPATE IN CLINICAL STUDIES AT THE HOSPITAL. WE ARE ACTIVE MEMBERS OF DEEP EAST TEXAS REGIONAL AREA COUNCIL TRAUMA SERVICES AREA H; IMPROVING TRAUMA CARE AND PREVENTION TO THE COMMUNITIES WE SERVE. |
| Part VI - Affilated Health Care System Roles and Promotion | IN ADDITION TO THE CUSTOMIZED OUTREACH IN EACH INDIVIDUAL COMMUNITY, THE CORPORATE STRUCTURE PROVIDES EACH HOSPITAL IN ANGELINA, POLK AND SAN AUGUSTINE COUNTIES WITH IMPROVED MEDICAL TECHNOLOGY THROUGH A COMMON COMPUTER SYSTEM, COMMUNICATION TO ALL COMMUNITIES THROUGH THE CORPORATE MARKETING DEPARTMENT, AND COORDINATION OF MEDICAL TRAINING FOR ALL EMPLOYEES. THE LUFKIN HOSPITAL (MEMORIAL HEALTH SYSTEM OF EAST TEXAS) IS ABLE TO ACCEPT TRANSFERS OF MORE MEDICALLY COMPLEX CASES FROM THE OTHER SYSTEM HOSPITALS. |
| Part VI - Additional Information | PART I, LINE 7 - THE HOSPITAL USED A COST-TO-CHARGE RATIO TO CALCULATE THE AMOUNTS REPORTED IN THIS TABLE. THIS COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 - "RATIO OF PATIENT CARE COST-TO-CHARGES". PART VI, LINE 1 - PART I, LINE 7, COLUMN (F):IN ACCORDANCE WITH THE INSTRUCTIONS, $5,510 IN COMMUNITY BENEFITS INCLUDED IN PART IX, LINE 25, COLUMN A, AS WELL AS $26,069 IN REVENUE FROM NON PATIENT SERVICES INCLUDED IN PART VIII, LINE 12, COLUMN A HAVE BEEN REMOVED FROM THE DENOMINATOR IN THE CALCULATION OF THE PERCENTAGES SHOWN IN COLUMN (F) FOR LINES 7 (A), 7 (B), 7 (D), 7 (I), 7(J) & 7 (K).AS A RESULT OF THE FOREGOING, THE CALCULATION OF THE DENOMINATOR AMOUNT IS SHOWN BY THE FOLLOWING: TOTAL FUNCTIONAL EXPENSES FROM PART IX, LINE 25, COLUMN A $5,749,011 LESS: COMMUNITY BENEFITS EXPENSE ( 5,510) REVENUE FROM NON-PATIENT CARE ACTIVITIES ( 26,069) ADJUSTED PATIENT CARE COSTS $5,717,432 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (true) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
| Rebuttable Presumption Proc | false | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DARLENE WILLIAMS | PersonNm |
| Title | ADMINISTRATOR | TitleTxt |
| Base Compensation Filing Org | $125,583 | BaseCompensationFilingOrgAmt |
| Bonus Filing Organization | $19,174 | BonusFilingOrganizationAmount |
| Other Compensation Filing Org | $413 | OtherCompensationFilingOrgAmt |
| Deferred Compensation Flng Org | $3,943 | DeferredCompensationFlngOrgAmt |
| Nontaxable Benefits Filing Org | $13,335 | NontaxableBenefitsFilingOrgAmt |
| Total Compensation Filing Org | $162,448 | TotalCompensationFilingOrgAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 3: Description of Delegated Duties to Management Company | MEMORIAL HEALTH SYSTEM OF EAST TEXAS PROVIDES MANAGEMENT AND FINANCIAL ASSISTANCE TO MMC-SAN AUGUSTINE, TO INCLUDE ATTENDANCE AT BI-MONTHLY MEETINGS OF THE BOARD OF DIRECTORS, BILLING AND COLLECTION OF CHARGES FOR PATIENT SERVICES, DATA PROCESSING SERVICES, KEEPING OF FINANCIAL RECORDS, PAYMENT OF SALARIES AND MONTHLY BILLS.IN AUGUST 2011, THE SYSTEM ENGAGED COMMUNITY HOSPITAL CONSULTING, INC. FOR CERTAIN MANAGEMENT SERVICES INCLUDING RESPONSIBILITY FOR OVERSIGHT AND MANAGEMENT OF DAY-TO-DAY OPERATIONS OF THE SYSTEM AND ITS HOSPITALS, AND TO MEMORIAL SPECIALTY HOSPITAL TO WHICH IT PROVIDES ADMINISTRATIVE OVERSIGHT AND SERVICES BY CONTRACT. THE CONTRACT AUTHORIZES PLACEMENT OF COMMUNITY HOSPITAL CONSULTING EMPLOYEES OR CONTRACTORS AS SUCH OF THE SENIOR AND OTHER MANAGEMENT PERSONNEL AS COMMUNITY HOSPITAL CONSULTING, INC. DEEMS APPROPRIATE SUBJECT TO THE OVERSIGHT OF THE SYSTEM BOARD OF DIRECTORS. |
| Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder | MEMORIAL HEALTH SYSTEM OF EAST TEXAS IS THE SOLE MEMBER. |
| Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body | THE MEMBER (MEMORIAL HEALTH SYSTEM OF EAST TEXAS) APPROVES THE INDIVIDUALS SELECTED TO THE BOARD OF DIRECTORS OF MMC-SAN AUGUSTINE AND THE MANAGEMENT OF MHSET PROVIDES OVERSITE OF FINANCIAL AND CLINICAL OPERATIONS. |
| Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders | THE MEMBER (MEMORIAL HEALTH SYSTEM OF EAST TEXAS) HAS THE AUTHORITY TO REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF MMC-SAN AUGUSTINE |
| Form 990, Part VI, Line 11b: Form 990 Review Process | THE BOARD OF DIRECTORS OF MEMORIAL MEDICAL CENTER - SAN AUGUSTINE REVIEWS THE FORM 990 BEFORE FILING. |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | PRIOR TO THE INITIAL MEETING OF A CALENDAR YEAR, EACH MEMBER OF THE BOARD AND OFFICER OF THE CORPORATION IS PROVIDED A COPY OF THE CONFLICTS OF INTEREST POLICY, A STATEMENT ACKNOWLEDGING ITS RECEIPT, AND DISCLOSURE OF OUTSIDE INTERESTS AND ACTIVITIES FORM. THE POLICY IS DISCUSSED WITH THE BOARD AND EACH OFFICER. EACH BOARD MEMBER AND OFFICER COMPLETES THE DISCLOSURE OF OUTSIDE INTERESTS AND ACTIVITIES FORM AND RETURNS THEM TO THE CHIEF EXECUTIVE OFFICER (CEO) OF MEMORIAL HEALTH SYSTEM OF EAST TEXAS (MHSET). THE CEO AND MHSET'S GENERAL COUNSEL REVIEW EACH STATEMENT ACKNOWLEDGING RECEIPT OF THE POLICY AND DISCLOSURES TO FAMILIARIZE THEMSELVES WITH THE POTENTIAL CONFLICTS. |
| Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management | THE SALARY OF THE ADMINISTRATOR OF THE CORPORATION IS SET BY THE CHIEF EXECUTIVE OFFICER OF MEMORIAL HEALTH SYSTEM OF EAST TEXAS WHO IS AN EMPLOYEE OF COMMUNITY HOSPITAL CONSULTING, INC. (CHC). AN APPROPRIATE SALARY IS ESTABLISHED FROM CHC'S INTERNAL COMPENSATION POLICY WHICH INCLUDES THE ASSISTANCE OF A COMPENSATION CONSULTANT, COMPETIVE MARKET ANALYSIS, JOB DESCRIPTION AND SCOPE OF RESPONSIBILITY. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | ORGANIZATIONAL DOCUMENTS, APPLICATIONS FOR EXEMPTION AND FINANCIAL STATEMENTS OF THE CORPORATION AND CONFLICTS OF INTEREST POLICY ARE AVAILABLE FOR INSPECTION AND COPYING IN THE OFFICE OF THE CHIEF FINANCIAL OFFICER OF MEMORIAL HEALTH SYSTEM OF EAST TEXAS LOCATED AT 1201 W. FRANK AVENUE, LUFKIN, TEXAS 75904 ON ORAL OR WRITTEN REQUEST DURING REGULAR BUSINESS HOURS, OR SUCH OTHER TIMES AS ARE SCHEDULED DIRECTLY WITH THE CHIEF FINANCIAL OFFICER. |
| FORM 990 - PART V - QUESTION 1A: | MEMORIAL HEALTH SYSTEM OF EAST TEXAS (MHSET) PAYS THE HOSPITAL'S BILLS FOR SERVICES THAT WOULD REQUIRE THE PREPARATION OF FORMS 1099 AND THE RELATED FORM 1096, AND REPORTS SUCH PAYMENTS UNDER ITS FEDERAL IDENTIFICATION NUMBER (75-0755367). THE HOSPITAL REIMBURSES MHSET FOR SUCH PAYMENTS. |
| PATIENT SERVICE REVENUE RECONCILIATION: | PATIENT SERVICE REVENUE SHOWN ON FORM 990, PART VIII, LINE 2A WAS DETERMINED AS FOLLOWS: GROSS CHARGES TO PATIENTS $20,320,786 LESS: MEDICARE CONTRACTUAL ADJUSTMENTS ( 5,417,233) MEDICAID CONTRACTUAL ADJUSTMENTS ( 764,495) INDUSTRY/MANAGED CARE ADJUSTMENTS ( 4,168,815) CHARITY DEDUCTIONS ( 422,605) UNCOLLECTIBLE ACCOUNTS ( 3,839,598) OTHER DISCOUNTS ( 184,650) PATIENT SERVICE REVENUE $ 5,523,390 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MEMORIAL HEALTH SYSTEM OF EAST TEXAS | |||||||||||
| 1201 W FRANK AVE | LUFKIN | TX | 75904 | 750755367 | LICENSED HOSPITAL | TX | 501(c)(3) | (3) HOSPITAL | N/A | false | |
| MEMORIAL MEDICAL CENTER - LIVINGSTON | |||||||||||
| 1717 HWY 59 BYPASS | LIVINGSTON | TX | 77351 | 760436439 | LICENSED HOSPITAL | TX | 501(C)(3) | (3) HOSPITAL | false | MEMORIAL HEALTH SYSTEM OF EAST TEXAS | |
| MEMORIAL MULTISPECIALTY ASSOCIATES | |||||||||||
| 1201 FRANK AVENUE | LUFKIN | TX | 75904 | 752721155 | PROVIDES PHYSICIANS TO NON PROFIT HOSPITALS | TX | 501(C)(3) | 11c | false | MEMORIAL HEALTH SYSTEM OF EAST TEXAS | |
| LUFKIN VISION ACQUISITIONS | |||||||||||
| 1201 FRANK AVENUE | LUFKIN | TX | 75904 | 820563768 | PROVIDES OFFICE SPACE FOR HEALTH CARE PROFESSIONALS | TX | 501(C)(3) | 11c | false | MEMORIAL HEALTH SYSTEM OF EAST TEXAS | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| MHI CLINICAL SERVICES | |||||||||
| 1201 W FRANK AVE | LUFKIN | TX | 75904 | 461967952 | MEDICAL SERVICES | TX | MEMORIAL HEALTH SYST | C | false |
| MEMORIAL CV SERVICE LINE MANAGEMENT | |||||||||
| 1201 W FRANK AVE | LUFKIN | TX | 75904 | 463622849 | MEDICAL SERVICES | TX | MEMORIAL HEALTH SYST | C | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |