2014-11-17T05:54:08-08:00 2013-12-31 Axley & Rode LLP 1307 S 1st St Lufkin TX 759014717 990 2013-01-01 752663904 Memorial Medical Center - San Augustine MEMO 9366348111 P O Box 1447 Lufkin TX 75902 GARY N LOOPER CEO 2014-11-06 true J LEON MANNING CPA P00045819 9366346621 2013 2015-11-30 17:44:51Z DARLENE WILLIAMS 321 NEAL ROAD HUNTINGTON TX 75949 6398774 false false X N/A X 1996 TX 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. 12 12 67 0 56441 6068885 6342342 -2263 -9 0 6066622 6398774 0 0 2882485 2829020 0 0 2830058 2919991 5712543 5749011 354079 649763 2519445 4176540 6155968 7163300 -3636523 -2986760 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. false false 4595811 6334586 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. 4595811 true true false false false false false false false false true false false true true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false false false false true false false false false true 0 0 false 67 true false false false false false false false false 0 false false false false false false false false false false X 12 12 false true false false true true true true true false false true true true true true true true true false X GARY N LOOPER 9366348111 1201 W FRANK LUFKIN TX 75901 CAROLYN LADNER CHAIRMAN 1.00 0.00 X 0 0 0 NORRELL THOMAS VICE CHAIRMAN 0.00 0.00 X 0 0 0 BARBARA MITCHELL SEC/TREAS 0.00 0.00 X 0 0 0 ALFRED BRODEN DIRECTOR 0.00 0.00 X 0 0 0 JOHN MATHEWS DIRECTOR 0.00 0.00 X 0 0 0 JEANETTE DAVIDSON DIRECTOR 0.00 0.00 X 0 0 0 THARASA N THOMAS Director 0.00 0.00 X 0 0 0 PATRICIA MCKENZIE EdD Director 0.00 0.00 X 0 0 0 HUGH MIXON Director 0.00 0.00 X 0 0 0 JEFF WATSON M D CHIEF OF STAFF 2.00 0.00 X 0 0 0 MARSHALL MCMILLAN Director 0.00 0.00 X 0 0 0 CHARLES BOYETTE EX-OFFICIO 0.00 0.00 X 0 0 0 DARLENE WILLIAMS ADMINISTRATOR 40.00 0.00 X 145170 0 17278 145170 17278 1 false true false EMCARE 7032 COLLECTION CENTER DR CHICAGO IL 60693 ER PHYSICIANS 351951 WILLIAM BASSUKCLINICAL ENGINEERING 1606 DOE CREST SAN ANTONIO TX 78248 EQUIPMNT MAINTENANCE 451337 SNG LUFKIN DIALYSIS CENTER LP 4425 W AIRPORT FWY STE 450 IRVING TX 75062 RENAL DIALYSIS 178889 3 56441 56441 CAFETERIA SERVICES 621990 7756 7756 COPY MACHINE INCOME 621990 5114 5114 ELECTRONIC HEALTH RECORDS 621990 792883 792883 PATIENT SERVICE REVENUE 621990 5523390 5523390 RENTAL INCOME - AFFILIATE 621990 8964 8964 4235 4235 6342342 -9 -9 0 0 0 0 0 0 0 0 6398774 6334586 7747 X 0 0 0 0 131430 131430 0 2263344 2096245 167099 32950 28836 4114 232631 203757 28874 168665 147607 21058 0 0 6919 6919 0 0 0 1149318 1015586 133732 3704 3704 190953 172461 18492 0 0 135757 135757 8720 3698 5022 0 0 0 0 317118 317118 100702 100702 HOME OFFICE COST ALLOCATION 482519 482519 PATIENT CARE SUPPLIES 374265 374265 OTHER EXPENSES 67074 26096 40978 REPAIRS & MAINTENANCE 64829 61782 3047 18113 12603 5510 5749011 4595811 1153200 0 1096 11267 0 0 375537 531869 0 0 0 127346 112332 24309 23326 6912191 3967690 1964744 2944501 0 0 0 0 26413 553245 2519445 4176540 764177 454188 5391791 6709112 6155968 7163300 X -3636523 -2986760 -3636523 -2986760 2519445 4176540 649763 X false true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2845884 1365200 1480684 9465 3111 6354 4056842 2599379 1457463 2944501 Due from Affiliates 26747 Electronic Health Records Receivable 526832 Miscellaneous Receivables -334 553245 DUE TO AFFILIATE 6395977 Insurance Reserve Payable 255392 PENSION PLAN PAYABLE 36327 SICK TIME PAYABLE 21416 6709112 true true true X true X true true true false true true 118921 118921 0.02070 836421 483559 352862 0.06140 955342 483559 471783 0.08210 5510 5510 0.00100 5510 5510 0.00100 960852 483559 477293 0.08310 false 1080463 540231 2655204 2661070 -5866 X true true 1 1 MMC-SAN AUGUSTINE 511 E HOSPITAL ST SAN AUGUSTINE TX 75972 X X X X MMC-SAN AUGUSTINE 1 true X X X X X X X X X 12 true true true X MEMORIALHEALTH.ORG X X X X X X X false false false true true 200.0000 true 250.0000 true X X X X true true X X X X false true X X X X X true X false true 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. 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 false false false false false true false false false false DARLENE WILLIAMS ADMINISTRATOR 125583 19174 413 3943 13335 162448 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 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 MEMORIAL HEALTH SYSTEM OF EAST TEXAS false MEMORIAL MULTISPECIALTY ASSOCIATES 1201 FRANK AVENUE LUFKIN TX 75904 752721155 PROVIDES PHYSICIANS TO NON PROFIT HOSPITALS TX 501(C)(3) 11c MEMORIAL HEALTH SYSTEM OF EAST TEXAS false LUFKIN VISION ACQUISITIONS 1201 FRANK AVENUE LUFKIN TX 75904 820563768 PROVIDES OFFICE SPACE FOR HEALTH CARE PROFESSIONALS TX 501(C)(3) 11c MEMORIAL HEALTH SYSTEM OF EAST TEXAS false 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 false false false false false false false false false true false false true false false true false false false