2013-05-15T15:02:21-05:00 2012-06-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2011-07-01 752616977 TRINITY CLINIC % MOTHER FRANCES HOSP ACCTG DE TRIN 9035315764 1315 DOCTORS DRIVE TYLER TX 75701 JOYCE HESTER 2013-05-15 true Amanda Maya 7134994600 2011 2016-02-24 21:20:13Z STEVEN KEUER 910 E HOUSTON TYLER TX 75701 126481348 false X WWW.TMFHS.ORG X 1995 TX TO PROVIDE PHYSICIAN SERVICES WITH A FULL RANGE OF COMPREHENSIVE HEALTH CARE SERVICES WITHOUT REGARD TO THE PATIENT'S RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. 12 0 1246 30 -88286 -88286 0 0 115908478 127491339 2455765 4592 -225766 -1721912 118138477 125774019 5000 0 0 0 29182077 17276516 0 0 0 107443463 132837119 136630540 150113635 -18492063 -24339616 100212393 135889145 115856429 157671418 -15644036 -21782273 TO PROVIDE PHYSICIAN SERVICES WITH A FULL RANGE OF COMPREHENSIVE HEALTH CARE SERVICES WITHOUT REGARD TO THE PATIENT'S RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. false false 136453621 127491329 OUR COMMITMENT TO OUR COMMUNITY EXTENDS TO FREE OR SUBSIDIZED INDIVIDUAL CARE, SUBSIDIZED EDUCATION OF HEALTHCARE PROFESSIONALS, DISCOUNTED FEES FOR PARTICIPANTS IN GOVERNMENT PROGRAMS, COMMUNITY HEALTH EDUCATION, AND DONATIONS TO OTHER COMMUNITY AGENCIES. SPECIFIC COMMUNITY SERVICES AND PROGRAMS INCLUDE: WELLNESS AND PREVENTION EDUCATION PROGRAMS, COMMUNITY DIAGNOSTIC SCREENING PROGRAMS, SENIOR CITIZEN HEALTH AWARENESS PROGRAMS, AWARENESS PROGRAMS FOR YOUTH AT RISK, AWARENESS PROGRAMS FOR PERSONS WITH SPECIAL PHYSICAL OR MENTAL NEEDS, CHILDREN WITH DIABETES SUMMER CAMP, SPORTS CARE PROGRAMS, SAFETY TRAINING FOR LOCAL BUSINESSES, AND RESEARCH PROGRAMS. 136453621 true false false false false false false false false true true false false true true false false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false false true X 73 0 true 1246 true true true false false false false false false false false false X 12 0 false true false false true false true true true false false true true true true true true true true true true X MOTHER FRANCES HOSP ACCTG DE 9035315764 1315 DOCTORS DRIVE TYLER TX 75701 X STEVEN KEUER MD 20.0 X X 702972 468649 27497 ROBERT MCKINNEY MD 40.0 X 527826 0 30250 GIFFORD ECKHOUT MD 20.0 X X 407389 271592 29125 ROGER FOWLER MD 40.0 X X 384694 0 15413 KENT WEBB MD 40.0 X 726539 0 26650 WILLIAM HOBBS MD 40.0 X 784166 0 26650 JIM STANFORD MD 40.0 X 326605 0 10413 GREGORY STOVALL MD 40.0 X X 471491 0 10413 KAI XIA MD 40.0 X 1409521 0 23434 JAMES CACCITOLO MD 40.0 X 806626 0 26625 HAMPTON WILLIAMS MD 40.0 X 589147 0 26074 JAMES ROGERS MD 40.0 X 265600 0 15413 MARK ANDERSON MD 40.0 X X 488137 0 19882 OLADIMEJI AKIODE MD 40.0 X 398009 0 28425 BARBARA ALLEN MD 35.0 X 325783 0 10173 BRYAN LOWERY MD 40.0 X 645694 0 9188 ORAN FERRELL 40.0 X 370500 0 15581 LORETTA SWAN 40.0 X 176404 0 12111 DAVID LINDZEY MD 35.0 X 346522 0 27200 JOYCE HESTER 10.0 X 0 229601 12196 PAM VUKOVICH 10.0 X 0 0 0 MARTIN HOLLAND MD 40.0 X 1682778 0 24200 LAURA O'HALLORAN MD 40.0 X 1695603 0 25425 WAYNE GLUF MD 40.0 X 1626948 0 20049 PETER SIRIANNI MD 40.0 X 1509729 0 25425 SAUYU LIN MD 40.0 X 1312847 0 27425 DAVID TEEGARDEN MD 0.0 X 226832 151220 23349 RICHARD KRONENBERG MD 0.0 X 136181 0 5003 WILLIAM BELLENFANT SR 0.0 X 0 2149403 2234 18344543 3270465 555823 287 true true false THOMAS CURTIS MD 5879 HWY 64 WEST HENDERSON TX 75652 PHYSICIAN SERVICES 412500 TYLER CARDIOVASCULAR CONSULTANTS 319 S FLEISHEL TYLER TX 75701 CARDIOVASCULAR SRVCS 394184 EAGLE HOSPITAL PHYSICIANS 16000 N DALLAS PARKWAY SUITE 450 DALLAS TX 75248 PHYSICIAN SERVICES 378025 DELTA FLEX TRAVELERS PO BOX 202940 DALLAS TX 75320 PHYSICIAN SERVICES 367322 HOSPITALIST CONNECTIONS 16000 NORTH DALLAS PKWY STE 450 DALLAS TX 75248 PHYSICIAN SERVICES 276557 21 0 NET PATIENT REVENUE 621500 109634157 109634157 OTHER OPERATING REVENUE 900099 17424846 17424846 EHR INCENTIVE REVENUE 621500 432336 432336 127491339 4592 4592 0 0 575038 707329 -132291 -132291 -88286 -44005 0 0 0 0 SELF INSURANCE TRUST INCOME 900099 -552127 -552127 LOSS FROM IMPAIRMENT OF ASSETS 900099 -1037494 -1037494 -1589621 125774019 127491339 -88286 -1629034 0 0 0 0 10521489 9130257 1391232 386984 335814 51170 0 731004 731004 2230298 1838732 391566 3406741 3332555 74186 397639 328695 68944 2645 2645 0 0 0 92 92 107862558 104905392 2957166 7644082 50693 7593389 740302 660932 79370 6646 3443 3203 0 1397234 1150880 246354 185223 20105 165118 0 901869 900560 1309 639690 149269 490421 0 472426 380865 91561 3143547 3128470 15077 MEDICAL SUPPLIES 2828000 2828000 0 BAD DEBT EXPENSE 6374327 6374327 REPAIRS AND MAINTENANCE 49570 37689 11881 PERFORMANCE STANDARDS 183155 165939 17216 8114 8114 150113635 136453621 13660014 0 2731751 3980108 0 0 0 0 8880468 10469530 80259 0 0 0 1205738 1490266 191644 300494 483441 521553 12212213 7998749 6098502 4213464 20223324 22354194 47923 90634 0 0 504359 427625 59764984 92041277 100212393 135889145 15316815 17291328 0 0 0 0 0 0 0 0 0 0 4031813 1631813 0 0 96507801 138748277 115856429 157671418 X -15644036 -21782273 0 0 0 0 -15644036 -21782273 100212393 135889145 X -24339616 18201379 X false true true X false X 2350337 30875 27664 2408876 2209013 50 141274 2350337 414414 1790794 4305 500 2209013 413932 239 243 414414 0.88532 0.11468 false true true 4749991 2699991 2050000 701674 216784 484890 6751378 5081974 1669404 9170 9170 4213464 DUE FROM AFFILIATES 91994588 OTHER ASSETS 46689 92041277 0 DUE TO AFFILIATES 107345482 ACCRUED PENSION LIABILITY 18788821 ESTIMATED SELF INSURANCE COSTS 3868639 DEFERRED COMPENSATION 8745335 138748277 125774019 150113635 -24339616 -24339616 121681912 2296950 2296950 119384962 6389057 6389057 125774019 146021528 2296950 2296950 143724578 6389057 6389057 150113635 RECONCILIATION OF REVENUE PER FINANCIAL STATEMENTS TO FORM 990 SCHEDULE D, PART XII, QUESTIONS 2D & 4B REVENUES ON BOOKS, NOT ON RETURN: LOSS ON IMPAIRMENT OF ASSETS $1,037,494 RENTAL EXPNSES INCLUDED WITH REVENUE ON RETURN 707,329 SELF-INSURANCE INTEREST INCLUDED IN AUDIT EXPENSES 552,127 ---------- $2,296,950 REVENUES ON RETURN, NOT ON BOOKS: BAD DEBT EXPENSE $6,374,327 OTHER CLASSIFICATION DIFFERENCES BETWEEN REVENUE AND EXPENSE 14,370 ---------- $6,389,057 RECONCILIATION OF EXPENSES PER FINANCIAL STATEMENTS TO FORM 990 SCHEDULE D, PART XIII, QUESTIONS 2D & 4B EXPENSES ON BOOKS, NOT ON RETURN: RENTAL EXPENSES INCLUDED WITH REVENUE ON RETURN $ 707,329 SELF-INSURANCE INTEREST INCLUDED IN AUDIT EXPENSES 552,127 LOSS ON IMPAIRMENT OF ASSETS 1,037,494 ---------- $2,296,950 EXPENSES ON RETURN, NOT ON BOOKS: BAD DEBT EXPENSE $6,374,327 OTHER CLASSIFICATION DIFFERENCES BETWEEN REVENUE AND EXPENSE 14,370 ---------- $6,389,057 INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS SCHEDULE D, PART V, QUESTION 4 THE ORGANIZATION HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR THE ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS AND ITEMS SUPPORTED BY THE ENDOWMENT WHILE SEEKING TO MAINTAIN ITS PURCHASING POWER. X X X X X false true false false false true false false false STEVEN KEUER MD 314819 209881 163121 108747 225032 150021 6248 4165 10252 6832 719472 479646 211918 141278 DAVID TEEGARDEN MD 158643 105762 0 0 68189 45458 4958 3305 9052 6034 240842 160559 64974 43315 ROBERT MCKINNEY MD 515468 0 0 0 12358 0 10413 0 19837 0 558076 0 0 0 GIFFORD ECKHOUT MD 380138 253425 24036 16024 3215 2143 4733 3155 12742 8495 424864 283242 0 0 ROGER FOWLER MD 362836 0 0 0 21858 0 10413 0 5000 0 400107 0 0 0 KENT WEBB MD 721181 0 0 0 5358 0 10413 0 16237 0 753189 0 0 0 WILLIAM HOBBS MD 762308 0 0 0 21858 0 10413 0 16237 0 810816 0 0 0 JIM STANFORD MD 321247 0 0 0 5358 0 10413 0 0 0 337018 0 0 0 GREGORY STOVALL MD 392545 0 55414 0 23532 0 10413 0 0 0 481904 0 474 0 KAI XIA MD 1387663 0 0 0 21858 0 9188 0 14246 0 1432955 0 0 0 JAMES CACCITOLO MD 801268 0 0 0 5358 0 9188 0 17437 0 833251 0 0 0 ORAN FERRELL 251015 0 69498 0 49987 0 10413 0 5168 0 386081 0 0 0 LORETTA SWAN 131746 0 24414 0 20244 0 6400 0 5711 0 188515 0 0 0 MARTIN HOLLAND MD 1653000 0 8000 0 21778 0 7963 0 16237 0 1706978 0 0 0 LAURA O'HALLORAN MD 1690245 0 0 0 5358 0 9188 0 16237 0 1721028 0 0 0 HAMPTON WILLIAMS MD 583789 0 0 0 5358 0 9188 0 16886 0 615221 0 0 0 JAMES ROGERS MD 260879 0 0 0 4721 0 10413 0 5000 0 281013 0 0 0 DAVID LINDZEY MD 340164 0 0 0 6358 0 7963 0 19237 0 373722 0 0 0 RICHARD KRONENBERG MD 126911 0 0 0 9270 0 5003 0 0 0 141184 0 0 0 MARK ANDERSON MD 436279 0 30000 0 21858 0 7963 0 11919 0 508019 0 0 0 WAYNE GLUF MD 1595090 0 10000 0 21858 0 7963 0 12086 0 1646997 0 0 0 PETER SIRIANNI MD 1504371 0 0 0 5358 0 9188 0 16237 0 1535154 0 0 0 SAUYU LIN MD 1290989 0 0 0 21858 0 9188 0 18237 0 1340272 0 0 0 OLADIMEJI AKIODE MD 376151 0 0 0 21858 0 9188 0 19237 0 426434 0 0 0 BARBARA ALLEN MD 293925 0 10000 0 21858 0 7673 0 2500 0 335956 0 0 0 BRYAN LOWERY MD 623836 0 0 0 21858 0 9188 0 0 0 654882 0 0 0 JOYCE HESTER 0 174243 0 36644 0 18714 0 8163 0 4033 0 241797 0 0 WILLIAM BELLENFANT SR 0 1890888 0 0 0 258515 0 0 0 2234 0 2151637 0 258515 PARTICIPATION IN OR PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, QUESTION 4B PARTICIPANTS IN SERP REPORTED IN W-2 DEFERRED COMPENSATION ---------------------- ----------------- --------------------- STEVEN KEUER MD 346,800 NONE DAVID TEEGARDEN MD NONE NONE WILLIAM BELLENFANT 258,515 NONE PARTICIPANTS IN 457(F) REPORTED IN W-2 ---------------------- ---------------- STEVEN KEUER MD 6,396 DAVID TEEGARDEN MD 108,289 GREGORY STOVALL MD 474 COMPENSATION CONTINGENT ON THE NET EARNINGS OF THE ORGANIZATION SCHEDULE J, PART I, QUESTION 6A SOME PHYSICIANS ARE PAID BASED ON THE COMPENSATION FORMULA OF THEIR INDIVIDUAL RESPECTIVE DEPARTMENTS. DESCRIBE REVIEW PROCESS OF FORM 990 FORM 990, PART VI, QUESTION 11B THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS AND BOARD PRIOR TO FILING. DESCRIBE THE ORGANIZATION'S MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 TRINITY MOTHER FRANCES HEALTH SYSTEM IS THE SOLE MEMBER OF TRINITY CLINIC. DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBER FORM 990, PART VI, QUESTION 7B THE MEMBER HAS THE AUTHORITY TO APPROVE OR DISAPPROVE CERTAIN MATTERS PREVIOUSLY APPROVED BY THE BOARD OF DIRECTORS. HOW DOES THE ORGANIZATION MONITOR AND ENFORCE COMPLIANCE WITH THE POLICY FORM 990, PART VI, QUESTION 12C THE BOARD REVIEWS AND RESOLVES, IF NECESSARY, ANY TRANSACTIONS AS THEY ARISE THROUGHOUT THE YEAR IN ACCORDANCE WITH POLICY STANDARDS. DESCRIBE WHETHER THE ORGANIZATION MAKES ITS DOCUMENTS AVAILABLE TO PUBLIC FORM 990, PART VI, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. PROCESS FOR DETERMINING COMPENSATION OF CEO, OFFICERS, OR KEY EMPLOYEES FORM 990, PART VI, QUESTIONS 15A & 15B THE ORGANIZATION USES COMPENSATION CONSULTANTS AND NATIONAL COMPENSATION SURVEYS TO DETERMINE COMPENSATION OF EMPLOYEES. COMPENSATION IS APPROVED BY THE ORGANIZATION'S GOVERNING BODY AND ULTIIMATELY APPROVED BY TRINITY MOTHER FRANCES HEALTH SYSTEM. COMPENSATION FROM RELATED ORGANIZATION FORM 990, PART VII & SCHEDULE J THE GOVERNING BOARD OF TRINITY MOTHER FRANCES HEALTH SYSTEM UPON ADVICE FROM NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS, WHO PERIODICALLY REVIEW ALL EXECUTIVE COMPENSATION, APPROVED A DEFERRED COMPENSATION PLAN THAT PROVIDES A 65% TOTAL RETIREMENT BENEFIT FOR SENIOR EXECUTIVES THAT SERVE 20 YEARS OR MORE. THIS PROGRAM HAS BOTH RETENTION AND NON-COMPETITION CLAUSES THAT CREATE A RISK OF FORFEITURE. DEFERRED COMPENSATION IS SUBJECT TO A RISK OF FORFEITURE BASED ON RETENTION, NON-COMPETITION AND OTHER CONTRACTUAL FACTORS. ACCRUALS OF DEFERRED COMPENSATION ARE NOT INCLUDIBLE IN W-2 COMPENSATION UNTIL PAID. OTHER EMPLOYEE BENEFITS INCLUDE QUALIFIED PENSION PLANS, HEALTH, DENTAL AND LIFE INSURANCE PLANS, DISABILITY INSURANCE, ETC. TAXABLE EXPENSES ARE INCLUDED IN THE W-2 PAID COMPENSATION SALARY AMOUNT. 1099S REPORTED BY ORGANIZATION FORM 990, PART V, QUESTION 1A FORMS 1099-INT ARE ISSUED BY THE FILING ORGANIZATION. HOWEVER, THE ORGANIZATION'S FORMS 1099-MISC ARE ISSUED BY A RELATED ORGANIZATION, MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER, WHICH REPORTS ALL FORMS 1099-MISC FOR THE ENTIRE SYSTEM AND ALLOCATES EXPENSES TO THE APPROPRIATE RELATED ORGANIZATION. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, QUESTION 5 TRANSFERS FROM AFFILIATE $18,201,379 DELEGATION OF MANAGEMENT DUTIES FORM 990, PART VI, QUESTION 3 THE ORGANIZATION HAS HIRED A MANAGEMENT COMPANY TO PERFORM THE DUTIES OF THE INTERIM CFO. UNDER EMPLOYMENT FOR THE UNRELATED MANAGEMENT COMPANY, THE FOLLOWING INDIVIDUAL SERVES AS AN OFFICER FOR THE CLINIC AND IS PAID COMPENSATION BY THE MANAGEMENT COMPANY FOR SERVICES TO THE CLINIC. PER IRS GUIDANCE, NO COMPENSATION IS SHOWN ON FORM 990, PART VII, FOR THIS INDIVIDUAL: PAM VUKOVICH - $218,341. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEVEN KEUER MD TITLE:SYSTEM PRESIDENT/CMO/DIRECTOR HOURS:22 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GIFFORD ECKHOUT MD TITLE:EXEC VP/DIRECTOR HOURS:20 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROGER FOWLER MD TITLE:DIRECTOR/CHAIRMAN HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BARBARA ALLEN MD TITLE:DIRECTOR HOURS:6 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID LINDZEY MD TITLE:SENIOR VP HOURS:5 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOYCE HESTER TITLE:VP, FINANCE HOURS:32 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PAM VUKOVICH TITLE:INTERIM CFO HOURS:32 CHAMPION EMERGENCY SERVICES LLC 2201 S MOBBERLY AVE LONGVIEW TX 75602 752747708 AMBULANCE SVC TX 501(C)(3) 9 NA false MOTHER FRANCES HOSPITAL REGIONAL HC CTR 1315 DOCTORS DRIVE TYLER TX 75701 750818167 HOSPITAL TX 501(C)(3) 3 TMFHS false MOTHER FRANCES HOSPITAL - JACKSONVILLE 1315 DOCTORS DRIVE TYLER TX 75701 751976930 HOSPITAL TX 501(C)(3) 3 TMFHS false TRINITY MOTHER FRANCES HEALTH SYSTEM FDN 1315 DOCTORS DRIVE TYLER TX 75701 752028241 SUPPORT TX 501(C)(3) 11A I TMFHS false REGIONAL MEDICAL SERVICES ASSOCIATION 1315 DOCTORS DRIVE TYLER TX 75701 752511459 HEALTHCARE TX 501(C)(3) 3 MFH REG false TRINITY MOTHER FRANCES HEALTH SYSTEM 1315 DOCTORS DRIVE TYLER TX 75701 752616975 HEALTHCARE TX 501(C)(3) 11A I NA false MOTHER FRANCES HOSPITAL - WINNSBORO 1315 DOCTORS DRIVE TYLER TX 75701 752771569 HOSPITAL TX 501(C)(3) 3 TMFHS false TRI-STATE FINANCIAL LLC 1315 DOCTORS DRIVE TYLER TX 75701 752728318 COLLECTION AG TX NA C-CORPORATION TRINCARE INC 1315 DOCTORS DRIVE TYLER TX 75701 752161369 RETAIL HEALTH TX NA C-CORPORATION HEALTHPLAN OF TEXAS INC 514 S BECKHAM TYLER TX 75701 752636832 THIRD PARTY A TX NA C-CORPORATION THE REGIONAL HEALTHCARE ALLIANCE 1315 DOCTORS DRIVE TYLER TX 75701 752484109 PREFER PROVID TX NA C-CORPORATION TEXAS HEALTH FACILITIES INSUR CORP LTD PO BOX 1109 BWI CAYMAN ISLANDS CJ 980136025 INSURANCE CJ NA C-CORPORATION CONCORDIUM HEALTH LLC 1315 DOCTORS DRIVE TYLER TX 75701 702811022 INACTIVE TX NA C-CORPORATION EMPLOYERS SERVICES INC 1315 DOCTORS DRIVE TYLER TX 75701 752602556 INACTIVE TX NA C-CORPORATION HERITAGE HEALTH PLANS OF TX 1315 DOCTORS DRIVE TYLER TX 75701 752622622 INACTIVE TX NA C-CORPORATION QUALITY CARE ALLIANCE 1315 DOCTORS DRIVE TYLER TX 75701 752662965 INACTIVE TX NA C-CORPORATION false false false false false false true false false true true true false true false false false true DIRECT CONTROLLING ENTITY SCHEDULE R, PART II, COLUMN F THE FOLLOWING RELATED ORGANIZATIONS REPORTABLE IN PART II ARE DIRECTLY CONTROLLED BY TRINITY MOTHER FRANCES HEALTH SYSTEM ("TMFHS"): MOTHER FRANCES HOSPITAL REGIONAL HEALTHCARE CENTER MOTHER FRANCES HOSPITAL - JACKSONVILLE MOTHER FRANCES HOSPITAL - WINNSBORO TRINITY MOTHER FRANCES HEALTH SYSTEM FOUNDATION REGIONAL MEDICAL SERVICES ASSOCIATION IS DIRECTLY CONTROLLED BY MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER ("MFH REG").