2013-11-15T08:48:19-06:00 2012-12-31 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2012-01-01 751912147 UNITED REGIONAL HEALTH CARE SYSTEM % STEPHEN A CALVERT UNIT 9407648624 1600 ELEVENTH STREET Suite WICHITA FALLS TX 76301 PHYLLIS COWLING 9407648624 2013-11-15 true Amanda Maya 7134994600 2012 2016-02-25 16:41:14Z PHYLLIS COWLING 1600 ELEVENTH STREET WICHITA FALLS TX 76301 473754716 false X WWW.UNITEDREGIONAL.ORG X 1983 TX ORGANIZED AND OPERATED FOR THE PURPOSE OF DEVELOPING AND OPERATING AN INTEGRATED HEALTH CARE SYSTEM. 16 12 2062 400 0 0 3102067 1940134 307513809 296757569 9579769 -3648700 158214 0 320353859 295049003 11900000 6028113 0 0 104165255 110161989 0 0 0 147389279 144280186 263454534 260470290 56899325 34578713 469825499 516237676 135401745 132229127 334423754 384008549 X TO OPERATE NONPROFIT HOSPITALS OR HOSPITAL FACILITIES, CLINICS, AND RELATED MEDICAL AND SURGICAL SERVICES BY PROVIDING SUCH SERVICES TO PERSONS THAT DO HAVE THE ABILITY TO PAY, AND TO THEREBY PROVIDE CHARITABLE MEDICAL, SURGICAL, AND HOSPITAL CARE FOR SICK, INJURED, AFFLICTED, INFIRM, DISABLED , OR DESTITUTE PERSONS THAT DO NOT HAVE THE ABILITY TO PAY. false false 221150548 6028113 296757569 UNITED REGIONAL HEALTH CARE SYSTEM, A 325-BED HOSPITAL, PROMOTES THE HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF HEALTH CARE SERVICES. IN ADDITION TO INPATIENT BEDS, THERE ARE 20 NEWBORN BASSINETTES INCLUDING 6 INTERMEDIATE NURSERY BASSINETTES AND 31 ER BEDS. IN 2012, INPATIENTS RECEIVED 60,994 PATIENT DAYS OF CARE AND 139,346 OUTPATIENT AND EMERGENCY OCCURRENCES OF SERVICE. ADDITIONAL PROGRAMS WHICH BENEFIT THE COMMUNITY INCLUDE: RESIDENCY/HEALTH PROFESSIONS TRAINING: AT ANY ONE TIME, THERE MAY BE UP TO 24 RESIDENTS IN TRAINING AT UNITED REGIONAL HEALTH CARE SYSTEM. THE RESIDENTS ARE PART OF THE UNITED REGIONAL HEALTH CARE SYSTEM PROGRAM IN PARTNERSHIP WITH THE WICHITA FALLS FAMILY PRACTICE RESIDENCY PROGRAM (THROUGH AN AFFILIATION WITH THE SOUTHWESTERN SCHOOL OF MEDICINE). STUDENTS IN NURSING, PHARMACY, LABORATORY TECHNOLOGY, RADIOLOGY, RESPIRATORY THERAPY AND OTHER ASSOCIATED HEALTH SCIENCES PROFESSIONS ALSO STUDY HERE. PREVENTIVE CARE A PRIORITY: UNITED REGIONAL HEALTH CARE SYSTEM HAS TAKEN STEPS TO ENHANCE PREVENTIVE CARE FOR PEOPLE OF ALL AGES THROUGH THE DEVELOPMENT OF LOW COST SCREENING PROGRAMS, VACCINATION CLINICS, AS WELL AS OTHER OUTREACH EDUCATION SERVICES. OTHER SERVICES ARE PROVIDED THROUGH THE UNITED REGIONAL REFERENCE LAB BOTH LOW COST FEE-FOR-SERVICE SCREENINGS AND FREE SCREENINGS AT COMMUNITY HEALTH FAIRS (CHOLESTEROL, PSA, TRIGLYCERIDES, ETC.). DESIGNATED TRAUMA CENTER: UNITED REGIONAL HEALTH CARE SYSTEM RECEIVED UPGRADED RECOGNITION OF TRAUMA CENTER. IN FEBRUARY 2012, UNITED REGIONAL WAS DESIGNATED LEVEL 2 TRAUMA CENTER FOR THE REGION. IN 2012, 717 PATIENTS WERE SEEN AT UNITED REGIONAL CARE SYSTEM AND RECORDED IN ITS TRAUMA REGISTRY. UNITED REGIONAL HEALTH CARE SYSTEM'S EMERGENCY DEPARTMENT IS STAFFED 24 HOURS A DAY/7 DAYS A WEEK MEETING THE NEEDS OF THE COMMUNITY WITH AN AVERAGE OF 214 VISITS PER DAY. COMMUNITY CONNECTIONS: UNITED REGIONAL HEALTH CARE SYSTEM REACHES OUT TO PEOPLE AND COMMUNITIES THROUGHOUT ITS PRIMARY SERVICE AREA OF WICHITA COUNTY AND ITS SECONDARY SERVICE AREA OF 8 SURROUNDING COUNTIES CONSISTING OF ARCHER, BAYLOR, CLAY, HARDEMAN, JACK, MONTAGUE, WILBARGER AND YOUNG COUNTIES. THROUGH COOPERATIVE AGREEMENTS WITH LOCAL GOVERNMENTS AND HOSPITALS, UNITED REGIONAL PROVIDES FUNDING FOR A NUMBER OF HEALTHCARE SERVICES. COMMUNITY EDUCATION: UNITED REGIONAL HEALTH CARE SYSTEM PROVIDES THE FOLLOWING TYPES OF COMMUNITY EDUCATION: COMMUNITY EDUCATION SEMINARS WITH PRESENTATIONS BY PHYSICIANS ON HEALTH ISSUES AND TREATMENT OPTIONS; HEALTHY YOU NEWSLETTER, SENT TO APPROXIMATELY 50,000 HOUSEHOLDS, PROVIDING HEALTH PROMOTION AND DISEASE PREVENTION INFORMATION, AS WELL AS HOSPITAL SERVICES; 55-ADVANTAGE SENIOR PROGRAM, PROVIDING SPEAKERS ON A VARIETY OF HEALTH-RELATED TOPICS; AND PARTICIPATION IN A VARIETY OF COMMUNITY HEALTH FAIRS AND EVENTS PROMOTING GENERAL HEALTH AND PROVIDING HEALTH SCREENINGS. CHARITY CARE: UNITED REGIONAL HEALTH CARE SYSTEM PROVIDES MEDICAL CARE TO MEMBERS OF THE COMMUNITY REGARDLESS OF ABILITY TO PAY. FINANCIAL ASSISTANCE AT COST IN THE AMOUNT OF $17,078,253 (FORM 990 SCHEDULE H COST) WAS PROVIDED IN THE CURRENT YEAR AND UNREIMBURSED COST OF PROVIDING MEANS TESTED PUBLIC HEALTH CARE PROGRAMS OF $6,520,121. COMMUNITY BENEFITS: THE ESTIMATED COST OF PROVIDING ADDITIONAL COMMUNITY BENEFITS DURING 2012 WAS $10,479,449 WHICH INCLUDED THE FOLLOWING: UNREIMBURSED COST OF EMERGENCY AND TRAUMA CARE $ 4,313,820 UNREIMBURSED COST OF FREE STANDING CLINICS $ 6,165,629 DONATIONS MADE BY THE HOSPITAL TO AREA CHARITABLE ORGANIZATIONS $ 12,015,849 TOTAL COSTS OF ADDITIONAL COMMUNITY BENEFITS $ 5,993,944 SOURCE: 2012 ANNUAL STATEMENT OF COMMUNITY BENEFIT STANDARDS (STATE OF TEXAS MANDATORY REPORT) 221150548 true true false false false false false false false true true false false true true false false true false false false false false false false false true true true false true true false false false false false false false false true true true false false false false true true true false false true 208 0 true 2062 true false false false false false false false false false false X 16 12 true false false false false true true true true false false true true true true true true true true true false X STEPHEN A CALVERT 9407648624 1600 ELEVENTH STREET WICHITA FALLS TX 76301 X DOUG KUNKLE 1.0 0.0 X X 0 0 0 MIKE ELYEA 1.0 0.0 X X 0 0 0 LARRY COOK 1.0 0.0 X X 0 0 0 BARRY HARDIN 1.0 0.0 X 0 0 0 R KEN HINES 1.0 0.0 X 0 0 0 CARLA NICHOLS 1.0 0.0 X 0 0 0 GARY OZIER MD 1.0 0.0 X 24000 0 0 ASHVIKUMAR PATEL MD 1.0 0.0 X 83980 0 0 BLAKE ANDREWS 1.0 0.0 X 0 0 0 HOWARD FARRELL 1.0 0.0 X 0 0 0 PAUL FOLEY 1.0 0.0 X 0 0 0 DON HAMLIN 1.0 0.0 X 0 0 0 KEVIN THOMAS MD 1.0 0.0 X 174022 0 0 YVONNE HEARN MD 1.0 0.0 X 0 0 0 LINDA YEAGER 1.0 0.0 X 0 0 0 PHYLLIS COWLING 40.0 2.0 X X 636078 0 40275 LEO LANE 1.0 0.0 X 0 0 0 NANCY TOWNLEY 40.0 2.0 X 339998 0 48848 ROBERT PERT 40.0 2.0 X 347873 0 50933 JOHN SCOTT HOYER MD 40.0 2.0 X 327397 0 51175 PAMELA BRADSHAW 40.0 0.0 X 242271 0 45189 STEPHANIE JO BROWN 40.0 0.0 X 163633 0 28217 RICHARD CARPENTER 40.0 0.0 X 185186 0 44437 TERESA SCARBOROUGH 40.0 0.0 X 134485 0 15682 MATTHEW BAKER 40.0 0.0 X 131606 0 37279 JERRY MARSHALL 40.0 0.0 X 131226 0 26831 JAMES BEASLEY 40.0 0.0 X 130257 0 17382 DWAYNE MCKEE 40.0 0.0 X 130216 0 27784 3182228 0 434032 50 false true false CLINICAL PARTNERS- WF PA 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 ANESTHESIA SERVICES 3121202 TITANIUM EMERGENCY GROUP LLP PO BOX 3407 WICHITA FALLS TX 76307 ER PHYSICIAN SVCS 1616365 NORTH CENTRAL TX MED FOUNDATION 1301 3RD STREET STE 200 WICHITA FALLS TX 76301 RESIDENCY PROGRAM 825152 STRASBERGER PRICE PO BOX 501100 DALLAS TX 76302 LEGAL SERVICE 660286 GARY BAKER ASSOCIATES 4309 OLD JACKSBORO HWY STE D-5 WICHITA FALLS TX 76302 ARCHITECTUAL SVCS 478989 40 1802484 137650 137650 1940134 PATIENT SERVICE REVENUE 621110 295955554 295955554 SUPPORTING REVENUE 900099 322999 322999 RELATED RENTAL REVENUE 900099 479016 479016 296757569 4398116 4398116 0 0 0 0 0 170603600 55297 174473533 4232180 -3869933 -4176883 -8046816 -8046816 0 0 0 0 295049003 296757569 -3648700 6028113 6028113 0 0 0 2551508 1913631 637877 0 92283888 69212916 23070972 2638462 1978847 659616 6097450 4573088 1524362 6590681 4943011 1647670 0 260443 260443 178780 178780 0 0 414862 414862 30744304 23192313 7551991 1090081 817561 272520 4392377 3686612 705765 939792 704844 234948 0 3416142 2562107 854036 612713 459535 153178 0 326629 8424 318205 4370986 4370986 0 17781633 17781633 2810466 2810466 MEDICAL SUPPLIES 47207120 47207120 BAD DEBT EXPENSE 25543565 25543565 EQUIPMENT RENTAL & MAINT. 2006088 1504566 501522 PROGRAM EXPENSES 850557 850557 0 1333648 1000653 332995 260470290 221150548 39319742 0 4799 4368 67733670 48351751 0 0 21592447 23931293 0 0 0 0 0 0 5815933 5729864 2053435 3322808 368715138 202737709 167667488 165977429 178626726 237892538 0 0 0 0 0 0 26331001 31027625 469825499 516237676 17688585 23902049 0 0 0 0 93740740 92706354 0 0 0 0 0 0 0 0 23972420 15620724 135401745 132229127 X 334423754 384008549 0 0 0 0 334423754 384008549 469825499 516237676 X 34578713 15143732 -137650 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1413719 1413719 1363593 50126 1413719 1293792 69801 1363593 1188415 105377 1293792 0.79410 0.20590 false true true 10971541 10971541 162694029 61450838 101243191 187345676 140313944 47031732 7703892 972927 6730965 165977429 DUE FROM AFFILIATE 30263218 DUE FROM PHYSICIANS 86 INTEREST RECEIVABLE 320790 UNAMORTIZED BOND COST 443531 31027625 0 EST 3RD-PARTY PAYOR SETTLEMENT 5524511 SELF-INSURANCE LIABILITY 10096213 15620724 283771772 15143732 -25688379 -10544647 294316419 414862 317722 732584 295049003 234186977 -180072 -180072 234367049 414862 25688379 26103241 260470290 RECONCILIATION OF REVENUE PER FINANCIAL STATEMENTS TO FORM 990 SCHEDULE D, PART XI, LINE 2D REVENUE ON RETURN, NOT ON BOOKS: BAD DEBT EXPENSE INCLUDED IN REVENUE ON AUDIT $ (25,543,565) CONTRIBUTION EXPENSE INCLUDED IN REVENUES ON AUDIT $ (144,751) CLASSIFICATION DIFFERENCES $ (63) ----------- $ (25,688,379) RECONCILIATION OF EXPENSES PER FINANCIAL STATEMENTS TO FORM 990 SCHEDULE D, PART XII, LINE 2D EXPENSES ON RETURN, NOT ON BOOKS: PHYSICIAN INCOME INCLUDED IN EXPENSE ON AUDIT $(180,072) INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS SCHEDULE D, PART V, LINE 4 THE ENDOWMENT INCLUDES BOTH DONOR-RESTRICTED ENDOWMENT FUNDS AND FUNDS DESIGNATED BY THE BOARD OF DIRECTORS. FUNDS ARE USED TO ADVANCE AND PROMOTE THE HEALTH AND WELL-BEING OF PEOPLE AND ORGANIZATIONS IN THE COMMUNITY AND SURROUNDING AREAS. RECONCILIATION OF REVENUE PER FINANCIAL STATEMENTS TO FORM 990 SCHEDULE D, PART XI, LINE 4B INCOME ON RETURN, NOT ON BOOKS: PHYSICIAN INCOME INCLUDED IN EXPENSE ON AUDIT $180,072 CONTRIBUTION INCOME INCLUDED IN INCOME ON FORM 990 BUT NOT AUDITED FINANCIAL STATEMENTS $137,650 ------------- $317,722 RECONCILIATION OF EXPENSES PER FINANCIAL STATEMENTS TO FORM 990 SCHEDULE D, PART XII, LINE 4B EXPENSES ON RETURN, NOT ON BOOKS: BAD DEBT EXPENSE INCLUDED IN REVENUE ON AUDIT $ 25,543,565 CONTRIBUTION EXPENSE INCLUDED IN REVENUE ON AUDIT $ 144,751 CLASSIFICATION DIFFERENCES $ 63 ----------- $ 25,688,379 true true X true X 175. true X true true true false true true 29884033 8931277 20952756 0.08920 28991528 28227130 764398 0.00330 570729 333308 237421 0.00100 59446290 37491715 21954575 0.09350 650448 686441 -35993 0.00000 20756190 10276741 10479449 0.04460 5993944 5993944 0.02550 27400582 10963182 16437400 0.07010 86846872 48454897 38391975 0.16360 false 25543565 2554357 91764888 89256751 2508137 X true true 1 1 UNITED REGIONAL HEALTH CARE SYSTEM

1600 ELEVENTH STREET WICHITA FALLS TX 76301

X X X X UNITED REGIONAL HEALTH CARE SYSTEM true true 175. true 400. true X X X X X true true X X X X X true false X true X false false 2 WICHITA FALLS ENDOSCOPY CENTER

1500 TENTH STREET WICHITA FALLS TX 76301

AMBULATORY SURGERY CENTER TEXOMA CANCER CENTER

5400 KELL WEST BLVD WICHITA FALLS TX 76301

CANCER TREATMENT CENTER PART I, LINE 6A: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT CAN BE OBTAINED BY REQUEST FROM UNITED REGIONAL ADMINISTRATION OFFICES OR COMMUNITY BENEFITS OFFICES. THE COMMUNITY BENEFIT REPORT IS ALSO ON FILE WITH THE HEALTH AND HUMAN SERVICES COMMISSION OF THE STATE OF TEXAS. PART I, LINE 7: THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET 2 WAS USED TO DETERMINE COST FOR LINES 7A, 7B AND 7C. ACTUAL COST PER GENERAL LEDGER WAS USED TO DETERMINE AMOUNTS ON LINE 7F, 7G AND 7I. PART I, LINE 7, COLUMN (F): BAD DEBT EXPENSE OF $25,543,565 WAS INCLUDED IN TOTAL EXPENSE ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT WAS SUBTRACTED FROM TOTAL EXPENSE FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSE IN COLUMN (F). PART I, LINE 7G: COSTS OF $15,479,727 WERE INCLUDED IN SUBSIDIZED HEALTH SERVICES ON LINE 7G FOR COMMUNITY CLINICS. PART III, LINE 2: THE ORGANIZATION'S BAD DEBT EXPENSE WAS CALCULATED USING THE EXPENSE REPORTED ON THE FINANCIAL STATEMENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY WAS DETERMINED BY ESTIMATING THAT 10% OF THE BAD DEBT WOULD LIKELY BE CHARITY CARE. THIS IS THE APPROXIMATE PERCENTAGE OF PATIENTS NOT COMPLETING THE PAPER WORK TO APPLY FOR CHARITY CARE. BAD DEBT EXPENSE REPRESENTS GROSS CHARGES ADJUSTED FOR APPROPRIATE DISCOUNTS AND PAYMENTS ON ACCOUNTS. PART III, LINE 4: AUDITED FINANCIAL STATEMENT FOOTNOTE: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, URHCS ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, URHCS ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, URHCS RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCES BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. URHCS ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS APPROXIMATELY 93% SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2012, AND DECEMBER 31, 2011. URHCS' WRITE-OFFS DECREASED APPROXIMATELY $2,616,000 FROM APPROXIMATELY $29,734,000 FOR THE YEAR ENDED DECEMBER 31, 2011, TO APPROXIMATELY $27,118,000 FOR THE YEAR ENDED DECEMBER 31, 2012. THIS DECREASE WAS PRIMARILY DUE TO MORE FAVORABLE COLLECTION RESULTS IN 2012 AS COMPARED TO 2011 AND CONSIDERATION OF THOSE RESULTS IN ESTIMATION OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AT DECEMBER 31, 2012. PART III, LINE 8: UNITED REGIONAL RECEIVED SOLE COMMUNITY PROVIDER STATUS IN 2012, THEREBY, INCREASING HOSPITAL REIMBURSEMENT BY APPROXIMATELY $2 MILLION IN 2012. ADDITIONALLY, UNITED REGIONAL HAS BEEN PROACTIVELY REDUCING COST OF CARE BY EXAMINING EXISTING CONTRACTS AND PROCESSES WHILE INCREASING QUALITY OF CARE (SEE VALUE BASED PURCHASING SCORES OF GREATER THAN 1) RESULTING IN A SURPLUS FOR 2012. THE HOSPITAL USES MEDICARE COST REPORT METHODOLOGY TO DETERMINE MEDICARE ALLOWABLE COST, WHICH APPORTIONS ROUTINE COSTS (ROOM AND BOARD) BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. PART III, LINE 9B: HOSPITAL PERSONNEL MAKE GOOD FAITH EFFORTS TO INFORM PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE, GOVERNMENTAL PROGRAMS AND ASSISTANCE IN APPLYING. SECTION 6.6 OF THE CHARITY AND BAD DEBT POLICY STATES: "AS SOON AS SUFFICIENT INFORMATION IS AVAILABLE CONCERNING THE PATIENT'S FINANCIAL RESOURCES AND ELIGIBILITY FOR GOVERNMENTAL ASSISTANCE, A DETERMINATION WILL BE MADE CONCERNING THE PATIENT'S ELIGIBILITY FOR CHARITY. IN MOST CASES, THE DETERMINATION DECISION WILL BE MADE WITHIN 10 BUSINESS DAYS. A WRITTEN NOTICE WILL BE MAILED TO THE PATIENT INFORMING THEM OF THE DETERMINATION DECISION. NO COLLECTION EFFORTS WILL BE PURSUED ON A CHARITY ACCOUNT FOR THE ELIGIBLE AMOUNT AFTER SUCH DETERMINATION IS MADE." PART V, SECTION B, LINE 18E: NEITHER THE UNITED REGIONAL HEALTH CARE SYSTEM, NOR THIRD PARTIES AUTHORIZED BY URHCS, TAKE ANY ACTIONS UPON NON-PAYMENT FROM A PATIENT BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY. PART V, SECTION B, LINE 20D: INDIVIDUALS WHO DID NOT HAVE INSURANCE AND QUALIFY FOR FINANCIAL ASSISTANCE CAN HAVE UP TO 100% OF THE HOSPITAL SERVICE CHARGES REDUCED TO ZERO. INDIVIDUALS THAT PARTIALLY QUALIFY FOR ASSISTANCE WILL HAVE THEIR BILLS REDUCED LOWER THAN THE AGGREGATE OF THE THREE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES. PART VI, LINE 2: NEEDS ASSESSMENT UNITED REGIONAL HEALTH CARE SYSTEM (URHCS) PROVIDES EMERGENCY, TRAUMA, OUTPATIENT AND SHORT TERM GENERAL ACUTE CARE INPATIENT CARE IN THE WICHITA FALLS AREA. IN CONJUNCTION WITH OTHER INTERESTED ORGANIZATIONS, IT UNDERTAKES PROJECTS TO ASSESS THE HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES. FOR EXAMPLE, URHCS COLLABORATES WITH OTHER COMMUNITY HEALTH ORGANIZATIONS TO CREATE A "HEALTHY WICHITA" REPORT WHICH IS UPDATED PERIODICALLY. THIS REPORT ASSESSES THE HEALTHCARE SERVICES PROVIDED IN THE COMMUNITY TO COMPARE THE OUTCOMES TO STATE AND FEDERAL OUTCOMES AND DETERMINE IF THE COMMUNITY HEALTH NEEDS ARE BEING MET. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE HOSPITAL INFORMS PATIENTS OF THE CHARITY CARE PROGRAM AND HOW TO APPLY FOR CHARITY CARE. THIS IS DONE BY POSTING NOTICES IN PATIENT REGISTRATION AREAS AND PROVIDING WRITTEN NOTICES TO PATIENTS. ALL PATIENT STATEMENTS HAVE AN ASSISTANCE APPLICATION ON THE REVERSE SIDE AND AN ALERT ON THE FRONT FOR THOSE ELIGIBLE OR INTERESTED IN APPLYING. THIS INCLUDES ALL STATEMENT NOTIFICATIONS AND NOT JUST PATIENT SHARE STATEMENTS. FURTHERMORE, IT IS THE POLICY OF URHCS TO ASSIST PATIENTS WITH INFORMATION AND RESOURCES FOR POTENTIALLY QUALIFYING FOR GOVERNMENTAL OR OTHER FINANCIAL ASSISTANCE PROGRAMS. THE BUSINESS OFFICE WILL REFER THOSE PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE FROM A GOVERNMENTAL PROGRAM TO THE APPROPRIATE PROGRAM, SUCH AS MEDICAID, COUNTY INDIGENT, CRIME VICTIMS, OR OTHER PROGRAM, OR TO THE HOSPITAL'S CONTRACTED ELIGIBILITY VENDOR FOR SCREENING FOR GOVERNMENTAL PROGRAM COVERAGE. PART VI, LINE 4: COMMUNITY INFORMATION URHCS PRIMARY SERVICE AREA IS MADE UP OF THE CBSA OF WICHITA, ARCHER AND CLAY COUNTIES. WICHITA COUNTY CONTAINS THE CITY OF WICHITA FALLS WHERE URHCS IS LOCATED. ACCORDING TO THE HUMAN RESOURCES AND SERVICES ADMINISTRATION, US DEPARTMENT OF HEALTH AND HUMAN SERVICES, WICHITA COUNTY HAS SEVERAL CENSUS TRACTS FEDERALLY DESIGNATED AS MEDICALLY UNDERSERVED, INCLUDING CENSUS TRACT 102 WHERE URHCS IS LOCATED. ARCHER AND CLAY COUNTIES HAVE BEEN DECLARED TO BE MEDICALLY UNDERSERVED COUNTIES. 2010 CENSUS DATA FOR WICHITA COUNTY IS AS FOLLOWS: MEDIAN HOUSEHOLD INCOME (2011): $ 44,786 PER CAPITA INCOME (2011): $ 23,292 UNDER AGE 18 CHILDREN BELOW POVERTY LEVEL (2011): 18.7% MEDIAN EARNINGS OF FULL-TIME WORKERS, FEMALE (2011): $ 30,154 PERSONS BELOW POVERTY LEVEL (2011): 13.9% URHCS IS RECOGNIZED BY MEDICARE AS QUALIFYING FOR SOLE COMMUNITY HOSPITAL STATUS AND SERVES A DISPROPORTIONATE SHARE OF LOW-INCOME PATIENTS. UNITED REGIONAL QUALIFIES AS A DISPROPORTIONATE SHARE HOSPITAL FOR BOTH THE MEDICARE AND MEDICAID PROGRAMS. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH THE HOSPITAL IS GOVERNED BY A BOARD OF DIRECTORS THAT REPRESENTS THE COMMUNITIES IN WHICH THE ORGANIZATION OPERATES. URHCS EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. UNITED REGIONAL OPERATES A LEVEL 2 TRAUMA UNIT FOR THE REGION. THE HOSPITAL CONTRACTS WITH A FAMILY RESIDENCY PROGRAM TO ASSIST IN TRAINING PRIMARY CARE PHYSICIANS AS WELL AS TRAINING COURSES FOR NURSING AND ALLIED HEALTH PROFESSIONALS FOR THE COMMUNITIES IT SERVES. THE HOSPITAL PARTICIPATES IN MEDICAID AND IS THE MANDATED COUNTY HEALTHCARE FACILITY. URHCS REINVESTS SURPLUS FUNDS IN THE FACILITIES TO ENSURE PATIENTS ARE PROVIDED WITH STATE OF THE ART MEDICAL CARE. PART VI, LINE 7: FILING OF COMMUNITY BENEFIT REPORT URHCS FILES AN ANNUAL STATEMENT OF COMMUNITY BENEFIT STANDARDS (ASCBS) WITH THE STATE OF TEXAS. THE CALCULATION OF COMMUNITY BENEFIT FOR THE ASCBS DIFFERS FROM THE CALCULATIONS REQUIRED FOR THE IRS SCHEDULE H REPORTING. THEREFORE, THE INFORMATION REPORTED IN THE TWO REPORTS IS INCONSISTENT. STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI TX, true MIDWESTERN STATE UNIVERSITY 3410 TAFT BOULEVARD WICHITA FALLS TX 76308 756001738 GOVERNMENTAL 120000 CONTRIBUTION SERVICE ORGANIZATION OF NORTH TEXAS 2950 50TH STREET LUBBOCK TX 76413 800368789 501(C)(3) 5900000 CONTRIBUTION 2 PROCESS TO MONITOR USE OF GRANT FUNDS IN U.S. SCHEDULE I, PART I, LINE 2 UNITED REGIONAL HEALTH CARE SYSTEM PROVIDES GENERAL CONTRIBUTIONS TO THE COMMUNITY AND NATIONAL CHARITIES FOR THE FURTHERANCE OF THEIR MISSION. THE ORGANIZATIONS MAKE THEIR REQUESTS IN WRITING. THESE CONTRIBUTIONS ARE REVIEWED AND APPROVED BY APPROPRIATELY AUTHORIZED BOARD ACTION; OR OFFICERS; OR EMPLOYEES AS APPROPRIATE IN THE CIRCUMSTANCE IN EACH INSTANCE OF SUCH CONTRIBUTION BEING MADE. UNITED REGIONAL FOLLOWS UP WITH EACH ORGANIZATION TO MAKE SURE EACH CONTRIBUTION WAS USED FOR ITS INTENDED PURPOSE. X true true X X X false true false false false true true false false KEVIN THOMAS MD 174022 0 0 0 0 0 0 0 0 0 174022 0 PHYLLIS COWLING 420129 0 130083 0 85866 0 29000 0 11275 0 676353 0 0 0 NANCY TOWNLEY 259993 0 72652 0 7353 0 23307 0 25541 0 388846 0 0 0 ROBERT PERT 257906 0 67834 0 22133 0 23500 0 27433 0 398806 0 0 0 JOHN SCOTT HOYER MD 255967 0 64100 0 7330 0 23292 0 27883 0 378572 0 0 0 PAMELA BRADSHAW 198329 0 0 0 43942 0 18566 0 26623 0 287460 0 0 0 STEPHANIE JO BROWN 131752 0 22488 0 9393 0 17491 0 10725 0 191849 0 0 0 RICHARD CARPENTER 156746 0 24478 0 3961 0 18018 0 26418 0 229622 0 0 0 TERESA SCARBOROUGH 126981 0 7450 0 54 0 0 0 15682 0 150167 0 0 0 MATTHEW BAKER 131419 0 0 0 187 0 7761 0 29518 0 168885 0 0 0 JERRY MARSHALL 124851 0 0 0 6375 0 7557 0 19274 0 158057 0 0 0 DWAYNE MCKEE 129472 0 0 0 745 0 7258 0 20526 0 158000 0 0 0 BENEFITS PROVIDED BY THE ORGANIZATION SCHEDULE J, PART I, LINE 1A DUES FOR THE WICHITA FALLS COUNTRY CLUB ARE PAID FOR THE FOLLOWING STAFF MEMBERS IN ORDER FOR THE HOSPITAL TO HAVE USE OF THE FACILITIES FOR BUSINESS USE SINCE MEMBERSHIPS CANNOT BE HELD IN A COMPANY NAME. THE DUES ARE $476.25 PER MONTH, OR $5,715 PER YEAR. ANY PERSONAL CHARGES INCURRED ARE REQUIRED TO BE PAID BY THE EMPLOYEE: PHYLLIS COWLING RICHARD CARPENTER ROBERT PERT PARTICIPATION IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B UNITED REGIONAL HEALTH CARE SYSTEM OFFERS A DEFERRED COMPENSATION PLAN. CERTAIN MANAGEMENT AND HIGHLY COMPENSATED EMPLOYEES MAY ELECT TO PARTICIPATE, IF ELIGIBLE, IN A DEFERRED COMPENSATION PLAN WHICH IS IN COMPLIANCE WITH THE IRC SECTION 457(F), ELIGIBLE DEFERRED COMPENSATION PLAN SPONSORED BY A TAX EXEMPT ORGANIZATION. THE FOLLOWING INDIVIDUALS PARTICIPATED IN THE PLAN DURING THE 2012 TAX YEAR: NAME AMOUNT ------------------------------------- PHYLLIS COWLING $ 16,000 ROBERT PERT 11,000 NANCY TOWNLEY 10,807 DR JOHN SCOTT HOYER 10,792 PAMELA BRADSHAW 9,000 STEPHANIE JO BROWN 8,000 RICHARD CARPENTER 8,000 UNITED REGIONAL HEALTH CARE SYSTEM ALSO OFFERS A NON-QUALIFIED RETIREMENT PLAN. THE FOLLOWING INDIVIDUAL PARTICIPATED IN THE PLAN: NAME AMOUNT ------------------------------------ PHYLLIS COWLING $ 49,154 COMPENSATION CONTINGENT ON THE ORGANIZATION'S NET EARNINGS SCHEDULE J, PART I, LINES 6A & 6B A RANGE BETWEEN 20% AND 25% OF ANNUAL BONUS IS BASED ON CONSOLIDATED NET OPERATING INCOME. OTHER BONUS CRITERIA INVOLVE QUALITY SCORES, SERVICE SCORES AND INDIVIDUAL GOALS. A NORTH TEXAS HEALTHCARE FACILITIES DEVELOPMENT 900049824 662823BS1 2003-08-13 34519436 EXPAND CARDIOLOGY SERVICES & OTHER false false false B NORTH TEXAS HEALTHCARE FACILITIES DEVELOPMENT 900049824 662823CG6 2007-07-12 93891074 CONSTRUCTION OF BRIDWELL TOWER, CO false false false A 0 0 34519436 3477883 0 0 476750 0 0 30564803 0 0 2006 false false true true B 0 0 93891074 4384937 0 26749095 2757042 0 0 60000000 0 0 2010 false true true true A false false false false 0.00000 0.00000 0.00000 false false true B false false false false 0.00000 0.00000 0.00000 false false true A false false false false false false 0 false 0 false true B false false false false false false 0 false 0 false true A false B false 0 BRANDON TOWNLEY SON OF OFFICER 82112 SALARIES/WAGES false JAMES LANE PLUMBING SEE PART V 1462833 MAINTENANCE SVCS false LESLIE THOMAS IN-LAW OF DIRECTOR 12647 SALARIES/WAGES false SHELBY BRADSHAW DAUGHTER OF VP OF NURSING 14336 SALARIES/WAGES false WICHITA FALLS DIALYSIS SEE PART V 800827 PROFESSIONAL FEES false HILLARY ESPEY SISTER OF VP OF NURSING 17317 SALARIES/WAGES false ADDITIONAL INFORMATION ON TRANSACTIONS WITH INTERESTED PERSONS SCHEDULE L, PART IV, COLUMN(B) LEO LANE, DIRECTOR, IS THE VICE PRESIDENT OF JAMES LANE PLUMBING, AN ORGANIZATION DOING BUSINESS WITH THE HOSPITAL. ADDITIONAL INFORMATION ON TRANSACTIONS WITH INTERESTED PERSONS SCHEDULE L, PART IV, COLUMN(B) ASHWINKUMAR PATEL, DIRECTOR, IS A MORE THAN 35% OWNER OF WICHITA FALLS DIALYSIS, AN ORGANIZATION DOING BUSINESS WITH THE HOSPITAL. X 1 137650 COST 1 false false false DIFFERENCES IN VOTING RIGHTS FOR THE GOVERNING BODY FORM 990, PART VI, LINE 1A THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIR, SECRETARY, TREASURER, PAST CHAIR, AND PRESIDENT/CHIEF EXECUTIVE OFFICER, FIVE MEMBERS WHO ARE DIRECTORS, AND ONE ADDITIONAL DIRECTOR. THE EXECUTIVE COMMITTEE HAS AUTHORITY TO TRANSACT ALL BUSINESS OF THE BOARD IN THE MANAGEMENT OF THE CORPORATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD, SUBJECT TO LIMITATIONS SET FORTH IN THE BYLAWS AND ANY LIMITATIONS OTHERWISE IMPOSED BY THE BOARD. THE EXECUTIVE COMMITTEE COORDINATES RECOMMENDATIONS FROM OTHER COMMITTEES OF THE BOARD, MAKE RECOMMENDATIONS TO THE BOARD ON ALL MATTERS OF POLICY, AND KEEPS THE BOARD ADVISED AT ALL TIMES CONCERNING THE STATE OF AFFAIRS OF THE CORPORATION. THE EXECUTIVE COMMITTEE ACTS IN ALL PERSONNEL MATTERS INVOLVING EXECUTIVE AND MEDICAL STAFF PERSONNEL, INCLUDING SEARCH, SELECTION, EMPLOYMENT, COMPENSATION, MANAGEMENT PERFORMANCE REVIEW, CONTRACTS, AND BENEFITS, AND MAY APPOINT AN AD HOC COMMITTEE TO MAKE RECOMMENDATIONS TO IT IN ANY PARTICULAR SITUATION. RELATIONSHIPS AMONG OFFICERS, DIRECTORS, TRUSTEES, OR KEY EMPLOYEES FORM 990, PART VI, LINE 2 LARRY COOK (CHAIRMAN) HAS BUSINESS RELATIONSHIPS WITH MIKE ELYEA, LEO LANE, AND R. KEN HINES (DIRECTORS). MIKE ELYEA HAS BUSINESS RELATIONSHIPS WITH CARLA NICHOLS, R. KEN HINES, LEO LANE AND BLAKE ANDREWS (ALL DIRECTORS). POWER TO ELECT OR APPOINT MEMBERS OF THE GOVERNING BODY FORM 990, PART VI, LINE 7A THE WICHITA COUNTY-CITY OF WICHITA FALLS, TEXAS HOSPITAL BOARD (WHB) APPOINTS ONE INDIVIDUAL TO SERVE EX OFFICIO AS A VOTING DIRECTOR. THE INDIVIDUAL APPOINTED BY THE WHB DOES NOT HAVE TO BE A MEMBER OF THE WHB BUT MUST MEET THE QUALIFICATIONS FOR DIRECTORS SET FORTH BY THE HOSPITAL. DECISIONS OF THE GOVERNING BODY SUBJECT TO APPROVAL FORM 990, PART VI, LINE 7B THE JOINT CITY-COUNTY BOARD HAS APPROVAL REGARDING BOND FINANCING AND APPROVAL OF THE BUDGET. PROCESS USED TO REVIEW THE FORM 990 FORM 990, PART VI, LINE 11B THE EXECUTIVE COMMITTEE CHARTER, AS APPROVED BY THE UNITED REGIONAL HEALTH CARE SYSTEM BOARD, DELEGATES THE REVIEW OF 990S TO THE EXECUTIVE COMMITTEE. ALL MEMBERS OF THE COMMITTEE ARE PROVIDED A COPY OF THE FORM 990 PRIOR TO FILING WITH THE IRS. THE 990 IS REVIEWED BY MANAGEMENT OFFICIALS OF THE HOSPITAL AND THE EXECUTIVE COMMITTEE OF THE BOARD. MONITORING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY FORM 990, PART VI, LINE 12C ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY. THE FORMS ARE REVIEWED INITIALLY BY THE CHIEF COMPLIANCE OFFICER AND THE CEO FOR POTENTIAL CONFLICTS. ANY ACTUAL CONFLICTS ARE REVIEWED BY THE BOARD OF DIRECTORS. A PERSON WITH A CONFLICT IS RESTRICTED FROM VOTING ON RELATED MATTERS. PROCESS USED TO DETERMINE COMPENSATION OF MANAGEMENT AND KEY EMPLOYEES FORM 990, PART VI, LINES 15A & 15B THE EXECUTIVE COMMITTEE PERFORMS AN ANNUAL REVIEW FOR THE CEO AND MAKES FINAL RECOMMENDATIONS REGARDING COMPENSATION. AN ANNUAL REVIEW IS PERFORMED BY THE CEO FOR ALL OTHER OFFICERS OF THE ORGANIZATION. THE EXECUTIVE COMMITTEE REVIEWS THE ANNUAL COMPENSATION OF ALL OFFICERS. A COMPENSATION CONSULTANT PROVIDES MARKET COMPARISONS ON AN EVERY OTHER YEAR BASIS. THIS WAS COMPLETED IN 2009 AND 2011. GOVERNING DOCUMENTS OF THE ORGANIZATION AVAILABLE TO THE PUBLIC FORM 990, PART VI, LINE 19 AN AD IS RUN IN THE LOCAL PAPER ON AN ANNUAL BASIS INFORMING THE COMMUNITY THE FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE OTHER DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. COMPENSATION OF OFFICERS AND DIRECTORS FORM 990, PART VII, SECTION A DIRECTORS REPORTED IN PART VII, SECTION A ARE COMPENSATED FOR PROFESSIONAL SERVICES AS PHYSICIANS AND NOT AS DIRECTORS. OTHER CHANGES IN NET ASSETS OR FUND BALANCE FORM 990, PART XI, LINE 9 TIMING DIFFERENCE ON RECEIPT OF NONCASH CONTRIBUTION ($137,650) TIMING DIFFERENCE IN RECEIPT OF NONCASH CONTRIBUTION ($137,650) UNITED REGIONAL HEALTH CARE FOUNDATION 1600 ELEVENTH STREET WICHITA FALLS TX 76301 752761467 SUPPORT TX 501(C)(3) 11A URHCS true RATHGEBER HOSPITALITY HOUSE 1615 TWELFTH STREET WICHITA FALLS TX 76301 752811394 LODGING TX 501(C)(3) 7 URHCS true UNITED REGIONAL PHYSICIAN GROUP 1600 ELEVENTH STREET WICHITA FALLS TX 76301 752925491 HEALTH CARE TX 501(C)(3) 9 URHCS true UNITED REGIONAL HEALTH CARE SYSTEM AUXIL 1600 ELEVENTH STREET WICHITA FALLS TX 76301 756004656 BENEVOL SVCS TX 501(C)(3) 11A URHCS true CITY OF WICHITA FALLS-WC HOSPITAL BOARD 1300 SEVENTH STREET WICHITA FALLS TX 76301 756002771 OVERSIGHT TX GOVERNMENT N/A NA false UNITED REGIONAL PROFESSIONAL SERVICES 1600 ELEVENTH STREET WICHITA FALLS TX 76301 752549298 MGMT SERVICES TX NA C-CORPORATION 2076257 3949907 1.00000 true TEXOMA INSURANCE AGENCY 1600 ELEVENTH STREET WICHITA FALLS TX 76301 422683761 INSURANCE TX NA C-CORPORATION -3315 124392 1.00000 true true false true false false false false false false false false false true true false false true false false UNITED REGIONAL HEALTH CARE FOUNDATION C 2651000 SEE PART VII UNITED REGIONAL PHYSICIAN GROUP Q 1076429 SEE PART VII UNITED REGIONAL PHYSICIAN GROUP A 47835 SEE PART VII PART V, LINE 2, COLUMN (D): METHOD OF DETERMINING AMOUNTS FOR TRANSACTIONS DESCRIBED IN LINES 1C AND 1Q: AMOUNTS REPORTED IN LINE 2, COLUMN (C) FOR THESE TRANSACTION TYPES ARE STATED AT CASH VALUE. METHOD OF DETERMINING AMOUNTS FOR TRANSACTIONS DESCRIBED IN LINES 1A,M,N: AMOUNTS REPORTED ON LINE 2, COLUMN (C) FOR THESE TRANSACTION TYPES ARE AT FAIR MARKET VALUE AND ARE COMPARABLE TO TRANSACTIONS BETWEEN TWO OR MORE UNRELATED PARTIES DEALING AT ARM'S LENGTH.