2013-05-07T16:00:07-05:00 2012-06-30 BKD LLP 7901 Woodway Drive Suite 100 Waco TX 76712 990 2011-07-01 741546619 GOODALL-WITCHER HEALTH CARE FOUNDATION % CLARENCE FIELDS JR GOOD 2546758322 PO BOX 549 CLIFTON TX 76634 ADAM B WILLMANN 2546758322 2013-02-21 true Amanda Maya 2547768244 2011 2016-03-07 17:11:31Z CLARENCE FIELDS JR PO BOX 549 CLIFTON TX 76634 18046045 false X WWW.GWHF.ORG X 1966 TX TO PROVIDE ACCESS TO AND DELIVERY OF QUALITY HEALTHCARE SERVICES THROUGH EFFICIENT, COMPREHENSIVE, AND FRIENDLY CARE. 7 7 274 20 0 0 464811 162961 20116287 17423914 13622 11633 232719 447537 20827439 18046045 0 0 0 0 9131121 8330356 0 0 0 10374124 10481670 19505245 18812026 1322194 -765981 16800355 17110638 9777820 10857102 7022535 6253536 TO PROVIDE ACCESS TO AND DELIVERY OF QUALITY HEALTHCARE SERVICES THROUGH EFFICIENT, COMPREHENSIVE, AND FRIENDLY CARE. false false 16817663 17732164 PROVIDED HEALTHCARE SERVICES THROUGH THE OPERATION OF A HOSPITAL, AN OUTPATIENT CLIENT, A HOME HEALTH AGENCY, A NURSING FACILITY AND A WELLNESS AND FITNESS CENTER. PATIENT DAYS TOTALED 4085; 373 OPERATIONS WERE PERFORMED, 99,829 TESTING PROCEDURES COMPLETED, AND 566 PHYSICIAL/OCCUPATIONAL SPEECH THERAPY VISITS OCCURRED. EMERGENCY ROOM VISITS TOTALED 4594. THE FOUNDATION ALSO PROVIDED CHARITY CARE IN THE AMOUNT OF $2,064,483. 16817663 true true false true false false false false false true false false false false false true false false false false false false false false false true true false false false false false false false false false false false false false false false false false false false false false true 273 0 true 274 true false false false false false false false false false false X 7 7 false false false false false false false true true false false false true true true true true true true false X CLARENCE FIELDS JR 2546758322 101 S AVENUE T CLIFTON TX 76634 RICHARD LUNDBERG 1.0 X X 0 0 0 TOM HENDERSON 1.0 X X 0 0 0 CHARLENE W PARKS 1.0 X X 0 0 0 ALAN MICHAEL DAY 1.0 X X 0 0 0 DARLENE MUNDEN 1.0 X 0 0 0 JOHN GILLIAM 1.0 X 0 0 0 BRUCE BERG 1.0 X 0 0 0 CLARENCE FIELDS JR 40.0 X 123660 0 3710 VICKI GLOFF 40.0 X 68634 2644 DAVID ZSCHIESCHE 40.0 X 108134 0 5728 MARY WERLINGER 40.0 X 98777 0 5499 399205 0 17581 2 false false false CLIFTON PHYSICIANS PA 101 S AVENUE T CLIFTON TX 76634 PHYSICIAN GROUP 1889786 BRAZOS STAFFING NETOWRK 101 S AVENUE T CLIFTON TX 76634 ER COVERAGE 658000 NORTH HILL COUNTRY ANESTHESIA P O BOX 93 CRANFILLS GAP TX 76637 CRNA COVERAGE 308051 BKD LLP 14241 DALLAS PKWY STE 1100 DALLAS TX 75254 ACCOUNTING SERVICES 132767 4 8387 154574 162961 HOSPITAL OPERATIONS 621110 17404814 17404814 CLINIC RENT 531120 19100 19100 17423914 11633 11633 0 0 0 0 0 0 EHR INCENTIVE REVENUE 900099 308250 308250 MISCELLANEOUS REVENUE 900099 110940 110940 CAFETERIA SALES 722100 23983 23983 4364 4364 447537 18046045 17732164 150920 0 0 0 0 207402 207402 0 0 7407284 6443142 964142 71693 60939 10754 54859 46627 8232 589118 459413 129705 0 0 0 0 0 0 3692394 3503584 188810 30234 1913 28321 109267 56228 53039 0 0 618084 585614 32470 28254 23490 4764 0 18020 12376 5644 346230 346230 0 1084417 1084417 812314 600189 212125 BAD DEBT 2150515 2150515 MEDICAL SUPPLIES 1428078 1428078 MISC EXPENSES 131543 131543 LICENSE AND PERMITS 32320 14908 17412 18812026 16817663 1994363 0 541581 787360 842782 969650 48138 24313 3275514 3103098 0 0 0 0 0 0 167414 175363 14018 83241 22754885 11946300 10749811 10808585 511225 475060 0 0 0 0 0 0 649872 683968 16800355 17110638 1550016 2816886 0 0 0 0 0 0 0 0 0 0 8227804 8040216 0 0 0 0 9777820 10857102 X 7022535 6253536 0 0 0 0 7022535 6253536 16800355 17110638 X -765981 -3018 X X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 3477 false false false 3477 false OTHER ACTIVITY PART II-B, LINE 1F HOSPITAL PAID DUES TO ORANIZATIONS, A PORTION OF WHICH IS DESIGNATED FOR LOBBYING EXPENSES. DUES %LOBBYING $LOBBYING TORCH DUES $2,750 10% $275 THA DUES $6,829 24% $1,639 AHA DUES $6,512 24% $1,563 TOTAL $16,091 $3,477 318041 318041 13427423 3988188 9439235 7412584 7352486 60098 1596837 605626 991211 10808585 18046045 18812026 -765981 -3018 -3018 -768999 18043027 -3018 -3018 18046045 18046045 18812026 18812026 18812026 true true X true X false true true true false true true 1006944 1006944 0.06040 1250414 808590 441824 0.02650 153278 123012 30266 0.00180 2410636 931602 1479034 0.08870 52508 52508 0.00320 64209 64209 0.00390 445024 445024 0.02670 561741 561741 0.03380 2972377 931602 2040775 0.12250 true 2150515 5221783 3336820 1884963 X true true 1 1 GOODALL-WITCHER HOSPITAL

101 S AVENUE T CLIFTON TX 76634

X X X GOODALL-WITCHER HOSPITAL 1 true X X X X X X X X 11 true false true X X X X X false true true 200. false true X X X X X X true true X X X X true false X X X X true X false false 3 CLIFTON MEDICAL CLINIC

201 S AVENUE T CLIFTON TX 76634

RURAL HEALTH CLINIC GOODALL-WITCHER HOME HEALTH AGENCY

300 HILLSIDE DRIVE CLIFTON TX 76634

HOME HEALTH AGENCY GOODALL-WITCHER NURSING FACILITY

101 S AVENUE T CLIFTON TX 76634

LONG TERM CARE NURSING FACILIT CHARITY CARE ELIGIBILITY CRITERIA SCHEDULE H, PART I, LINE 3C PATIENTS WITHOUT INSURANCE ARE ELIGIBLE FOR A 15% DISCOUNT OF TOTAL CHARGES WHEN THE BALANCE IS PAID IN FULL WITHIN THIRTY DAYS. BAD DEBT EXPENSE EXCLUDED IN CALCULATION OF PATIENT CARE COST TO CHARGES SCHEDULE H, PART I, LINE 7 COLUMN F BAD DEBT EXPENSE IN THE AMOUNT OF $2,150,515 WAS INCLUDED ON FORM 990, PART IV, LINE 25 IN TOTAL EXPENSES. HOWEVER, THIS AMOUNT WAS EXCLUDED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF PATIENT CARE COST TO CHARGES. BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A, LINE 4 THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS, AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNT RECEIVABLES ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. THE AMOUNT ON LINE 2 IS THE BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. COSTING METHODOLOGY SCHEDULE H, PART III, SECTION B, LINE 8 THE MEDICAL CENTER USES COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. COLLECTION POLICY SCHEDULE H, PART III, SECTION B, LINE 9B THE ORGANIZATIONS COLLECTION POLICY STATES THAT NO COLLECTION EFFORTS WILL BE PURSUED ON A CHARITY ACCOUNT AFTER SUCH A DETERMINATION IS MADE. INPUT FROM THE COMMUNITY FOR NEEDS ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 3 COMMUNITY WAS REPRESENTED BY NURSING FACILITY ADMINISTRATION, TEXAS REGION 7 PUBLIC HEALTH NURSE, BUSINESSES IN THE COMMUNITY, CHAMBER OF COMMERCE, MINISTERIAL ALLIANCE, CHAIRMAN OF HOSPITAL BOARD AND PRESIDENT OF THE CLIFTON PHYSICIANS GROUP. NEEDS NOT ADDRESSED FROM NEEDS ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 7 SOME NEEDS WERE NOT ADDRESSED DUE TO BUDGET CONSTRAINTS. MENTAL HEALTH ISSUES WERE NOT ADDRESSED DUE TO STAFFING SHORTAGES. SCHEDULE H, PART V, SECTION B, LINE 15, 16 & 17 NEITHER GOODALL-WITCHER HEALTH CARE FOUNDATION, NOR THIRD PARTIES AUTHORIZED BY THE GOODALL-WITCHER HEALTH CARE FOUNDATION, 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. DETERMINATION OF AMOUNTS BILLED FOR EMERGENCY CARE SCHEDULE H, PART V, SECTION B, LINE 19 PATIENTS WITHOUT INSURANCE ARE ELIGIBLE FOR A 15% DISCOUNT OF TOTAL CHARGES WHEN THE BALANCE IS PAID IN FULL WITHIN THIRTY DAYS. ELIGIBILTY FOR FREE CARE IS DETERMINED BASED UPON 200% OF FEDERAL POVERTY GUIDELINES. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 PERIODIC INPUT FROM THE COMMUNITY IS GATHERED TO IDENTIFY NEEDS. PHYSICIAN RECRUITMENT ATTEMPTS TO ADDRESS COMMUNITY NEEDS WITH HOSPITAL SERVICES. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 ANNUAL CHARITY AMOUNTS ARE POSTED IN THE LOCAL NEWSPAPER. EACH PATIENT IS GIVEN AN APPLICATION FOR CHARITY CARE UPON ADMISSION. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 THE HOSPITAL SERVES THE RURAL AREAS OF BOSQUE COUNTY AND SOME PORTIONS OF CONTIGUOUS COUNTIES. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 THE HOSPITAL PROVIDES MEDICAL ASSISTANCE SERVICES FOR QUALIFYING INDIVIDUALS. A LICENSED DIETICIAN IS ALSO MADE AVAILABLE FOR COUNSELING. THE HOSPITAL ALSO HAS HOSTED MCLENNAN COMMUNITY COLLEGE LVN SCHOOL STUDENTS AS WELL. THE HOSPITAL PARTICIPATED IN RELAY FOR LIFE, SAY NO TO DRUGS SCHOOL INITIATIVE, TRICK OR TREAT MAIN STREET, JUNIOR AND HIGH SCHOOL VOLUNTEER PROGRAMS AND CAREER WEEKS, ALONG WITH MONTHLY HOSTING OF THE MINISTERIAL ALLIANCE. THE HOSPITAL HAS AN OPEN MEDICAL STAFF AND ALL MEMBERS OF THE BOARD OF DIRECTORS RESIDE IN THE COMMUNITY SERVED BY THE HOSPITAL. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 N/A STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 TEXAS PROCESS TO REVIEW THE FORM 990 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM FOLLOWING THE COMPLETION OF AN AUDIT OF FINANCIAL STATEMENTS. THE CEO REVIEWS THE RETURN PRIOR TO FILING. PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST ACKNOWLEDGEMENT ANNUALLY. REVIEW OF CEO OR TOP MGMT OFFICIAL COMPENSATION FORM 990, PART VI, SECTION B, LINE 15A TEXAS ORGANIZATION OF RURAL & COMMUNITY HOSPITAL SALARY SURVEY IS USED IN REVIEWING CEO SALARY. THE FINANCIAL CONDITION OF THE FACILITY IS ALSO A CONSIDERATION IN DETERMINING ANY COMPENSATION INCREASES. CEO SALARY REVIEWED BY GOVERNING BOARD DEC 2011. REVIEW OF OTHER OFFICER OR KEY EMPLOYEES COMPENSATION FORM 990, PART VI, SECTION B, LINE 15B CEO REVIEWED CFO COMPENSATION IN 2011. OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE FORM 990, PART VI, SECTION C, LINE 19 ORGANIZATIONAL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER ADJUSTMENT FORM 990, PART XI, LINE 5 UNREALIZED GAIN -$3,018 --------------------------- TOTAL -$3,018