2013-11-13T12:26:20-06:00 2012-12-31 861065772 Deloitte Tax LLP 1111 Bagby Street Suite 4500 Houston TX 770024196 990 2012-01-01 760556120 SAN JACINTO FAMILY PRACTICE EDUCATION FOUNDATION SANJ 2814208701 4401 Garth Road Baytown TX 77521 Jonathan Sturgis 2814206114 2013-11-13 1 Jeffrey D Frank P00287234 7139822000 2012 2016-03-07 17:11:31Z Donna Gares 4401 Garth Road Baytown TX 77521 4740565 0 X www.methodisthealth.com X 1996 TX See Schedule O. 7 1 115 3 0 0 493330 363160 4568585 4111543 0 0 60194 265862 5122109 4740565 0 0 0 0 7738187 8177752 0 0 0 2010601 1595583 9748788 9773335 -4626679 -5032770 0 296824 37485053 42814647 -37485053 -42517823 X See Schedule O. 0 0 9065886 4355658 See Schedule O. 9065886 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 115 1 0 0 0 0 0 0 0 0 0 0 0 X 7 1 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 X Jonathan Sturgis Treasurer 2814206114 4401 Garth Road Baytown TX 77521 X Bruce Kennedy MD 3.00 47.00 X 0 318672 50520 Rebecca Gladu MD 48.00 2.00 X 236286 0 36105 Clare Hawkins MD 48.00 2.00 X X 260797 0 51109 Mohammad Khoshnevis MD 2.00 0.00 X 0 95605 0 Bufford Moore MD 2.00 0.00 X 0 84182 0 Ted Krell MD 2.00 0.00 X 0 44385 0 John Rogers MD 2.00 0.00 X 0 0 0 Donna Gares 2.00 48.00 X 0 604161 47927 Jonathan Sturgis 2.00 48.00 X 0 241437 41791 Susan Garcia 50.00 0.00 X 0 111422 24275 Quynh Uyen Bui MD 50.00 0.00 X 268504 0 18172 Rosemary Obudulu MD 50.00 0.00 X 240280 0 44786 Hubert Williston MD 50.00 0.00 X 224695 0 27090 Isaac Goldberg MD 50.00 0.00 X 216895 0 45382 Hamidreza Iranmanesh 50.00 0.00 X 228521 0 39788 1675978 1499864 426945 16 0 1 0 0 363160 363160 Patient Services 900099 4111543 4111543 4111543 Meaningful Use Rev-Med 900099 191250 191250 Intercompany Revenue 900099 52865 52865 Miscellaneous Revenue 900099 19661 19661 2086 2086 265862 4740565 4355658 0 21747 584297 584297 6099795 5960414 139381 264002 221226 42776 828147 755766 72381 401511 383355 18156 311539 298709 12830 986 986 421701 399271 22430 219049 219049 66483 33785 32698 77328 75488 1840 Management Fees 334368 334368 Medical Supplies 164129 133540 30589 9773335 9065886 707449 0 0 296824 0 296824 40946 221233 37444107 42593414 37485053 42814647 X -37485053 -42517823 -37485053 -42517823 0 296824 -5032770 0 X 0 1 X 1 1 1 X X X 0 0 0 San Jacinto Methodist Hospital 741287015 3 1 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 Due to Related Organizations 42593414 42593414 X Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: San Jacinto Family Practice Education Foundation's financial statements are included in the consolidated financial statements of The Methodist Hospital System (TMHS) which were audited by an independent accountant. TMHS did not recognize any adjustments related to uncertain tax positions as of December 31, 2012. 0 0 0 0 0 0 0 0 0 Bruce Kennedy MD 0 229906 0 65809 0 22957 0 21139 0 29381 0 369192 0 0 Rebecca Gladu MD 226985 0 0 0 9301 0 20472 0 15633 0 272391 0 0 0 Clare Hawkins MD 250035 0 0 0 10762 0 21111 0 29998 0 311906 0 0 0 Donna Gares 0 385287 0 112573 0 106301 0 21085 0 26842 0 652088 0 0 Jonathan Sturgis 0 185355 0 46773 0 9309 0 15744 0 26047 0 283228 0 0 Quynh Uyen Bui MD 179429 0 0 0 89075 0 16291 0 1881 0 286676 0 0 0 Rosemary Obudulu MD 169517 0 0 0 70763 0 16200 0 28586 0 285066 0 0 0 Hubert Williston MD 211617 0 0 0 13078 0 17532 0 9558 0 251785 0 0 0 Isaac Goldberg MD 204667 0 0 0 12228 0 19693 0 25689 0 262277 0 0 0 Hamidreza Iranmanesh 172845 0 0 0 55676 0 14369 0 25419 0 268309 0 0 0 Supplemental Information Part III Part I, Line 3: The CEO of this organization is employed by a related organization who utilized the following items to establish compensation: (1)compensation committee; (2)independent compensation consultant; (3)compensation survey or study; (4)approval by the board or compensation committee. Part I, Line 4a: The Methodist Hospital System has a formal severance plan. Eligible System employees include all staff including hourly staff up through senior vice presidents provided they work at least 20 hours per week and are not otherwise covered by a physician employment agreement. The plan only provides salary and benefits in the event an eligible employee is involuntarily terminated due to the elimination of their position or if their current position is significantly impacted by an organizational restructuring or change in requirement and a comparable position is not available within the organization. The eligible person must also sign a termination agreement in order to receive salary continuation and benefits under the plan to which they would not normally be eligible to receive under a voluntary resignation. No reportable individuals received payments from this plan in 2012. Part I, Line 4b: Bruce Kennedy, MD: $15,727, Donna Gares: $63,430, and Jonathan Sturgis: $3,480, all received monies from Supplemental Executive Retirement Plan (SERP) described below. The SERP is a non qualified employer funded plan. Contributions are made annually into a tax deferred account and are considered taxable upon vesting (i.e. completion of three years of vesting service). Once vested, each year's subsequent contribution is taxable within the calendar year in which the deposit was made. Account balances cannot be accessed until retirement or termination (whichever occurs first) and may be subject to non-revocable distribution options selected upon employment. Mission Statement Form 990, Part I and Part III, Line 1 This organization is part of The Methodist Hospital System, whose mission is: To provide high quality, cost-effective health care that delivers the best value to the people we serve in a spiritual environment of caring in association with internationally recognized teaching and research. Program Service Accomplishments Form 990, Part III, Line 4a In 2012, eight physicians successfully completed their residency program with San Jacinto Family Practice Education Foundation (SJFPEF). The residency program exists to take physicians (who have graduated from medical school) into clinical practice via a three year family medicine residency program. Six of the graduates are practicing within the state of Texas. SJFPEF faculty and residents engaged in over 49,000 visits to include 35,431 clinic encounters, 13,689 inpatient encounters and over 187 deliveries. The residency faculty has published four articles, given two national presentations and five state presentations in addition to two statewide poster presentations. The residency director is currently serving as the president-elect of the Texas Academy of Family Physicians. One faculty as the president of the Harris County Academy of Family Physicians and one as the president-elect. The clinic also provided healthcare to the indigent and underinsured population in San Jacinto Methodist Hospital's service area. These services are provided through the provision of charity care, a Texas State Department of Health Services grant and self-pay discounts. In 2012, individuals received $88,330.34 in charity care and $75,435.26 in grant write-offs which were based on medical and financial need. The Department of State Health Services provided $100,000 in funds through a Primary Healthcare Grant. The Foundation provided healthcare services to 169 individual patients with 707 outpatient visits. This was provided to patients who fell between 100 and 150% of federal poverty guidelines and did not quality for other types of state assistance. Form 990, Part VI, Section A, line 6 San Jacinto Methodist Hospital is the Sole Member of this organization. The sole member of San Jacinto Methodist Hospital is The Methodist Hospital. Form 990, Part VI, Section A, line 7a The Member of the Corporation (San Jacinto Methodist Hospital) appoints the Board of Directors. Form 990, Part VI, Section A, line 7b The member of the corporation (San Jacinto Methodist Hospital) reserves the following powers: -Budgets: Annual capital and operating budgets for the Corporation and any financial expenditure which deviates therefrom if the sum of such deviating financial expenditure and the aggregate of all prior deviating financial expenditures for the fiscal year is greater than $5,000; -Debt: Any incurrence or guarantee of any debt, directly or indirectly, by the Corporation or by any subsidiary of the Corporation; -Corporate Modification: Any dissolution, merger, consolidation, sale or other modification of the Corporation or any creation, dissolution, merger, consolidation, sale or other modification of any subsidiary of the Corporation; -Property: Any acquisition, sale, lease, mortgage, or other transfer or encumbrance (i) of any real property of the Corporation or (ii) of any personal property of the Corporation of a value in excess of $10,000; -Financial Relations: Any affiliation, joint venture, contract, employment, retention, indemnification or other arrangements between the Corporation and any insurer, health maintenance organization, preferred provider organization, medical school, hospital, clinic, pharmacy, physician, or other provider of health or related services, including, without limitation, all service terms and compensation arrangements; -Compensation: Adoption or amendment of salaries or other compensation (including the awarding of any incentive compensation) with respect to the officers of the Corporation, physician employees of the Corporation, and physicians who are independent contractors to the Corporation; -Selections: Selection of the Corporation's auditors and legal counsel; -Grants: The giving, seeking or receiving of grants; -Litigation and Claims: The commencement of litigation or the settlement of litigation or other claims; -Fee Schedule: Approval of the adoption or amendment of fee schedules relating to patient services; and -Other Matters: Any other matters with respect to which exclusive authority is granted to the Member by the Statute, the Articles of the Bylaws. Form 990, Part VI, Section B, line 11 Management, including certain Officers, works diligently to complete the Form 990 and attached schedules (Return) in a thorough manner. The Return is prepared by a Paid Preparer. Form 990, Part VI, Section B, line 12c All Individuals serving in a significant decision making capacity complete a Conflict of Interest (COI) questionnaire annually. A comprehensive evaluation and thorough review of all disclosures is performed by a 6-member COI Committee comprised of executives, management, and staff. The results of the COI disclosures are reported to the parent corporation, The Methodist Hospital System's Audit & Compliance Committee and Board of Directors, including the actions being taken to protect the integrity of decision-making. In addition, disclosure results are also communicated to management and to affected committee chairs to promote transparency and to ensure that actions are taken and restrictions are imposed where appropriate. Conflicted individuals may not vote or exert self-serving influence on the disclosed matter. Form 990, Part VI, Section B, line 15a The corporate member of this organization, San Jacinto Methodist Hospital, follows IRS regulations as it relates to establishing a rebuttable presumption of reasonableness related to total compensation of top officers of the organization listed below. It has established a rigorous process that includes the following elements: A separate committee of independent directors (the "Board Committee") meets at least annually to review, deliberate and make recommendations to the full Board as it relates to any changes in total compensation including base pay, bonus awards from incentive programs or benefits and perquisites of the CEO. For 2012, the Board Committee reviewed and recommended the compensation package for the President and CEO, San Jacinto Methodist Hospital who also serves as the President/CEO of this organization. The Board Committee establishes that no member has any conflict of interest with regard to the executive compensation arrangements being approved. The Board Committee reviews and considers information provided by an external consultant engaged to ensure it has direct access to: -Compensation information paid by comparable organizations, for functionally comparable positions. -Compensation norms in the organization's immediate locale and from other independent compensation surveys by nationally recognized independent firms that represent the organization's logical peer group. -Compensation information that includes information on base salary, incentives, benefits and perquisites for total compensation comparison purposes to ensure reasonable competitive ranking. The Board Committee relies on the comparability data to reach consensus that its recommendations to the Board regarding executive compensation changes are reasonable and in line with the organization's overall total compensation philosophy for executive pay. The deliberation and decisions of the committee are contemporaneously substantiated. The compensation for positions held by the other compensated Officers, Directors and Key Employees listed on Part VII, is determined based on a thorough review of numerous compensation studies conducted by nationally recognized, independent firms that provide market data for total compensation for similar positions. The compensation information considered includes information on base salary, incentives, and benefits for total compensation purposes to ensure reasonable competitive ranking in order to meet recruitment and retention objectives that secure the talent required to contribute to organizational success. Form 990, Part VI, Section C, line 19 The governing documents (except the Articles of Incorporation, which are on file with the Secretary of the State of Texas), conflict of interest policy and financial statements of the organization are not made available to the general public. Average Hours Per Week Form 990, Part VII, Column B Certain officers/directors of San Jacinto Family Practice Education Foundation are employees of San Jacinto Methodist Hospital. These officers and directors who are employed by San Jacinto Methodist Hospital work approximately 50 hours per week on behalf of this entity and other entities of The Methodist Hospital System. The compensation shown on Part VII and Schedule J reflects the total compensation earned for the officer/director for the combined hours spent working for all the entities in the organization. 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