TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH (EIN 75-2678857)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-12-05
- IRS object ID
- 201213409349300731
- Schema version
- 2011v1.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-12-05T03:32:13-07:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TEXAS HEALTH RESOURCES | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 612 E LAMAR BLVD STE 1400 | AddressLine1 |
| City | ARLINGTON | City |
| State | TX | State |
| ZIP Code | 76011 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 752678857 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Texas Health Harris Methodist Hospital Southwest Fort Worth | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | TEXA | NameControl |
| Phone | 8174335000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6100 Hospital Parkway | AddressLine1 |
| City | Fort Worth | City |
| State | TX | State |
| ZIP Code | 76132 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | John Mitchell | Name |
| Title | Assistant Secretary | Title |
| Phone | 8174335000 | Phone |
| Date Signed | 2012-11-13 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TEXAS HEALTH RESOURCES | Name |
| Phone | 2547862001 | Phone |
| Date Prepared | 2012-12-05 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Texas Health Southwest | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Brett McClung | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6100 Hospital Parkway | AddressLine1 |
| City | Fort Worth | City |
| State | TX | State |
| ZIP Code | 76132 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 150999997 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.texashealth.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1987 | YearFormation |
| State Legal Domicile | TX | StateLegalDomicile |
| Activity Or Mission Description | A faith-based organization whose mission is to improve the health of the people in the communities it serves regardless of one's ability to pay. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1179 | TotalNbrEmployees |
| Total Nbr Volunteers | 158 | TotalNbrVolunteers |
| Total Gross UBI | 555192 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 31987 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 262546 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 564119 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 150595096 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 146795155 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -27509 | InvestmentIncomePriorYear |
| Investment Income Current Year | -42289 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1606317 | OtherRevenuePriorYear |
| Other Revenue Current Year | 3626365 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 152436450 | TotalRevenuePriorYear |
| Total Revenue Current Year | 150943350 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 20823 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 29750 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 56259516 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 63791894 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 79109838 | OtherExpensePriorYear |
| Other Expenses Current Year | 68822983 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 135390177 | TotalExpensesPriorYear |
| Total Expenses Current Year | 132644627 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 17046273 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 18298723 | RevenuesLessExpensesCY |
| Total Assets BOY | 84975505 | TotalAssetsBOY |
| Total Assets EOY | 87015668 | TotalAssetsEOY |
| Total Liabilities BOY | 39314054 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 21611988 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 45661451 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 65403680 | NetAssetsOrFundBalancesEOY |
| Mission Description | A faith-based organization whose mission is to improve the health of the people in the communities it serves regardless of one's ability to pay. | MissionDescription |
| Expense | 112414938 | Expense |
| Grants | 29750 | Grants |
| Revenue | 150943350 | Revenue |
| Description | Texas Health Harris Methodist Hospital Southwest (THSW) is located in the southwest sector of Fort Worth for more than 20 years and operates 220 beds. THSW provides a wide array of comprehensive services, including: surgical and imaging services, 24-hour emergency services, orthopedics and sports therapy, adult critial care and a Level IIIa neonatal intensive care unit, obstetrics and gynecology, cardiovascular services, cancer care, rehabiliation, and more. THSW recently became the second Texas hospital to earn Acute Heart Failure Center status from the Society of Chest Pain Centers. ************************************************************************** During the year, THSW had 38,808 patient days, 10,324 discharges, 81,393 outpatient encounters, 46,281 emergency room visits and 2,895 births. ************************************************************************** THSW provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. The hospital provides care to persons covered by governmental programs including Medicare and Medicaid for reimbursement that does not always cover the cost of providing the care. Recognizing its mission to the community, services are provided to both financially indigent and medically indigent patients. ************************************************************************** Community benefit is provided through many reduced price services and free programs to the community. These services are essential to provide complete healthcare to the communities served. Some of these programs include: * Various health screenings were offered to the community free of charge or for a nominal charge such as diabetes and breast cancer. * Community education classes offered such as Safe Sitter, Girls Growing Up, Lamaze, CPR and parenting. * Senior adult community education through Seniorcising, a program designed to promote health education, wellness strategies and healthy living with physical exercise in senior adults. | Description |
| Total Program Service Expense | 112414938 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 83 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 1179 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Jack Roper | NamePerson |
| Telephone Number | 6822367900 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 612 E Lamar Blvd | AddressLine1 |
| City | Arlington | City |
| State | TX | State |
| ZIP Code | 76011 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| William Bleibdrey | ||||||||
| Trustee | 2.00 | X | 923 | 0 | 0 | |||
| Curtis R Evans MD | ||||||||
| Trustee | 2.00 | X | 688 | 0 | 0 | |||
| Kevin G Connelly MD | ||||||||
| Trustee | 2.00 | X | 706 | 0 | 0 | |||
| T Ray Jones | ||||||||
| Trustee | 2.00 | X | 211 | 0 | 0 | |||
| Robert H Lilli MD | ||||||||
| Secretary | 2.00 | X | 211 | 0 | 0 | |||
| Kenneth W Reeves | ||||||||
| Vice Chair | 2.00 | X | 0 | 0 | ||||
| John W Schaub | ||||||||
| Trustee | 2.00 | X | 211 | 0 | 0 | |||
| Ron E Schneider | ||||||||
| Chair | 2.00 | X | 618 | 0 | 0 | |||
| Susan L Weeks DNP | ||||||||
| Secretary | 2.00 | X | 829 | 0 | 0 | |||
| Monique Gibson | ||||||||
| Trustee | 2.00 | X | 0 | 0 | ||||
| Brett McClung | ||||||||
| President | 40.00 | 0 | 59686 | X | ||||
| Mary Robinson | ||||||||
| Vice President | 40.00 | 0 | 34380 | X | ||||
| Barclay Berdan | ||||||||
| Corporate Officer | 0 | 119583 | X | |||||
| Charles Boes | ||||||||
| Asst Secretary | 0 | 82524 | X | |||||
| Kenneth Kramer | ||||||||
| Asst Secretary | 0 | 66227 | X | |||||
| John Mitchell | ||||||||
| Asst Secretary | 0 | 61351 | X | |||||
| Jennifer Schroeder | ||||||||
| Asst Secretary | 0 | 24602 | X | |||||
| Susan Christenson | ||||||||
| Nursing Supervisor | 40.00 | 0 | 26095 | X | ||||
| Kathy Terryah | ||||||||
| RN | 40.00 | 0 | 14608 | X | ||||
| Eric Bauer | ||||||||
| Director | 40.00 | 0 | 23821 | X | ||||
| Larry Lookingbill | ||||||||
| RN | 40.00 | 0 | 32519 | X | ||||
| Gary Wallace | ||||||||
| Director | 40.00 | 0 | 18342 | X | ||||
| Stephen Hanson | ||||||||
| Former Officer | 0 | 114130 | X | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1513838 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 4062059 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 677868 | TotalOtherCompensation |
| Number Individuals GT100 K | 63 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Texas Health Resources | |||||
| 612 E Lamar Blvd | Arlington | TX | 76011 | Management Fee | 17412608 |
| Hospital Housekeeping Systems LTD | |||||
| 216 E 4th St | Austin | TX | 78701 | Housekeeping Svcs | 1158404 |
| Skiles Group Inc | |||||
| PO Box 743636 | Dallas | TX | 75374 | Construction | 932723 |
| Brandt Companies LLC | |||||
| 1728 Briercroft Ct | Carrollton | TX | 75006 | Construction | 873595 |
| TX Health Single Source Staffing | |||||
| 524 E Lamar | Arlington | TX | 76011 | Labor | 804012 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 25 | NumberOfContractorsGT100K |
| Related Organizations | 548667 | RelatedOrganizations |
| All Other Contributions | 15452 | AllOtherContributions |
| Total Contributions | 564119 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| Patient Serv Revenue | 146719750 | 146719750 |
| Education | 75405 | 75405 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 146795155 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11907 | TotalRevenueColumn |
| Exclusion | $11,907 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 75937 | TotalRevenueColumn |
| Exclusion | $75,937 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 54196 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -54196 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -54196 | TotalRevenueColumn |
| Exclusion | -$54,196 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 17585 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 2451 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15134 | TotalRevenueColumn |
| Exclusion | $15,134 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Business CodeBusinessCode | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| Electronic Health Records Stimulus Rev | 1921475 | $1,921,475 | ||
| Cafeteria Reveue | 748080 | $748,080 | ||
| Lab UBI Revenue | 555192 | 621500 | 555192 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 310547 | TotalRevenueColumn |
| Exclusion | $310,547 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 3535294 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 150943350 | TotalRevenueColumn |
| Related Or Exempt Function Income | 146795155 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 555192 | UnrelatedBusinessRevenue |
| Exclusion | $3,028,884 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27750 | Total |
| Program Services | 27750 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2000 | Total |
| Program Services | 2000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 757031 | Total |
| Management And General | 757031 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50475678 | Total |
| Program Services | 49891241 | ProgramServices |
| Management And General | 584437 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2076155 | Total |
| Program Services | 2076155 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6927254 | Total |
| Program Services | 6896937 | ProgramServices |
| Management And General | 30317 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3555776 | Total |
| Program Services | 3504245 | ProgramServices |
| Management And General | 51531 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17412608 | Total |
| Management And General | 17412608 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 191193 | Total |
| Program Services | 106 | ProgramServices |
| Management And General | 191087 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6065976 | Total |
| Program Services | 5191000 | ProgramServices |
| Management And General | 874976 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 234566 | Total |
| Program Services | 227660 | ProgramServices |
| Management And General | 6906 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 171470 | Total |
| Program Services | 165151 | ProgramServices |
| Management And General | 6319 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1217991 | Total |
| Program Services | 1213765 | ProgramServices |
| Management And General | 4226 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2208329 | Total |
| Program Services | 2150488 | ProgramServices |
| Management And General | 57841 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 95489 | Total |
| Program Services | 81465 | ProgramServices |
| Management And General | 14024 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 247575 | Total |
| Program Services | 161983 | ProgramServices |
| Management And General | 85592 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2223426 | Total |
| Program Services | 2223426 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7399023 | Total |
| Program Services | 7376677 | ProgramServices |
| Management And General | 22346 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -73370 | Total |
| Program Services | -73370 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Supplies | 22471696 | 22412266 | 59430 |
| Patient Care Expenses | 3321262 | 3321262 | |
| Repairs & Maintenance | 2179724 | 2143794 | 35930 |
| Equipment Rental | 2071349 | 2067389 | 3960 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1384676 | Total |
| Program Services | 1353548 | ProgramServices |
| Management And General | 31128 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 132644627 | Total |
| Program Services | 112414938 | ProgramServices |
| Management And General | 20229689 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -220751 | BOY |
| EOY | -275895 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13082516 | BOY |
| EOY | 15362857 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 379921 | BOY |
| EOY | 185464 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2546880 | BOY |
| EOY | 2632154 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 492683 | BOY |
| EOY | 315729 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 133275851 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 64480492 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68694256 | BOY |
| EOY | 68795359 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 84975505 | BOY |
| EOY | 87015668 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11502400 | BOY |
| EOY | 13107454 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27811654 | BOY |
| EOY | 8504534 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39314054 | BOY |
| EOY | 21611988 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45645563 | BOY |
| EOY | 65403680 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15888 | BOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45661451 | BOY |
| EOY | 65403680 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 84975505 | BOY |
| EOY | 87015668 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 18298723 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | true | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | true | MailingsMembers |
| Mailings Members | $100 | MailingsMembersAmount |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 100 | TotalLobbyingExpendituresIIB |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | Description of Activity Officers and/or Board Members of the corporation may, to an insubstantial degree, make comments or statements concerning legislation that may affect either the healthcare industry or the health status of the communities the Corporation serves. In pursuing this activity, Officers and/or Board Members may engage in conversations and/or write letters to various federal, state, and local officials regarding such matters. The amount of time and money involved in these activities is negligible. In no case has either the Corporation, or any person acting on behalf of the Corporation, intervened in any political campaign. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Included On FS | false | IncludedOnFS |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5610682 | OtherCostOrOtherBasis |
| Book Value | 5610682 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 79257194 | OtherCostOrOtherBasis |
| Depreciation | 36531294 | Depreciation |
| Book Value | 42725900 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 43950242 | OtherCostOrOtherBasis |
| Depreciation | 27949198 | Depreciation |
| Book Value | 16001044 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4457732 | OtherCostOrOtherBasis |
| Book Value | 4457732 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 68795358 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Intercompany Payable | Description |
| Amount | $8,504,534 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 8504534 | TotalOfAmounts |
| Total Revenue | 150943350 | TotalRevenue |
| Total Expenses | 132644627 | TotalExpenses |
| Excess Or Deficit For Year | 18298723 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 18298723 | ExcessOrDeficitPerFS |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Popcorn Sales | NameOfEvent1 |
| Gross Receipts Event1 | 11245 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 11245 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 2451 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 11245 | GrossReceiptsTotal |
| Gross Revenue Total Events | 11245 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 2451 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 2451 | DirectExpenseSummaryEvents |
| Net Income Summary | 8794 | NetIncomeSummary |
Gaming Information GamingInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteer Labor Bingo | false | VolunteerLaborBingo |
| Volunteer Labor Pull Tabs | false | VolunteerLaborPullTabs |
| Volunteer Labor Other Gaming | false | VolunteerLaborOtherGaming |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5512405 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 64882 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5447523 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04110 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10761439 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11641781 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -880342 | NetCommunityBenefitExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5227 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5365 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -138 | NetCommunityBenefitExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16279071 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11712028 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4567043 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03440 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 25923 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 25923 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 399448 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 399448 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00300 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1691808 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1691808 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01280 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2117179 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2117179 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01600 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18396250 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11712028 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6684222 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05040 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1105 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1105 | NetCommunityBuildingExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Building Expense | 1105 | NetCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1105 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1105 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense | $15,172,067 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 25622515 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 26513805 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -891290 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Texas Health Southwest Fort Worth | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6100 Harris Pkwy | AddressLine1 |
| City | Fort Worth | City |
| State | TX | State |
| ZIP Code | 76132 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 1 | Part 1, line 3c | Part 1, line 3c: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. |
| 2 | Part 1, line7 | Part 1, line7: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. |
| 3 | Part III, line 4 | Part III, line 4: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. |
| 4 | Part III, line 8 | Part III, line 8: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. |
| 5 | Part III, line 9b | Part III, line 9b: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. |
| 6 | Part VI, line 1 | Part VI, line 1: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c |
| 7 | Part V, Section B, line 11h | Part V, Section B, line 11h: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 |
| 8 | Part V, Section B, line 13g | Part V, Section B, line 13g: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital |
| 9 | Part VI, line 2 | Part VI, line 2: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital The organization is developing strategies to ensure that it is in full compliance with the 2013 Community Health Needs Assessment (CHNA) requirements, and has completed work on the community profile for the defined community or service area in preparation for conducting the CHNA. Special attention will be given to persons facing disproportionate unmet health related needs. The organization is in the process of identifying resources for strategic planning and community health improvement project planning. The CHNA process will result in the compilation of data, opinion, and observation about the health and well-being of the surrounding community. The goals identified for action at the end of this process will translate the organizations mission and priorities into a strategy with specific activities and projects focusing on a positive community impact that is demonstrative, sustainable and measurable. The organization's community health profile provides a snapshot of the service area using key health indicators, which facilitate comparisons locally, regionally and over time. National, state and local secondary and primary data sources are used to provide a current overview of local health needs, factors impacting disease and injury burden, socioeconomic status, access to health care, age distribution, indicators and lifestyle behaviors. This data is used to galvanize joint community health efforts to improve health, to reduce inequalities and to empower the greater community. |
| 10 | Part VI, line 3 | Part VI, line 3: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital The organization is developing strategies to ensure that it is in full compliance with the 2013 Community Health Needs Assessment (CHNA) requirements, and has completed work on the community profile for the defined community or service area in preparation for conducting the CHNA. Special attention will be given to persons facing disproportionate unmet health related needs. The organization is in the process of identifying resources for strategic planning and community health improvement project planning. The CHNA process will result in the compilation of data, opinion, and observation about the health and well-being of the surrounding community. The goals identified for action at the end of this process will translate the organizations mission and priorities into a strategy with specific activities and projects focusing on a positive community impact that is demonstrative, sustainable and measurable. The organization's community health profile provides a snapshot of the service area using key health indicators, which facilitate comparisons locally, regionally and over time. National, state and local secondary and primary data sources are used to provide a current overview of local health needs, factors impacting disease and injury burden, socioeconomic status, access to health care, age distribution, indicators and lifestyle behaviors. This data is used to galvanize joint community health efforts to improve health, to reduce inequalities and to empower the greater community. A description of both the Charity Care program and application are available on the THR website at www.TexasHealth.org in English and Spanish. Signs alerting patients of charity care assistance and related contact information are posted in various areas of the hospital including admissions & registration, the emergency room and other outpatient departments. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms forms necessary to apply for the assistance. At the same time, patients are provided with a Charity Care application and information flyer. The patient is informed that the hospital is a non-profit organization offering financial assistance to patients deemed medically or financially indigent. The financial counselors may assist the patient in completing the application and obtain available verification information. Once the patient is discharged, the counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and Charity Care have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the financial assistance program. Each bill sent for hospital services also contains contact information alerting patients that Texas Health has a charity care program. |
| 11 | Part VI, line 4 | Part VI, line 4: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital The organization is developing strategies to ensure that it is in full compliance with the 2013 Community Health Needs Assessment (CHNA) requirements, and has completed work on the community profile for the defined community or service area in preparation for conducting the CHNA. Special attention will be given to persons facing disproportionate unmet health related needs. The organization is in the process of identifying resources for strategic planning and community health improvement project planning. The CHNA process will result in the compilation of data, opinion, and observation about the health and well-being of the surrounding community. The goals identified for action at the end of this process will translate the organizations mission and priorities into a strategy with specific activities and projects focusing on a positive community impact that is demonstrative, sustainable and measurable. The organization's community health profile provides a snapshot of the service area using key health indicators, which facilitate comparisons locally, regionally and over time. National, state and local secondary and primary data sources are used to provide a current overview of local health needs, factors impacting disease and injury burden, socioeconomic status, access to health care, age distribution, indicators and lifestyle behaviors. This data is used to galvanize joint community health efforts to improve health, to reduce inequalities and to empower the greater community. A description of both the Charity Care program and application are available on the THR website at www.TexasHealth.org in English and Spanish. Signs alerting patients of charity care assistance and related contact information are posted in various areas of the hospital including admissions & registration, the emergency room and other outpatient departments. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms forms necessary to apply for the assistance. At the same time, patients are provided with a Charity Care application and information flyer. The patient is informed that the hospital is a non-profit organization offering financial assistance to patients deemed medically or financially indigent. The financial counselors may assist the patient in completing the application and obtain available verification information. Once the patient is discharged, the counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and Charity Care have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the financial assistance program. Each bill sent for hospital services also contains contact information alerting patients that Texas Health has a charity care program. See Schedule O |
| 12 | Part VI, line 5 | Part VI, line 5: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital The organization is developing strategies to ensure that it is in full compliance with the 2013 Community Health Needs Assessment (CHNA) requirements, and has completed work on the community profile for the defined community or service area in preparation for conducting the CHNA. Special attention will be given to persons facing disproportionate unmet health related needs. The organization is in the process of identifying resources for strategic planning and community health improvement project planning. The CHNA process will result in the compilation of data, opinion, and observation about the health and well-being of the surrounding community. The goals identified for action at the end of this process will translate the organizations mission and priorities into a strategy with specific activities and projects focusing on a positive community impact that is demonstrative, sustainable and measurable. The organization's community health profile provides a snapshot of the service area using key health indicators, which facilitate comparisons locally, regionally and over time. National, state and local secondary and primary data sources are used to provide a current overview of local health needs, factors impacting disease and injury burden, socioeconomic status, access to health care, age distribution, indicators and lifestyle behaviors. This data is used to galvanize joint community health efforts to improve health, to reduce inequalities and to empower the greater community. A description of both the Charity Care program and application are available on the THR website at www.TexasHealth.org in English and Spanish. Signs alerting patients of charity care assistance and related contact information are posted in various areas of the hospital including admissions & registration, the emergency room and other outpatient departments. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms forms necessary to apply for the assistance. At the same time, patients are provided with a Charity Care application and information flyer. The patient is informed that the hospital is a non-profit organization offering financial assistance to patients deemed medically or financially indigent. The financial counselors may assist the patient in completing the application and obtain available verification information. Once the patient is discharged, the counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and Charity Care have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the financial assistance program. Each bill sent for hospital services also contains contact information alerting patients that Texas Health has a charity care program. See Schedule O See Schedule O |
| 13 | Part VI, line 6 | Part VI, line 6: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital The organization is developing strategies to ensure that it is in full compliance with the 2013 Community Health Needs Assessment (CHNA) requirements, and has completed work on the community profile for the defined community or service area in preparation for conducting the CHNA. Special attention will be given to persons facing disproportionate unmet health related needs. The organization is in the process of identifying resources for strategic planning and community health improvement project planning. The CHNA process will result in the compilation of data, opinion, and observation about the health and well-being of the surrounding community. The goals identified for action at the end of this process will translate the organizations mission and priorities into a strategy with specific activities and projects focusing on a positive community impact that is demonstrative, sustainable and measurable. The organization's community health profile provides a snapshot of the service area using key health indicators, which facilitate comparisons locally, regionally and over time. National, state and local secondary and primary data sources are used to provide a current overview of local health needs, factors impacting disease and injury burden, socioeconomic status, access to health care, age distribution, indicators and lifestyle behaviors. This data is used to galvanize joint community health efforts to improve health, to reduce inequalities and to empower the greater community. A description of both the Charity Care program and application are available on the THR website at www.TexasHealth.org in English and Spanish. Signs alerting patients of charity care assistance and related contact information are posted in various areas of the hospital including admissions & registration, the emergency room and other outpatient departments. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms forms necessary to apply for the assistance. At the same time, patients are provided with a Charity Care application and information flyer. The patient is informed that the hospital is a non-profit organization offering financial assistance to patients deemed medically or financially indigent. The financial counselors may assist the patient in completing the application and obtain available verification information. Once the patient is discharged, the counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and Charity Care have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the financial assistance program. Each bill sent for hospital services also contains contact information alerting patients that Texas Health has a charity care program. See Schedule O See Schedule O See Schedule O |
| 14 | Part VI, line 7 | Part VI, line 7: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. A cost to charge ratio is used in computing the amounts reported in Lines 7a-7c. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital The organization is developing strategies to ensure that it is in full compliance with the 2013 Community Health Needs Assessment (CHNA) requirements, and has completed work on the community profile for the defined community or service area in preparation for conducting the CHNA. Special attention will be given to persons facing disproportionate unmet health related needs. The organization is in the process of identifying resources for strategic planning and community health improvement project planning. The CHNA process will result in the compilation of data, opinion, and observation about the health and well-being of the surrounding community. The goals identified for action at the end of this process will translate the organizations mission and priorities into a strategy with specific activities and projects focusing on a positive community impact that is demonstrative, sustainable and measurable. The organization's community health profile provides a snapshot of the service area using key health indicators, which facilitate comparisons locally, regionally and over time. National, state and local secondary and primary data sources are used to provide a current overview of local health needs, factors impacting disease and injury burden, socioeconomic status, access to health care, age distribution, indicators and lifestyle behaviors. This data is used to galvanize joint community health efforts to improve health, to reduce inequalities and to empower the greater community. A description of both the Charity Care program and application are available on the THR website at www.TexasHealth.org in English and Spanish. Signs alerting patients of charity care assistance and related contact information are posted in various areas of the hospital including admissions & registration, the emergency room and other outpatient departments. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms forms necessary to apply for the assistance. At the same time, patients are provided with a Charity Care application and information flyer. The patient is informed that the hospital is a non-profit organization offering financial assistance to patients deemed medically or financially indigent. The financial counselors may assist the patient in completing the application and obtain available verification information. Once the patient is discharged, the counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and Charity Care have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the financial assistance program. Each bill sent for hospital services also contains contact information alerting patients that Texas Health has a charity care program. See Schedule O See Schedule O See Schedule O See Schedule O |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|
| Davey OBrien Foundation | ||||||
| 306 W Seventh St | Fort Worth | TX | 76102 | 751620423 | 7000 | General Donation |
| Ft Worth Stock Show Syndicate | ||||||
| PO Box 150 | Fort Worth | TX | 76102 | 751790417 | 5000 | General Donation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 12 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | The organization receives various requests from the community for assistance. Management reviews these requests to verify they are benefiting the community and they in agreement with the organization's mission. The grants or assistance given are generally to local organizations who have a longstanding record of benefiting the local community. Since the vast majority of the assistance given by the organization is to local organizations, management is able to monitor the use of the funds using personal inspection. Many of the events are published in the local paper. Many are community wide events where the organization's employees attend, or work as volunteers or coordinators. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Discretionary Spending Account | X | DiscretionarySpendingAccount |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
Form990 Schedule J Part II Form990ScheduleJPartII (14 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg |
|---|---|---|---|---|---|---|
| Monique Gibson | ||||||
| Brett McClung | ||||||
| 257799 | 167463 | 51075 | 41955 | 17731 | 536023 | 75704 |
| Mary Robinson | ||||||
| 167880 | 45540 | 31901 | 14372 | 20007 | 279700 | |
| Barclay Berdan | ||||||
| Charles Boes | ||||||
| Kenneth Kramer | ||||||
| John Mitchell | ||||||
| Jennifer Schroeder | ||||||
| Susan Christenson | ||||||
| 163047 | 6788 | 5067 | 13104 | 12991 | 200997 | |
| Kathy Terryah | ||||||
| 148067 | 4556 | 6290 | 9351 | 5257 | 173521 | |
| Eric Bauer | ||||||
| 141478 | 7226 | 7621 | 11464 | 12358 | 180147 | |
| Larry Lookingbill | ||||||
| 143786 | 731 | 4326 | 11580 | 20940 | 181363 | |
| Gary Wallace | ||||||
| 130079 | 12762 | 5959 | 10384 | 7959 | 167143 | |
| Stephen Hanson | ||||||
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | Sch J, Part I, Line 1 Travel for Companions The organization and/or related organizations allow spouses or guests to accompany an officer of the organization on business related travel, as long as the spouse's or guest's presense on the trip is for a justified business purpose. . Gross-up payments Certain imputed income is grossed-up to include the employment taxes paid on the listed person's behalf. The grossed up amount is included in the taxable compensation of the employee. . Discretionary Spending Account Each executive at the vice president level and above receive a perk allowance which is included in the taxable compensation of the employee. . Personal Services - Financial Planning Officers can use their discretionary spending account to pay for financial planning services. The organization does not directly pay for any officer's personal services. . . Sch J, Part I, Question 3 The organization relied on Texas Health Resources (THR), a related 501(c)(3) organization, with centralized compensation professionals to use the following methods to establish compensation of the organization's President. - THR has a compensation committee comprised of external Board members that review compensation philosophy and design. - THR Board hired independent compensation consultants - THR & the independent compensation consultants utilize published third-party compensation surveys . An independent third party compensation consultant is hired by the THR Board of Trustees (Board) to review base pay annually as compared to a peer group of employers similar in size and scope to THR. Every three years the independent compensation consultant reviews all aspects of executive compensation (base, incentives, benefits, etc.) which includes: - Review and confirmation of the executive compensation philosophy, - Market review of base and incentive pay for all positions. National, regional, and local data is reviewed when available. - Market review of benefits and perquisites, - Interview of selected officers and members of the Governance Committee of the THR Board of Trustees, and - Review of financial reports, job descriptions, organizational charts, current salaries, incentive opportunities, incentive payments, benefits, perquisites and plan documents. . The independent compensation consultant meets directly with the executive compensation & benefits sub-committee which is made up of five independent Board members and the governance committee to report the results of the total compensation study. . At the beginning of each year, the executive compensation & benefits sub-committee reviews; the governance committee reviews and recommends for approval by the Board; and the Board approves the following: - Market analysis recommendation based on the results of the outside consultant's review - Officer market/equity base salary adjustments - Prior year executive annual incentive awards - Current year executive annual incentive plan targets, key performance indicators and potential payout amounts . . Sch J, Part I, Question 4b Participation in the plan is made available to a select group of management and highly compensated employees, as determined by the THR Board of Trustees, who are providing services to an employer in key positions of management and responsibility. - Benefits are calculated for eligible employees when base pay and incentives exceed the IRS qualified plan compensation limit. - SERP benefits vest while the participant is employed if the participant: reaches age 68, becomes disabled, dies, or reaches the following years of service: 2 years - 25%; 3 years - 50%; 4 years - 75%; and 5 or more - 100%. - For Frozen Restoration Accounts (account balances prior to 1/1/2010), the participant or beneficiary shall be taxed on his or her vested SERP benefit upon the earliest of: *Remaining employed by THR to age 68; *Termination of employment for disability or death; *Involuntary termination of employment without reasonable cause; or *Satisfying a 24 month non-compete period following his or her termination of employment. Payment is made following the before mentioned events, except in the case of involuntary separations for which the participant must wait until after 24 months to receive the previously taxed benefit. - For the Active Restoration Accounts (account balances after 12/31/2009) participants must be employed on Dec 1 to qualify for the current year's SERP amount unless separation is due to death, disability, retirement (age 65) or early retirement (age 60 or above with 15 or more years of service). SERP amounts are calculated each Dec 1; vested balances are taxed; and the net balances can begin accruing earnings. Vested balances are paid in cash lump sums within the 90-day period commencing upon the earlier of death, disability, or separation from service. - THR owns any investments purchased in connection with its obligations under the SERP Plan. If THR becomes insolvent, executives are unsecured creditors and will have no preferred claim to any assets. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Megan Lilli | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Family member of Robert Lilli- board member | Relationship |
| Amount Of Transaction | 92393 | AmountOfTransaction |
| Description Of Transaction | Compensation as employee | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | Part VI, Section A, Line 2: Brett McClung, John Mitchell & Barclay Berdan have a business relationship. Part VI, Section B, Line 11b: A full copy of the Form 990 is provided to members of the governing board before filing. In addition, the Audit & Compliance Committee of the Texas Health Resources (THR) Board of Trustees is given the opportunity to review, comment, and ask questions regarding the Form 990s filed for THR and each of its wholly controlled affiliates. Part VI, Section B, Line 12c: Texas Health Resources (THR) has adopted a Conflict of Interest policy that applies to THR and all of its wholly owned or wholly controlled affiliates. During the first quarter of each fiscal year, a Duality and Conflict Statement Form is distributed by the THR Chief Compliance Officer to all persons who are covered by this policy. All disclosed conflicts are reviewed by the THR Chief Compliance Officer, THR General Counsel and the THR Audit & Compliance Committee. A report listing each reported Duality of Interest or Conflict of Interest is given to both the Chair of the Governing Body and the President of the Corporation with which the reporting person is affiliated. The THR Board of Trustees receives a report when the Annual Disclosure process is complete. Part VI, Section B, Line 15 a& b An independent third party compensation consultant is hired by the Texas Health Resources (THR) Board of Trustees (Board) to review base pay annually as compared to a peer group of employers similar in size and scope to THR. Every three years the independent compensation consultant reviews all aspects of executive compensation (base, incentives, benefits, etc.) which includes: - Review and confirmation of the executive compensation philosophy, - Market review of base and incentive pay for all positions. National, regional, and local data is reviewed when available. - Market review of benefits and perquisites, - Survey of officers and members of the Governance Committee of the THR Board of Trustees, and - Review of financial reports, job descriptions, organizational charts, current salaries, salary range midpoints, incentive opportunities, incentive payments, benefits, perquisites and plan documents. The independent compensation consultant meets directly with the executive compensation & benefits sub-committee which is made up of five independent Board members and the governance committee to report the results of the total compensation study. At the beginning of each year, the executive compensation & benefits sub-committee reviews; the governance committee reviews and recommends for approval by the Board; and the Board approves the following: - Market analysis recommendation based on the results of the outside consultant's review - Officer Market/equity base salary adjustments - Prior year executive annual incentive awards - Current year executive annual incentive plan targets, key performance indicators, and potential payout amounts Part VI, Section C, Line 19: The organization does not make its governing documents or conflict of interest policy available to the public. The consolidated financial statements of Texas Health Resources (THR) are made available to the public on the website www.dacbond.com. Consolidated financial statements are posted to this website quarterly and the audited financial statements are posted annually. The financial statements of the wholly controlled affiliates of THR are not posted to the website nor are they generally made available to the public in any other manner. Part VII, Section A, Officers Related Entity Hours: The following persons devoted the indicated estimated average hours per week to related organizations: William Bleibdrey - 2 hours Barclay Berdan - 40 hours Charles Boes - 40 hours John Mitchell - 40 hours Kenneth Kramer - 40 hours Jennifer Schroeder - 40 hours Part XII, Line 2c: Texas Health Resources (THR) prepares consolidated financial statements with its related entities. The THR Board appoints an audit and compliance sub-committee that assumes responsibility for oversight of the consolidated audit for all related entities. The related entities do not have a separate audit committee, but abide by the THR committee's oversight. There has been no change during the year in the organizaiton's oversight or selection process. Sch H, Part VI, Line 4-Community Information Texas Health Harris Methodist Hospital Southwest Fort Worth (THSW) is a suburban hospital in a service area with a population of more than 747,000. The average household income in THSWs service area is $64,275. During the year, 11.1% of THSWs patients were uninsured and 14% were Medicaid recipients. THSW's service area has an uninsured rate of 18.9% of the population. Eight other acute care hospitals are located in THSWs service area, three of which are for-profit hospitals. Sch H, Part VI, Line 5-Promotion of Community Health The board of trustees is comprised of community members including medical and business professionals. A majority of these trustees reside in THSWs service area and volunteer their time to serve on THSWs board. The hospital has an open medical staff and privileges are offered to qualified physicians in the community. The organization utilizes surplus funds to maintain access to patient services and to expand access to healthcare. The uses of these surplus funds include providing community benefit programs and expended capital improvements to the healthcare facilities of the organization. Of the $1,691,808 in contributions to community groups reported on Sch H, Part I, line 7i, $1,688,223 was contributed to or at the direction of Tarrant County Indigent Care Corporation, a charitable organization that provides various local organizations with funds to to cover healthcare provided to indigent patients. Sch H, Part VI, Line 6 Healthcare System The organization is part of the THR healthcare system. THR is one of the largest faith-based, nonprofit healthcare delivery systems in the US and the largest in North TX in terms of patients served. The system of 14 hospitals includes an organization for medical research and education. The system also includes two foundations that foster philanthropic relationships which support the programs and services of the hospitals they support. The mission of the hospitals in the THR system is to improve the the health of the people in the communities we serve. THR takes its responsibility to its communities seriously and invests charitable resources to promote good health and prevent disease. Not only does THR provide health care to those who do not have the means to pay, its hospitals also conduct a variety of programs designed to improve health and prevent illness in the community. The community health strategies of THR and its affiliated healthcare organizations are driven by community health needs, are community-based and include confronting health problems at the source and emphasize health promotion, disease prevention, and early treatment of illness. Sch H, Part VI, Line 7 State Filing The organization files a Texas an Annual Statement of Community Benefit Standard. Texas has established a minimum level of charity care and community benefit that must be provided by nonprofit hospitals in order to retain their Texas tax- exempt status. The standard set by the state is met when charity care and community benefits are provided in a combined amount equal to at least five percent of the hospital's or hospital system's net patient revenue, provided that charity care and government- sponsored indigent health care are provided are at least least four percent of net patient revenue. The hospital is part of the THR system of healthcare organizations. During the year, the THR system, as a whole, reported to Texas the following charity care and community benefits amounts. $145,581,949 in patient charity care, $64,476,774 in support provided by others, $17,816,432 in unreimbursed Medicaid, $13,351,949 in other community benefits and $477,948,889 in unreimbursed Medicare | Explanation |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Texas Health Partners LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14131 Midway Rd Ste 1050 | AddressLine1 |
| City | Addison | City |
| State | TX | State |
| ZIP Code | 75001 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 020546958 | EIN |
| Primary Activities | Management Company | PrimaryActivities |
| Legal Domicile State | TX | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Texas Health Resources | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII (25 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Deuteronomy | |||||||||||
| 612 E Lamar Blvd | Arlington | TX | 76011 | 752561680 | Physician Clinic - Inactive | TX | 501(c)(3) | 9 | Texas Health Resources | false | |
| Harris Methodist Health System | |||||||||||
| 612 E Lamar Blvd | Arlington | TX | 76011 | 751823547 | Supporting Organization | TX | 501(c)(3) | 11 Type 1 | false | N/A | |
| Healty Tarrant County Collaboration | |||||||||||
| PO Box 8040 | Fort Worth | TX | 76124 | 432087946 | Supporting Organization | TX | 501(c)(3) | 11 Type 1 | false | N/A | |
| Presbyterian Healthcare Resources | |||||||||||
| 612 E Lamar Blvd | Arlington | TX | 76011 | 510190395 | Supporting Organization | TX | 501(c)(3) | 11 Type 3 | false | N/A | |
| Texas Health Arlington Memorial Hospital | |||||||||||
| 800 West Randol Mill Rd | Arlington | TX | 76012 | 750972805 | Hospital | TX | 501(c)(3) | 3 | Texas Health Resources | false | |
| Texas Health Harris Methodist Foundation | |||||||||||
| 612 E Lamar Blvd | Arlington | TX | 76011 | 752401033 | Supporting Organization | TX | 501(c)(3) | 9 | Texas Health Resources | false | |
| Texas Health Presbyterian Hospital Alliance | |||||||||||
| 10864 Texas Health Trail | Fort Worth | TX | 76244 | 451502252 | Hospital | TX | 501(c)(3) Pend | 3 | Texas Health Resources | false | |
| Texas Health Harris Methodist Hospital Azle | |||||||||||
| 108 Denver Trail | Azle | TX | 76020 | 751748586 | Hospital | TX | 501(c)(3) | 3 | Texas Health Resources | false | |
| Texas Health Harris Methodist Hospital Cleburne | |||||||||||
| 201 Walls Dr | Cleburne | TX | 76033 | 751977850 | Hospital | TX | 501(c)(3) | 3 | Texas Health Resources | false | |
| Texas Health Harris Methodist Hospital Fort Worth | |||||||||||
| 1301 Pennsylvania Ave | Fort Worth | TX | 76104 | 756001743 | Hospital | TX | 501(c)(3) | 3 | Texas Health Resources | false | |
| Texas Health Harris Methodist Hospital Hurst-Euless-Bedford | |||||||||||
| 1600 Hospital Parkway | Bedford | TX | 76022 | 751438726 | Hospital | TX | 501(c)(3) | 3 | Texas Health Resources | false | |
| Texas Health Harris Methodist Hospital Southwest Fort Worth | |||||||||||
| 6100 Hospital Parkway | Fort Worth | TX | 76132 | 752678857 | Hospital | TX | 501(c)(3) | 3 | Texas Health Resources | false | |
| Texas Health Harris Methodist Hospital Stephenville | |||||||||||
| 411 Belknap | Stephenville | TX | 76401 | 751752253 | Hospital | TX | 501(c)(3) | 3 | Texas Health Resources | false | |
| Texas Health Physicians Group | |||||||||||
| 1301 Pennsylvania Ave | Fort Worth | TX | 76104 | 752613493 | Physician Clinic | TX | 501(c)(3) | 11 Type 1 | Texas Health Resources | false | |
| Texas Health Presbyterian Foundation | |||||||||||
| 612 E Lamar Blvd | Arlington | TX | 76011 | 752022128 | Supporting Organization | TX | 501(c)(3) | 9 | Texas Health Resources | false | |
| Texas Health Presbyterian Hospital Allen | |||||||||||
| 1105 Central Expressway North | Allen | TX | 75013 | 752890358 | Hospital | TX | 501(c)(3) | 3 | Texas Health Resources | false | |
| Texas Health Presbyterian Hospital Dallas | |||||||||||
| 8200 Walnut Hill Ln | Dallas | TX | 75231 | 751047527 | Hospital | TX | 501(c)(3) | 3 | Texas Health Resources | false | |
| Texas Health Presbyterian Hospital Denton | |||||||||||
| 3000 North Interstate 35 | Denton | TX | 76201 | 432008974 | Hospital | TX | 501(c)(3) | 3 | Texas Health Resources | false | |
| Texas Health Presbyterian Hospital Kaufman | |||||||||||
| 850 Ed Hall Drive | Kaufman | TX | 75142 | 752771437 | Hospital | TX | 501(c)(3) | 3 | Texas Health Resources | false | |
| Texas Health Presbyterian Hospital Plano | |||||||||||
| 6200 W Parker Rd | Plano | TX | 75093 | 752770738 | Hospital | TX | 501(c)(3) | 3 | Texas Health Resources | false | |
| Texas Health Research Education Institute | |||||||||||
| 612 E Lamar Blvd | Arlington | TX | 76011 | 752562191 | Medical Research & Education | TX | 501(c)(3) | 4 | Texas Health Resources | false | |
| Texas Health Resources | |||||||||||
| 612 E Lamar Blvd | Arlington | TX | 76011 | 752702388 | Mgmt Supporting Organization | TX | 501(c)(3) | 11 Type 3 | false | N/A | |
| Texas Health Resources Self-Insurance Trust | |||||||||||
| 612 E Lamar Blvd | Arlington | TX | 76011 | 756335901 | Insurance Trust | TX | 501(c)(3) | 11 Type 3 | Texas Health Resources | false | |
| Texas Health Specialty Hospital Fort Worth | |||||||||||
| 1301 Pennsylvania Ave 4th Flr | Fort Worth | TX | 76104 | 751648589 | Long Term Hospital | TX | 501(c)(3) | 3 | Texas Health Resources | false | |
| WW Ward Endowment Fund Trust | |||||||||||
| 612 E Lamar Blvd | Arlington | TX | 76011 | 756196065 | Supporting Organization | TX | 501(c)(3) | 11 Type 1 | Texas Health Harris Methodist Foundation | false | |
Form990 Schedule R Part III Form990ScheduleRPartIII (17 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| AMH Cath Labs LLC | |||||||
| 800 W Randol Mill Rd | Arlington | TX | 76012 | 203003947 | Healthcare Services | TX | N/A |
| Denton Surgery Center LLC | |||||||
| 14131 Midway Rd Ste 1050 | Addison | TX | 75001 | 470926556 | Ambulatory Surgery Center | TX | N/A |
| Flower Mound Hospital Partners LLC | |||||||
| 14131 Midway Rd Ste 1050 | Addison | TX | 75001 | 260684968 | Hospital | TX | N/A |
| Harris Oncology LLC | |||||||
| 1600 Hospital Parkway | Bedford | TX | 76022 | 752927939 | Rental Real Estate | TX | N/A |
| Health Imaging Partners LLC | |||||||
| 8610 Explorer Dr Ste 300 | Colorado Spring | CO | 80920 | 271385885 | Outpatient Diag. Imaging Ctr | TX | N/A |
| HEB Oncology LP | |||||||
| 1601 Hospital Parkway | Bedford | TX | 76022 | 752927940 | Rental Real Estate | TX | N/A |
| Physician Medical Center LLC | |||||||
| 6200 W Parker Rd | Plano | TX | 75093 | 481281376 | Hospital | TX | N/A |
| Presbyterian Cancer Center-Dallas LLC | |||||||
| 6200 W Parker Rd | Plano | TX | 75093 | 260422749 | Medical Management | TX | N/A |
| Rockwall Regional Hospital LLC | |||||||
| 14131 Midway Rd Ste 1050 | Addison | TX | 75001 | 202848116 | Hospital | TX | N/A |
| Sherman Grayson Health System LLC | |||||||
| 500 Highland Ave | Sherman | TX | 75092 | 272025497 | Hospital | TX | N/A |
| Southlake Specialty Hospital LLC | |||||||
| 14131 Midway Rd Ste 1050 | Addison | TX | 75001 | 020555370 | Hospital | TX | N/A |
| Texas Health MedSynergies LLC | |||||||
| 1255 Corporate Drive Fl 3 | Irving | TX | 75038 | 800272951 | Management Consulting | TX | N/A |
| Texas Single Source Staffing | |||||||
| 524 E Lamar Blvd Ste 300 | Arlington | TX | 76011 | 270324828 | Manage Contract Nursing | TX | N/A |
| Texas Institute for Surgery LLP | |||||||
| 7715 Greenville Ave Ste 100 | Dallas | TX | 75231 | 770628004 | Hospital | TX | N/A |
| Womens Specialty Surgery Center | |||||||
| 1300 Post Oak Blvd Ste 600 | Houston | TX | 77056 | 262310072 | Ambulatory Surgery Center | TX | N/A |
| USMD Hospital at Fort Worth LP | |||||||
| 801 I-20 West | Arlington | TX | 76107 | 731662763 | Hospital | TX | N/A |
| USMD Hospital at Arlington LP | |||||||
| 801 I-20 West | Arlington | TX | 76107 | 203571243 | Hospital | TX | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Address Line2AddressUS/AddressLine2 | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|
| AMH Health Ventures Inc | ||||||||||
| 800 W Randol Mill Road | Arlington | TX | 76012 | 752141114 | Computer & Billing Services | TX | Arlington Memorial Hospital | C-Corp | ||
| PH Denton Physicians Inc | ||||||||||
| 3000 N Interstate 35 | Denton | TX | 76201 | 261696945 | Physician Services | TX | Texas Health Presbyterian Hospital Denton | C-Corp | ||
| Biomedical Advancement Center Inc | ||||||||||
| 612 E Lamar Blvd | Arlington | TX | 76011 | 752636884 | Inactive | TX | Texas Health Research Education Institute | C-Corp | ||
| Texas Health Resources Casualty Company | ||||||||||
| c/o AON Insurance | Burlington | VT | 05401 | 030310676 | Insurance | VT | Texas Health Resources | C-Corp | 76 St Paul 5th floor | |
| Charitable Remainder Trusts 5 | ||||||||||
| 612 E Lamar Blvd | Arlington | TX | 76011 | TX | N/A | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
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