2012-05-15T17:30:30-04:00 2011-06-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2010-07-01 752616977 TRINITY CLINIC TRIN 9035315764 1315 DOCTORS DRIVE TYLER TX 75701 JOYCE HESTER 2012-05-15 true Amanda Maya 7134994600 2010 2016-02-24 21:20:13Z X DAVID TEEGARDEN 910 E HOUSTON TYLER TX 75701 118890376 false X WWW.TMFHS.ORG X 1995 TX TO PROVIDE PHYSICIAN SERVICES WITH A FULL RANGE OF COMPREHENSIVE HEALTH CARE SERVICES WITHOUT REGARD TO THE PATIENT'S RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. 15 1 1218 1 -223219 -194065 0 0 125907687 115908478 188027 2455765 -165225 -225766 125930489 118138477 5000 5000 0 0 23583713 29182077 0 0 0 124099321 107443463 147688034 136630540 -21757545 -18492063 81057788 100212393 93327362 115856429 -12269574 -15644036 TO PROVIDE PHYSICIAN SERVICES WITH A FULL RANGE OF COMPREHENSIVE HEALTH CARE SERVICES WITHOUT REGARD TO THE PATIENT'S RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. false false 119206012 5000 115908478 OUR COMMITMENT TO OUR COMMUNITY EXTENDS TO FREE OR SUBSIDIZED INDIVIDUAL CARE, SUBSIDIZED EDUCATION OF HEALTHCARE PROFESSIONALS, DISCOUNTED FEES FOR PARTICIPANTS IN GOVERNMENT PROGRAMS, COMMUNITY HEALTH EDUCATION, AND DONATIONS TO OTHER COMMUNITY AGENCIES. SPECIFIC COMMUNITY SERVICES AND PROGRAMS INCLUDE: WELLNESS AND PREVENTION EDUCATION PROGRAMS, COMMUNITY DIAGNOSTIC SCREENING PROGRAMS, SENIOR CITIZEN HEALTH AWARENESS PROGRAMS, AWARENESS PROGRAMS FOR YOUTH AT RISK, AWARENESS PROGRAMS FOR PERSONS WITH SPECIAL PHYSICAL OR MENTAL NEEDS, CHILDREN WITH DIABETES SUMMER CAMP, SPORTS CARE PROGRAMS, SAFETY TRAINING FOR LOCAL BUSINESSES, AND RESEARCH PROGRAMS. 119206012 true false false false false false false false true true false false true true false false true false false false false false false false false false false false true false false false true false false false false false false false false false true false false false false true X 31 0 true 1218 true true true false false false false false false false false false X 15 1 false false false false true false true true true false false true true true true true true true true true true X MOTHER FRANCES HOSP ACCTG DEPT 9035315764 1315 DOCTORS DRIVE TYLER TX 75701 X STEVEN KEUER MD 20.0 X X 2203605 1469071 365945 DAVID TEEGARDEN MD 20.0 X X 3999590 2666392 19145 ROBERT MCKINNEY MD 40.0 X 528721 0 21356 GIFFORD ECKHOUT MD 40.0 X 656325 0 20056 MELISSA GERDES MD 40.0 X X 229667 0 19659 ROGER FOWLER MD 40.0 X X 375653 0 13783 KENT WEBB MD 40.0 X 774026 0 21356 WILLIAM HOBBS MD 40.0 X 704786 0 21356 JIM STANFORD MD 40.0 X 317237 0 21356 GREGORY STOVALL 40.0 X 494618 0 21356 KAI XIA MD 40.0 X 1019882 0 19145 JAMES CACCITOLO MD 40.0 X 831787 0 21356 HAMPTON WILLIAMS MD 40.0 X 575960 0 15851 JAMES ROGERS MD 40.0 X 248502 0 19549 STEVEN HELF MD 40.0 X 194517 0 18981 MARK ANDERSON MD 40.0 X 0 0 0 ORAN FERRELL 40.0 X 249609 0 15453 LORETTA SWAN 40.0 X 135413 0 12936 KIRT WOOLSEY 40.0 X 125834 0 12824 DAVID LINDZEY MD 20.0 X 369449 0 21356 RICHARD KRONENBERG MD 20.0 X 250949 0 7842 JAMES CABELL MD 40.0 X 1282769 0 16907 VIVEK MEHTA MD 40.0 X 1739049 0 21356 ALBERT LEE MD 40.0 X 1085894 0 21356 MARTIN HOLLAND MD 40.0 X 1566177 0 21115 LAURA O'HALLORAN MD 40.0 X 1182805 0 8343 MATTHEW VIERKANT MD 30.0 X 498664 0 21356 STEVE WALLING MD 40.0 X 230096 0 17494 MEG REITMEYER MD 40.0 X 300931 0 20934 ANDY KIRKPATRICK MD 40.0 X 737964 0 21356 22910479 4135463 880878 266 true true false THOMAS CURTIS MD 5879 HWY 64 WEST HENDERSON TX 75652 PHYSICIAN SERVICES 382680 CLINTON CARTER MD 4048 CHARLESTON PARK TYLER TX 75652 PHYSICIAN SERVICES 282690 LAW OFFICE OF BILL LIEBBE PC 223 S BONNER TYLER TX 75702 LEGAL SETTLEMENT 225000 D Y PO BOX 635715 CINCINNATI OH 45263 CONTRACT LABOR 217555 SUHEL PATEL MD 2249 HOMESTEAD LANE TYLER TX 75701 PHYSICIAN SERVICES 222570 16 0 NET PATIENT REVENUE 621500 103128544 103125997 2547 OTHER OPERATING REVENUE 900099 12779934 12779934 115908478 2455765 2455765 0 0 526133 751899 -225766 -225766 -225766 0 0 0 0 0 118138477 115905931 -223219 2455765 5000 5000 0 0 0 14555748 9606794 4948954 0 1699763 849881 849882 2571753 2559204 12549 7242783 6459657 783126 3112030 3050755 61275 446426 348481 97945 8099 8099 6300 6300 0 0 0 84146008 79657125 4488883 5303468 52276 5251192 832269 713062 119207 12498 6048 6450 0 1380739 986039 394700 124616 31247 93369 0 895014 874195 20819 270356 161679 108677 0 590228 450066 140162 1726688 1711132 15556 MEDICAL SUPPLIES 3410637 3410637 BAD DEBT EXPENSE 5929198 5929198 REPAIRS AND MAINTENANCE 186430 169101 17329 PERFORMANCE STANDARDS 404163 404163 INDIRECT EXPENSES 1614421 1614421 155904 155851 54 136630540 119206012 17424528 0 1788938 2731751 11019876 8880468 327818 1285997 67085 191644 406733 483441 11930616 5832114 6978728 6098502 18113542 20223324 577039 504359 41778029 59812907 81057788 100212393 12637326 15316815 6431813 4031813 74258223 96507801 93327362 115856429 X -12269574 -15644036 -12269574 -15644036 81057788 100212393 X -18492063 15117601 X false true true X false X 2209013 50 141274 2350337 414414 1790794 4305 500 2209013 413932 239 243 414414 0.04858 0.95142 false true true 4749991 1424997 3324994 618716 149073 469643 6561909 4258044 2303865 6098502 DUE FROM AFFILIATES 59688740 OTHER ASSETS 124167 59812907 0 DUE TO AFFILIATES 74513649 ACCRUED PENSION LIABILITY 7309743 ESTIMATED SELF INSURANCE COSTS 5278200 DEFERRED COMPENSATION 9406209 96507801 118138477 136630540 -18492063 -18492063 116442147 759429 759429 115682718 2455759 2455759 118138477 134934210 759429 759429 134174781 2455759 2455759 136630540 RECONCILIATION OF REVENUE PER FINANCIAL STATEMENTS TO FORM 990 PART XII, LINES 2D & 4B REVENUES ON BOOKS, NOT ON RETURN: RENTAL EXPENSES INCLUDED WITH REVENUE ON RETURN $751,899 NON SELF-INSURANCE INCOME INCLUDED IN OTHER REVENUE 7,530 --------- $759,429 REVENUES ON RETURN, NOT ON BOOKS: SELF-INSURANCE INTEREST NETTED WITH COST $2,455,759 RECONCILIATION OF EXPENSES PER FINANCIAL STATEMENTS TO FORM 990 PART XIII, LINES 2D & 4B EXPENSES ON BOOKS, NOT ON RETURN: RENTAL EXPENSES INCLUDED WITH REVENUE ON RETURN $751,899 NON SELF-INSURANCE INCOME INCLUDED IN OTHER REVENUE 7,530 --------- $759,429 EXPENSES ON RETURN, NOT ON BOOKS: SELF-INSURANCE INTEREST NETTED WITH COST $2,455,759 FIN 48 DISCLOSURE MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS PART V, QUESTION 4 THE ORGANIZATION HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR THE ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS AND ITEMS SUPPORTED BY THE ENDOWMENT WHILE SEEKING TO MAINTAIN ITS PURCHASING POWER. X X X X X false true false false false true false false false STEVEN KEUER MD 304240 202827 109147 72765 1790218 1193479 211020 140680 8547 5698 2423172 1615449 1790218 1193479 DAVID TEEGARDEN MD 401995 267996 201334 134222 3396261 2264174 2940 1960 8547 5698 4011077 2674050 3396261 2264174 ROBERT MCKINNEY MD 528721 0 0 0 0 0 4900 0 16456 0 550077 0 0 0 GIFFORD ECKHOUT MD 656325 0 0 0 0 0 3600 0 16456 0 676381 0 0 0 MATTHEW VIERKANT MD 498664 0 0 0 0 0 4900 0 16456 0 520020 0 0 0 STEVE WALLING MD 230096 0 0 0 0 0 4284 0 13210 0 247590 0 0 0 MELISSA GERDES MD 229667 0 0 0 0 0 3977 0 15682 0 249326 0 0 0 ROGER FOWLER MD 375653 0 0 0 0 0 4900 0 8883 0 389436 0 0 0 KENT WEBB MD 774026 0 0 0 0 0 4900 0 16456 0 795382 0 0 0 WILLIAM HOBBS MD 704786 0 0 0 0 0 4900 0 16456 0 726142 0 0 0 JIM STANFORD MD 317237 0 0 0 0 0 4900 0 16456 0 338593 0 0 0 GREGORY STOVALL 494618 0 0 0 0 0 4900 0 16456 0 515974 0 0 0 KAI XIA MD 1019882 0 0 0 0 0 4900 0 14245 0 1039027 0 0 0 JAMES CACCITOLO MD 831787 0 0 0 0 0 4900 0 16456 0 853143 0 0 0 ORAN FERRELL 195063 0 54546 0 0 0 4900 0 10553 0 265062 0 0 0 JAMES CABELL MD 1282769 0 0 0 0 0 4900 0 12007 0 1299676 0 0 0 VIVEK MEHTA MD 1739049 0 0 0 0 0 4900 0 16456 0 1760405 0 0 0 ALBERT LEE MD 1085894 0 0 0 0 0 4900 0 16456 0 1107250 0 0 0 MARTIN HOLLAND MD 1566177 0 0 0 0 0 4900 0 16215 0 1587292 0 0 0 LAURA O'HALLORAN MD 1182805 0 0 0 0 0 4900 0 3443 0 1191148 0 0 0 MEG REITMEYER MD 300931 0 0 0 0 0 4900 0 16034 0 321865 0 0 0 HAMPTON WILLIAMS MD 575960 0 0 0 0 0 4900 0 10951 0 591811 0 0 0 JAMES ROGERS MD 248502 0 0 0 0 0 3977 0 15572 0 268051 0 0 0 STEVEN HELF MD 194517 0 0 0 0 0 3511 0 15470 0 213498 0 0 0 DAVID LINDZEY MD 369449 0 0 0 0 0 4900 0 16456 0 390805 0 0 0 RICHARD KRONENBERG MD 250949 0 0 0 0 0 4900 0 2942 0 258791 0 0 0 ANDY KIRKPATRICK MD 737964 0 0 0 0 0 4900 0 16456 0 759320 0 0 0 PARTICIPATION IN OR PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PART I, QUESTION 4B PARTICIPANTS IN SERP REPORTED IN W-2 DEFERRED COMPENSATION ---------------------- ----------------- --------------------- STEVEN KEUER MD 2,983,696 346,800 DAVID TEEGARDEN MD 5,660,435 0 PARTICIPANTS IN 457(F) REPORTED IN W-2 ---------------------- ---------------- STEVEN KEUER MD NONE DAVID TEEGARDEN MD NONE COMPENSATION CONTINGENT ON THE NET EARNINGS OF THE ORGANIZATION PART I, QUESTION 6A SOME PHYSICIANS ARE PAID BASED ON THE COMPENSATION FORMULA OF THEIR INDIVIDUAL RESPECTIVE DEPARTMENTS. VIVEK MEHTA MD SALARY ADVANCE X 74580 74580 false true true ROGER FOWLER MD SALARY ADVANCE X 5 5 false true true STEVE WALLING MD SALARY ADVANCE X 5674 5674 false true true 80259 DESCRIBE REVIEW PROCESS OF FORM 990 FORM 990, PART VI, QUESTION 11A THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS AND BOARD PRIOR TO FILING. DESCRIBE THE ORGANIZATION'S MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 TRINITY MOTHER FRANCES HEALTH SYSTEM IS THE SOLE MEMBER OF TRINITY CLINIC. DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBER FORM 990, PART VI, QUESTION 7B THE MEMBER HAS THE AUTHORITY TO APPROVE OR DISAPPROVE CERTAIN MATTERS PREVIOUSLY APPROVED BY THE BOARD OF DIRECTORS. HOW DOES THE ORGANIZATION MONITOR AND ENFORCE COMPLIANCE WITH THE POLICY FORM 990, PART VI, QUESTION 12C THE BOARD REVIEWS AND RESOLVES, IF NECESSARY, ANY TRANSACTIONS AS THEY ARISE THROUGHOUT THE YEAR IN ACCORDANCE WITH POLICY STANDARDS. DESCRIBE WHETHER THE ORGANIZATION MAKES ITS DOCUMENTS AVAILABLE TO PUBLIC FORM 990, PART VI, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. PROCESS FOR DETERMINING COMPENSATION OF CEO, OFFICERS, OR KEY EMPLOYEES FORM 990, PART VI, QUESTIONS 15A & 15B THE ORGANIZATION USES COMPENSATION CONSULTANTS AND NATIONAL COMPENSATION SURVEYS TO DETERMINE COMPENSATION OF EMPLOYEES. COMPENSATION IS APPROVED BY THE ORGANIZATION'S GOVERNING BODY AND ULTIIMATELY APPROVED BY TRINITY MOTHER FRANCES HEALTH SYSTEM. COMPENSATION FROM RELATED ORGANIZATION FORM 990, PART VII & SCHEDULE J THE GOVERNING BOARD OF TRINITY MOTHER FRANCES HEALTH SYSTEM UPON ADVICE FROM NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS, WHO PERIODICALLY REVIEW ALL EXECUTIVE COMPENSATION, APPROVED A DEFERRED COMPENSATION PLAN THAT PROVIDES A 65% TOTAL RETIREMENT BENEFIT FOR SENIOR EXECUTIVES THAT SERVE 20 YEARS OR MORE. THIS PROGRAM HAS BOTH RETENTION AND NON-COMPETITION CLAUSES THAT CREATE A RISK OF FORFEITURE. DEFERRED COMPENSATION IS SUBJECT TO A RISK OF FORFEITURE BASED ON RETENTION, NON-COMPETITION AND OTHER CONTRACTUAL FACTORS. ACCRUALS OF DEFERRED COMPENSATION ARE NOT INCLUDIBLE IN W-2 COMPENSATION UNTIL PAID. OTHER EMPLOYEE BENEFITS INCLUDE QUALIFIED PENSION PLANS, HEALTH, DENTAL AND LIFE INSURANCE PLANS, DISABILITY INSURANCE, ETC. TAXABLE EXPENSES ARE INCLUDED IN THE W-2 PAID COMPENSATION SALARY AMOUNT. 1099S REPORTED BY ORGANIZATION FORM 990, PART V, QUESTION 1 FORMS 1099-INT ARE ISSUED BY THE FILING ORGANIZATION. HOWEVER, THE ORGANIZATION'S FORMS 1099-MISC ARE ISSUED BY A RELATED ORGANIZATION, MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER, WHICH REPORTS ALL FORMS 1099-MISC FOR THE ENTIRE SYSTEM AND ALLOCATES EXPENSES TO THE APPROPRIATE RELATED ORGANIZATION. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 OTHER CHANGES IN NET ASSETS: TRANSFERS FROM AFFILIATE $15,117,601 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEVEN KEUER MD TITLE:EXECUTIVE VP HOURS:21 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID TEEGARDEN MD TITLE:PRESIDENT & CMO HOURS:21 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROGER FOWLER MD TITLE:CHAIRMAN HOURS:20 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID LINDZEY MD TITLE:SENIOR VP HOURS:20 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD KRONENBERG MD TITLE:SENIOR VP HOURS:20 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MATTHEW VIERKANT MD TITLE:FORMER DIRECTOR HOURS:10 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ANDY KIRKPATRICK MD TITLE:FORMER DIRECTOR HOURS:10 CHAMPION EMERGENCY SERVICES LLC 2201 S MOBBERLY AVE LONGVIEW TX 75602 752747708 AMBULANCE SVC TX 501(C)(3) 11A NA MOTHER FRANCES HOSPITAL REGIONAL HC CTR 1315 DOCTORS DRIVE TYLER TX 75701 750818167 HOSPITAL TX 501(C)(3) 3 NA MOTHER FRANCES HOSPITAL - JACKSONVILLE 1315 DOCTORS DRIVE TYLER TX 75701 751976930 HOSPITAL TX 501(C)(3) 3 NA TRINITY MOTHER FRANCES HEALTH SYSTEM FDN 1315 DOCTORS DRIVE TYLER TX 75701 752028241 SUPPORT TX 501(C)(3) 11C NA REGIONAL MEDICAL SERVICES ASSOCIATION 1315 DOCTORS DRIVE TYLER TX 75701 752511459 HEALTHCARE TX 501(C)(3) 3 NA TRINITY MOTHER FRANCES HEALTH SYSTEM 1315 DOCTORS DRIVE TYLER TX 75701 752616975 HEALTHCARE TX 501(C)(3) 11C NA MOTHER FRANCES HOSPITAL - WINNSBORO 1315 DOCTORS DRIVE TYLER TX 75701 752771569 HOSPITAL TX 501(C)(3) 3 NA TRI-STATE FINANCIAL LLC 1315 DOCTORS DRIVE TYLER TX 75701 752728318 COLLECTION AGENCY TX NA C-CORPORATION 0 0 0.00000 TRINCARE INC 1315 DOCTORS DRIVE TYLER TX 75701 752161369 RETAIL HEALTH SVC TX NA C-CORPORATION 0 0 0.00000 HEALTHPLAN OF TEXAS INC 514 S BECKHAM TYLER TX 75701 752636832 THIRD PARTY ADMIN TX NA C-CORPORATION 0 0 0.00000 THE REGIONAL HEALTHCARE ALLIANCE 1315 DOCTORS DRIVE TYLER TX 75701 752484109 PREFER PROVIDER TX NA C-CORPORATION 0 0 0.00000 TEXAS HEALTH FACILITIES INSUR CORP LTD PO BOX 1109 BWI CAYMAN ISLANDS CJ 980136025 INSURANCE CJ NA C-CORPORATION 0 0 0.00000 CONCORDIUM HEALTH LLC 1315 DOCTORS DRIVE TYLER TX 75701 702811022 INACTIVE TX NA C-CORPORATION 0 0 0.00000 EMPLOYERS SERVICES INC 1315 DOCTORS DRIVE TYLER TX 75701 752602556 INACTIVE TX NA C-CORPORATION 0 0 0.00000 HERITAGE HEALTH PLANS OF TX 1315 DOCTORS DRIVE TYLER TX 75701 752622622 INACTIVE TX NA C-CORPORATION 0 0 0.00000 QUALITY CARE ALLIANCE 1315 DOCTORS DRIVE TYLER TX 75701 752662965 INACTIVE TX NA C-CORPORATION 0 0 0.00000 false false false false false false true false false true true true false false false false false true