2012-12-05T03:34:08-07:00 2011-12-31 TEXAS HEALTH RESOURCES 612 E LAMAR BLVD STE 1400 ARLINGTON TX 76011 990 2011-01-01 752890358 Texas Health Presbyterian Hospital Allen TEXA 9727471000 1105 Central Expressway North Allen TX 75013 John Mitchell 9727471000 2012-11-14 TEXAS HEALTH RESOURCES 2547862001 2012-12-05 2011 2016-02-24 21:20:13Z Texas Health Allen Jeffrey Reecer 1105 Central Expressway North Allen TX 75013 75818627 false false X www.texashealth.org X 2000 TX A faith-based organization whose mission is to improve the health of the people in the communities it serves regardless of their ability to pay. 10 10 577 134 0 373182 114420 75859483 72999306 110753 36155 770519 2344625 77113937 75494506 46300 0 28457756 31102357 0 0 48097480 40090497 76555236 71239154 558701 4255352 50509925 54779228 45765301 45788596 4744624 8990632 A faith-based organization whose mission is to improve the health of the people in the communities it serves regardless of their ability to pay. 60342975 46300 74512680 Located in Allen, Texas, for 12 years, Texas Health Presbyterian Hospital Allen (THA) operates 73 beds. The city of Allen is a suburb north of Plano and Dallas. THA offers a broad range of inpatient and outpatient medical services including: cardiology, colorectal surgery, comprehensive diagnostic imaging, endocrinology, gastroenterology, neurosurgery, obstetrics/genecology, orthopedics, pediatrics, cosmetic/reconstructive surgery, women's services and urology. The facility has undergone several expansions over the past few years. THA completed an expansion project, which included the addition of eight ICU beds, 13 new medical surgical beds, and six new labor-delivery-recovery- postpartum beds. Later, a six bed Level II neonatal nursery and a new special procedures suite for providing diagnostic cardiac catheterization studies and interventional radiology procedures was added. In 2009, the Emergency Department was expanded to add four fast track beds to improve the patient flow in this department. In 2011, an eleven bed surgical impatient unit was added to the facility. Growth plans for the facility are expected in the future as THA continues to support the growth of Collin County and the North Texas market. ************************************************************************** THA had 14,049 patient days, 4,283 discharges, 1,264 births, 50,996 outpatient encounters, and 28,885 emergency room visits during the year. ************************************************************************** THA provides quality medical healthcare services regardless of the patients race, creed, sex, national origin, handicap, age or ability to pay. THA 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. THA also provides charity care to patients who are unable to pay for the servcies they receive. 60342975 true true false true false false false false false true false false true true false false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false true 115 0 true 577 true false false false false false false X 10 10 true false false false false false false true true false false true true true true true true true true false X X Jack Roper 6822367900 612 E Lamar Blvd Arlington TX 76011 X Charles Boes X 0 0 82524 Paige Fugate X 0 0 19981 Kenneth Kramer X 0 0 65227 Sheila McKinney 40.00 X 0 0 44092 John Mitchell X 0 0 61351 Yuri Cook MD 2.00 X 0 0 Kimberly A Barksdale MD 2.00 X 0 0 Debra Sue Stout 2.00 X 0 0 Tony Hill 2.00 X 0 0 Sherry Tucker David 2.00 X 0 0 Wade Johnson 2.00 X 230 0 Benjamin Joel Williams MD 2.00 X 0 0 Todd Pollock MD 2.00 X 0 0 John Wroten 2.00 X 242 0 Jane Cook 40.00 X 0 0 25427 Nolan Rich II 40.00 X 0 0 28170 Christopher Amaya 40.00 X 0 0 25599 Sharon Chisholm 40.00 X 123159 0 15295 Kathy Bounds 40.00 X 122256 0 14227 Barclay Berdan X 0 0 119583 Robert Adams Schwab 16.00 X 0 0 41966 Julian Vasquez Sr 2.00 X 0 0 Kenneth Braxton X 0 0 7479 1223651 3216523 550921 19 true true false Texas Health Resources 612 E Lamar Blvd Arlington TX 76011 Mgmt Svc 8535878 Austin Commercial Inc PO Box 279 Dallas TX 75221 Construction 846212 Vanguard Resources Inc 17300 Henderson Pass 200 San Antonio TX 78232 Housekeeping 597641 Michael Deck MD PA 6124 W Parker Rd Ste G36 Plano TX 75093 Physician Svc 485972 One Southwest Media Group Inc 2100 Ross Ave 3000 Dallas TX 75201 Advertising 415713 21 114420 114420 Patient Revenue 72805567 72805567 Medicare/Medicaid Adj. 165016 165016 Education 28723 28723 72999306 56479 56479 143023 143023 143023 143023 303797 324121 -20324 -20324 0 Electronic Medical Records 1513374 1513374 Gift Shop 388281 388281 Cafeteria Revenue 194852 194852 105095 105095 2201602 75494506 74512680 867406 46300 46300 545138 545138 24699137 24426671 272466 940119 940119 3128186 3118088 10098 1789777 1765804 23973 8535878 8535878 112996 3132 109864 8032556 7646536 386020 607327 606163 1164 357342 338683 18659 426561 426561 4437290 3636924 800366 48029 45403 2626 12247 11353 894 1295046 1295046 3939249 3883871 55378 -69939 -69939 Supplies 9356838 9327575 29263 Repairs & Maintenance 1226948 1226948 Patient Services 808911 808911 Furniture & Equipment 658491 655732 2759 304727 203094 101633 71239154 60342975 10896179 0 -268474 -330792 6370332 8257521 33345 1564721 908546 1209442 1424532 249805 177867 72388299 28467003 40903686 43921296 447068 420258 50509925 54779228 4401346 6717512 41363955 39071084 45765301 45788596 X 4735280 8990632 9344 4744624 8990632 50509925 54779228 X 4255352 -9344 X X false true true X X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true false false true 100 false false false false false 100 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. false 8903474 8903474 39107577 17228077 21879500 5606366 854903 4751463 17822825 10384023 7438802 948057 948057 43921296 UPL Receivable 392019 Other Receivable 28239 420258 Intercompany Payables 38584654 Medicare/Medicaid Payable 486430 39071084 75494506 71239154 4255352 4255352 true true X true X true true true true true 4535735 64635 4471100 0.06270 9391771 7698220 1693551 0.02380 5941 7365 -1424 13933447 7770220 6163227 0.08650 74839 74839 0.00110 98403 98403 0.00140 71267024 71267024 0.01130 71440266 71440266 0.01380 85373713 7770220 77603493 0.10020 894 894 50 50 894 944 944 13279143 9301332 10777001 -1475669 X 1 1 Texas Health Allen

1105 Central Expy North Allen TX 75013

X X X 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 Texas Health Allen Part VI, line 1 Texas Health Allen 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 Texas Health Allen Part V, Section B, line 11h Texas Health Allen 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 Texas Health Allen Part V, Section B, line 13g Texas Health Allen 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. 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. 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. 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. 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. 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. 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 true Susan G Komen Foundation PO Box 261730 Plano TX 75029 752356437 501(c)(3) 7500 General Purpose Allen Community Outreach 301 W Boyd Dr Allen TX 75013 751986190 501(c)(3) 20000 General Purpose 8 2 Texas Health Presbyterian Hospital Allen (THA) receives various requests from the community for assistance. THA management reviews these requests to verify that they are benefiting the community and they are in agreement with THA's mission. the grants or assistance given by THA are generally to local organizations who have a longstanding record of benefiting the local community. Since the vast majority of the assistance given by THA is to local organizations, management is able to monitor the use of the funds using person inspection. Many of the events are published in the local paper. Many are community wide events where THA employees attend, or work as volunteers or coordinators. X X true true true Charles Boes Paige Fugate Kenneth Kramer Sheila McKinney 214127 132754 41160 37106 6986 432133 69371 John Mitchell Jane Cook 139694 10315 8532 6883 18544 183968 Nolan Rich II 139587 10919 3221 10431 17738 181896 Christopher Amaya 123260 4093 6130 10248 15351 159082 Barclay Berdan Robert Adams Schwab 106922 16510 20540 5062 10363 159397 Kenneth Braxton 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 the 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. - Contributions to the following employees were made during the year. The amounts below are included in the amount reported in Sch J, Part II, Column B(iii) and Column (F). Jeffrey Canose $8,559 Part VI, Section A, Line 2 John Mitchell & Barclay Berdan have a business relationship. Part VI, Section B, Line 11a: 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: Barclay Berdan 40 hrs Charles Boes 40 hrs John Mitchell 40 hrs Kenneth Kramer 40 hrs Paige Fugate 32 hrs Robert Schwab 24 hrs Kenneth Braxton 40 hrs. 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 organizations oversight or selection process. Sch H, Part V, Section B, Line 10 For Rockwall Regoinal, Physicians Medical Center, Southlake Specialty, and Flower Mound see response to Part I, Line 3c For USMD Arlington & USMD Fort Worth see the following. 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 35% off the hospital's charge for general hospital services. 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. For Sherman Grayson, see the following. 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 15% off the hospital's charge for general hospital services. Patients with family income betwen 200-300% 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, land, savings and housing Texas Health Partners LLC 14131 Midway Rd Ste 1050 Addison TX 75001 020546958 Management Company TX Texas Health Resources 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 N/A false Healty Tarrant County Collaboration PO Box 8040 Fort Worth TX 76124 432087946 Supporting Organization TX 501(c)(3) 11 Type 1 N/A false Presbyterian Healthcare Resources 612 E Lamar Blvd Arlington TX 76011 510190395 Supporting Organization TX 501(c)(3) 11 Type 3 N/A false 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 N/A false 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 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 Institute for Surgery LLP 7715 Greenville Ave Ste 100 Dallas TX 75231 770628004 Hospital TX N/A Texas Single Source Staffing 524 E Lamar Blvd Ste 300 Arlington TX 76011 270324828 Manage Contract Nursing TX N/A USMD Hospital at Arlington LP 801 I-20 West Arlington TX 76107 203571243 Hospital TX N/A USMD Hospital at Fort Worth LP 801 I-20 West Arlington TX 76107 731662763 Hospital TX N/A Womens Specialty Surgery Center 1300 Post Oak Blvd Ste 600 Houston TX 77056 262310072 Ambulatory Surgery Center TX N/A 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 76 St Paul 5th floor Burlington VT 05401 030310676 Insurance VT Texas Health Resources C-Corp Charitable Remainder Trusts 5 612 E Lamar Blvd Arlington TX 76011 TX N/A true true true true true true true true true