2011-05-13T07:30:33-05:00 2010-06-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2009-07-01 751976930 MOTHER FRANCES HOSPITAL - JACKSONVILLE MOTH 9035315764 1021 E IDEL TYLER TX 75701 JOYCE HESTER 2011-05-16 M Paige Gerich 7134994600 2009 2016-02-24 21:20:13Z RAY THOMPSON 910 E HOUSTON TYLER TX 75701 35939243 false X N/A X 2000 TX TO PROVIDE THE COMMUNITY WITH A FULL RANGE OF COMPREHENSIVE HEALTHCARE SERVICES WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. 7 3 207 3 0 0 0 0 32318671 35911468 0 0 28363 27775 32347034 35939243 0 541691 0 0 9325588 9478248 0 0 0 22908563 24067806 32234151 34087745 112883 1851498 19437979 12235284 10871124 1816931 8566855 10418353 TO PROVIDE THE COMMUNITY WITH A FULL RANGE OF COMPREHENSIVE HEALTHCARE SERVICES WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. false false 30625316 541691 35911468 The Hospital's operating plan incorporates provisions for individuals who do not possess the ability to purchase essential medical services. Our committment to our community extends to free or subsidized individual care, subsidized education of healthcare professionals, discounted fees for participants in government programs, community health education and donations to other community agencies. Specific community services and programs include: wellness and prevention education programs, community diagnostic screening programs, senior citizen health awareness programs, awareness programs for youth at risk, and awareness programs for persons with special physical or mental needs. 30625316 true false false true false false false false false true false true false false false false false false false false true true false true false false false false false false false false false false false false false true false false false true 0 0 true 207 true false false false false false false false false false 7 3 false false false false true true true true true false false true true true true true true true true false X MOTHER FRANCES HOSP ACCTG DEPT 9035315764 1315 DOCTORS DRIVE TYLER TX 75701 TOM CAMMACK 40.0 X X 264671 0 14010 MATTHEW VIERKANT MD 10.0 X 0 507270 18062 RAY THOMPSON 1.0 X X 0 1267520 405024 GLEN HAMILTON 1.0 X X 0 0 0 WILLIAM MILAWSKI MD 10.0 X 0 264300 15517 DICK STONE 1.0 X 0 0 0 RANDY GORHAM 1.0 X 0 0 0 MICHAEL LEWIS 40.0 X 115019 0 13115 BARRY THIBODEAUX 40.0 X 235368 0 5831 JACK CAPPS 40.0 X 227210 0 17639 BEN BEATHARD 40.0 X 106321 0 11703 948589 2039090 500901 5 false true false CARDIAC IMAGING MANAGEMENT SPECIALI 1357 DOMINION PLAZA TYLER TX 75703 MANAGEMENT SERVICES 174581 JOHNSON AND JOHNSON HEALTH CARE SYS 5972 COLLECTIONS CENTER DR CHICAGO IL 60693 ACCT MGMT CONTRACTOR 159894 MEDTRONIC USA INC PO BOX 84086 DALLAS TX 75284 MED TECHNOLOGY SVCS 523430 TYLER CARDIOVASCULAR PO BOX 9015 TYLER TX 75711 CARDIO SERVICES 147000 VIRTUAL RADIOLOGIC PROFESSIONALS OF DEPT 7080 CAROL STREAM IL 60122 RADIOLOGY SERVICES 174051 20 0 Net Patient Revenue 621110 35892432 35892432 Other Revenue 900099 19036 19036 35911468 0 0 0 27512 27512 27512 27512 0 0 0 0 Medical Records Fees 900099 263 263 263 35939243 35911468 27775 541691 541691 0 0 0 406815 328962 77853 0 7266977 5875961 1391016 0 1804456 1460636 343820 0 352506 22132 330374 0 0 0 0 0 10052130 9111617 940513 67833 67833 129867 83129 46738 18221 10189 8032 0 2799156 2659198 139958 2820 1997 823 0 12703 4427 8276 0 0 610339 579822 30517 0 Bad Debt Expense 6589478 6589478 Medical Supplies 2664987 2619650 45337 Food 92143 88235 3908 Repairs and Maintenance 575358 569037 6321 Minor Equipment 74902 65871 9031 25363 13284 12079 34087745 30625316 3462429 0 110293 124336 4327075 3426703 185631 233509 78828 66289 8528027 7372953 1622577 1155074 13113575 7229373 19437979 12235284 1192628 1189888 35994 36113 9642502 590930 10871124 1816931 X 8566855 10418353 8566855 10418353 19437979 12235284 X false true true X false X false false false false false true 1218 false false false 1218 false 8528027 7372953 1155074 1155074 DUE FROM AFFILIATES 7229373 7229373 0 THIRD PARTY PAYOR LIABILITIES 269918 ESTIMATED SELF INSURANCE COSTS 321012 590930 35939243 34087745 1851498 1851498 35939243 35939243 35939243 34087745 34087745 34087745 FIN 48 DISCLOSURE MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true X true X true X true true true false true true 1432751 1432751 0.04200 5032727 3656883 1375844 0.04040 33063 38481 -5418 0.00020 6498541 3695364 2803177 0.08220 18340 18340 0.00050 541691 541691 0.01590 560031 560031 0.01640 7058572 3695364 3363208 0.09860 false 1484787 9880376 9532962 347414 X true true Mother Frances Hospital - Jacksonville

1026 S Jackson St Jacksonville TX 75766

X X X X PATIENT ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL, THE CLINIC, JACKSONVILLE AND WINNSBORO PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THIRD-PARTY PAYERS ARE BILLED DIRECTLY AND BILLS ARE SENT TO THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS AFTER APPLYING THE COST TO CHARGE RATIO. THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. THE HOSPITAL USES MEDICARE COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS (ROOM AND BOARD) BASED ON MEDICAID OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. THE ORGANIZATION HAS A WRITTEN POLICY COVERING PROCEDURES FOR COLLECTING AND WRITING OFF BAD DEBTS. ACCORDING TO THE POLICY, IF A PATIENT APPEARS TO BE INDIGENT, ACCOUNTS SHOULD BE REVIEWED, AT ANY TIME DURING THE COLLECTION PROCESS, FOR POSSIBLE CONSIDERATION AS A CHARITY CASE IN ACCORDANCE WITH THE ORGANIZATION'S CHARITY CARE POLICY. THE HOSPITAL'S COMMUNITY HEALTH PROFILES PROVIDE A SNAPSHOT OF SUBURBAN, URBAN, AND RURAL SERVICE AREAS WITHIN TEXAS USING KEY HEALTH INDICATORS, WHICH FACILITATE COMPARISONS LOCALLY, REGIONALLY, AND OVER TIME. COMMUNITY HEALTH PROFILES ARE INTENDED TO ASSIST INTERNAL STAKEHOLDERS, COMMUNITY HEALTH COUNCIL MEMBERS, AND THE COMMUNITY HEALTH IMPROVEMENT DEPARTMENT IN DECIDING WHERE TO ALLOCATE RESOURCES AND ADDRESS HEALTH INEQUALITIES. ALL ENTITY ADVOCATES USE NATIONAL, STATE, AND LOCAL SECONDARY AND PRIMARY DATA SOURCES TO PROVIDE A CURRENT OVERVIEW OF LOCAL HEALTH NEEDS, FACTORS IMPACTING DISEASE AND INJURY BURDEN, SOCIOECONOMIC STATUS, ACCESS TO HEALTH CARE, AGE DISTRIBUTION, INDICATORS AND LIFESTYLE BEHAVIORS. THIS DATA IS USED TO GALVANIZE JOINT COMMUNITY HEALTH EFFORTS TO IMPROVE HEALTH AND REDUCE HEALTH INEQUALITIES AND TO EMPOWER THE GREATER COMMUNITY. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND CONTACT INFORMATION IS POSTED IN VARIOUS AREAS OF THE HOSPITAL INCLUDING ADMISSIONS & REGISTRATION, EMERGENCY, AND OUTPATIENT DEPARTMENTS. ADDITIONALLY, FINANCIAL ASSISTANCE INFORMATION IS PROVIDED, VERBALLY AND IN WRITTEN BROCHURES, TO ALL SELF PAY PATIENTS BY FINANCIAL COUNSELORS. FINANCIAL ASSISTANCE INFORMATION IS ALSO INCLUDED IN EVERY PATIENT BILL. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO THE PATIENT BY FINANCIAL COUNSELORS WHO ALSO SCREEN SELF PAY PATIENTS FOR POTENTIAL ELIGIBILITY FOR OTHER GOVERNMENTAL ASSISTANCE PROGRAMS. IF IT IS DETERMINED THAT THE PATIENT IS POTENTIALLY ELIGIBLE FOR GOVERNMENTAL ASSISTANCE, THE FINANCIAL COUNSELOR WILL ASSIST THE PATIENT IN COMPLETING ANY FORMS NECESSARY TO APPLY FOR THE ASSISTANCE. AT THE SAME TIME, THE PATIENTS ARE PROVIDED WITH A CHARITY CARE APPLICATION AND INFORMATIONAL FLYER. THE PATIENT IS INFORMED THAT MOTHER FRANCES HOSPITAL-JACKSONVILLE IS A NON-PROFIT CHARITABLE ORGANIZATION OFFERING FINANCIAL ASSISTANCE TO PATIENTS WHO ARE DEEMED MEDICALLY OR FINANCIALLY INDIGENT. THE FINANCIAL COUNSELORS WILL THEN ASSIST THE PATIENT IN COMPLETING THE CHARITY CARE APPLICATION AND OBTAIN ANY AVAILABLE VERIFICATIONS. ONCE THE PATIENT IS DISCHARGED, THE FINANCIAL COUNSELORS WILL CONTINUE TO CONTACT THE PATIENT TO ENSURE ALL NEEDED FORMS AND VERIFICATIONS NEEDED TO FILE AN APPLICATION FOR GOVERNMENTAL ASSISTANCE AND CHARITY CARE HAVE BEEN PROVIDED. MOTHER FRANCES HOSPITAL-JACKSONVILLE IS A 25-BED ACUTE CARE MEDICARE CERTIFIED CRITICAL ACCESS HOSPITAL. CHEROKEE COUNTY, THE PRIMARY SERVICE AREA FOR MFH-JACKSONVILLE, HAS A POPULATION OF APPROXIMATELY 57,000 AND IS PRIMARILY 48,000 IN A 1,052 SQUARE MILE AREA. THE SECONDARY SERVICE AREA INCLUDES THE SOUTHERN PART OF SMITH COUNTY. MOTHER FRANCES HOSPITAL-JACKSONVILLE PROMOTES HEALTHCARE AND WELLNESS EDUCATION BY OFFERING OUTREACH PROGRAMS AND SPECIAL INITIATIVES THAT IMPROVE THE QUALITY OF LIFE AND HEALTH IN THE COMMUNITIES SERVED. COMMUNITY BENEFIT IS PROVIDED THROUGH MANY REDUCED PRICE SERVICES AND FREE PROGRAMS TO THE COMMUNITY. THESE SERVICES ARE ESSENTIAL TO PROVIDE COMPLETE HEALTHCARE TO THE COMMUNITIES SERVED. SOME OF THESE PROGRAMS INCLUDE THE FOLLOWING: CHEROKEE COUNTY RELAY FOR LIFE: PROVIDED SPONSORSHIP AND STAFFING SUPPORT FOR CHEROKEE COUNTY RELAY FOR LIFE. STAFF PLANNED ACTIVITIES FOR THE ALL-NIGHT EVENT AND MANNED THE EVENT. THE COUNTY HAS AN ABOVE AVERAGE RATE OF CANCER. FAMILYCARE CENTER-WOMEN'S SERVICES: OVER 315 VISITS FOR GYNECOLOGICAL SERVICES AT THE LOCAL CLINIC WERE PROVIDED FOR WOMEN THAT DID NOT HAVE A PRIMARY CARE OR SPECIALTY MEDICAL HOME. IN ADDITION, SURGERIES WERE PERFORMED BY FAMILYCARE PHYSICIANS AT MFH-JACKSONVILLE. JACKSONVILLE RODEO: HANDED OUT FANS AND WATER TO PARTICIPANTS AND SPECTATORS AT THE RODEO. HELPED EDUCATE PARTICIPANTS ABOUT THE DANGERS OF EXCESSIVE HEAT AND INJURIES CAUSED BY EXTENSIVE HEAT. REACHED OVER 1,000 PEOPLE WITH HEAT PREVENTION INFORMATION AND MEDICAL SUPPORT ON SITE. JACKSONVILLE ROTARY, ACCESS, AND OTHERS: PROVIDED SPONSORSHIP, STAFFING, AND DEVELOPMENT OF PROGRAMS AND EVENTS FOR THE LOCAL COMMUNITY. ORGANIZATIONS INCLUDED LITERACY COUNCIL, LIONS CLUB, ROTARY, RED CROSS, ACCESS, HOPE CENTER, UNITED FUND, AND AMERICAN CANCER SOCIETY. MEMBERS OF THE STAFF SERVE IN LEADERSHIP POSITIONS ON VARIOUS BOARDS AND NON PROFITS IN THE COMMUNITY. COMMUNITY HEALTH INFORMATION AND SCREENINGS: A VARIETY OF COMMUNITY EVENTS AND OPPORTUNITIES FOR SCREENINGS WERE HELD INCLUDING COMMUNITY HEALTH FAIRS, TOMATO FEST, BLOOD DRIVES, HEALTH FAIRS FOR COMMERCIAL AND INDUSTRIAL SITES, AND EDUCATIONAL FACILITIES. THESE PROGRAMS INCLUDED SPEAKERS FROM TRINITY CLINIC TO LIONS CLUB, KIWANIS, AND HOPE. HOPE CENTER: SUPPORTED A COMMUNITY WIDE EVENT TO BENEFIT THE RESIDENTS OF ANDERSON AND CHEROKEE COUNTIES. PROVIDED FOOD FOR THE RESIDENTS OF THE AREA. MOTHER FRANCES HOSPITAL-JACKSONVILLE IS PART OF AN AFFILIATED HEALTH CARE SYSTEM CALLED TRINITY MOTHER FRANCES HEALTH SYSTEM. TRINITY MOTHER FRANCES IS A FAITH-BASED ORGANIZATION DEDICATED TO CREATING HEALTHY LIVES FOR PEOPLE AND COMMUNITIES. MFH-JACKSONVILLE AND ITS AFFILIATES PROMOTE THE HEALTH OF THE COMMUNITIES SERVED BY PROVIDING ACUTE CARE FACILITIES AND CRITICAL ACCESS FACILITIES, WHOSE OPERATIONS CONSIST PRIMARILY OF PROVIDING INPATIENT AND OUTPATIENT ACUTE CARE AND MEDICAL SERVICES TO PATIENTS RESIDING IN EAST TEXAS. TX true SERVICE ORGANIZATION OF NORTH AND EAST TEXAS 2950 50TH STREET LUBBOCK TX 79314 260468622 501(c)(3) 541691 CONTRIBUTION 1 0 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S. SCHEDULE I, PART I, LINE 2 GRANT RECIPIENTS ARE REQUIRED TO ACKNOWLEDGE PRIOR TO THE ISSUANCE OF GRANT FUNDS THAT THE GRANT WILL BE USED IN ACCORDANCE WITH THE STATED PURPOSE OF THE GRANT APPLICATION AND ANY UNUSED FUNDS RELATED TO THE SPECIFIC PURPOSE OF THE GRANT WILL BE RETURNED TO THE ORGANIZATION. THE ORGANIZATION MONITORS AND REVIEWS THE FINANCIAL DATA OF RECIPIENTS TO ENSURE THAT THE GRANTED FUNDS ARE BEING USED PROPERLY. X X X X X false true false false false false false false false TOM CAMMACK 233980 0 30691 0 0 0 3631 0 10379 0 278681 0 MATTHEW VIERKANT MD 0 507270 0 0 0 0 0 4900 0 13162 0 525332 RAY THOMPSON 0 603880 0 222843 0 440797 0 391818 0 13206 0 1672544 0 418686 BARRY THIBODEAUX 235368 0 0 0 0 0 4342 0 1490 0 241200 0 JACK CAPPS 227210 0 0 0 0 0 4350 0 13289 0 244849 0 WILLIAM MILAWSKI MD 0 264300 0 0 0 0 0 4671 0 10846 0 279817 PARTICIPATION IN OR PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, QUESTION 4B PARTICIPANTS IN SERP REPORTED IN W-2 DEFERRED COMPENSATION -------------------- --------------- --------------------- RAY THOMPSON $418,686 $386,918 DESCRIBE REVIEW PROCESS OF FORM 990 FORM 990, PART VI, QUESTION 11A THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS PRIOR TO FILING. DESCRIBE THE ORGANIZATION'S MEMBERS OR STOCKHOLDERS FROM 990, PART VI, QUESTION 6 TRINITY MOTHER FRANCES HEALTH SYSTEM IS THE SOLE MEMBER OF MOTHER FRANCES HOSPITAL - JACKSONVILLE. MEMBERS OR STOCKHOLDERS WHO MAY ELECT MEMBERS OF THE GOVERNING BOARD FORM 990, PART VI, QUESTION 7A THE SOLE MEMBER, TRINITY MOTHER FRANCES HEALTH SYSTEM, APPOINTS ALL DIRECTORS AND THEIR SUCCESSORS TO THE GOVERNING BOARD. DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBER FORM 990, PART VI, QUESTION 7B THE MEMBER HAS THE RIGHT TO APPROVE OR DISAPPROVE CERTAIN ACTIONS THAT HAVE BEEN APPROVED BY THE BOARD OF DIRECTORS. HOW DOES THE ORGANIZATION MONITOR AND ENFORCE COMPLIANCE WITH POLICY FORM 990, PART VI, QUESTION 12C THE BOARD REVIEWS AND RESOLVES, IF NECESSARY, ANY TRANSACTIONS AS THEY ARISE THROUGHOUT THE YEAR IN ACCORDANCE WITH POLICY STANDARDS. PROCESS FOR DETERMINING COMPENSATION OF CEO, OFFICERS, OR KEY EMPLOYEES FORM 990, PART VI, QUESTIONS 15A & 15B THE ORGANIZATION USES COMPENSATION CONSULTANTS AND NATIONAL COMPENSATION SURVEYS TO DETERMINE COMPENSATION OF EMPLOYEES. COMPENSATION IS APPROVED BY THE ORGANIZATION'S GOVERNING BODY. DESCRIBE WHETHER THE ORGANIZATION MAKES ITS DOCUMENTS AVAILABLE TO PUBLIC FORM 990, PART VI, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. COMPENSATION FROM RELATED ORGANIZATIONS FORM 990, PART VII & SCHEDULE J THE GOVERNING BOARD OF TRINITY MOTHER FRANCES HEALTH SYSTEM UPON ADVICE FROM NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS, WHO PERIODICALLY REVIEW ALL EXECUTIVE COMPENSATION, APPROVED A DEFERRED COMPENSATION PLAN THAT PROVIDES A 65% TOTAL RETIREMENT BENEFIT FOR SENIOR EXECUTIVES THAT SERVE 20 YEARS OR MORE. THIS PROGRAM HAS BOTH RETENTION AND NON-COMPETITION CLAUSES THAT CREATE A RISK OF FORFEITURE. DEFERRED COMPENSATION IS SUBJECT TO A RISK OF FORFEITURE BASED ON RETENTION, NON-COMPETITION AND OTHER CONTRACTUAL FACTORS. ACCRUALS OF DEFERRED COMPENSATION ARE NOT INCLUDIBLE IN W-2 COMPENSATION UNTIL PAID. OTHER EMPLOYEE BENEFITS INCLUDE QUALIFIED PENSION PLANS. HEALTH, DENTAL AND LIFE INSURANCE PLANS, DISABILITY INSURANCE, ETC. TAXABLE EXPENSES ARE INCLUDED IN THE W-2 PAID COMPENSATION SALARY AMOUNT. AVERAGE HOURS WORKED FOR RELATED ORGANIZATIONS FORM 990, PART VII AVG HOURS WORKED FOR RELATED ORGS WILLIAM MILAWSKI MD 30 MATTHEW VIERKANT MD 30 RAY THOMPSON 41 1099S REPORTED BY ORGANIZATION FORM 990, PART V, QUESTION 1 NO 1099S WERE ISSUED BY THE FILING ORGANIZATION. THE ORGANIZATION'S 1099S ARE ISSUED BY A RELATED ORGANIZATION, MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER, WHO REPORTS ALL 1099S FOR THE ENTIRE SYSTEM AND ALLOCATES EXPENSES TO THE APPROPRIATE RELATED ORGANIZATION; THEREFORE, THIS QUESTION IS ANSWERED AS "NONE" FOR THIS FILING ORGANIZATION. 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