2017-11-13T11:15:16-06:00 2016-12-31 990 2016-01-01 752678857 Texas Health Harris Methodist Hospital Southwest Fort Worth % DAVID JACKSON TEXA 8174335000 6100 Harris Parkway Fort Worth TX 76132 RICK MCWHORTER Asst Secretary 6822367900 2017-11-13 208.189.200.252 75667320173175000003 2017-11-13 P 0D3B03028D7E1673678AB7251DEC05E73315DFDB 2BFF1EEB615D38F0D677249738DFA08CF19DC1E3 2016 2017-02-10 21:41:12Z Joseph DeLeon 6100 Hospital Parkway Fort Worth TX 76132 296778539 false X www.texashealth.org X 1987 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 1571 90 70243 25267 232110 259264 271822157 294270792 -184051 122749 2127069 2112027 273997285 296764832 1843015 2698412 0 0 91463850 101250865 0 0 0 130702036 143065027 224008901 247014304 49988384 49750528 230909970 285764352 20542513 25646367 210367457 260117985 X 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. false false 205560990 2698412 294931298 Located in the southwest sector of Fort Worth since 1987, Texas Health Harris Methodist Hospital Southwest Fort Worth (THSW) is licensed for 259 beds. THSW provides a wide array of comprehensive services including: surgical and imaging services, 24-hour emergency services, a Breast Care Center, orthopedics and sports therapy, adult critical care, a Level III neonatal intensive care unit, obstetrics and gynecology, cardiovascular services, cancer care, physical rehabilitation, and more. The hospital continually ranks among the area's preferred facilities to deliver babies, according to Fort Worth Child magazine. During the year, THSW had 52,161 patient days, 14,927 discharges, 93,819 outpatient encounters, 65.870 emergency room visits and 3,114 births. THSW provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. The hospital provides care to persons covered by governmental programs including Medicare and Medicaid for reimbursement that does not always cover the cost of providing the care. Recognizing its mission to the community, services are provided to both financially indigent and medically indigent patients. These are some accomplishments and awards received by THSW in 2016: 1. Opened Texas Health Hospital Clearfork and the Texas Health Southwest Outpatient Surgery Center. 2. Received Magnet Recognition from the American Nurses Credentialing Center. 3. Named 100 Top Hospital & Everest Award Winner by Truven Health Analytics. 4. Certified by The Joint Commission in chest pain and primary stroke. 5. Achieved an A rating from the Leapfrog Hospital Safety Score. 6. Awarded five-star rating for overall hospital quality by Hospital Compare. 7. Received QUEST Finalist Award for High-value Healthcare from Premier, Inc. 205560990 true true false true false false false false false false true false false true false 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 false false false true 75 0 true 1571 true true true false false false false false false false false false X 10 10 true false false false true true true true true false false true true true true true true false false false X X DAVID JACKSON 6822367900 612 E LAMAR BLVD Arlington TX 76011 X Barrera David DO Trustee 2.0 0.0 X 0 0 0 Bowman Mitch Dee MD Trustee 2.0 0.0 X 0 0 0 Casarez Richard PE Trustee 2.0 0.0 X 0 0 0 Conner Rev James Trustee 2.0 0.0 X 0 0 0 Dingmore Jr Darrell Vice Chair 2.0 0.0 X 0 0 0 Harvey James MD Trustee 2.0 0.0 X 0 0 0 Holland Anne Trustee 2.0 0.0 X 0 0 0 Munford Tracy MD Trustee 2.0 0.0 X 0 0 0 Patterson Michael Trustee 2.0 0.0 X 0 0 0 Weeks Susan DNP RN Chair 2.0 0.0 X 0 0 0 Berenzweig Harold MD THR Corporate Officer 0.5 40.0 X 0 743909 212496 King Kirk THR Corporate Officer 0.5 40.0 X 0 1031444 208638 Kramer Kenneth J Assistant Secretary 0.5 40.0 X 0 645136 170671 Krejci Jacque Assistant Secretary 0.5 40.0 X 0 163702 34138 McWhorter Rick E Assistant Secretary 0.5 40.0 X 0 545901 212205 Stout Luanne R Corporate Secretary 0.5 40.0 X 0 404579 49116 DeLeon Joseph C President THSW 40.0 0.0 X 443131 0 187972 Montgomery Gary Mark CHIEF MEDICAL OFFICER THSW 40.0 0.0 X 456588 0 101698 Robinson Mary C CHIEF NURSING OFFICER THSW 40.0 0.0 X 298596 0 87997 Kirkham Brett Daniel VP PROFESSIONAL SVCS OFFI THSW 40.0 0.0 X 213758 0 24404 Ward Charlotte M CHIEF FINANCIAL OFFICER 37.5 2.5 X 178458 14039 50201 Goins Marva Marie DIR PHARMACY 40.0 0.0 X 177886 0 32362 Hunt Gretchen L ASSOC CNO THSW 40.0 0.0 X 172365 0 19306 Williams Sheila D PHARMACIST 40.0 0.0 X 169965 0 42805 Christenson Susan O SUPV NRSG 40.0 0.0 X 167251 0 31567 Wallace Gary D DIR NRSG EMERGENCY SVC 40.0 0.0 X 166191 0 39167 Berdan Barclay E Former Officer 0.0 40.0 X 0 1723962 440540 Canose Jeffrey L Former Officer 0.0 40.0 X 0 1491947 266931 Mitchell John D Former Officer 0.0 40.0 X 0 441187 122625 McClung Brett S Former Officer 0.0 40.0 X 0 766269 214773 Boes Charles W Former Officer 0.0 0.0 X 0 779622 31117 Schroeder Jennifer Former Officer 0.0 40.0 X 0 202034 52462 2444189 8953731 2633191 129 true true false Texas Health Resources 612 E Lamar Blvd ARLINGTON TX 76011 Management Fee 30921267 Texas Health Physicians Group 9229 LBJ Freeway DALLAS TX 75243 Physician Services 3129125 Vanguard Resources 6500 Highway 21 North SPRING BRANCH TX 78070 Housekeeping Service 2941786 Novitas Solutions Inc 2020 Technology Pkwy Ste 100 MECHANICSBURG PA 17050 Medicare Processing 1027532 Faron Group PLLC 6628 Bryant Irvin Rd 110 FORT WORTH TX 76132 Physician Services 981000 42 X 259264 259264 PATIENT REVENUE 622110 289204874 289204874 DSRP REVENUE 622110 2611040 2611040 MEDICARE/MEDICAID ADJ 622110 2430594 2430594 EDUCATION 624190 24284 24284 294270792 3675 3675 0 47198 47198 0 0 0 132782 13707 119075 119074 119074 13351 0 13351 13351 0 0 0 0 0 0 CAFETERIA REVENUE 722514 1063299 1063299 REBATES & INCENTIVES 622110 554519 554519 GIFT SHOP 453220 166497 166497 267163 105987 70243 90933 2051478 296764832 294931298 70243 1504027 2698412 2698412 0 0 0 2023225 2023225 0 78706648 77964948 741700 3247499 3247499 11772142 11696697 75445 5501351 5501351 30921267 30921267 0 0 0 0 0 14795033 9278296 5516737 263627 262602 1025 2021257 1675413 345844 2036680 2032411 4269 0 3688341 3598367 89974 99188 83903 15285 0 236940 194105 42835 3436912 3436912 0 13364768 12971447 393321 1060554 1060554 SUPPLIES 57107121 57056097 51024 REPAIRS & MAINTENANCE 4469145 4428627 40518 FURNITURE & EQUIPMENT 5694500 5574678 119822 PATIENT SERVICES 2061055 2061055 1808639 737616 1071023 247014304 205560990 41453314 0 141309 -989441 0 0 0 0 29045273 34605380 0 0 0 0 233237 197790 4617378 6160896 256989 516723 316606764 106392135 96071851 210214629 0 0 0 0 0 0 0 0 100543933 35058375 230909970 285764352 20540713 25646367 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1800 0 20542513 25646367 X 210367457 260117985 0 0 0 0 210367457 260117985 230909970 285764352 49750528 X X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true true false true false false false false false false Additional Information Part II-B 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 on a personal level, and not as a representative of the organization. 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. 10414255 10414255 182714085 54322090 128391995 7774232 3082050 4692182 115438770 48987996 66450774 265423 265423 210214629 INTERCOMPANY RECEIVABLE 35045956 DEPOSITS 12419 35058375 true true X true X true X 500. true true false true true 16130092 1716785 14413307 0.05840 20025361 13326322 6699039 0.02710 0 0 0 0.00000 36155453 15043107 21112346 0.08550 35855 0 35855 0.00010 834089 0 834089 0.00340 0 0 0 0.00000 0 0 0 0.00000 2718562 0 2718562 0.01100 3588506 0 3588506 0.01450 39743959 15043107 24700852 0.10000 9343 0 9343 0.00000 9343 0 9343 0.00000 false 20011561 0 45196335 53412285 -8215950 X true true 1 1 Texas Health Southwest 6100 Harris Parkway Fort Worth TX 76132 www.texashealth.org TDH #627 X X X Texas Health Southwest 1 false false true X X X X X X X X X 16 true true false true X www.texashealth.org/chna X X false 15 true www.texashealth.org/chna false true X 200. 500. X X X true true X X X true X See Section C X See Section C X See Section C X X X X X X true X false X X X X true X false false Texas Health Southwest Part V. Section B, Line 5 Texas Health Southwests (THSW) Community Health Needs Assessment (CHNA) was a one-year collaborative process which utilized qualitative and quantitative data to assess the health needs of persons in the communities served by the hospital. The CHNA for USMD Hospital at Fort Worth was conducted in collaboration with THSW. As a means to further understand the needs of the community, THSW gathered feedback through key informant interviews, focus groups and an online community survey. Key informants and focus group participants included, but were not limited to: faith community representatives, public health officials, lay community members, school officials and city administration. Eleven persons with interests specific to the health of THSWs community participated in a focus group, five served as key informants and 560 individuals responded to the online survey. The online survey was conducted only in English. While the online survey may not have reached the medically underserved, low-income or minority populations directly, organizations serving those populations were present at the focus group and served as key informants; these organizations included: Healthy Tarrant County Collaboration, Tarrant County Public Health, the Mercy Clinic, and the YMCA of Metropolitan Fort Worth. In order to gain a comprehensive understanding of the significant health needs for THSWs service area, the findings from all three data sets (secondary data, interviews and focus groups, and the online community survey) were compared and studied together. The top five to seven health needs identified by each data source were analyzed for areas of overlap with the other two data sources. Health needs were determined to be significant if they were cited as a top need in at least two of the three data sources. Part V. Section B, Line 6a The CHNA for USMD Hospital at Fort Worth was conducted in collaboration with Texas Health Southwest. Part V. Section B, Line 7d The hospital produced executive summaries of the completed CHNA along with other information that is of benefit to community members as well as a comparison between the health needs of the community and the state of Texas statistics. This information is widely available throughout the facility and given out at various community coalition and partnership meetings in an effort to disseminate the information through various community-based outlets. Part V. Section B, Line 8 While a CHNA was conducted in 2016, the implementation strategy tied to the assessment was not adopted until 2017. In 2016, THSW completed the three year cycle of the hospitals previous CHNAs implementation strategy (2014-2016). Part V. Section B, Line 11 The CHNA conducted in 2013 revealed a vast number of community health issues that required collective action to improve the health of the community. In order to assist the organization in determining which health needs should be addressed, THSW categorized the community needs in alignment with the national objectives of Healthy People 2020 categories. By using a strategic prioritization method to determine the top needs within the community aligned with the ability to address the issues, two areas were chosen and addressed through the 2014-2016 implementation plans. The two priority areas from the 2013 CHNA were Chronic Disease and Awareness, Literacy and Navigation. In 2016, THSW continued to align and coordinate services and interventions with community partners for a collective impact to meet the two priority areas defined. Below are some ways in which the priority areas were addressed by THSW. 1. Chronic Disease 1a. Community Health Improvement strategies included implementing new evidence-based and maintaining existing chronic disease programs provided at the hospital with a focus on self-management programs. Active partnerships and sponsorships aligned with the strategic efforts to address chronic diseases remained a top priority. 1b. The Chronic Disease Self-Management Program (CDSMP) is a program offered by Texas Health Resources and local community partners with the goal of enabling individuals to build the self-confidence and motivation they need to manage the challenges of living with a chronic health condition. Participants are adults experiencing chronic health conditions such as hypertension, arthritis, heart disease, stroke, lung disease and diabetes. The program provides information and teaches practical skills on managing chronic health problems through the use of lay leaders. In 2016, 50 registrants participated in a six-session course co-served by THSW. 2. Awareness, Literacy, and Navigation (ALN) 2a. Community Health Improvement strategies included collaboration to develop the online database called Community Connect, which is an area resource guide of key services available to the local community, individuals and non-profit partners that addresses the social determinants of health. In 2016, more than 2,200 searches for information regarding free and reduced-cost social services were conducted using this online database. 2b. The Texas Health Grant and Sponsorship Program provides community benefit grants, sponsorships and other in-kind resources to improve the health status of the communities served. Grants are limited to the specific areas of health disparities, disease management, wellness, disease prevention and health promotion programs, clinics, charitable care and community health collaborations. 2c. Partnering with area collaborations working to address ALN continued; THSW maintained and supported relationships with key partners, such as the Healthy Tarrant County Collaboration. 2d. Texas Health Resources has partnered with local Area Agencies on Aging and community partners since 2013 to implement the national award-winning program A Matter of Balance (AMOB), an evidence-based fall prevention program for older adults, across the Texas Health system. AMOB has objectives that focus on increasing lower body strength, flexibility and coordination to reduce participants fear of falling. In 2016, 65 registrants participated in an eight-week workshop co-served by THSW. 2e. Academy 4 is a non-profit organization founded to build self-esteem and vision in economically disadvantaged students. The focus is on fourth graders, and the intent is to guide them into technical high schools. The program consists of clubs, assemblies and mentoring relationships. In 2016, Texas Health Southwest provided a program named Club Med to 14 students each month of the school year, delivering information regarding healthcare careers while also teaching first aid, CPR and safety. 2f. The Faith Community Nursing (FCN) program is offered by THSW to link faith communities with health-related resources that focus on holistic care including body, mind and spirit. Program emphasis is place on prevention and wellness through education, coaching, advocacy and coordination of healthcare. Texas Health Southwest did not adopt new strategies for the following identified needs in the community for the reasons listed. 1. Access: Provider Supply Resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 2. Cancer - This need is currently being addressed by multiple outside organizations in the community. The facility will continue to address the need at its current level of support. 3. Environmental Quality Lack of expertise. 4. Injury and Violence Lack of expertise and low priority assigned. This need is currently being addressed by multiple organizations in the community, and the facility will continue to address the need at its current level of support. 5. Maternal, Infant, & Child Health This need is currently being addressed by multiple outside organizations in the community. The facility will continue to address the need at its current level of support. 6. Mental Health Resource constraints and lack of effective intervention. The facility will continue to address the need at its current level of support. 7. Nutrition, Physical Activity, and Obesity This need is currently being addressed by multiple outside organizations in the community. The facility will continue to address the need at its current level of support. 8. Oral Health Lack of expertise. 9. Other Clinical/Preventive The facility will continue to address the need at its current level of support. 10. Reproductive and Sexual Health This need is currently being addressed by multiple outside organizations in the community. The facility will continue to address the need at its current level of support. 11. Social Determinants Resource constraints, low priority assigned, and lack of effective intervention. 12. Transportation Lack of expertise. Part V. Section B, Lines 16 a, b & c The FAP, FAP Application and the Plain Language Summary of the FAP were widely available at this website: www.texashealth.org/financial-assistance. Texas Health Southwest Part I, Line 3c - Patient Eligibility 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. 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, as determined on a sliding scale based on FPG, 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 in relation to FPG. 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 financial assistance 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 financial assistance application. Part I, Line 7 Cost-to-Charge Ratio A cost-to-charge ratio is used in computing the amounts reported in Lines 7a-7c. The cost-to-charge ratio is derived from Worksheet 2 Ratio of Patient Care Cost-to-Charges, as found in Schedule H Instructions. The amounts reported on Lines 7e-7i were obtained using direct costs, as determined by a cash outlay. Part II - Community Building The organization participates in community building activities that aim to address the socio-economic factors that influence the overall health of individuals in the communities served. As identified in the community health needs assessment, there are areas of need that are not in alignment with the operations of a hospital system. Our volunteerism, collaborations and partnerships with various aid organizations and various area coalitions aid in addressing the socio-economic factors that are the backbone for many underlying health concerns. Part III, Lines 2, 3 & 4 - Bad Debts Bad debt expense is not included as a community benefit for purposes of reporting community benefits. Each patient qualifying for charity care is treated as a charity patient and no charges related to that 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). THR's 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 balance sheets. The allowance and resulting 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 for each of its major payor sources of revenue. 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. For receivables associated with services provided to patients who have third-party coverage, the System analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the System records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the billed rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The Systems allowance for doubtful accounts for self-pay patients (including allowances for charity care) increased from 96.1% of self-pay accounts receivable at December 31, 2015 to 97.7% of self-pay accounts receivable at December 31, 2016. In addition, the Systems self-pay write-offs for bad debts increased from approximately $250,000,000 for fiscal year 2015 to approximately $306,000,000 for fiscal year 2016. The increase in write offs was the result of an increase in overall revenue and uninsured patients in fiscal year 2016. The System does not maintain a material allowance for doubtful accounts from third-party payors, nor did it have significant write-offs from third-party payors. Part III, Line 8 - Medicare Shortfall The state of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care & community benefit. For state purposes, 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 generally accepted accounting principles) to billed charges. The shortfall amount reported to the state of Texas for 2016 is $39,890,054. Sch H requires a different method of calculating the Medicare shortfall shown on Part III, Lines 5-7. Part III, Line 9b - Debt Collection 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 Financial Assistance Policy. Part VI, Line 2 - Needs Assessment The organization is part of the Texas Health Resources (THR) Healthcare System. In addition to the organizations Community Health Needs Assessment (CHNA), THR developed and implemented, as a healthcare system, a Community Benefit Framework (CBF) based on the Public Health Institutes Best Practices Advancing the State of the Art in Community Benefit (ASACB) Program. The CBF systematically integrates internal practices into the community to improve the efficiency and effectiveness of THRs Community Health Improvement (CHI) Strategy, to address disproportionate unmet health needs (DUHN), to address primary prevention and to improve community capacity. The CBF provides a quantitative approach to parallel the CHNA in identifying key communities within THRs service area and the means to align them with a THR entity. The CBF contains five phases: assessment/profile, infrastructure, community health council, programmatic review and strategy development. THR works with each entitys Community Health Advocate to examine the entitys structure and programs for gaps, needs, strengths and alignment with the CBF, CHNA and ASACB standards. Part VI, Line 3 - Patient Education A description of the Financial Assistance Policy (FAP), the Plain Language Summary of the FAP (PLS) and the FAP application are available on the THR website at www.TexasHealth.org in English and other languages. The PLS is included in the patients admission packets. Signs alerting patients of financial assistance and related contact information are posted in various areas of the hospital including admissions & registration and the emergency room. 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 necessary to apply for the assistance. At the same time, patients are provided with a financial assistance application. The patient is informed that the hospital is true Tarrant County Indigent Care Corporation 612 E Lamar Blvd Arlington TX 76011 260648532 501(c)(3) 2652079 Indigent Care Southwestern Assembly of God 1200 Sycamore St Waxahachie TX 75165 750891463 501(c)(3) 7222 General Purpose 2 0 Part I, Line 2 - Monitoring Grants Texas Health Southwest (THSW) is a member of the Texas Health Resources (THR) Healthcare system. The majority of the grants distributed by the system are to related tax exempt organizations. The hospital does not specifically monitor the use of grants paid to related organizations since THR administration monitors the use of these grants on a system basis for all members of the THR healthcare system. Grants to non-related tax exempt organizations are generally given to entities that are in the hospital's community and/or service area or to certain organizations which will specifically impact the hospital's community. These grants are typically monitored by hospital personnel who are working closely with the non-related nonprofit organization. X true true true true false false false false false false false Berenzweig Harold MD THR Corporate Officer 0 478216 0 182260 0 83433 0 171102 0 41394 0 956405 0 24136 King Kirk THR Corporate Officer 0 444075 0 478848 0 108521 0 159775 0 48863 0 1240082 0 264798 Kramer Kenneth J Assistant Secretary 0 419511 0 113769 0 111856 0 118564 0 52107 0 815807 0 11618 Krejci Jacque Assistant Secretary 0 157542 0 5480 0 680 0 9519 0 24619 0 197840 0 0 McWhorter Rick E Assistant Secretary 0 365938 0 114611 0 65352 0 179337 0 32868 0 758106 0 11875 Stout Luanne R Corporate Secretary 0 204324 0 177198 0 23057 0 16395 0 32721 0 453695 0 105035 DeLeon Joseph C President THSW 291215 0 96536 0 55380 0 144127 0 43845 0 631103 0 10061 0 Montgomery Gary Mark CHIEF MEDICAL OFFICER THSW 333834 0 84877 0 37877 0 61076 0 40622 0 558286 0 2232 0 Robinson Mary C CHIEF NURSING OFFICER THSW 213479 0 55051 0 30066 0 47794 0 40203 0 386593 0 1964 0 Kirkham Brett Daniel VP PROFESSIONAL SVCS OFFI THSW 169517 0 29100 0 15141 0 0 0 24404 0 238162 0 0 0 Ward Charlotte M CHIEF FINANCIAL OFFICER 148034 12020 10733 0 19691 2019 11127 884 35435 2755 225020 17678 0 0 Berdan Barclay E Former Officer 0 993734 0 478429 0 251799 0 399869 0 40671 0 2164502 0 42735 Canose Jeffrey L Former Officer 0 679439 0 646236 0 166272 0 227522 0 39409 0 1758878 0 419149 Mitchell John D Former Officer 0 263927 0 101243 0 76017 0 77713 0 44912 0 563812 0 10605 McClung Brett S Former Officer 0 484927 0 182778 0 98564 0 170080 0 44693 0 981042 0 17900 Boes Charles W Former Officer 0 0 0 150600 0 629022 0 6605 0 24512 0 810739 0 26128 Schroeder Jennifer Former Officer 0 188381 0 13653 0 0 0 10813 0 41649 0 254496 0 0 Goins Marva Marie DIR PHARMACY 168644 0 8547 0 695 0 3954 0 28408 0 210248 0 0 0 Hunt Gretchen L ASSOC CNO THSW 157132 0 13078 0 2155 0 9735 0 9571 0 191671 0 0 0 Williams Sheila D PHARMACIST 163736 0 668 0 5561 0 10356 0 32449 0 212770 0 0 0 Christenson Susan O SUPV NRSG 162344 0 719 0 4188 0 12611 0 18956 0 198818 0 0 0 Wallace Gary D DIR NRSG EMERGENCY SVC 154157 0 7405 0 4629 0 12027 0 27140 0 205358 0 0 0 SCHEDULE J, PART I, LINE 1A - DISCRETIONARY SPENDING ACCOUNT EACH EXECUTIVE AT THE VICE PRESIDENT LEVEL AND ABOVE RECEIVES A PERK ALLOWANCE WHICH IS INCLUDED IN THE TAXABLE COMPENSATION OF THE EMPLOYEE. THIS ALLOWANCE COVERS COSTS SUCH AS BUSINESS USE OF THEIR PERSONAL VEHICLES IN LIEU OF REIMBURSEMENT FOR AUTO MILEAGE. SCHEDULE J, PART I, LINE 3 - CEO COMPENSATION 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 organizations President. *The Compensation committee (which includes independent persons) performs reviews and makes recommendations to the THR Board. *An Independent compensation consultant may be hired. *Compensation surveys or studies are utilized. *Approval by the Board or Compensation committee is required. SCHEDULE J, PART I, LINE 4A - POSITION ELIMINATION THR'S SEPARATION PAY PLAN PROVIDES PAYMENTS TO EMPLOYEES WHO'S POSITIONS WERE ELIMINATED BY THE ORGANIZATION BASED ON THE EMPLOYEE'S YEARS OF SERVICE AND THE LEVEL OF THE AFFECTED POSITION. THE LISTED EMPLOYEES QUALIFIED FOR SEVERANCE BASED ON AN INVOLUNTARY SEPARATION FROM SERVICE WITHOUT A COMPARABLE POSITION BEING OPEN AND AVAILABLE AT THE TIME OF SEPARATION. Boes,Charles $471,686.35 SCHEDULE J, PART I, LINE 4B - NONQUALIFIED RETIREMENT PLAN 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 IN KEY POSITIONS OF MANAGEMENT AND RESPONSIBILITY. FOR THE ACTIVE RESTORATION ACCOUNT (ACCOUNT BALANCES AFTER 12/31/2009), SERP BENEFITS VEST WHILE THE PARTICIPANT IS EMPLOYED IF THE PARTICIPANT: * REACHES AGE 65, * BECOMES DISABLED OR DIES, * REACHES THE FOLLOWING YEARS OF SERVICE: 2 YEARS - 25%; 3 YEARS -50%; 4 YEARS - 75%; AND 5 OR MORE - 100%. PARTICIPANTS MUST BE EMPLOYED ON DEC 1 TO QUALIFY FOR THE CURRENT YEAR'S SERP BENEFIT UNLESS SEPARATION IS DUE TO DEATH, DISABILITY, RETIREMENT (AGE 65) OR EARLY RETIREMENT (SEPARATION FROM SERVICE AT OR AFTER AGE 55 WITH 75 YEARS OF COMBINED AGE AND CONTINUOUS SERVICE WITH THE SYSTEM). SERP BENEFITS ARE CALCULATED EACH DEC 1. VESTED BALANCES ARE TAXED TO THE EMPLOYEE AND THE NET BALANCES BEGIN ACCRUING EARNINGS. VESTED BALANCES ARE PAID IN A CASH LUMP SUM WITHIN A 90 DAY PERIOD COMMENCING ON THE EARLIER OF DEATH, DISABILITY, OR SEPARATION FROM SERVICE. THE DEFERRED PORTION IS INCLUDED IN SCHEDULE J, PART II, COLUMN C. IN FROZEN RESTORATION ACCOUNTS (ACCOUNT BALANCES PRIOR TO 1/1/2010), THE PARTICIPANT OR BENEFICIARY SHALL BE TAXED ON HIS OR HER VESTED SERP BENEFITS UPON THE EARLIEST OF: * CONTINUED EMPLOYMENT IN THR UNTIL 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/HER TERMINATION OF EMPLOYMENT. PAYMENT FOLLOWS THE BEFORE MENTIONED EVENTS, EXCEPT IN THE CASE OF INVOLUNTARY SEPARATION WHEN THE PARTICIPANT MUST WAIT 24 MONTHS TO RECEIVE THE PREVIOUSLY TAXED BENEFIT. PAYOUTS TO THE FOLLOWING EMPLOYEES WERE MADE DURING THE YEAR. THE AMOUNTS BELOW ARE INCLUDED IN THE AMOUNT REPORTED ON SCH J, PART II, COLUMN B(III) AND COLUMN (F). Berdan,Barclay E $42,734.67 Berenzweig,Harold K $24,135.67 Boes,Charles $153,713.34 Canose,Jeffrey L $419,148.87 DeLeon,Joseph C. $10,061.33 King,James Kirk $330,423.83 Kramer,Kenneth J. $11,618.00 McClung,Brett S. $17,899.67 McWhorter,Ricky E. $11,874.67 Mitchell,John D. $10,604.67 Robinson,Mary C. $1,964.00 Stout,Luanne R $136,588.40 Business Relationship-Part VI, Section A, Line 2 Texas Health Resources (THR) and its related organizations included in the THR healthcare system encourage employees to become involved in philanthropic endeavors in their communities. As a result, THR healthcare system employees who are serving as officers, board members, or key employees may, from time to time, also serve on the boards of various community organizations such as church boards, United Way, etc. There may be a business relationship as a result of multiple THR employees serving on the same community boards. THR employees serve as the corporate officers of each subsidiary organization. As THR system employees, all officers have a business relationship within the organizations of the THR healthcare system. THR also appoints system officers to the boards of various controlled joint ventures. As THR system employees, various officers of the organization may have a business relationship through serving on THR controlled joint venture boards. Members-Part VI, Section A, Lines 6&7a Texas Health Resources (THR) is the sole member of the organization. Governance Decisions Reserved-Part VI, Section A, Line 7b The following actions require the approval of Texas Health Resources (THR): (a) Amendment, restatement or repeal of the Certificate of Formation or these Bylaws. (b) Sale, exchange, lease or other transfer of all or substantially all of the assets of the Corporation. (c) Merger or consolidation of the Corporation. (d) Dissolution of the Corporation. (e) Election of members of the Board of Trustees (f) Removal of a member of the Board of Trustees (g) Creation of affiliates or subsidiaries and approval of the initial governing documents. (h) Incurrence of debt not included in the budgets. (i) Discontinuing the operations of a licensed health care facility controlled by the corporation. (j) Activities involving winding up, distribution, conversion or exchange under Chapter 11 Form 990 Filing-Part VI, Section B, Line 11b The Texas Health Resources (THR) tax department staff prepares the Forms 990 for THR and all of its wholly controlled affiliates. In order to accurately prepare the returns, the tax staff works closely with various other departments to gather and review the information needed to complete the return. The departments involved in this process include, but are not limited to accounting, finance, treasury, human resources, payroll, legal, governance, and corporate compliance. The returns are then reviewed twice within the tax department before being given to the Financial Reporting department to review and to ensure that the financial information is accurate and up to date. All THR System Forms 990 are provided to members of the Audit and Compliance Committee of the THR Board, giving them an opportunity to review, comment and ask questions regarding the Forms 990. The tax department Sr. Director provides an overview presentation to the committee highlighting various areas of the Form 990. A resolution to approve all of the returns is voted upon at this meeting. Once the Audit and Compliance Committee has approved the returns, each return is then reviewed and signed by the Sr. Vice President of Finance. The members of the governing Boards are provided a copy of the Form 990 for their respective entity after the Audit and Compliance Committee approval process and before the Form 990 is filed. Conflict of Interest- 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 of Interest Statement Form is distributed by the THR Chief Compliance Officer to all board members, officers, contracted medical directors, employees with a title of manager or above, employed physicians, and certain committee members and other employees based upon function. All disclosed conflicts are reviewed by the THR Chief Compliance Officer. 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. Progressive corrective action is taken for any identified noncompliance which may include removal from a board or committee or physician/employee counseling if the person fails to provide the disclosure. In addition, THR monitors physician payments through a public database implemented by CMS. Management plans are executed as needed based upon disclosures. THR also educates the Boards and workforce annually through either a web based or live compliance training. Compensation Determination-Part VI, Section B, Line 15 a&b The organization relied on Texas Health Resources (THR) with centralized compensation professionals to review and establish the compensation of the organizations officers. The THR Board approves the compensation of certain officer of this organization. See Schedule J, Part III. Public Disclosure-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. Consolidated Financial Statements-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 selection process. Healthy Tarrant County Collaboration PO Box 8040 Fort Worth TX 76124 432087946 Support Org. TX 501(c)(3) 12a NA false Johnson County Community Care Corp 612 E Lamar Blvd Arlington TX 76011 452793120 Support Org. TX 501(c)(3) 12a TH Cleburne false North Texas Healthy Communities 612 E Lamar Blvd Arlington TX 76011 464513182 Comm Support TX 501(c)(3) 7 TH Resources false Southwestern Health Resources JOC 5323 Harry Hines Blvd Dallas TX 75390 811575989 Support Org. TX 501(c)(3) 12b TH Resources false Texas Health Arlington Memorial Hospital 800 West Randol Mill Rd Arlington TX 76011 750972805 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Back Care 9229 LBJ Freeway Dallas TX 75243 474724257 Phys. Clinic TX 501(c)(3) 10 TH Phys Grou false TH Behavioral Health Hospital Corinth 612 E Lamar Blvd Arlington TX 76011 814317635 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Alliance 10864 Texas Health Trail Fort Worth TX 76244 451502252 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Azle 108 Denver Trail Azle TX 76020 751748586 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Cleburne 201 Walls Dr Cleburne TX 76033 751977850 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Fort Worth 1301 Pennsylvania Ave Fort Worth TX 76104 756001743 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Hurst-Euless-Bedford 1600 Hospital Parkway Bedford TX 76022 751438726 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Southwest Fort Worth 6100 Harris Parkway Fort Worth TX 76132 752678857 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Stephenville 411 Belknap Stephenville TX 76401 751752253 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Huguley Inc 11801 S Freeway Burleson TX 76028 452694620 Hospital FL 501(c)(3) 3 TH Resources false Texas Health Medical Support 612 E Lamar Blvd Arlington TX 76011 812833150 Spec Drugs TX 501(c)(3) 10 TH Resources false TX Health Outpatient Surg Ctr Alliance 10840 Texas Health Trail Fort Worth TX 76244 800800294 Hospital TX 501(c)(3) 3 TH Alliance false Texas Health Physicians Group 9229 LBJ Freeway Dallas TX 75243 752613493 Phys. Clinic TX 501(c)(3) 10 TH Resources false TH Recovery and Wellness Center 612 E Lamar Blvd Arlington TX 76011 812813227 Resd Trmt Ctr TX 501(c)(3) 3 TH Resources false Texas Health Resources Foundation 612 E Lamar Blvd Arlington TX 76011 752022128 Fundraising TX 501(c)(3) 7 TH Resources false Texas Health Allen 1105 Central Expressway N Allen TX 75013 752890358 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Dallas 8200 Walnut Hill Ln Dallas TX 75231 751047527 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Denton 3000 North Interstate 35 Denton TX 76201 432008974 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Kaufman 850 Ed Hall Drive Kaufman TX 75142 752771437 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Plano 6200 W Parker Rd Plano TX 75093 752770738 Hospital TX 501(c)(3) 3 TH Resources false TX Health Research & Education Institute 612 E Lamar Blvd Arlington TX 76011 752562191 Edu& Research TX 501(c)(3) 4 TH Resources false Texas Health Resources 612 E Lamar Blvd Arlington TX 76011 752702388 Mgmt Supp Org TX 501(c)(3) 12c NA false TH Seay Behavioral Health Hospital 6110 W Parker Rd Plano TX 75093 812792484 Hospital TX 501(c)(3) 3 TH Resources false TH Springwood Behavioral Health Hospital 2717 Tibbets Dr Bedford TX 76022 812798838 Hospital TX 501(c)(3) 3 TH Resources false TH Specialty Hospital Fort Worth 1301 Pennsylvania Ave Fort Worth TX 76104 751648589 LT Hospital TX 501(c)(3) 3 TH Resources false WW Ward Endowment Fund Trust 612 E Lamar Blvd Arlington TX 76011 756196065 Support Org. TX 501(c)(3) 12a TH Foundatio false AMH Cath Labs LLC 811 Wright St Arlington TX 76012 203003947 Hospital TX NA N/A Arlington Surgery Ctr LLC 918 N Davis Dr Arlington TX 76012 752055800 Amb Surg Ctr TX NA N/A Cleburne Imaging LLC PO Box 820519 Dallas TX 75382 460767278 Medical Imaging TX NA N/A Cleburne Surgical Ctr LLC 2010 W Katherine P Raines Blvd St Cleburne TX 76033 203742012 Amb Surg Ctr TX NA N/A Denton Surgery Ctr LLC 207 North Bonnie Brea Denton TX 76201 470926556 Amb Surg Ctr TX NA N/A Flower Mound Hospital Ptrs LLC 4400 Long Prairie Rd Flower Mound TX 75028 260684968 Hospital TX NA N/A Fort Worth Endoscopy Ctr LLC 900 W Magnolia Ave 101 Fort Worth TX 76104 770368346 Endoscopy Ctr TX NA N/A FTH DFW Partners LLC 1401 E trinity Mills Rd Carrollton TX 75006 473426036 Hospital/ER TX NA N/A Greenville Surgery Ctr LLC 7150 Greenville Ave Ste 200 Dallas TX 75231 742411643 Amb Surg Ctr TX NA N/A Health Imaging Ptrs LLC 8610 Explorer Drive Ste 300 Colorado Springs CO 80920 271385885 Medical Imaging TX NA N/A North Dallas Surgical Ctr LLC 17980 Dallas Parkway Ste 100 Dallas TX 75287 272248103 Amb Surg Ctr TX NA N/A Ophthalmology Surgery Ctr of Dallas LLC 10740 N Central Expressway Ste 400 Dallas TX 75231 261914835 Amb Surg Ctr TX NA N/A Physician Medical Ctr LLC 6020 W Parker Rd Plano TX 75093 481281376 Hospital TX NA N/A Presbyterian Cancer Ctr-Dallas LLC PO Box 819607 Dallas TX 75381 260422749 Cancer Ctr TX NA N/A Rockwall Regional Hospital LLC 3150 Horizon Rd Rockwall TX 75032 202848116 Hospital TX NA N/A Southlake Specialty Hospital LLC 1545 E Southlake Blvd Southlake TX 76092 020555370 Hospital TX NA N/A Surgical Caregivers of Fort Worth LLC 2001 W Rosedale Street Fort Worth TX 76104 751925497 Amb Surg Ctr TX NA N/A Texas Health Craig Ranch Surgery Ctr LLC 8080 State Hwy 121 Ste 100 McKinney TX 75070 383897811 Amb Surg Ctr TX NA N/A Texas Health Flower Mound Orthopedic Sur 5000 Long Prairie Road Flower Mound TX 75028 800866449 Amb Surg Ctr TX NA N/A TH Medsynergies LLC 909 Hidden Ridge Ste 300 Irving TX 75038 800272951 Mgmt Services TX NA N/A TH Spine Center Arlington 1545 E Southlake Blvd Ste 100 Southlake TX 76092 464143686 Amb Surg Ctr TX NA N/A TH Surgery Ctr Preston Plaza LLC 17950 Preston Road Ste 75 Dallas TX 75252 203991622 Amb Surg Ctr TX NA N/A TH Surgery Ctr Rockwall LLC 569 Brookwood Village Ste 901 Birmingham AL 35209 474425996 Inactive TX NA N/A Texas Institute for Surgery LLP 7715 Greenville Ave Ste 100 Dallas TX 75231 770628004 Hospital TX NA N/A THR-STT Rockwall ASC LLC 1545 E Southlake Blvd Southlake TX 76092 262429878 Amb Surg Ctr TX NA N/A THR-STT Southlake ASC LLC 1545 E Southlake Blvd Southlake TX 76092 201728912 Amb Surg Ctr TX NA N/A USMD Hospital at Arlington LP 801 I -20 West Arlington TX 76017 731662763 Hospital TX NA N/A USMD Hospital at Fort Worth LP 5900 Altamesa Blvd Fort Worth TX 76132 203571243 Hospital TX NA N/A Wilson Creek Surigcal Ctr LLC 8855 Synergy Dr McKinney TX 75070 274816583 Amb Surg Ctr TX NA N/A Women's Specialty Surgery Ctr 8230 Walnut Hill Ln Ste 101 Dallas TX 75231 262310072 Amb Surg Ctr TX NA N/A Huguley Medical Associates Inc 11801 South Freeway Burleson TX 76028 752547668 Phys Clinics TX NA C Corp false Magnum Health Holdings Inc 612 E Lamar Blvd Arlington TX 76011 475486814 Inactive TX NA C Corp false Texas Health Aetna Health Plan 612 E Lamar Blvd Arlington TX 76011 475548221 Inactive TX NA C Corp false TH Biomedical Advancement Center Inc 612 E Lamar Blvd Arlington TX 76011 752636884 Research TX NA C Corp false SWHR Specialty Programs Groups 612 E Lamar Blvd Arlington TX 76011 465588632 Inactive TX NA C Corp false THR Primary Care Ext Physcian Network 612 E Lamar Blvd Arlington TX 76011 465365421 Inactive TX NA C Corp false Texas Health Resources Spine Services 612 E Lamar Blvd Arlington TX 76011 465347751 Inactive TX NA C Corp false Texas Health Resources Women's Services 612 E Lamar Blvd Arlington TX 76011 465330487 Inactive TX NA C Corp false Charitable Remainder Trusts (4) 612 E Lamar Blvd Arlington TX 76011 465330487 CR Trust TX NA Trust false Grace Indemnity Company Ltd 1159 Carribean Plaza Grand Cayman CJ KY 1-1102 981209573 Captive Insurance CJ NA C Corp false false false true false false false false false false false true false true false false true true true true Related Transactions- Part V, Line 2 Texas Health Resources (THR) is the parent organization in a large healthcare system made up of both wholly owned entities as well as related controlled joint ventures as listed on Schedule R. THR's role is to plan, manage and coordinate the activities of the affiliated healthcare system in order to maximize opportunities to deliver cost effective quality medical care to residents of north central Texas. THR provides direction and oversight to its wholly owned affiliates through centralized services. They also provide oversight for the controlled joint ventures. As an integral part of providing centralized services to the affiliates, THR maintains intercompany receivable/payable accounts, most of which do not fall within the scope of IRC Section 512(b)(13). The range of centralized services provided by THR include information services, managed care contracting, Human resources, revenue cycle, billing and collections, patient access/admissions, legal, tax, compliance, supply chain, quality, business development, insurance, treasury, marketing, general accounting, real estate services, coding, transcription and strategic planning. In addition, THR does daily cash sweeps of all controlled tax exempt entity cash accounts. As a result, THR has numerous daily transactions with controlled tax exempt entities, none of which fall within the scope of IRC Section 512(b)(13). A management fee is charged for the centralized services and reported on Form 990, Part VII, Section B as a professional services fee. Transactions with related tax exempt organizations falling within the meaning of centralized services as described above, are not listed on Schedule R, Part V, Line 2. Part II Texas Health Behavioral Health Hospital Corinth has applied for tax exempt status. The application is currently pending.