2016-02-22T06:31:50-06:00 2015-06-30 721396621 CARR RIGGS & INGRAM LLC TWO RIVERWAY FLOOR 15 HOUSTON TX 77056 990 2014-07-01 203069241 WALKER COUNTY HOSPITAL CORPORATION WALK 9362913411 PO BOX 4001 HUNTSVILLE TX 773424001 SHANNON BROWN CEO 9362913411 2016-02-22 1 DAVID DONNELLY P00956426 7136218090 2016-02-15 2014 2016-08-17 19:52:53Z HUNTSVILLE MEMORIAL HOSPITAL SHANNON BROWN 110 MEMORIAL HOSPITAL DRIVE HUNTSVILLE TX 77340 106115859 0 X WWW.HUNTSVILLEMEMORIAL.COM X 2005 TX WE ARE DEVOTED TO THE HEALTH AND WELL-BEING OF OUR REGIONAL COMMUNITIES BY PROVIDING EXCEPTIONAL CARE TO EVERY PATIENT EVERY DAY WITH A SPIRIT OF WARMTH, COMPASSION AND PERSONAL PRIDE. WE ACHIEVE THIS THROUGH ADVANCED AND EFFICIENT MEDICAL CARE WITH STRONG SELF-GOVERNANCE. 17 16 728 71 0 0 30334 40574 86093571 100919060 203100 139860 1671489 1418861 87998494 102518355 1911689 3350 0 0 37182631 38448556 0 0 0 45352862 60030893 84447182 98482799 3551312 4035556 74377425 73984378 34191388 31339829 40186037 42644549 X WE ARE DEVOTED TO THE HEALTH AND WELL-BEING OF OUR REGIONAL COMMUNITIES BY PROVIDING EXCEPTIONAL CARE TO EVERY PATIENT EVERY DAY WITH A SPIRIT OF WARMTH, COMPASSION AND PERSONAL PRIDE. WE ACHIEVE THIS THROUGH ADVANCED AND EFFICIENT MEDICAL CARE WITH STRONG SELF-GOVERNANCE. 0 0 79727384 3350 100919060 TO PROVIDE BENEVOLENT AND CHARITABLE SERVICES FOR THE SICK, INFIRM, AND AFFLICTED RESIDENTS OF WALKER COUNTY THROUGH THE ESTABLISHMENT, MAINTENANCE, SUPPORT, AND OPERATION OF A HOSPITAL. 79727384 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 535 0 1 728 1 0 0 0 0 0 0 0 0 0 0 X 17 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X SHANNON L BROWN 9364352230 110 MEMORIAL HOSPITAL DRIVE HUNTSVILLE TX 77340 DAVID A PRIER MEMBER 1.00 X 0 0 0 NANCY C GAERTNER SECRETARY 1.00 X 0 0 0 DONALD H JOHNSON FINANCE CHAIR 1.00 X 0 0 0 SHANNON L BROWN CEO 40.00 1.00 X X 413731 0 8602 SAM H BURRIS MEMBER 1.00 X 0 0 0 TIMOTHY J DEAHL VICE PRESIDENT 1.00 X 0 0 0 WILLIAM W DURHAM MEMBER 1.00 X 0 0 0 JOHN D KNIGHT MEMBER 1.00 X 0 0 0 MICHAEL J LECOURSE MEMBER 1.00 X 0 0 0 DOYLE WAYNE SCOTT PRESIDENT 1.00 X 0 0 0 URMIL R SHUKLA MEMBER 1.00 X 0 0 0 ROSA M MARTINEZ-READORE MEMBER 1.00 X 0 0 0 HELEN A WATKINS MEMBER 1.00 X 0 0 0 REAGAN COOKSEY MEMBER 1.00 X 0 0 0 DANA GIBSON MEMBER 1.00 X 0 0 0 MORRIS JOHNSON MEMBER 1.00 X 0 0 0 JACK CHOATE MEMBER 1.00 X 0 0 0 GUY L GROS CFO 40.00 1.00 X 284390 0 15810 SHEILA HOGUE ARD CNO 40.00 X 200670 0 26545 ELIZABETH A ROGERS RN 40.00 X 149576 0 4965 DAWN A LAWRENCE RN 40.00 X 146020 0 3104 LILLIAN M GULLEDGE-WARD RN 40.00 X 129393 0 9748 BRENDA RAY RN 40.00 X 129065 0 3869 JULIE M PICKENS RN 40.00 X 124173 0 5017 1577018 0 77660 28 0 1 0 CARDINAL HEALTH 411 INC 13651 DUBLIN CT STAFFORD TX 77477 MEDICAL SUPPLIERS 2304613 OWENS AND MINOR 2700 BRITIMOORE HOUSTON TX 77043 MEDICAL SUPPLIERS 2118206 MORRISON MANAGEMENT SPECIALISTS INC PEACHTREE DUNWOODY ROAD ATLANTA GA 30342 FOOD SERVICES 1655636 HSS SYSTEMS LLC PO BOX 550 NASHVILLE TN 37202 PATIENT ACCOUNTS SERVICES 1362795 CALIFORNIA FIRST NATIONAL BANK 18201 VON KARMAN AVE 8TH FLOOR IRVINE CA 92612 LOAN SERVICES 1238328 78 40574 40574 ROUTINE & ANCILLARY SERVICES 621990 100751485 100751485 EDUCATION NURSING REVENUE 621990 167575 167575 100919060 144403 144403 68677 68677 50556 0 50556 50556 50556 3592961 3592179 5325 782 -5325 -4543 -4543 MEANINGFUL USE 900099 1204586 1204586 OTHER INCOME 900099 62542 62542 MEDICAL RECORDS REVENUE 900099 17984 17984 14516 14516 1299628 102518355 100919060 0 1558721 3350 3350 949748 802825 146923 30083434 25429637 4653797 732580 619253 113327 4522836 3823170 699666 2159958 1825820 334138 468075 468075 518046 518046 7396568 6176479 1220089 134806 113952 20854 486566 222031 264535 445022 115926 329096 1227109 294243 932866 16246 16246 109912 79542 30370 675483 675483 4800301 4800301 429706 429706 BAD DEBT EXPENSE 17570478 17570478 MEDICAL SUPPLIES 10513697 9983616 530081 PURCHASES SERVICES 9471700 5288603 4183097 EQUIPMENT RENTAL 2975809 1319854 1655955 2791369 1242058 1549311 98482799 79727384 18755415 0 3951287 1353126 4396259 7620506 13321075 10980500 1908194 1987038 818713 871231 75847159 49948487 25789645 25898672 5000000 0 10493524 10636435 8698728 14636870 74377425 73984378 12264092 13381547 16682533 11379459 5244763 6578823 34191388 31339829 X 40056978 42512642 129059 131907 40186037 42644549 74377425 73984378 X 4035556 -26752 -1550294 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2452 0 0 0 0 0 0 0 1 2452 0 0 0 2452 0 PART II-B, LINE 1: AMOUNT REPORTED IN PART II-B, QUESTION 1F REPRESENTS PORTION OF DUES PAID TO TRADE ASSOCIATIONS THAT IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 851223 851223 20192164 10954625 9237539 2118688 1598251 520437 51921140 37395611 14525529 763944 763944 25898672 ESTIMATED DUE TO THIRD PARTIES 8524097 DUE FROM AFFILIATE 4146585 ASSETS LIMITED AS TO USE 1966188 14636870 PENSION LIABILITY 6457144 ASSET RETIREMENT OBLIGATION 121679 6578823 84918277 -26752 -26752 84945029 17573326 17573326 102518355 80912321 0 80912321 17570478 17570478 98482799 PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE IN AUDIT REVENUE 17,570,478. INVESTMENT INCOME RECORDED TO NET ASSETS 2,848. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE IN AUDIT REVENUE 17,570,478. 1 1 X 1 X 1 X 1 1 1 0 1 1 1947274 1947274 0.02410 6371125 4816760 1554365 0.01920 8318399 4816760 3501639 0.04330 448448 448448 0.00550 604094 172180 431914 0.00530 1626626 1626626 0.02010 1026157 1026157 0.01270 3705325 172180 3533145 0.04360 12023724 4988940 7034784 0.08690 1 17570478 4392620 20401457 20865867 -464410 X 1 1 1 HUNTSVILLE HEART & VASCULAR CENTER LLC HEART & VASCULAR CENTER 0.51000 1 1 WALKER COUNTY HOSPITAL CORPORATION 110 MEMORIAL HOSPITAL DRIVE HUNTSVILLE TX 77340 X X X WALKER COUNTY HOSPITAL CORPORATION 1 0 0 1 X X X X X X X X X 14 1 0 0 1 X HTTP://WWW.HUNTSVILLEMEMORIAL.COM 1 14 1 HTTP://WWW.HUNTSVILLEMEMORIAL.COM 0 0 1 X 100.000000000000 200.000000000000 X X X X X X 1 1 X X X X 1 X HTTP://WWW.HUNTSVILLEMEMORIAL.COM X HTTP://WWW.HUNTSVILLEMEMORIAL.COM X HTTP://WWW.HUNTSVILLEMEMORIAL.COM X X X X X 1 X 0 X X X 1 X 0 0 PART V, SECTION A: WALKER COUNTY HOSPITAL CORPORATION HAS ONE FACILITY THAT INCLUDES THE ACUTE CARE HOSPITAL, I/P REHAB, AMBULATORY SURGERY CENTER, O/P IMAGING CENTER, AND RURAL HEALTH CARE CLINIC. WALKER COUNTY HOSPITAL CORPORATION HAS THE STAND-ALONE ER AND FOUR CLINIC LOCATIONS THAT INCLUDES THE WOUND CARE CLINIC, RURAL HEALTH CLINIC MADISONVILLE, MADISONVILLE FREE STANDING ER, RURAL HEALTH CLINIC RIVERSIDE, COLDSPRING CLINIC, AND WOMEN'S CENTER.NEEDS ASSESSMENTIN THE PAST, HUNTSVILLE MEMORIAL HOSPITAL HAS CONTRACTED WITH A 3RD PARTY VENDOR TO CONDUCT A COMMUNITY NEEDS ASSESSMENT AND MARKET ANALYSIS. THE COMMUNITY ASSESSMENT IS EVALUATED AND REPORTED EVERY THREE (3) YEARS AND THE MARKET ANALYSIS EVERY 1-2 YEARS AS NEEDED. AFTER DATA IS GATHERED AND FULL ASSESSMENT COMPLETED, THIS INFORMATION IS REPORTED TO THE HOSPITAL LEADERSHIP TEAM AND BOARD OF DIRECTORS. HOSPITAL LEADERS UTILIZE THE INFORMATION GATHERED IN BOTH OF THESE REPORTS TO FORMAT OUR STRATEGIC PLAN FOR THE NEXT FISCAL YEAR, AS WELL AS A FIVE YEAR PLAN. PATIENT EDUCATION OF ELIGIBILITY OF ASSISTANCETHE PATIENT IS ENCOURAGED TO APPLY FOR CHARITY AS EARLY AS POSSIBLE IN THE ACCOUNT MANAGEMENT PROCESS. CHARITY APPLICATION AND QUALIFICATIONS GUIDELINES ARE GIVEN UP FRONT IN REGISTRATION. THE SELF PAY BALANCES (AFTER A SIGNIFICANT STANDARD DISCOUNT IS APPLIED) ARE SENT TO A MEDICAID ELIGIBILITY COMPANY, WHO SCREENS PATIENTS FROM DAY 1 TO DAY 60. THE SELF PAY BALANCES ARE RETURNED IF THE COMPANY IS UNABLE TO REACH THE PATIENT OR THE PATIENT DOES NOT QUALIFY. SELF PAY BALANCES THAT ARE RETURNED ARE SENT TO AN EARLY OUT COMPANY, WHO HAS OUR CHARITY GUIDELINES, IF THE PATIENT EXPRESSES AN INABILITY TO PAY, THEY ARE REFERRED TO THE HOSPITAL FOR SCREENING. ONCE A COMPLETED APPLICATION IS RECEIVED AND APPROVED, ANY ACCOUNT BALANCES ARE ADJUSTED ACCORDING TO THE LEVEL OF CHARITY THE PATIENT HAS QUALIFIED FOR. IF THE ACCOUNT IS WITH A COLLECTION AGENCY, IT IS RETURNED TO THE HOSPITAL.COMMUNITY INFORMATIONHUNTSVILLE MEMORIAL HOSPITAL IS A JOINT COMMISSION-ACCREDITED, NOT-FOR-PROFIT ACUTE CARE COMMUNITY HOSPITAL. SINCE 1927, WE HAVE PROVIDED CHARITABLE HEALTH CARE SERVICES, DELIVERING QUALITY HEALTHCARE TO THE RESIDENTS OF WALKER COUNTY AND THE SURROUNDING COMMUNITIES. FOUNDED IN 1835, HUNTSVILLE IS ONE OF TEXAS' OLDEST CITIES AND THE HOME OF SAM HOUSTON, THE FIRST AND THIRD PRESIDENT OF THE REPUBLIC OF TEXAS. WE ARE HOME TO SAM HOUSTON STATE UNIVERSITY AND THE TEXAS DEPARTMENT OF CRIMINAL JUSTICE (THE ONLY STATE AGENCY WITH HEADQUARTERS OUTSIDE OF AUSTIN). THE CITY OF HUNTSVILLE IS PART OF WALKER COUNTY IN EAST TEXAS, APPROXIMATELY 70 MILES NORTH OF HOUSTON AND 170 MILES SOUTH OF DALLAS VIA INTERSTATE 45. IT IS ON TEXAS HIGHWAY 30 (WEST TO BRYAN-COLLEGE STATION) AND HIGHWAY 190 (EAST TO LIVINGSTON). OTHER CITIES IN WALKER COUNTY INCLUDE NEW WAVERLY AND RIVERSIDE. HUNTSVILLE COVERS 31 SQUARE MILES, WHILE WALKER COUNTY INCLUDES 790 SQUARE MILES. THE POPULATION OF HUNTSVILLE IS 35,078, NEW WAVERLY IS 950, AND RIVERSIDE IS 425. THE POPULATION IN WALKER COUNTY IS 61,758. WALKER COUNTY IS LOCATED NEAR LAKE LIVINGSTON AND LAKE CONROE AND IS SURROUNDED BY THE SAM HOUSTON NATIONAL FOREST. WALKER COUNTY IS PROUD TO HOST A CULTURALLY DIVERSE COMMUNITY. THE POPULATION DENSITY IS 78 PEOPLE PER SQUARE MILE (30/KM^2). THERE ARE 21,099 HOUSING UNITS AT AN AVERAGE DENSITY OF 27 PER SQUARE MILE (10/KM^2). THE RACIAL MAKEUP OF THE COUNTY IS 67.9% WHITE, 23.88% BLACK OR AFRICAN AMERICAN, 0.35% NATIVE AMERICAN, 0.77% ASIAN, 0.05% PACIFIC ISLANDER, 4.42% FROM OTHER RACES, AND 1.41% FROM TWO OR MORE RACES. 14.11% OF THE POPULATION ARE HISPANIC OR LATINO OF ANY RACE.PROMOTION OF COMMUNITY HEALTHHUNTSVILLE MEMORIAL HOSPITAL'S COMMITMENT TO CHARITABLE CARE GOES BACK TO THE 1927 HOSPITAL CHARTER PROMISING "BENEVOLENT AND CHARITABLE" SERVICES FOR THE "SICK AND INFIRM." OUR GOAL IS TO EDUCATE AND BUILD AWARENESS, PROMOTING HEALTHY LIFESTYLES IN WALKER COUNTY. WE BELIEVE IN GIVING BACK TO THE COMMUNITY THROUGH A NUMBER OF VALUABLE HEALTH RESOURCES SUCH AS EDUCATIONAL MATERIALS, HANDS-ON CLASSES AND INFORMATIVE EVENTS. ON A MONTHLY BASIS, THE HOSPITAL HOLDS FREE COMMUNITY EDUCATION SESSIONS THAT ARE OPEN TO THE PUBLIC. THESE FORUMS PROVIDE CITIZENS A CHANCE TO DETECT A HEALTH THREAT AT ITS EARLIEST, MOST TREATABLE STAGE OR A WAY TO LEARN MORE ABOUT A LOVED ONE'S ILLNESS. EACH SESSION FEATURES A LOCAL PHYSICIAN AS THE KEY SPEAKER AND IS ALSO ASSOCIATED WITH A MEDICAL SCREENING. NOT ONLY DO WE PROVIDE ADVANCED CARE WITH A FRIENDLY TOUCH, WE ALSO FOCUS ON GIVING BACK TO THE GREAT COMMUNITY OF WALKER COUNTY EACH AND EVERY YEAR. WE PROVIDE REDUCED- OR NO-COST CARE FOR THOSE WITH FINANCIAL CHALLENGES. WE EDUCATE AND PRODUCE TOP-NOTCH NURSES THROUGH OUR ACCREDITED JOE G. DAVIS SCHOOL OF VOCATIONAL NURSING. WE RECRUIT EXPERT PHYSICIANS INTO OUR OPEN MEDICAL STAFF. UNDER THE LEADERSHIP OF OUR BOARD OF DIRECTORS, AND THROUGH THE DEDICATION OF OUR PROFESSIONAL HEALTH CARE STAFF, HUNTSVILLE MEMORIAL HOSPITAL IS SETTING THE STANDARD IN QUALITY HEALTH CARE TODAY. HUNTSVILLE MEMORIAL HOSPITAL IS ALSO ABLE TO GAIN VALUABLE INSIGHT FROM LOCAL COMMUNITY LEADERS WHO SERVE ON OUR FOUNDATION BOARD AND COMMUNITY ADVISORY BOARD.THE HUNTSVILLE MEMORIAL HOSPITAL MEDICAL CLINIC WAS ESTABLISHED IN 1992 TO MEET THE PRIMARY HEALTH CARE NEEDS OF THE RESIDENTS OF WALKER COUNTY. IT IS AN AMBULATORY ACUTE CARE CLINIC THAT PROVIDES CARE FOR PATIENTS OF ALL AGES. SERVICES INCLUDE PEDIATRIC CARE, ADOLESCENT MEDICINE AND ADULT MEDICINE. WALKER COUNTY HOSPITAL CORPORATION PART V, SECTION B, LINE 5: THE ORGANIZATION GATHERED INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY BY TELEPHONE INTERVIEWS WITH THE TEXAS AGRILIFE EXTENSION, WALKER COUNTY HOSPITAL DISTRICT, A HEALTH/CSCOPE SPECIALIST, AND THE HUNTSVILLE INDEPENDENT SCHOOL DISTRICT NURSE DIRECTOR. GATHERED DATA WAS REVIEWED TO IDENTIFY HEALTH NEEDS OF THE COMMUNITY. WALKER COUNTY HOSPITAL CORPORATION PART V, SECTION B, LINE 22D: THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE CALCULATED USING A SLIDING SCALE BASED UPON FEDERAL POVERTY GUIDELINES. IN ALL CASES, AMOUNTS CHARGED TO PATIENTS WILL BE BELOW THE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE, THE AVERAGE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATE, AND MEDICARE RATES. SCHEDULE H, PART V, LINE 18, 19, & 20 NEITHER HUNTSVILLE MEMORIAL HOSPITAL, NOR THIRD PARTIES AUTHORIZED BY HMH, TAKE ANY ACTIONS UPON NON-PAYMENT FROM A PATIENT BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY. PART V, SECTION B, LINE 8 THE IMPLEMENTATION STRATEGY IS INCLUDED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IS POSTED ONLINE AT THE FOLLOWING WEBSITE ADDRESS:HTTP://WWW.HUNTSVILLEMEMORIAL.COM/RES/FILES/12/HMH%20FY2014%20COMMUNITY%20BENEFIT%20PLAN.PDF PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY WALKER COUNTY HOSPITAL CORPORATION PART V, SECTION B, LINE 16A WEBSITE: HTTP://WWW.HUNTSVILLEMEMORIAL.COM WALKER COUNTY HOSPITAL CORPORATION PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.HUNTSVILLEMEMORIAL.COM WALKER COUNTY HOSPITAL CORPORATION PART V, SECTION B, LINE 16C WEBSITE: HTTP://WWW.HUNTSVILLEMEMORIAL.COM 9 HUNTSVILLE HEART & VASCULAR CENTER LLC 110 MEMORIAL HOSPITAL DRIVE HUNTSVILLE TX 77340 HEART & VASCULAR CENTER FREE STANDING ER 3301 EAST MAIN STREET MADISONVILLE TX 77864 FREE STANDING ER HUNTSVILLE MEMORIAL AUXILIARY 110 MEMORIAL HOSPITAL DRIVE HUNTSVILLE TX 77340 AUXILIARY HMH PHYSICIAN ORGANIZATION 129 MEDICAL PARK LANE HUNTSVILLE TX 77340 ORTHOPEDIC PHYSICIAN OFFICE RURAL HEALTH CLINIC MADISONVILLE 1613 EAST MAIN HUNTSVILLE TX 77340 CLINIC WOUND CARE CLINIC 116C MEDICAL PARK LANE HUNTSVILLE TX 77340 WOUND CLINIC PHYSICIAN OFFICES-DRBRUCE &DRWARRIER 125 MEDICAL PARK LANE SUITE D HUNTSVILLE TX 77340 PHYSICIAN OFFICES RURAL HEALTH CLINIC RIVERSIDE 3638 HIGHWAY 19 HUNTSVILLE TX 77320 CLINIC WOMEN'S CENTER 123 MEDICAL PARK SUITE B HUNTSVILLE TX 77340 MAMMOGRAPHY CLINIC PART I, LINE 3C: GRADUATED SCALE UP TO 200% OF FPG TO DETERMINE DISCOUNT. PART I, LINE 6A: HUNTSVILLE MEMORIAL HOSPITAL AND THE MATTHEWS GROUP WORK TOGETHER TO PREPARE THE ANNUAL COMMUNITY BENEFIT REPORT. HUNTSVILLE MEMORIAL HOSPITAL'S COMMITMENT TO CHARITABLE CARE GOES BACK TO OUR 1927 HOSPITAL CHARTER PROMISING "BENEVOLENT AND CHARITABLE" SERVICES FOR THE "SICK, INFIRM AND AFFLICTED." WE KEPT THIS PROMISE EVERY YEAR BY HELPING OUR COMMUNITY THROUGH EDUCATIONAL PROGRAMS AND SUPPORT GROUPS. IN ADDITION, HMH INCURRED COSTS EXCEEDING $3 MILLION FROM ITS CHARITY CARE PROGRAMS AND OVER $2 MILLION IN UNREIMBURSED COSTS FROM MEDICARE AND STATE MEDICAID CARE. ALL INFORMATION REGARDING HUNTSVILLE MEMORIAL HOSPITAL'S COMMUNITY BENEFIT REPORT CAN BE LOCATED ON THE EXTERNAL WEBSITE. PART I, LN 7 COL(F): BAD DEBT EXPENSE OF $17,570,478 WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT WAS SUBTRACTED FROM TOTAL EXPENSE FOR THE CALCULATION OF "PERCENT OF TOTAL EXPENSE" IN THIS COLUMN.IN ADDITION TO CHARITY CARE PROVIDED BY THE HOSPITAL TO RESIDENTS OF WALKER COUNTY, THE WALKER COUNTY HOSPITAL DISTRICT HAS A SPECIFIC INDIGENT CARE PROGRAM FOR WALKER COUNTY RESIDENTS THAT PROVIDES ADDITIONAL CHARITY CARE RESOURCES TO THE COMMUNITY OUTSIDE HOSPITAL CARE. THE HOSPITAL PROVIDES CARE TO PATIENTS QUALIFYING UNDER THE COUNTY'S INDIGENT CARE PROGRAM. IF PATIENTS DO NOT QUALIFY FOR THE COUNTY'S PROGRAM, THEY ARE THEN ABLE TO APPLY TO THE HOSPITAL'S CHARITY CARE PROGRAM. THE COUNTY'S INDIGENT CARE PROGRAM PROVIDES ADDITIONAL CHARITY CARE RESOURCES TO THE COMMUNITY FOR NON-HOSPITAL RELATED HEALTHCARE SERVICES REDUCING THE OVERALL COMMUNITY BENEFIT PERCENTAGE OF THE HOSPITAL FOR SERVICES IT WOULD HAVE PROVIDED WERE THE PROGRAM NOT IN PLACE. THE ORGANIZATION BELIEVES THE COMMUNITY BENEFIT AS A PERCENTAGE OF EXPENSES REPORTED IN SCHEDULE H, PART I, LINE 7 IS REASONABLE GIVEN THE ADDITIONAL CHARITY CARE RESOURCES TO THE COMMUNITY PROVIDED BY THE WALKER COUNTY HOSPITAL DISTRICT. PART I, LINE 7 THE ORGANIZATION CHANGED THE END DATES OF THE COST REPORTS FROM OCTOBER 31 TO JUNE 30 IN 2014 TO MATCH THE ORGANIZATION'S ACCOUNTING PERIOD; THE COST REPORT FOR THE PERIOD JULY 1, 2014 THROUGH JUNE 30, 2015 HAS BEEN USED FOR THE CURRENT YEAR'S TAX RETURN. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE MEDICARE SHORTFALL WAS COMPUTED USING THE ANNUAL MEDICARE COST REPORT FOR THE PERIOD 07/01/14 THRU 06/30/15. THE MEDICAL CENTER USES COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. THE SHORTFALL BENEFITS THE COMMUNITY BY LESSENING THE BURDEN OF GOVERNMENT. IN ADDITION, THE STATE OF TEXAS TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT FOR MEETING STATUTORY REQUIREMENTS FOR CHARITY CARE AND COMMUNITY BENEFIT. PART III, LINE 9B: THE HOSPITAL SHALL CONTRIBUTE APPROPRIATE RESOURCES, ADVOCACY AND COMMUNITY SUPPORT TO PROMOTE THE HEALTH STATUS OF THE COMMUNITY, WHICH IT SERVES, WITHIN ITS ECONOMIC ABILITY TO DO SO. CHARITY CARE WILL BE PROVIDED TO PATIENTS WITH A DEMONSTRATED INABILITY TO PAY. THE PURPOSE OF THIS POLICY IS TO ESTABLISH CRITERIA FOR DETERMINING IF A PATIENT'S ACCOUNT QUALIFIES FOR A CHARITY CARE DISCOUNT. THE AMOUNT OF CHARITY CARE TO BE MADE AVAILABLE, AS WELL AS ANY OTHER CHANGES TO THIS POLICY SHALL BE ASSESSED AND DETERMINED BY THE HOSPITAL'S CHIEF EXECUTIVE OFFICER ON AN ANNUAL BASIS, AND WILL ADHERE TO STATE GUIDELINES FOR NON-PROFIT FACILITIES, IF APPLICABLE. THE AMOUNT OF CHARITY CARE AS WELL AS THE OTHER TERMS OF THIS POLICY MAY BE CHANGED BY THE HOSPITAL'S CHIEF EXECUTIVE OFFICER. PART III, LINE 2: EXPLANATION: THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS.THE DECREASE IN WRITE-OFFS YEAR OVER YEAR IS DUE TO THE SIGNIFICANT WRITE-OFFS IN FISCAL YEAR 2014 OF AGED RECEIVABLES, WHICH WERE NOT REQUIRED IN FISCAL YEAR 2015.THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS APPROXIMATELY 100 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT BOTH JUNE 30, 2015 AND 2014. THE HOSPITAL'S WRITE-OFFS DECREASED FROM APPROXIMATELY $21,442,000 FOR THE YEAR ENDED JUNE 30, 2014 TO APPROXIMATELY $7,235,000 FOR THE YEAR ENDED JUNE 30, 2015. THE DECREASE IN WRITE-OFFS RESULTED FROM A SUBSTANTIAL INCREASE IN DISCOUNTS ON UNINSURED CHARGES IN FISCAL YEAR 2015, WHICH REDUCED SELF-PAY RECEIVABLES, AND THE TIMING AND AMOUNT OF RECEIVABLES BEING WORKED, DUE TO A CHANGE IN THIRD-PARTY BUSINESS OFFICE ADMINISTRATORS. PART III, LINE 3: EXPLANATION: AMOUNTS REPORTED ON LINE 3 ARE THE ORGANIZATION'S ESTIMATE OF THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO CHARITY CARE PATIENTS, ESTIMATED AT 25%. X X X X 0 0 0 0 0 1 1 0 0 SHANNON L BROWN CEO 305458 0 108273 0 0 0 8404 0 198 0 422333 0 0 0 GUY L GROS CFO 223859 0 60531 0 0 0 4918 0 10892 0 300200 0 0 0 SHEILA HOGUE ARD CNO 158645 0 42025 0 0 0 5163 0 21382 0 227215 0 0 0 ELIZABETH A ROGERS RN 149123 0 453 0 0 0 4885 0 80 0 154541 0 0 0 PART I, LINE 6 THE INCENTIVE PROGRAM FOR EXECS AND EMPLOYEES ARE BASED ON EARNINGS AND QUALITY METRICS. FORM 990, PART VI, SECTION B, LINE 11 THE DETAILED REVIEW OF THE FORM 990 IS CONDUCTED BY THE CFO FOLLOWING THE PREPARATION AND REVIEW OF THE RETURN BY THE ORGANIZATION'S PAID PREPARER. AN ELECTRONIC COPY OF THE FINAL FORM 990 IS EMAILED TO EACH BOARD MEMBER PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION FOLLOWS A CONFLICT OF INTEREST DISCLOSURE PROCESS WHICH REQUIRES ALL OFFICERS, DIRECTORS, KEY EMPLOYEES, HIGHLY COMPENSATED EMPLOYEES AND OTHER MANAGEMENT OFFICIALS ("COVERED PERSONS") TO DISCLOSE POTENTIAL CONFLICTS. PURSUANT TO THE POLICY, A DISCLOSURE STATEMENT IS CIRCULATED ANNUALLY TO COVERED PERSONS IN WHICH THE INDIVIDUAL MUST DISCLOSE TRANSACTIONS THAT MAY RESULT IN A CONFLICT. COVERED PERSONS ARE ALSO ENCOURAGED TO NOTIFY THE BOARD, APPROPRIATE MANAGEMENT PERSONNEL, CHIEF COMPLIANCE OFFICE, GENERAL COUNSEL, OR THE AUDIT AND COMPLIANCE COMMITTEE OF THE GOVERNING BODY AS NECESSARY. WHEN NECESSARY, THE BOARD CHAIR OR APPROPRIATE BOARD COMMITTEE MAY APPOINT A DISINTERESTED PERSON(S) OR COMMITTEE TO INVESTIGATE THE POTENTIAL CONFLICT OF INTEREST AND RECOMMEND ALTERNATIVES TO THE APPLICABLE TRANSACTION OR ARRANGEMENT OR OTHERWISE DETERMINE IF THE CONFLICT CAN BE RESOLVED. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLY UNDER THE CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTEREST OF THE ORGANIZATION, AND WHETHER IT IS REASONABLE. THE GOVERNING BOARD OR COMMITTEE MAKES THE DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. ANY MEMBER OF THE BOARD OPERATING UNDER A CONFLICT IS NOT PERMITTED TO BE PRESENT OR OTHERWISE PARTICIPATE IN THE VOTE ON ANY MATTER TO WHICH THE CONFLICT RELATES. IF THE GOVERNING BOARD OR COMMITTEE OF THE ORGANIZATION HAS REASONABLE CAUSE TO BELIEVE THAT A COVERED PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST AND AFTER INVESTIGATION THE BOARD OR COMMITTEE DETERMINES THAT THE COVERED PERSON FAILED TO DISCLOSE A CONFLICT OF INTEREST, THE ORGANIZATION TAKES APPROPRIATE DISCIPLINARY OR CORRECTIVE ACTION, WHICH MAY INCLUDE, TERMINATION OF THE INDIVIDUAL'S MEMBERSHIP, EMPLOYMENT, OR CONTRACT. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USED AON HEWITT TO DEVELOP THE COMPENSATION PLAN AND AON HEWITT UTILIZED NUMEROUS MARKET SURVEYS TO ESTABLISH THE PLAN. THE PLAN WAS DEVELOPED BY AN INDEPENDENT PERSON AND APPROVED BY THE FINANCE COMMITTEE AND BOARD. HMH ALSO UTILIZES SALARY REVIEWS AND SURVEYS FOR COMPARISON WHEN DETERMINING COMPENSATION OF HIGHLY COMPENSATED EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTERET POLICY AVAILABLE AT ITS BUSINESS OFFICE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY -1,550,294. FORM 990, PART V, LINE 3A THE TAXPAYER HAS DETERMINED IN GOOD FAITH THAT THE TAXPAYER DOES NOT HAVE ANY ACTIVITIES GENERATING UNRELATED BUSINESS TAXABLE INCOME ( AS DEFINED IN IRC SECTION 152 (A)) IN THE CURRENT YEAR. THEREFORE, THE TAXPAYER IS NOT REQUIRED TO FILE ANY RETURN OTHER THAN FORM 990. HUNTSTVILLE MEMORIAL HOSPITAL AUXILIARY 110 MEMORIAL HOSPITAL DRIVE HUNTSVILLE TX 77340 741508450 SUPPORT ORG TX 501(C)(3) 9 0 HUNTSVILLE MEMORIAL HOSPITAL FOUNDATION 110 MEMORIAL HOSPITAL DRIVE HUNTSVILLE TX 77340 273311765 SUPPORT ORG TX 501(C)(3) 11A 0 HMH PHYSICIAN ORGANIZATION 110 MEMORIAL HOSPITAL DRIVE HUNTSVILLE TX 77340 760500960 HEALTHCARE TX 501(C)(3) 3 HMH 1 HUNTSVILLE HEART & VASCULAR LLC 110 MEMORIAL HOSPITAL DRIVE HUNTSVILLE TX 77340 463408635 OUTPATIENT CARE TX HMH RELATED -424169 23800 0 1 0.51000 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0