2025-12-18T15:36:58-06:00 2025-06-30 742752212 MASSEY ITSCHNER & CO PC 820 MAIN STREET SUITE 101 KERRVILLE TX 78028 990 2024-07-01 742557820 SID PETERSON MEMORIAL HOSPITAL SIDP 8302587795 551 HILL COUNTRY DRIVE KERRVILLE TX 78028 LISA MEDOVICH CFO 8302587728 2025-12-18 1 1 CASEY T MIKESKA P01435690 8302575330 2025-12-18 2024 2025-03-06 01:10:19Z COREY EDMONDSON 551 HILL COUNTRY DRIVE KERRVILLE TX 78028 272191679 0 X WWW.PETERSONHEALTH.COM X 1990 TX THE HOSPITAL'S MISSION IS TO PROVIDE WORLD CLASS CARE TODAY, TOMORROW, ALWAYS IN DELIVERING EXCEPTIONAL, COMPASSIONATE, PATIENT-CENTERED CARE. 12 12 1622 0 0 0 4618344 2256874 200690315 226964261 6258745 6864888 1704694 2210137 213272098 238296160 114328 104306 0 0 102088273 113855336 0 0 528825 79049945 90757279 181252546 204716921 32019552 33579239 323259705 353644819 70956691 67294586 252303014 286350233 X PETERSON REGIONAL MEDICAL CENTER PROVIDES EXCEPTIONAL, COMPASSIONATE, PATIENT-CENTERED HEALTHCARE. 0 0 163926441 104306 217893194 PETERSON REGIONAL MEDICAL CENTER IS A PRIVATE, NOT-FOR-PROFIT COMMUNITY HOSPITAL IN KERRVILLE, TEXAS. KERRVILLE IS LOCATED IN KERR COUNTY, APPROXIMATELY 60 MILES NORTHWEST OF SAN ANTONIO AND 80 MILES SOUTH WEST OF AUSTIN. PETERSON REGIONAL MEDICAL CENTER SERVES THE COMMUNITIES AND RESIDENTS IN THE FOLLOWING COUNTIES: KERR, BANDERA, GILLESPIE, KIMBLE, EDWARDS AND REAL. PETERSON REGIONAL MEDICAL CENTER ANCHORS A 35-ACRE CAMPUS INCLUDING A 124-BED ACUTE CARE HOSPITAL PROVIDING SERVICES INCLUDING: 24/7EMERGENCY DEPARTMENT, WOMEN'S SERVICES (INCLUDING MATERNAL/NEWBORN), ACUTE INPATIENT REHABILITATION, ORTHOPEDICS, GENERAL SURGERY, DIAGNOSTIC IMAGING, INTENSIVE CARE UNIT, AND LABORATORY. ON THE SAME CAMPUS IS AN AMBULATORY CARE CENTER PROVIDING OUTPATIENT REHAB SERVICES, OUTPATIENT SURGERY, OUTPATIENT DIAGNOSTIC IMAGING AND HYPERBARIC WOUND CARE. PETERSON HOSPICE SERVICE AND PETERSON HOME CARE SERVICES ARE ALSO MEMBERS OF THE PETERSON REGIONAL FAMILY OF SERVICES BUT LOCATED OFF-SITE. 5091362 4849229 PETERSON HOME CARE PROVIDES A COMPREHENSIVE TEAM OF HEALTHCARE PROFESSIONALS TO THE RESIDENTS OF THE HILL COUNTRY, SPECIFICALLY KERR, GILLESPIE AND BANDERA COUNTIES. PETERSON HOME CARE IS A NOT-FOR-PROFIT ORGANIZATION PROVIDING A COMPREHENSIVE RANGE OF PROFESSIONAL SERVICES INCLUDING: NURSING CARE, PHYSICAL AND SPEECH THERAPY, OSTOMY AND WOUND CARE, IV ANTIBIOTICS, CHEMOTHERAPY, AIDE SERVICES AND MEDICATION MANAGEMENT. ALL SERVICES ARE COORDINATED THROUGH AN INTERDISCIPLINARY APPROACH TO PATIENT CARE AND ESTABLISHED UNDER A PLAN OF TREATMENT OF A PHYSICIAN. DIAGNOSTIC AND LABORATORY SERVICES, AS WELL AS MEDICAL AND SURGICAL SUPPLIES ARE ALSO PROVIDED IN CONJUNCTION WITH SKILLED CARE. HOME CARE HAD 1,554 ADMISSIONS DURING THE YEAR AND 24,164 VISITS. 5248451 6268050 PETERSON HOSPICE IS A DEPARTMENT OF PRMC AND IS LOCATED OFF CAMPUS. IT OPERATES AS ONE OF THE HOSPITAL'S MANY OUTREACHES FOR THE HILL COUNTRY COMMUNITIES IT SERVES. PETERSON HOSPICE IS THE ONLY NON-PROFIT HOSPICE IN THE HILL COUNTRY WITH A MISSION THAT NO ONE WILL BE DENIED HOSPICE CARE BECAUSE OF AN INABILITY TO PAY. IN ADDITION TO PROVIDING HOSPICE CARE, PETERSON HOSPICE ALSO PROVIDES THE FOLLOWING UNFUNDED COMMUNITY SERVICES: 1. NAVIGATING THE WATERS OF GRIEF A SIX WEEK GRIEF SUPPORT GROUP FOR ADULTS. THIS PROGRAM IS FACILITATED TWICE A YEAR BY A GRIEF EXPERT WHO IS A LICENSED MEDICAL SOCIAL WORKER (MSW). NAVIGATING THE WATERS OF GRIEF WORKS CLOSELY WITH HILL COUNTRY CLERGY AND THE LOCAL COMMUNITIES TO SERVE HOSPICE FAMILIES AS WELL AS OTHERS FACING THE LOSS OF A LOVED ONE OR FRIEND. 2. BRIDGING THE GAP A SIX WEEK GRIEF SUPPORT GROUP FOR CHILDREN AGES KINDER THROUGH 12TH GRADE. THIS PROGRAM GIVES THEM THE TOOLS THEY NEED TO WORK THROUGH THE GRIEVING PROCESS. THE PARENTS ATTEND AS WELL TO OPEN COMMUNICATION AND FEELINGS TO HELP THE CHILD DEAL WITH GRIEF AT THEIR AGE APPROPRIATE LEVEL. BTG WORKS WITH ALL HILL COUNTRY SCHOOLS AND THEIR COUNSELORS. THE LOCAL COMMUNITY SERVES AS FACILITATORS AND VOLUNTEERS FOR THIS EXCELLENT PROGRAM. 3. CAMP RAYS OF HOPE IS A STATEWIDE PROGRAM WHICH IS A WEEKEND RETREAT FOR GRIEVING CHILDREN THAT INCORPORATES THE PARENTS AS WELL. THE CHILDREN LEARN NEW WAYS TO COPE WITH THEIR LOSS, AND TO MEET OTHERS WITH SIMILAR CIRCUMSTANCES TO REMEMBER SPECIAL TIMES, TO MAKE NEW FRIENDS, AND TO HAVE FUN. 4. FLORAL PROGRAM IS A VOLUNTEER DRIVEN PROGRAM THAT DELIVERS FLOWERS TO OUR PATIENTS. THE LOCAL FLORISTS IN THE AREA DONATE THE FLOWERS AND VOLUNTEERS ARRANGE AND DELIVER THEM. VOLUNTEERS ALSO SUPPORT FAMILIES AND PATIENTS WITH THEIR VISITS. 5. PATHWAYS THIS VOLUNTEER OUTREACH OFFERS HOME BASED SOCIAL AND EMOTIONAL SUPPORT TO CLIENTS WITH AN ILLNESS THAT HAS A LIMITED LIFE EXPECTANCY BUT IS NOT YET HOSPICE APPROPRIATE. VOLUNTEERS HELP REDUCE THE ISOLATION AND VULNERABILITY THAT CLIENTS AND FAMILIES EXPERIENCE DURING A DIFFICULT TIME. EDUCATION IS AVAILABLE THROUGH PRMC RESOURCES REGARDING DISEASE PROCESSES, COPING STRATEGIES, ADVANCE DIRECTIVES, AND PRACTICAL AND SPIRITUAL ISSUES. THIS SUPPORT HELPS CLIENTS DEFINE THEIR QUALITY OF LIFE. 6. COMMUNITY SERVE PROGRAM OFFERING OPPORTUNITIES FOR CITIZENS TO FULFILL COURT OBLIGATIONS IN A BENEFICIAL MANNER. 367 ADMISSIONS ACCOUNTED FOR 38,423 PATIENT DAYS. 48959 56291 48959 56291 174315213 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 153 0 1622 1 1 1 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 X THE ORGANIZATION 8302587728 551 HILL COUNTRY DRIVE KERRVILLE TX 78028 BRIAN P BOWERS DIRECTOR 10.00 X 0 0 0 KRISTEN MCALEXANDER DIRECTOR 5.00 X X 0 0 0 JAMES A YOUNG MD DIRECTOR 5.00 X 0 0 0 KEITH WILLIAMS DIRECTOR 5.00 X 0 0 0 MARY LIZ EASTLAND CHAIR ELECT 5.00 X 0 0 0 KENDALL DAVISON DIRECTOR 5.00 X 0 0 0 ROSE BRADSHAW DIRECTOR 5.00 X 0 0 0 SYLVIA FRITZ DOBBS VICE CHAIR 5.00 X 0 0 0 THOMAS HOUDESHELL CHAIRMAN 5.00 X 0 0 0 TONI MANCHESTER DIRECTOR 5.00 X 0 0 0 MARK ARMSTRONG DIRECTOR 5.00 X 0 0 0 JEREMY WALTHER DIRECTOR 40.00 X 0 0 0 MICHAEL ROSS MD DIRECTOR 40.00 X 0 0 0 GAYE AVERY DIRECTOR 40.00 X 0 0 0 BRIAN ROBICHEAUX CIO 40.00 X 255406 0 52114 CORY EDMONSON CEO 40.00 X 725619 0 103598 DENTON GRUZENSKY CHIEF HUMAN RESOURCES OFFI 40.00 X 0 0 0 JOE PISZCZOR VP OF OPERATIONS 40.00 X 269644 0 70332 KAELI DRESSLER CNO 40.00 X 246047 0 71992 LISA MEDOVICH CFO 40.00 X 394936 0 100006 TRACY DAVIS VP OF POPULATION HEALTH 40.00 X 251880 0 33622 ANNE RAYMOND DIRECTOR OF PHARMACY 40.00 X 213759 0 44343 CHRISTOPHER GLANTON CMO 40.00 X 462165 0 74362 KAREN CLARK DIRECTOR OF MATERIALS MGMT 40.00 X 189994 0 54441 TIMOTHY RYE CHIEF STRATEGY DEVELOPMENT 40.00 X 217465 0 55982 3226915 0 660792 10 0 1 0 INTUITIVE SURGICAL INC 3410 CENTRAL EXPY SANTA CLARA CA 95051 6721606 MEDLINE INDUSTRIES INC 12002 GENERAL MILTON DR LAREDO TX 78045 5759749 SKILES GROUP LLC 1810 N GREENVILLE AVENUE RICHARDSON TX 75081 3049089 AYA HEALTHCARE INC 5930 CORNERSTONE CT W STE 300 SAN DIEGO CA 92121 2730011 HEALTH CAROUSEL LLC 4000 SMITH RD SUITE 410 CINCINNATI OH 45209 2695013 5 2124575 132299 2256874 NET PATIENT SERVICE REVENUE 621110 226032026 226032026 MANAGEMENT FEE REVENUE 900099 932235 932235 226964261 4093290 4093290 348596 1133737 240962 1133737 107634 0 107634 107634 35292418 32520820 2771598 2771598 2771598 MISCELLANEOUS 900099 1461225 1461225 MISCELLANEOUS 900099 641278 641278 2102503 238296160 229066764 0 6972522 64006 64006 40300 40300 3272142 1936249 1235726 100167 89445285 79694020 9644799 106466 15506711 10391071 5056749 58891 5631198 4949634 671897 9667 288578 150896 129718 7964 169246 10904 150633 7709 780683 780683 15220234 11970652 3195078 54504 1085474 126486 852434 106554 4629303 2836022 1781421 11860 2282091 1960700 321375 16 45997 31727 13753 517 1718814 1075351 636384 7079 9065807 6398908 2639365 27534 501346 401690 99656 MEDICAL SUPPLIES 37257690 36311236 945499 955 BAD DEBT EXPENSE 6685858 6685858 0 0 EQUIPMENT REPAIRS & MAI 6239863 5747476 491991 396 OTHER EXPENSES 3758343 2763658 969483 25202 1027952 768369 256239 3344 204716921 174315213 29872883 528825 15799756 6294135 24766631 27781911 4641768 5238055 2985161 3584339 256901076 124869647 118315438 132031429 155567721 178167467 1183230 547483 323259705 353644819 27865524 27330837 366627 462242 39737328 36226558 2987212 3274949 70956691 67294586 X 252041552 286102214 261462 248019 252303014 286350233 323259705 353644819 X 33579239 14017399 -13549419 X X 0 1 X 1 1 1 X 0 0 0 0 0 1 5890 0 0 0 5890 0 220000 220000 220000 220000 220000 220000 134138 -134138 132017 2437 316 134138 1.00000 0 1 1 6489350 6489350 159344712 68836546 90508166 4200138 936620 3263518 86866876 55096481 31770395 132031429 SELF- INSURANCE FUND 2717100 PROFESSIONAL LIABILITY 519366 RIGHT OF USE LIABILITY 38483 3274949 244158892 14017399 -6685859 7331540 236827352 780683 688125 1468808 238296160 198625080 1374700 1374700 197250380 780683 6685858 7466541 204716921 PART V, LINE 4: THE ENDOWMENT FUND WILL BE USED PRIMARILY TO FUND EQUIPMENT IMPROVEMENTS/UPGRADES AND SCHOLARSHIPS. A SMALL PORTION MAY ALSO BE USED FOR RECRUITMENT OF PHYSICIANS, NURSES AND OTHER ADVANCED PRACTICE PROVIDERS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE OFFSETTING AUDIT REVENUE -6,685,858. ROUNDING -1. PART XI, LINE 4B - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 2,062,824. RENTAL EXPENSE INCLUDED IN REVENUE -1,374,699. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE INCLUDED IN REVENUE FOR 990 1,374,699. ROUNDING 1. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE OFFSETTING AUDIT REVENUE 6,685,858. 1 1 1 X 1 X 1 1 0 1 1 16752488 8054509 8697979 0.04250 10198431 3261349 6937082 0.03390 10198431 3261349 6937082 0.03390 37149350 14577207 22572143 0.11030 63620 63620 0.00030 56646 56646 0.00030 120266 120266 0.00060 37269616 14577207 22692409 0.11090 0 6685858 2674343 61786834 74688040 -12901206 X 1 1 1 1 SID PETERSON MEMORIAL HOSPITAL 551 HILL COUNTRY DRIVE KERRVILLE TX 78028 WWW.PETERSONHEALTH.COM X X X PETERSON REGIONAL MEDICAL CENTER 0 0 1 X X X X X X X X X 25 1 0 0 1 X WWW.PETERSONHEALTH.COM X 1 22 1 WWW.PETERSONHEALTH.COM 0 1 X 200.000000000000 200.000000000000 X 1 1 X X X X 1 X WWW.PETERSONHEALTH.COM X WWW.PETERSONHEALTH.COM X WWW.PETERSONHEALTH.COM X X X X X X X 1 1 X X X 1 0 0 PETERSON REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: PETERSON HEALTH INCLUDED ALL LEVELS AND FACETS AND POPULATIONS OF THE KERRVILLE AREA COMMUNITY, AS WELL AS 7 OTHER REGIONS/COUNTIES TO SUCCESSFULLY AND COMPREHENSIVELY COMPLETE THE COMMUNITY HEALTH NEEDS ASSESSMENT. BROKEN INTO THREE MAIN PHASES, REPRESENTATIVES OF THE COMMUNITY WERE CULLED, CONTACTED, INTERVIEWED, INVITED TO MEETINGS AND A DIRECT PART OF THE CHNA SUMMIT AND REPORT AS FOLLOWS:- INFORMATION GATHERING, USING SECONDARY PUBLIC HEALTH SOURCES, OCCURRED IN MARCH 2025- 30 COMMUNITY MEMBERS, NOT-FOR-PROFIT ORGANIZATIONS REPRESENTING MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS, THE ELDERLY, HEALTH PROVIDERS, EDUCATION PROVIDERS, AND THE HEALTH DEPARTMENT PARTICIPATED IN TWO FOCUS GROUPS AND INDIVIDUAL INTERVIEWS FOR THEIR PERSPECTIVES ON COMMUNITY HEALTH NEEDS AND ISSUES IN APRIL 2025.- A COMMUNITY HEALTH SUMMIT WAS CONDUCTED ON MAY 22, 2025 WITH 50 COMMUNITY STAKEHOLDERS. THE AUDIENCE CONSISTED OF HEALTHCARE PROVIDERS, BUSINESS LEADERS, GOVERNMENT REPRESENTATIVES, SCHOOLS, NOT-FOR-PROFIT ORGANIZATIONS, EMPLOYERS AND OTHER COMMUNITY MEMBERS. PETERSON REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: A COLLABORATIVE VENTURE WHICH BROUGHT TOGETHER ALL OF THE CARE PROVIDERS, CITIZENS, GOVERNMENT, SCHOOLS, CHURCHES, NOT-FOR-PROFIT ORGANIZATIONS, AND BUSINESS AND INDUSTRY AROUND AN EFFECTIVE PLAN OF ACTION TOOK PLACE. PRMC SELECTED KEY ELEMENTS OF THE ASSESSMENT TO ADDRESS, AS SET FORTH IN THE IMPLEMENTATION PLAN, AND ENCOURAGED OTHER ORGANIZATIONS IN THE COMMUNITY TO DO THE SAME.BASED ON THE RESULTS OF THIS CHNA, PRMC SELECTED FOUR (4) OF THE IDENTIFIED SIGNIFICANT HEALTH NEEDS TO ADDRESS.1. MENTAL HEALTH2. ACCESS TO HEALTHCARE AND INSURANCE, COORDINATION OF RESOURCES3. HEALTHY EATING/LIVING - DECREASE OBESITY AND DIABETES4. SUBSTANCE ABUSEPRMC WILL MONITOR THE PROGRESS THROUGH THE HOSPITAL'S EXECUTIVE TEAM AND WILL ANNUALLY REPORT THE PROGRESS TO THEIR BOARD AND THE COMMUNITY. PETERSON REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE APPLICATION IS ALSO AVAILABLE IN SPANISH AT THE FOLLOWING WEBSITE: WWW.PETERSONHEALTH.COM/WP-CONTENT/DOWNLOADS/PLS2017-SPANISH.PDF 6 1 - PETERSON AMBULATORY CARE CENTER 260 CULLY DRIVE KERRVILLE TX 78028 AMBULATORY SURGICAL CENTER 2 - PETEERSON HOME CARE 250 CULLY DRIVE KERRVILLE TX 78028 HOME HEALTH SERVICES 3 - PETERSON HOSPICE 250 CULLY DRIVE KERRVILLE TX 78028 HOSPICE CARE 4 - KMP OUTREACH LAB 1331 BANDERA HWY KERRVILLE TX 78028 LAB DRAW SITE 5 - PETERSON COMMUNITY CARE CLINIC 823 JUNCTION HWY KERRVILLE TX 78028 RURAL HEALTH HOSPITAL BASED CLINIC 6 - AMANDA AND J DAVID WILLIAMS SURGERY CTR 535 HILL COUNTRY DR KERRVILLE TX 78028 AMBULATORY SURGERY CENTER PART I, LINE 3C: IN ADDITION TO FEDERAL POVERTY GUIDELINES, THE ORGANIZATION USED INSURANCE STATUS TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: BAD DEBT EXPENSE OF $6,685,858 WAS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT WAS SUBTRACTED FROM TOTAL EXPENSE FOR THE CALCULATION OF "PERCENT OF TOTAL" IN THIS COLUMN. SCHEDULE H, PART I, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: PATIENTS WHO HAVE OR WILL HAVE A PATIENT RESPONSIBILITY ARE APPROACHED BY PATIENT REGISTRATION STAFF TO MAKE FINANCIAL ARRANGEMENTS PRIOR TO OR AT THE TIME OF SERVICE. ANY PATIENT WHO CANNOT MAKE APPROPRIATE FINANCIAL ARRANGEMENTS IS REFERRED TO HOSPITAL RECEIVABLES SOLUTION (H.S.I.) (A GROUP CONTRACTED BY THE HOSPITAL TO ASSIST PATIENTS IN QUALIFYING FOR FINANCIAL ASSISTANCE) FOR POSSIBLE FINANCIAL ASSISTANCE FOR WHICH THEY MAY QUALIFY. IF PATIENT DOES NOT QUALIFY FOR ASSISTANCE THROUGH H.S.I., REGISTRATION STAFF OFFER AN INTERNAL FINANCIAL AID APPLICATION (CHARITY CARE) AND EXPLAIN THE PROCESS. H.S.I. CONTACT ALL REFERRED UNINSURED PATIENTS, NOT SEEN AT THE TIME OF HOSPITAL PRE-REGISTRATION OR AT REGISTRATION, BY SENDING A LETTER, CONTRACT BY PHONE, AND OR PERSONAL VISIT, INFORMING THEM OF FEDERAL, STATE OR LOCAL GOVERNMENT PROGRAMS THAT MAY ASSIST WITH UNPAID MEDICAL BILLS. THE PATIENT IS INSTRUCTED TO CALL OR COME BY THE OFFICE TO BE SCREENED FOR POSSIBLE ASSISTANCE. IF PATIENT IS POTENTIALLY ELIGIBLE, H.S.I. WILL ASSIST WITH THE APPLICATION PROCESS AND GATHERING OF NECESSARY VERIFICATION. IF NO ASSISTANCE IS AVAILABLE THROUGH THESE PROGRAMS, H.S.I. WILL OFFER A FINANCIAL AID APPLICATION (CHARITY CARE) FOR POSSIBLE ASSISTANCE WITH THE HOSPITAL BILL. AT THE TIME OF BILLING FOR PATIENTS WITH SELF PAY BALANCES, BUSINESS OFFICE INCLUDE LETTERS WHICH STATE TO CALL IF FINANCIAL ASSISTANCE IS NEEDED. WHEN PAYMENTS ARE NOT RECEIVED IN A TIMELY MANNER, A COURTESY CALL TO THE PATIENT IS ATTEMPTED TO MAKE PAYMENT ARRANGEMENTS. IF THE PATIENT STATES THAT THEY DO NOT HAVE MEANS TO PAY THE BILL, AN OFFER IS AGAIN MADE TO CONTACT H.S.I. FOR FINANCIAL ASSISTANCE OR WE OFFER TO MAIL OUR FINANCIAL AID APPLICATION. A POSTING IS DISPLAYED IN REGISTRATION AREAS THAT WE OFFER CHARITY CARE AND TO CONTACT THE BUSINESS OFFICE (PHONE NUMBER PROVIDED) FOR DETAILS. PART III, LINE 2: AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 3: AMOUNT REPORTED IN ITEM 3 IS THE ORGANIZATION'S ESTIMATE OF THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO CHARITY CARE PATIENTS ESTIMATED AT 40%. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE MEDICAL CENTER 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. FOR RECEIVABLES ASSOCIATED WI TH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE , THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS , IF NECESSARY . 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 MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS 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 STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE MEDICAL CENTER USES MEDICARE COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS (ROOM AND BOARD) BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. THE ORGANIZATION HAD A MEDICARE SHORTFALL IN THE AMOUNT OF $12,901,206 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: IF THE PATIENT QUALIFIES FOR CHARITY CARE PER WRITTEN HOSPITAL CRITERIA, THE QUALIFYING BALANCE IS WRITTEN OFF TO CHARITY CARE AND NO FURTHER COLLECTION EFFORTS ARE MADE. 1 KERR CONNECT PO BOX 290194 KERRVILLE TX 78029 821998719 501(C)(3) 10000 0 GENERAL SUPPORT EDUCATION ASSISTANCE PART I, LINE 2: IN ORDER TO BE ELIGIBLE TO RECEIVE FUNDS FROM PETERSON REGIONAL MEDICAL CENTER'S SCHOOL OR WORK STUDY PROGRAMS, THE FOLLOWING CRITERIA MUST BE MET: 1) A COPY OF THE STUDENT'S DEGREE PLAN FROM THE EDUCATIONAL INSTITUTION 2) A COPY OF THE BILLS 3) THE REQUESTED COURSES FOR THE SEMESTER 4) A CURRENT COPY OF THE STUDENT'S FAFSA CONFIRMATION 5) E-MAIL/MOX FROM THE UNIT MANAGER ACKNOWLEDGING THE STUDENT IS ENROLLING 6) PERSONAL DATA FROM CURRENT TO THIS SEMESTER 7) GRADES FROM ANY PREVIOUS PAID CLASSES 8) IF WORK STUDY, A COPY OF THE SIGNED PROMISSORY AGREEMENT 9) IF WORK STUDY, THE APPLICATION. EVERY STUDENT IS REQUIRED TO COMPLETE AND PRESENT THIS INFORMATION FOR EVERY SEMESTER THEY REQUEST SCHOLARSHIP FUNDS. THE REQUEST FOR FUNDS IS CONSIDERED ONLY AFTER ALL PAPERWORK IS TURNED IN AND PASSING GRADES FROM THE PREVIOUS SEMESTER FUNDS ARE PRESENTED. X X X X 0 1 0 0 0 0 0 0 0 CORY EDMONSON CEO 725619 0 0 0 0 0 53000 0 50598 0 829217 0 0 0 CHRISTOPHER GLANTON CMO 462165 0 0 0 0 0 27413 0 46949 0 536527 0 0 0 LISA MEDOVICH CFO 394936 0 0 0 0 0 52870 0 47136 0 494942 0 0 0 JOE PISZCZOR VP OF OPERATIONS 269644 0 0 0 0 0 23000 0 47332 0 339976 0 0 0 KAELI DRESSLER CNO 246047 0 0 0 0 0 28656 0 43336 0 318039 0 0 0 BRIAN ROBICHEAUX CIO 255406 0 0 0 0 0 8760 0 43354 0 307520 0 0 0 TRACY DAVIS VP OF POPULATION HEALTH 251880 0 0 0 0 0 30500 0 3122 0 285502 0 0 0 TIMOTHY RYE CHIEF STRATEGY DEVELOPMENT 217465 0 0 0 0 0 11900 0 44082 0 273447 0 0 0 ANNE RAYMOND DIRECTOR OF PHARMACY 213759 0 0 0 0 0 4123 0 40220 0 258102 0 0 0 KAREN CLARK DIRECTOR OF MATERIALS MGMT 189994 0 0 0 0 0 17371 0 37070 0 244435 0 0 0 PART I, LINE 4B PERSONS PARTICIPATING IN, OR RECEIVING PAYMENT FROM, A RETIREMENT PLAN: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SERP. AMOUNTS FOR THE CURRENT YEAR WERE AS FOLLOWS: PARTICIPANTS IN SERP REPORTED IN W-2 DEFERRED COMPENSATION ------------------------ --------------- --------------- KAELI DRESSLER 246,047 6,400 LISA MEDOVICH 394,936 22,500 CORY EDMONSON 725,619 22,500 INDIVIDUALS ARE NOT ELIGIBLE TO RECEIVE ANY FUNDS UNTIL AFTER 5 YEARS OF SERVICE OR RETIRE AFTER 3 YEARS OF PROGRAM IMPLEMENTATION. A CITY OF KERRVILLE TX HEALTH FACILITIES DEV CORP 203591155 492436AZ3 2015-11-24 59726042 TO REFINANCE 2005 BONDS 0 0 0 A 59726042 1053005 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: THE EXTERNAL ACCOUNTING FIRM PREPARES THE FORM 990 AND THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE ORGANIZATION INTERNALLY REVIEWS TRANSACTIONS FOR POSSIBLE CONFLICT ON A ROUTINE BASIS THROUGHOUT THE YEAR. ALL BOARD MEMBERS ARE COVERED UNDER THIS POLICY. THE BOARD REVIEWS ALL POSSIBLE CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15A REVIEW OF CEO OR TOP MANAGEMENT. OFFICIAL COMPENSATION: THE BOARD OF DIRECTORS USED AN OUTSIDE AGENCY TO CONDUCT A MARKET SURVEY. THE RESULTS OF THE SURVEY WERE USED TO DETERMINE THE CEO'S SALARY FOR THE YEAR. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CLASSIFICATION DIFFERENCE -13,446. TRANSFER TO AFFILIATES -13,535,968. ROUNDING -5. FORM 990, PART XII, LINE 2C: PROCESS HAS NOT CHANGED FROM PREVIOUS YEAR. PH EQUITY I LLC 551 HILL COUNTRY DR KERRVILLE TX 78028 933433321 REAL ESTATE HOLDING TX 6788 SID PETERSON MEMORIAL HOSPITAL PETERSON REGIONAL MEDICAL CENTER FDN 551 HILL COUNTRY DRIVE KERRVILLE TX 78028 742645149 SUPPORT TX 501(C)(3) LINE 12A, I SID PETERSON MEMORIAL HOSPITAL 1 PETERSON MEDICAL ASSOCIATES 551 HILL COUNTRY DRIVE KERRVILLE TX 78028 272184637 HEALTHCARE TX PRMC C 1.00000 1 0 0 1 0 0 0 0 0 0 1 0 1 0 1 1 0 0 1 1 PETERSON REGIONAL MEDICAL CENTER FOUNDATION C 2184541 FMV