2013-11-13T08:28:26-08:00 2012-12-31 Axley & Rode LLP 1307 S 1st St Lufkin TX 759014717 990 2012-01-01 750755367 Memorial Health System of East Texas MEMO 9366348111 P O Box 1447 Lufkin TX 75902 GARY N LOOPER 2013-11-12 true J LEON MANNING CPA P00045819 9366346621 2012 2016-02-24 21:20:13Z GARY N LOOPER 156 MAGNOLIA BEND LUFKIN TX 75904 130312613 false false X N/A X 1944 TX THE ORGANIZATION OPERATES AN ACUTE CARE HOSPITAL WITH 271 LICENSED BEDS, A CANCER CENTER, AN IMAGING CENTER, A REHABILITATION CENTER AND A DEDICATED HEART STROKE CARE FACILITY. 18 15 1140 66 0 2521664 2159487 114103590 126520680 2030790 479290 4212 22915 118660256 129182372 0 0 56814412 57934959 0 0 73964166 68868148 130778578 126803107 -12118322 2379265 250955939 250660919 150079986 151133986 100875953 99526933 THE MISSION IS TO SUPPORT, MANAGE & FURNISH FACILITIES TO PROVIDE QUALITY ACUTE HEALTHCARE SERVICES FOR THE CITIZENS OF ANGELINA, POLK, SAN AUGUSTINE & SURROUNDING COUNTIES REGARDLESS OF RACE, COLOR, GENDER, AGE, NATIONAL ORIGIN, OR, TO THE EXTENT OF ITS AVAILABLE RESOURCES, ABILITY TO PAY, & TO FACILITATE & ENCOURAGE EDUCATION & TRAINING ACTIVITIES TO PROMOTE THE HEALTH & WELFARE OF THOSE CITIZENS. false false 114483823 125879655 HOSPITAL SERVICES TO PATIENTS AND SERVICES TO THE COMMUNITY INCLUDE 35,995 PATIENT DAYS DURING THE YEAR. THIS ALSO INCLUDES 8,339 INPATIENT ADMISSIONS, 99,750 OUTPATIENT VISITS, 39,031 EMERGENCY ROOM VISITS AND 10,454 HOME HEALTH VISITS. 114483823 true true false false false false false false false false true false true true true false false true false false false false false false false false true true false false true true false false false false false false false false true true false false false false false true false false false false true 205 0 true 1140 true false false false false false false false false 0 false false false false false false false false false false X 18 15 true true true false false true true true true false false false true true true true true true true false X GARY N LOOPER 9366348111 1201 W Frank Avenue LUFKIN TX 75904 X MIKE SMITH 0.00 0.00 X 0 0 0 GEORGE FIDONE M D 0.00 0.00 X 0 0 0 DAVID TAMMINGA 0.00 0.00 X 0 0 0 DAVID GLENN M D 0.00 0.00 X 0 0 0 THOMAS MOORE 0.00 0.00 X 0 0 0 JERRY SUTTON 0.00 0.00 X 0 0 0 EDD TERRILL III 0.00 0.00 X 21600 0 0 KEVIN SMITHHART 0.00 0.00 X 0 0 0 H J TROUT JR 0.00 0.00 X 0 0 0 MACK FRAZIER 0.00 0.00 X 0 0 0 ARTIE BEDARD 0.00 0.00 X 0 0 0 JOHN STRAIN 0.00 0.00 X 0 0 0 JACK GORDEN 0.00 0.00 X 0 0 0 DR THOMAS DUNCAN 0.00 0.00 X 0 0 0 DON DURAN 0.00 0.00 X 0 0 0 RONNIE ROBINSON 0.00 0.00 X 0 0 0 ROSS ELDER 0.00 0.00 X 0 0 0 BRUCE BRYANT 0.00 0.00 X 0 0 0 DON BRILEY 0.00 0.00 X 0 0 0 GREG WALLEY 0.00 0.00 X 0 0 0 JOHN MILLER 0.00 0.00 X 0 0 0 DR THOMAS MCLAURIN 0.00 0.00 X 0 0 0 DAVID PERKINS 0.00 0.00 X 0 0 0 JOHN ANDERSON 0.00 0.00 X 0 0 0 RONA FRIESEN 1.00 0.00 X 0 0 0 HE STRIEDEL 1.00 0.00 X 0 0 0 TED LANKFORD 0.00 0.00 X 0 0 0 SID ROBERTS MD 1.00 0.00 X 42000 0 0 CARL RAY POLK 1.00 0.00 X 0 0 0 H J SHANDS III 1.00 0.00 X 0 0 0 JACK SWEENY 1.00 0.00 X 0 0 0 SW HENDERSON III 1.00 0.00 X 0 0 0 GEORGE HENDERSON III 1.00 0.00 X 0 0 0 RANDY GEORGE 1.00 0.00 X 0 0 0 RAY BALDWIN 1.00 0.00 X 0 0 0 PATRICIA MCKENZIE EDD 1.00 0.00 X 0 0 0 RAVINDER BACHIREDDY M D 1.00 0.00 X 0 0 0 GIPSON FRIESEN 1.00 0.00 X 0 0 0 AL MEYER 0.00 0.00 X 0 0 0 ROBERT TELFORD 0.00 0.00 X 0 0 0 DANIEL FUENTES D O 1.00 0.00 X 0 0 0 JOHN F GLICK 1.00 0.00 X 0 0 0 MIKE ARNOLD M D 1.00 0.00 X 0 0 0 HAROLD MAXWELL 0.00 0.00 X 0 0 0 GARY N LOOPER 40.00 0.00 X 0 0 50000 DAVID HEARNE 40.00 0.00 X 177044 0 8607 KRISTI GAY 40.00 0.00 X 165004 0 19007 MARIO B ESTRELLA 40.00 0.00 X 113010 0 187 PEGGY MORTENSON 40.00 0.00 X 0 0 0 BRYANT H KRENEK 40.00 0.00 X 882521 0 8099 SUZANNE FRAPPIER 40.00 0.00 X 152590 0 10266 THOMAS A BROSE 40.00 0.00 X 137927 0 23156 LESLIE LEACH 40.00 0.00 X 144359 0 19823 LOU A CHESSER 42.00 0.00 X 124595 0 9487 SANYUDE SANYUDE 41.00 0.00 X 125327 0 19605 KATHY GRIFFIN 42.00 0.00 X 145446 0 11005 2231423 179242 26 false true true SODEXO SERVICES P O BOX 536992 ATLANTA GA 30353 DIETARY/ENVIROMENTAL 5382735 WILLIAM BASSUKCLINICAL ENG 1606 DOE CREST SAN ANTONIO TX 78248 EQUIPMENT MAINTENANC 2892322 MCKESSON TECHNOLOGIES INC P O BOX 98347 CHICAGO IL 60693 TECHNOLOGY SERVICES 9193797 HB ANESTHESIOLOGY GROUP PA P O BOX 4502 LONGVIEW TX 75606 ANESTHESIOLOGY 4850925 COMMUNITY HOSPITAL CONSULTING INC 5801 TYNNYSON PARKWAY PLANO TX 75024 MANAGEMENT & OTHER 3040000 5 164627 1994860 2159487 RENTAL INCOME - AFFILIATE 621990 228720 228720 PATIENT SERVICE REVENUE 621990 124627438 124627438 OTHER HOSPITAL SERVICES 621990 319916 319916 ELECTRONIC HEALTH RECORDS 621990 548930 548930 CAFETERIA REVENUE 621990 517938 517938 277738 154650 123088 126520680 1063318 1063318 0 0 63941 41027 22914 22914 22914 330208 914236 -584028 -584028 -584028 0 0 174979 174978 1 1 0 129182372 125879654 1143231 X 0 0 0 0 889605 155220 734385 0 42132867 37691100 4441767 1015266 895175 120091 10799036 9377414 1421622 3098185 2731717 366468 2679408 2679408 535019 295533 239486 126880 126880 0 0 36200 36200 25142520 22283881 2858639 336654 43302 293352 733038 202012 531026 893254 893254 0 2526141 2513262 12879 325359 227059 98300 0 0 4845029 4845029 0 10362335 10362335 1113960 647819 466141 OTHER OPERATING EXPENSES 783675 456394 327281 RENTS & LEASES - EQUIP 1469760 1049851 419909 REPAIRS & MAINTENANCE 2470278 665266 1805012 PATIENT CARE SUPPLIES 20314737 20314737 -5826099 -273283 -5552816 126803107 114483823 12319284 0 1494808 1985433 58317617 57068263 0 13626347 14746621 0 0 0 2223759 2107083 1161092 838914 193228165 116473063 77606679 76755102 389216 0 0 15766869 15495514 0 80369552 81663989 250955939 250660919 17367087 16219112 110985000 109085000 21727899 25829874 150079986 151133986 X 82445660 80247728 18430293 19279205 100875953 99526933 250955939 250660919 X 2379265 -3728285 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2613815 2613815 91256146 42183460 49072686 93043007 72235618 20807389 6315197 2053985 4261212 76755102 15495514 PREPAID BOND ISSUANCE COST 691504 PHYSICIAN CONTRACT RECEIVABLE 1565656 OTHER ASSETS Miscellaneous Receivables 37911 INVESTMENT IN PREMIER 345569 INSURANCE RECOVERIES - LONG TERM 645840 HELD IN TRUST ACCOUNTS 19192910 GRANT RECEIVABLE 194152 DUE TO MEMORIAL SPECIALTY HOSPITAL -25882211 DUE FROM PINEYWOODS MED DEV CO 17754932 Due from AFFILIATES 66171959 DEFFERED CHARGE BOND DISCOUNTS 945767 81663989 THIRD PARTY SETTLEMENTS 4316823 PENSION PLAN PAYABLE 10314332 LEASES PAYABLE 56286 Insurance Reserve Payable 1940920 EXECUTIVE RETIREMENT BENEFIT PAYABLE 75033 CHANGE IN FAIR VALUE OF SWAP 10217828 BOND ISSUE DISCOUNT -1119507 2007 BOND ORIGINAL ISSUE DISCOUNT 28159 25829874 true true X true X true X true true true false true true 6248446 6248446 0.04990 12968092 12092926 875166 0.00700 19216538 12092926 7123612 0.05690 215495 215495 0.00170 215495 215495 0.00170 19432033 12092926 7339107 0.05860 false 10303484 1030348 40961762 47262335 -6300573 X true true 1 1 MEMORIAL HEALTH SYSTEM OF E T

1201 W FRANK AVE LUFKIN TX 75904

X X X MEMORIAL HEALTH SYSTEM OF E T 1 true X X X X X X X X X 12 true true true X X X X X X X X false false false true true 200.0000 true 250.0000 true X X X X true true X X X X false true X X X X X true X false true Part VI - Additional Information PART I, LINE 7 - THE HOSPITAL USED A COST-TO-CHARGE RATIO TO CALCULATE THE AMOUNTS REPORTED IN THIS TABLE. THIS COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2- "RATIO OF PATIENT CARE COST-TO-CHARGES".PART I, LINE 7, COLUMN (F):IN ACCORDANCE WITH THE INSTRUCTIONS,COMMUNITY BENEFITS EXPENSE TOTALING $215,495 INCLUDED IN PART IX, LINE 25, COLUMN A AND $1,298,095 IN REVENUE FROM NON PATIENT CARE ACTIVITIES INCLUDED IN PART VIII, LINE 12, COLUMN A HAVE BEEN REMOVED FROM THE DENOMINATOR IN THE CALCULATION OF THE PERCENTAGES SHOWN IN COLUMN (F) FOR LINES 7 (A) THRU 7 (K). AS THE RESULT OF THE FOREGOING, THE CALCULATION OF THE DENOMINATOR AMOUNT IS SHOWN BELOW: TOTAL FUNCTIONAL EXPENSES FROM PART IX, LINE 25, COLUMN A $126,803,107 LESS: COMMUNITY BENEFITS EXPENSE ( 215,495) CAFETERIA REVENUE ( 517,938) COPY REVENUE - MEDICAL RECORDS ( 76,870) RENTAL INCOME ( 383,370) OTHER REVENUE ( 319,917) ADJUSTED PATIENT CARE COSTS $125,289,517 Part VI - States Where Community Benefit Report Filed TX Part VI - Affilated Health Care System Roles and Promotion IN ADDITION TO THE CUSTOMIZED OUTREACH IN EACH INDIVIDUAL COMMUNITY THE CORPORATE STRUCTURE PROVIDES EACH HOSPITAL IN ANGELINA, POLK AND SAN AUGUSTINE COUNTIES WITH IMPROVED MEDICAL TECHNOLOGY THROUGH A COMMON COMPUTER SYSTEM, COMMUNICATION TO ALL COMMUNITIES THROUGH THE CORPORATE MARKETING DEPARTMENT, AND COORDINATION OF MEDICAL TRAINING FOR ALL CLINICAL EMPLOYEES. MEMORIAL HEALTH SYSTEM OF EAST TEXAS IS ABLE TO ACCEPT TRANSFERS OF MORE MEDICALLY COMPLEX CASES FROM OTHER AFFILIATED HOSPITALS. Part VI - Explanation Of How Organization Furthers Its Exempt Purpose THE HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY THROUGH PARTICIPATION IN DIABETIC, CARDIOVASCULAR AND STROKE, ORTHOPEDIC, CANCER THERAPY AND NUTRITION EDUCATION. THE HOSPITAL PARTICIPATES IN HEALTH FAIRS AT THE HOSPITAL, DIABETES EXPO, SENIOR LIFESTYLE EXPO, WOMEN'S LIFESTYLE EXPO, AND AT MANY LOCAL BUSINESSES. ADDITIONALLY, THE HOSPITAL IS ACTIVE WITH THE ANGELINA COUNTY BUSINESS COALITION THAT PROMOTES A DRUG FREE WORKPLACE AND EDUCATES THE COMMUNITY ON HOW TO LEAD A HEALTHIER LIFE. WE ALSO PROVIDE SPEAKERS TO COMMUNITY GROUPS AS REQUESTED. THE HOSPITAL PARTNERS WITH THE FOLLOWING COMMUNITY GROUPS: CANCER SUPPORT GROUPS, DIABETES SUPPORT GROUP, RELAY FOR LIFE, RED CROSS, ANGELINA COUNTY HEART ASSOCIATION, BLOOD CENTER OF EAST TEXAS, ANGELINA COLLEGE, STEPHEN F. AUSTIN STATE UNIVERSITY, AND TYLER COUNTY NURSING PROGRAMS, AND WITH AREA HIGH SCHOOLS' HEALTH CAREERS PROGRAMS WHICH ALLOW HIGH SCHOOL STUDENTS TO PARTICIPATE IN CLINICAL STUDIES AT THE HOSPITAL. WE HOST A MONTHLY WOMEN'S POWER LUNCH TO PROVIDE MEDICAL EDUCATION TO THE COMMUNITY AND HOST THE ANNUAL POWER OF PINK BANQUET TO EDUCATE WOMEN AND TO CELEBRATE CANCER SURVIVORS. HOSPICE IN THE PINES, WHICH IS A NOT-FOR-PROFIT ORGANIZATION, HAS AN INPATIENT FACILITY IN OUR HOSPITAL. WE HAVE A CLOSE PARTNERSHIP WITH THE ANGELINA COUNTY AND CITIES HEALTH DISTRICT WHICH MEETS THE MEDICAL NEEDS OF UNDERSERVED PEOPLE IN OUR COMMUNITY AND PROVIDE FUNDING FOR THE DIRECTOR'S SALARY. THE HOSPITAL IS A MEMBER OF THE ANGELINA COUNTY EMERGENCY PLANNING COMMITTEE IN ORDER TO PLAN FOR MEETING MEDICAL NEEDS IN COMMUNITY EMERGENCIES. WE ALSO FILM HEALTHY COOKING CLASSES WHICH AIR ON A LOCAL TV CHANNEL AND PROVIDE HEART EDUCATION CLASSES. THE HOSPITAL'S WEB SITE OFFERS A MEDICAL LIBRARY TO VISITORS AND A HOST OF VIDEOS THAT DETAIL MEDICAL PROCEDURES. THE HOSPITAL OFFERS EDUCATION TO THE PUBLIC THROUGH SOCIAL NETWORKS SUCH AS YOU TUBE, FACEBOOK AND TWITTER. Part VI - Community Information ANGELINA COUNTY HAS AN APPROXIMATE POPULATION OF 87,597 AS OF 2012 AND IS A FEDERALLY DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREA. THE POPULATION MEDIAN INCOME PER HOUSEHOLD, AS OF 2011, IS $39,325; AS OF 2011, 18.4% OF PERSONS IN ANGELINA COUNTY ARE BELOW THE POVERTY LEVEL. APPROXIMATELY 11% OF OUR PATIENT BASE IS UNINSURED, APPROXIMATELY 18% OF OUR PATIENT BASE IS MEDICAID RECIPIENTS, AND APPROXIMATELY 50% OF OUR PATIENT BASE IS MEDICARE RECIPIENTS. THE HOSPITAL IS ONE OF TWO ACUTE CARE FACILITIES IN ANGELINA COUNTY, AND IS THE ONLY NOT-FOR-PROFIT HOSPITAL WHICH DIRECTLY SERVES OUR COMMUNITY.WITH THE CITY OF LUFKIN BEING THE COUNTY SEAT, WE SERVE AS THE MEDICAL AND RETAIL HUB OF ANGELINA AND SURROUNDING COUNTIES. WITH PROXIMITY TO TWO NATIONAL FORESTS AND LAKE SAM RAYBURN, WHICH IS THE LARGEST LAKE COMPLETELY IN TEXAS, THE HOSPITAL SERVES A LARGE POPULATION OF RETIREES AND RECREATIONAL LAND USERS. ANGELINA COUNTY IS HOME TO ANGELINA COLLEGE, A VETERAN'S ADMININSTRATION HEALTH CLINIC, THREE MUSEUMS, AND A ZOO. Part VI - Patient Education of Eligibility for Assistance THE HOSPITAL INFORMS AND EDUCATES PATIENTS BY PROVIDING PATIENT HANDBOOKS TO INPATIENT AND DAY SURGERY PATIENTS THAT CONTAIN INFORMATION FOR UNINSURED PATIENTS AS WELL AS FINANCIAL COUNSELOR INFORMATION. PATIENT BILLS HAVE INFORMATION AND WORDING IN THEM WHICH INSTRUCTS THE PATIENT TO CALL THE BUSINESS OFFICE FOR POSSIBLE DISCOUNTS FOR UNINSURED PATIENTS. WE ALSO PROVIDE LITERATURE FOR THE PUBLIC TITLED, "NEED HELP WITH HOSPITAL BILLS?" THAT LISTS POSSIBLE PROGRAMS AND FINANCIAL COUNSELOR HOURS OF OPERATION.THE HOSPITAL HAS SIGNS IN THE EMERGENCY DEPARTMENT AND ALL OUTPATIENT REGISTRATION AREAS NOTIFYING PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE AND GIVES INSTRUCTIONS FOR CONTACTING FINANCIAL COUNSELORS.WE ALSO HAVE A THIRD PARTY ELIGIBILITY CONTRACTOR WHOSE ROLE IS TO SCREEN SELF PAY PATIENTS AND QUALIFY THEM FOR GOVERNMENT PROGRAMS AND TO FORWARD POTENTIAL CHARITY PATIENTS TO OUR FINANCIAL COUNSELORS. THE HOSPITAL HAS AN ON-SITE MEDICAID ELIGIBILITY SPECIALIST TO HELP PATIENTS COMPLETE PAPERWORK AND EXPEDITE APPLICATION PROCESSING. Part VI - Needs Assessment IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT REQUIRED BY LAW, THE HOSPITAL HAS A BOARD OF DIRECTORS MADE UP OF COMMUNITY MEMBERS WHO PROVIDE INPUT ABOUT NEEDS IN THE COMMUNITY. OUR PHYSICIANS HAVE NUMEROUS COMMITTEES AT THE HOSPITAL, IN PART TO KEEP US INFORMED ABOUT COMMUNITY MEDICAL NEEDS. Number of Hospital Faciltiy - 1 Part V, Line 22 - Charge Patients Amount Equal Gross Charge for Services ALL PATIENTS ARE EQUALLY CHARGED. PATIENTS WHO FILE AN APPLICATION FOR FINANCIAL ASSISTANCE ARE NOT BILLED UNLESS IT IS LATER DETERMINED THAT THEY DO NOT QUALIFY FOR ASSISTANCE. Number of Hospital Faciltiy - 1 Part V, Line 20d - Other Billing Determination of Individuals Without Insurance PATIENTS WITHOUT INSURANCE ARE BILLED USING THE SAME RATES FOR SERVICES AS ALL OTHER PATIENTS. Number of Hospital Faciltiy - 1 Part V, Line 17e - Other Collection Actions by Facility or Third Party Engaged ACCIDENT LIABILITY CASE LIENS FILED AGAINST FUTURE SETTLEMENT IN CASES INVOLVING THIRD-PARTY LIABILITY. Number of Hospital Faciltiy - 1 Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why Following the completion of thorough process designed to comply with the requirements of Patient Protection and Affordable Care Act, including research, individual interviews with stakeholders, and receipt of the survey results, a Community Health Needs Assessment Team consisting of hospital representatives and the Executive Director of the local Health District reviewed all results identified and prioritized eight (8) specific health needs. Working with the consultants from Community Hospital Consulting, the team identified actions to address those needs and developed implementation plans FOR Seven (7) of the eight (8) needs identified. The eighth identified need, increasing access to affordable dental care, was not addressed as it was deemed not a core business function of the health system. Number of Hospital Faciltiy - 1 Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment The Community Health Needs Assessment was conducted to include all four (4) facilities which comprise Memorial Health System of East Texas: (1) Memorial Medical Center of East Texas (Lufkin), (2) Memorial Medical Center Livingston, (3) Memorial Medical Center San Augustine, and (4) Memorial Specialty Hospital. Number of Hospital Faciltiy - 1 Part V, Line 3 - Account Input from Person Who Represent the Community Interview Methodology- Memorial Health System of East Texas provided CHC Consulting with a list of people with special knowledge of Angelina, Polk and San Augustine Counties including public health representatives, not-for-profit organization professionals, charities and other individuals who focus specifically on underrepresented groups.- From that list, 21 in depth interviews were conducted using a structured interview guide. In order to further quantify the data, a follow up survey was sent to the list of 21 with the option to forward the survey on to others.- Extensive notes were taken during each interview and then quantified based on responses, communities and populations (minority, elderly, un/underinsured, etc.)served, and priorities identified by respondents. Qualitative data from the interviews was also analyzed and reported. Survey Construction, Distribution, and Collection- An electronic survey was constructed using Survey Monkey(TM) software in order to gather opinions and input of those with special knowledge regarding the health needs and priorities of the study area.- The survey was restricted so that respondents could only complete the survey once per computer to protect the integrity of the data.- The survey was initially distributed to the 21 interviewees. Recipients were allowed to forward the survey to other stakeholders in the community. The survey remained open for approximately one month.- Responses were quantified and analyzed for reporting purposes, including any free-form comments. Interviewee list- Tina Battise, Deputy Administrator, Alabama-Coushatta Tribe- Deborah Walters, RN, Director, Case Management and Social Work, MHSET- Marilyn Kegler, Director of Nurses, Lufkin ISD- Marshall McMillan, Member, MMC-San Augustine Board of Directors, Chair, Boys and Girls Club of San Augustine- John L. Brink, RN, Nurse Manager, Cardiac Cath Lab/Cardiac Rehab, MHSET/Member of the Angelina County Heart Alliance- Dr. Sid Roberts, Radiation Oncologist- Jean Hines, SAN Augustine County Hospital District Board member- Carla Hight, Director, United Way - Angelina County- Judge Sammye Johnson, San Augustine County Judge- Brittney Johnson, Project Manager, San Augustine County- Sharon Shaw, Administrator, Angelina County and Cities Health District- Dr. Robert Fayle, Neurologist- Jerry Hathorne, Chairman, Polk County Advisory Committee- Susan Rushing, CEO, Burke Center- Letha Tullos, Regional Vice President for the East Texas Region, American Cancer Society- Carrie Yocum, Administrator, Twin Lakes Rehabilitation and Care Center- Ray Polk, Diabetes Activist and former Board Member, Memorial Medical Center- Lufkin- Phyllis Grandgeorge, Executive Director, Alcohol and Drug Abuse Council- Heather Kartye, Executive Director, Family Crisis Center of East Texas- Minerva Palomino, Social Worker, MHSET- Judge John Thompson, Judge, Polk County Part III, Line 9b - Provisions On Collection Practices For Qualified Patients AS SOON AS SUFFICIENT INFORMATION IS AVAILABLE CONCERNING THE PATIENT'S FINANCIAL RESOURCES AND ELIGIBILITY FOR GOVERNMENT ASSISTANCE, A DETERMINATION IS MADE CONCERNING THE PATIENT'S ELIGIBILITY FOR CHARITY. NO COLLECTION EFFORTS ARE PURSUED ON A CHARITY ACCOUNT AFTER SUCH DETERMINATION IS MADE. Part III, Line 8 - Explanation Of Shortfall As Community Benefit THE HOSPITAL BELIEVES THAT THE SHORTFALL SHOWN ON LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT. IN THE HOSPITAL'S ANNUAL COMMUNITY BENEFIT REPORT FILED WITH THE STATE OF TEXAS, THE UNREIMBURSED COST APPLICABLE TO MEDICARE PATIENTS IS A PART OF THE DETERMINATION THAT A HOSPITAL MEETS THE STATE'S REQUIREMENT THAT THE COST OF PROVIDING CHARITY CARE IS EQUAL TO AT LEAST 5% OF NET PATIENT SERVICE REVENUE. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NON-PROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.THE SHORTFALL AMOUNT WAS DETERMINED BY USING THE COST INFORMATION SHOWN ON THE 2012 "COST REPORT" FILED WITH THE CENTERS OF MEDICARE AND MEDICAID SERVICES (CMS). Part III, Line 4 - Bad Debt Expense THE HOSPITAL DOES NOT REPORT BAD DEBT EXPENSE (UNCOLLECTIBLE ACCOUNTS) IN ACCORDANCE WITH HFMA STATEMENT NO. 15. THE HOSPITAL ACCOUNTS FOR ANY LOSSES ON ACCOUNTS RECEIVABLE USING THE ALLOWANCE METHOD. THE HOSPITAL IS A MEMBER OF A SYSTEM WITH CONSOLIDATED FINANCIAL STATEMENTS AUDITED BY BDK, LLP. THE CONSOLIDATED FINANCIAL STATEMENTS FOOTNOTE TO PATIENT ACCOUNTS RECEIVABLE INCLUDES THE FOLLOWING:"ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM 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 UNCOLLECTILBE ACCOUNTS." Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit THE AMOUNT SHOWN ON LINE 3 IS BASED ON THE HOSPITAL'S ESTIMATE THAT 10% OF THE ACCOUNTS RECORDED AS BAD DEBT EXPENSE WOULD HAVE BEEN CLASSIFIED AS CHARITY (COMMUNITY BENEFIT) HAD THE APPROPRIATE INFORMATION BEEN OBTAINED. THIS ESTIMATE IS PRIMARILY BASED ON THE FACT THAT THE MEDIAN INCOME PER HOUSEHOLD OF THE COMMUNITY IS $39,325, THAT 18.4% OF COMMUNITY RESIDENTS HAD INCOME BELOW THE POVERTY LIMIT AND THAT 51.47% OF GROSS PATIENT REVENUE WAS FROM OUTPATIENTS. REASONS WHY ADEQUATE INFORMATION WAS NOT OBTAINED INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: LANGUAGE BARRIERS WITH THE SPANISH SPEAKING POPULATION A PATIENT'S LACK OF UNDERSTANDING ABOUT THE PROCESS AND WHERE TO FIND THE INFORMATION REQUESTED SOME PATIENTS ARE UNABLE OR UNWILLING TO SUPPLY SUPPORTING DOCUMENTATION, SUCH AS INCOME TAX RETURN DATA LACK OF UNDERSTANDING ON THE PATIENT'S PART ABOUT HOW A CHARITY CLASSIFICATION RATHER THAN A BAD DEBT CLASSIFICATION MAY BENEFIT THEM Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense THE AMOUNT SHOWN ON LINE 2 WAS DETERMINED BY USING THE COSTING METHODOLOGY DERIVED FROM WORKSHEET 2 - "RATIO OF PATIENT CARE COST-TO-CHARGES". THE HOSPITAL ACCOUNTS FOR DISCOUNTS AS A DEDUCTION FROM GROSS PATIENT REVENUE AND WHERE APPLICABLE, PAYMENTS ON PATIENTS' ACCOUNTS AS DEDUCTIONS FROM UNCOLLECTIBLE (BAD DEBTS EXPENSE) ACCOUNTS. X true true X X true true false false false false false false false false THOMAS A BROSE 137428 499 3056 20100 161083 SUZANNE FRAPPIER 152002 588 1530 8736 162856 LESLIE LEACH 143968 391 3289 16534 164182 KRISTI GAY 164750 254 1589 17418 184011 KATHY GRIFFIN 144936 510 3094 7911 156451 GARY N LOOPER 50000 50000 DAVID HEARNE 176549 495 8607 185651 BRYANT H KRENEK 150064 732457 4952 3147 890620 675160 Sch J, Part I, Line 1a Part I, Line 1a: Relevant information in regards to selections on 1a. THE ORGANIZATION PAID MONTHLY COUNTRY CLUB DUES FOR THE CURRENT CEO AND FORMER CEO. IN 2012, THE AMOUNT OF DUES WAS $7,070. B LUFKIN HEALTH FACILITIES DEVELOPMENT CORPORATION 521441564 549802BY1 2009-11-19 70186034 REFUND 2005A & 2005B BONDS/HOSP BLDGS/EQUIP false false false A LUFKIN HEALTH FACILITIES 521441564 549802BN5 2007-10-17 42372303 HOSPITAL BUILDINGS & EQUIPMENT, BOND RESERVE FUND false false false B 3180000 70186034 5936406 1363916 5004694 57881018 2010 true false true true A 1640000 42372303 4100766 638477 37633060 2009 false false true true B false false false false false false A false false false false false false false B false true false false false false A false true false false false false B false A false Supplemental Information Part VI A PORTION ($57,881,018) OF THE BONDS ISSUED ON 11/19/2009 WERE USED TO RETIRE SERIES 2005 AND 2005A VARIABLE RATE DEMAND REVENUE BONDS. THE ORGANIZATION HAD ENTERED INTO TWO INTEREST RATE SWAPS IN CONJUNCTION WITH THE ISSUANCE OF THE SERIES 2005 AND 2005A REVENUE BONDS. THESE SWAPS WERE ORIGINALLY DESIGNATED AS CASH FLOW HEDGES. THE SWAPS FAILED TO QUALIFY AS CASH FLOW HEDGES UPON REPAYMENT OF THE 2005 AND 2005A REVENUE BONDS DURING 2009. CONSEQUENTLY, ALL PRIOR CHANGES IN THE SWAPS' FAIR VALUE THAT HAD BEEN DEEMED EFFECTIVE, TOTALING $8,499,134, WERE RECLASSIFIED INTO DEFICIENCY OF REVENUES OVER EXPENSES FOR 2009. THE SWAPS REMAIN IN EFFECT SUBSEQUENT TO THE RETIREMENT OF 2005 AND 2005A BONDS. AT DECEMBER 31, 2012 THE FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS TOTALING $10,217,828 IS INCLUDED IN LIABILITIES ON THE ORGANIZATION'S BALANCE SHEET.PART III - PRIVATE BUSINESS USE, LINE 9 - BOND ISSUES A & B:THE ORGANIZATION IS IN THE PROCESS OF ESTABLISHING WRITTEN PROCEDURES TO ENSURE THAT NONQUALIFIED BONDS OF THE ISSUE, IF THERE ARE ANY, ARE REMEDIATED IN ACCORDANCE WITH THE REQUIREMENTS UNDER REGULATIONS SECTIONS 1.141-12 AND 1.145-2. PART IV - ARBITRAGE - LINE 2C - BOND ISSUE A:THE DATE THE REBATE COMPUTATION WAS PERFORMED - NOVEMBER 26, 2012PART IV - ARBITRAGE - LINE 9 - BOND ISSUES A & B: THE ORGANIZATION IS IN THE PROCESS OF ESTABLISHING WRITTEN PROCEDURES TO MONITOR THE REQUIREMENTS OF SECTION 148.PART V - PROCEDURES TO UNDERTAKE CORRECTIVE ACTION - BOND ISSUES A & B:THE ORGANIZATION IS IN THE PROCESS OF ESTABLISHING WRITTEN PROCEDURES TO ENSURE THAT VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH THE VOLUNTARY CLOSING AGREEMENT PROGRAM IF SELF-REMEDIATION IS NOT AVAILABLE UNDER APPLICABLE REGULATIONS. SID ROBERTS M D DIRECTOR 343331 MEDICAL SERVICES false DANIEL FUENTES D O DIRECTOR 365853 MEDICAL SERVICES false EDD TERRILL III TRUSTEE 315900 SECURITY SERVICES false MERLINA ESTRELLA SPOUSE/OFFICER 116390 SALARY/BENEFITS false RAY BALDWIN DIRECTOR 665910 COMMERCIAL INS BROKER false RAY BALDWIN HAS AN OWNERSHIP INTEREST IN SWAIN AND BALDWIN INSURANCE TO WHICH THE ORGANIZATION PAID $665,910 FOR INSURANCE COVERAGE.MERLINA ESTRELLA, AN EMPLOYEE, IS THE SPOUSE OF AN INDIVIDUAL WHO SERVED AS AN OFFICER OF THE ORGANIZATION FOR PART OF 2012EDD TERRILL, III HAS AN OWNERSIP INTEREST IN SECURITY SERVICES OF LUFKIN TO WHICH THE ORGANIZATION PAID $315,900 FOR SECURITY SERVICES.DANIEL FUENTES, D. O. HAS A PARTNERSHIP INTEREST IN TEXAS SPECIALIST CENTER, PLLC TO WHICH THE ORGANIZATION PAID $365,853 FOR MEDICAL SERVICESSID ROBERTS, M. D. HAS AN OWNERSHIP INTEREST IN ANGELINA RADIATION ONCOLOGY ASSOCIATES TO WHICH THE ORGANIZATION PAID $343,331 FOR MEDICAL SERVICES PATIENT SERVICE REVENUE RECONCILIATION: PATIENT SERVICE REVENUE SHOWN ON FORM 990, PART VIII, LINE 2A WAS DETERMINED AS FOLLOWS: GROSS CHARGES TO PATIENTS $760,429,642 LESS: MEDICARE CONTRACTUAL ADJUSTMENTS (311.709,818) MEDICAID CONTRACTUAL ADJUSTMENTS ( 46,916,738) INSURED/MANAGE CARE ADJUSTMENTS (158,854,421) OTHER DISCOUNTS ( 17,884,755)UNCOLLECTIBLE ACCOUNTS ( 62,521,142) CHARITY DEDUCTIONS ( 37,915,330) PATIENT SERVICE REVENUE 124,627,438 Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Decreases NET RESTRICTED FUND ASSETS RELEASED FROM RESTRICTIONS = -$1818013 Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Increases NET INCREASE IN BENEFICIAL INTEREST IN TRUST = $2573254 Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Increases INTEREST INCOME - RESTRICTED FUND = $421 Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Increases CONTRIBUTIONS RECEIVED - RESTRICTED FUND = $93251 Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Decreases CHANGE IN DEFINED BENEFIT PLAN GAINS AND LOSSES = -$4704103 Form 990, Part XI, Line 9 Other Changes In Net Assets Or Fund Balances - Other Increases ASSETS RELEASED FROM RESTRICTIONS USED FOR PURCHASE OF P & E = $126905 Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available ORGANIZATIONAL DOCUMENTS, APPLICATIONS FOR EXEMPTION AND FINANCIAL STATEMENTS OF THE CORPORATION ARE AVAILABLE FOR INSPECTION AND COPYING IN THE OFFICE OF THE CHIEF FINANCIAL OFFICER LOCATED AT 1201 W. FRANK AVENUE, LUFKIN, TX 75904 ON ORAL OR WRITTEN REQUEST DURING REGULAR BUSINESS HOURS, OR SUCH OTHER TIMES AS ARE SCHEDULED DIRECTLY WITH THE CHIEF FINANCIAL OFFICER. Form 990, Part VI, Line 15b Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees The Executive Committee of the Board of Directors is responsible for establishing compensation for Executives and key management employees of corporation. As a part of the management services provided corporation pursuant to the Management Agreement referenced in response to Part VI, Line 3, Community Hospital Consulting, Inc. (CHC) assists the Executive Committee in its review and evaluation of compensation for its Executives, and its key management employees, some of which are employees of CHC seated with corporation. To set compensation for the Chief Executive Officer, CHC establishes an appropriate salary using its internal compensation policy and then engages an independent nationally known compensation consultant to perform a competitive market analysis considering the job description, scope of responsibility and current compensation of the Chief Executive Officer. The consultant recommends appropriate comparison data, and using data from four major compensation surveys, provides the data and makes recommendations based on the articulated compensation policy. Those recommendations and the market data on which they are based are then forwarded to the Executive Committee of the Board which establishes an appropriate compensation level for the Chief Executive Officer. Other key employees compensation is set in much the same manner using information related to their positions and data developed with the assistance of CHC from major compensation surveys, passed on to the Chief Executive Officer and the Executive Committee of the Board, which establishes compensation levels as appropriate. Form 990, Part VI, Line 12c Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts ANNUALLY, EACH MEMBER OF THE BOARD AND OFFICER OF THE CORPORATION IS PROVIDED A COPY OF THE CONFLICTS OF INTEREST POLICY, A STATEMENT ACKNOWLEDGING ITS RECEIPT, AND DISCLOSURE OF OUTSIDE INTERESTS AND ACTIVITIES FORM. THE POLICY IS DISCUSSED WITH THE BOARD AND EACH OFFICER. EACH BOARD MEMBER AND OFFICER COMPLETES THE DISCLOSURE OF OUTSIDE INTERESTS AND ACTIVITIES FORM AND RETURNS THEM TO THE CHIEF EXECUTIVE OFFICER (CEO). THE CEO AND THE SYSTEM'S GENERAL COUNSEL REVIEW EACH STATEMENT ACKNOWLEDGING RECEIPT OF THE POLICY AND THE DISCLOSURES TO FAMILIARIZE THEMSELVES WITH POTENTIAL CONFLICTS. Form 990, Part VI, Line 11b Form 990, Part VI, Line 11b: Form 990 Review Process THE BOARD OF DIRECTORS, BY RESOLUTION, DETERMINES WHETHER THE FORM 990 WILL BE REVIEWED BY ALL DIRECTORS, AN EXISTING COMMITTEE, OR A SPECIAL COMMITTEE APPOINTED FOR SUCH PURPOSE PRIOR TO FILING. ONCE THE RETURN IS COMPLETED, IT IS PROVIDED TO THE DIRECTORS OF THE COMMITTEE RESPONSIBLE FOR REVIEWING, EITHER INDIVIDUALLY OR IN A JOINT SESSION. EMPLOYEES OF THE CORPORATION RESPONSIBLE FOR FILING ARE AVAILABLE TO RESPOND TO QUESTIONS OR PROVIDE BACKGROUND AS NEEDED. ONCE THE DIRECTORS RESPONSIBLE FOR REVIEWING THE FORM 990 ARE SATISFIED IT IS COMPLETE, THE RETURN IS FILED. SUBSEQUENTLY, THE RETURN IS MADE AVAILABLE TO ALL DIRECTORS FOR THEIR REVIEW. Form 990, Part VI, Line 7b Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders The Board of Trustees has authority to amend the Articles of Incorporation, to elect new and additional Directors, and to approve the ultimate disposition of assets of the corporation on dissolution in accordance with the provisions of the Articles of Incorporation. Form 990, Part VI, Line 7a Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body Nominations for election to the Board of Trustees may be made by any Member, the Board of Directors, or by any Trustee. Nominations for election to the Board of Trustees may be made by the Board of Directors or by any Trustee. In each case, nominations other than those made on behalf of the Board of Directors must be in writing and mailed or delivered to the Chair of the Board of Directors not less than10 days, nor more than 30 days, prior to any meeting called for election of Directors or Trustees. Form 990, Part VI, Line 4 Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents The Bylaws of the corporation were amended in 2012 to:1. Delegate transactional authority from the Trustees to the Board of Directors,2. Increase the size of the Board from 16 to 18,3. Create a separate class of members for six (6) Physicians to include the two (2) Medical Staff officer members ex officio with vote (already members) and four (4) new at-large physician positions,4. Establish term limits for all positions,5. Remove requirements for prescribed percent of Directors from Trustees,6. Create certain standing committees of the Board, and7. Extend terms of all current Directors for one (1) additional year. Form 990, Part VI, Line 3 Form 990, Part VI, Line 3: Description of Delegated Duties to Management Company IN AUGUST 2011, THE SYSTEM ENGAGED COMMUNITY HOSPITAL CONSULTING, INC. (CHC) FOR CERTAIN MANAGEMENT SERVICES INCLUDING RESPONSIBILITY FOR OVERSIGHT AND MANAGEMENT OF DAY-TO-DAY OPERATIONS OF THE SYSTEM AND ITS HOSPITALS, AND TO MEMORIAL SPECIALTY HOSPITAL TO WHICH IT PROVIDES ADMINISTRATIVE OVERSIGHT AND SERVICES BY CONTRACT. THE CONTRACT AUTHORIZES PLACEMENT OF COMMUNITY HOSPITAL CONSULTING EMPLOYEES OR CONTRACTORS AS SUCH OF THE SENIOR AND OTHER MANAGEMENT PERSONNEL AS COMMUNITY HOSPITAL CONSULTING, INC. DEEMS APPROPRIATE SUBJECT TO THE OVERSIGHT OF THE SYSTEM BOARD OF DIRECTORS. IN 2012, THE FOLLOWING SENIOR PERSONNEL WERE EMPLOYEES OF CHC: CHIEF EXECUTIVE OFFICER CHIEF OPERATING OFFICER/VP CLINICAL OPERATIONS Form 990, Part VI, Line 2 Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et BOARD MEMBER RELATIONSHIPS: GEORGE H. HENDERSON, III AND H.J. SHANDS, III - BUSINESS RELATIONSHIP CARL RAY POLK AND GEORGE H. HENDERSON, III - BUSINESS RELATIONSHIP GIBSON FRIESEN AND RONA FRIESEN - FAMILY RELATIONSHIP MEMORIAL MULTISPECIALTY ASSOCIATES 1201 W FRANK AVE LUFKIN TX 75904 752721155 PHYSICIAN OFFICES TX 501(C)(3) 11 - TYPE III MEMORIAL HEALTH SYSTEM OF EAST TEXAS false LUFKIN VISION ACQUISITIONS 1201 W FRANK AVE LUFKIN TX 75904 820563768 PROVIDES OFFICE SPACE FOR HEALTH CARE PROFESSIONALS TX 501(C)(3) 11C MEMORIAL HEALTH SYSTEM OF EAST TEXAS false MEMORIAL MEDICAL CENTER - SAN AUGUSTINE 511 HOSPITAL ST SAN AUGUSTINE TX 75972 752663904 LICENSED HOSPITAL TX 501(C)(3) (3) HOSPITAL MEMORIAL HEALTH SYSTEM OF EAST TEXAS false MEMORIAL MEDICAL CENTER - LIVINGSTON 1717 HWY 59 BYPASS LIVINGSTON TX 77351 760436439 LICENSED HOSPITAL TX 501(C)(3) (3) HOSPITAL MEMORIAL HEALTH SYSTEM OF EAST TEXAS false false false false false false false false false false true true true false false false false true false false MEMORIAL MULTISPECIALTY ASSOCIATES q 1027024 COST MEMORIAL MEDICAL CENTER - SAN AUGUSTINE q 526433 COST MEMORIAL MEDICAL CENTER - SAN AUGUSTINE l 47636 COST MEMORIAL MEDICAL CENTER - SAN AUGUSTINE k 15120 COST MEMORIAL MEDICAL CENTER - LIVINGSTON q 4006871 COST MEMORIAL MEDICAL CENTER - LIVINGSTON l 230706 COST MEMORIAL MEDICAL CENTER - LIVINGSTON j 6498 AMOUNT CHARGED