MEMORIAL SPECIALTY HOSPITAL: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- MEMORIAL SPECIALTY HOSPITAL (EIN 75-2492741)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-13
- IRS object ID
- 201323179349302182
- Schema version
- 2012v2.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-13T08:34:20-08:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Axley & Rode LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1307 S 1st St | AddressLine1 |
| City | Lufkin | City |
| State | TX | State |
| ZIP Code | 759014717 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 752492741 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Memorial Specialty Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MEMO | NameControl |
| Phone | 9366397016 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O Box 1447 | AddressLine1 |
| City | Lufkin | City |
| State | TX | State |
| ZIP Code | 75902 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LESLIE LEACH | Name |
| Title | VP Post Acute Serv | Title |
| Date Signed | 2013-11-08 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | J LEON MANNING CPA | Name |
| PTIN | P00045819 | PTIN |
| Phone | 9366346621 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | LESLIE LEACH | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 FRANK AVE | AddressLine1 |
| City | LUFKIN | City |
| State | TX | State |
| ZIP Code | 75904 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 13919996 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1992 | YearFormation |
| State Legal Domicile | TX | StateLegalDomicile |
| Activity Or Mission Description | THE ORGANIZATION OPERATES A SPECIALTY HOSPITAL THAT PROVIDES EXTENDED ACUTE HEALTH CARE SERVICES TO PATIENTS FROM ANGELINA AND SURROUNDING COUNTIES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 99 | TotalNbrEmployees |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 12290798 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 13919990 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 43 | InvestmentIncomePriorYear |
| Investment Income Current Year | 6 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 12290841 | TotalRevenuePriorYear |
| Total Revenue Current Year | 13919996 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4856056 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4121956 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 4165035 | OtherExpensePriorYear |
| Other Expenses Current Year | 4484377 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 9021091 | TotalExpensesPriorYear |
| Total Expenses Current Year | 8606333 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3269750 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 5313663 | RevenuesLessExpensesCY |
| Total Assets BOY | 22226193 | TotalAssetsBOY |
| Total Assets EOY | 27508007 | TotalAssetsEOY |
| Total Liabilities BOY | 1348948 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1317099 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 20877245 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 26190908 | NetAssetsOrFundBalancesEOY |
| Mission Description | The mission of Memorial Specialty Hospital is to support, manage, and furnish facilities to provide quality acute long term healthcare services for the citizens of Angelina, Polk, San Augustine and the surrounding counties of deep East Texas. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 7036522 | Expense |
| Revenue | 13919990 | Revenue |
| Description | HOSPITAL SERVICES TO PATIENTS, INCLUDING 7,972 PATIENT DAYS AND 293 ADMISSIONS TO THE HOSPITAL. | Description |
| Total Program Service Expense | 7036522 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | false | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | false | ComplianceWithBackupWitholding |
| Number Of Employees | 99 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Form990-T Filed | false | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Licensed More Than One State | false | LicensedMoreThanOneState |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | LESLIE LEACH | NamePerson |
| Telephone Number | 9366397016 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 W FRANK | AddressLine1 |
| City | LUFKIN | City |
| State | TX | State |
| ZIP Code | 75901 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (12 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| SUSHIL GEORGE MD | ||||||||
| VP OF MED STF | 0.00 | 0.00 | X | 0 | 0 | 0 | ||
| ROBERT HALLETT M D | ||||||||
| PRES OF MED STF | 0.00 | 0.00 | X | 0 | 0 | 0 | ||
| GARY LOOPER | ||||||||
| EX-OFFICIO | 0.00 | 0.00 | X | 0 | 0 | 0 | ||
| TIM STACY | ||||||||
| Director | 0.00 | 0.00 | X | 0 | 0 | 0 | ||
| DAVID PERKINS | ||||||||
| Director | 0.00 | 0.00 | X | 0 | 0 | 0 | ||
| TERRY MORGAN | ||||||||
| Director | 0.00 | 0.00 | X | 0 | 0 | 0 | ||
| VAN WATSON | ||||||||
| Vice Chairman | 0.00 | 0.00 | X | 0 | 0 | 0 | ||
| BOB BROWN | ||||||||
| Chairman | 0.00 | 0.00 | X | 0 | 0 | 0 | ||
| PHIL MEDFORD | ||||||||
| Secretary | 0.00 | 0.00 | X | 0 | 0 | 0 | ||
| LESLIE LEACH | ||||||||
| VP Post Acute S | 40.00 | 0.00 | 0 | 126358 | 19823 | X | ||
| LEEANN HAYGOOD | ||||||||
| CNO | 40.00 | 0.00 | 0 | 0 | 0 | X | ||
| SHINGFAI E IP | ||||||||
| PHARMACIST | 40.00 | 0.00 | 117146 | 0 | 22798 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 117146 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 126358 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 42621 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | false | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| SODEXO SERVICES | |||||
| P O BOX 536922 | ATLANTA | GA | 303536922 | DIETARY/ENVIRONMENTA | 239999 |
| MEMORIAL HEALTH SYSTEM OF EAST TEXAS | |||||
| 1201 W FRANK AVENUE | LUFKIN | TX | 75904 | MEDICAL SERVICES | 1124764 |
| COMMUNTY HOSPITAL CONSULTING INC | |||||
| 5801 TYNNYSON PKWY STE 550 | PLANO | TX | 75024 | MGMT/MEDICAL | 137495 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| Total Contributions | 0 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621990 | 13866236 | 13866236 |
| MISCELLANEOUS REVENUE | 621990 | 53754 | 53754 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 13919990 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6 | TotalRevenueColumn |
| Exclusion | $6 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13919996 | TotalRevenueColumn |
| Related Or Exempt Function Income | 13919990 | RelatedOrExemptFunctionIncome |
| Exclusion | $6 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3441668 | Total |
| Program Services | 3074229 | ProgramServices |
| Management And General | 367439 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65615 | Total |
| Program Services | 59260 | ProgramServices |
| Management And General | 6355 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 383953 | Total |
| Program Services | 346922 | ProgramServices |
| Management And General | 37031 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 230720 | Total |
| Program Services | 208373 | ProgramServices |
| Management And General | 22347 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 134712 | Total |
| Management And General | 134712 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12118 | Total |
| Management And General | 12118 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 665725 | Total |
| Program Services | 595278 | ProgramServices |
| Management And General | 70447 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2525 | Total |
| Management And General | 2525 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9615 | Total |
| Management And General | 9615 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 435170 | Total |
| Program Services | 435170 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19097 | Total |
| Program Services | 48 | ProgramServices |
| Management And General | 19049 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 135218 | Total |
| Program Services | 135218 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28169 | Total |
| Management And General | 28169 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| RENTS & LEASES - EQUIP | 31295 | 23779 | 7516 |
| HOME OFFICE COST ALLOCATION | 837378 | 837378 | |
| OTHER PATIENT CARE EXPENSE | 986870 | 986870 | |
| PATIENT CARE SUPPLIES | 1170716 | 1170716 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15769 | Total |
| Program Services | 659 | ProgramServices |
| Management And General | 15110 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8606333 | Total |
| Program Services | 7036522 | ProgramServices |
| Management And General | 1569811 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 95000 | BOY |
| EOY | 2890 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1727684 | BOY |
| EOY | 1189069 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 94732 | BOY |
| EOY | 88685 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15651 | BOY |
| EOY | 7419 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 2008702 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1670969 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 472951 | BOY |
| EOY | 337733 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19820175 | BOY |
| EOY | 25882211 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22226193 | BOY |
| EOY | 27508007 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 352512 | BOY |
| EOY | 615131 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 996436 | BOY |
| EOY | 701968 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1348948 | BOY |
| EOY | 1317099 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20877245 | BOY |
| EOY | 26190908 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20877245 | BOY |
| EOY | 26190908 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22226193 | BOY |
| EOY | 27508007 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 5313663 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | false | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 25801 | OtherCostOrOtherBasis |
| Depreciation | 22653 | Depreciation |
| Book Value | 3148 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1982901 | OtherCostOrOtherBasis |
| Depreciation | 1648316 | Depreciation |
| Book Value | 334585 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 337733 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE FROM MEMORIAL HEALTH SYSTEM | Description |
| Book Value | 25882211 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 25882211 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| PENSION PLAN PAYABLE | $537,221 |
| INSURANCE RESERVE PAYABLE | $164,747 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 701968 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent250 | X | Pcent250 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 131987 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 131987 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01540 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 131987 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 131987 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01540 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 131987 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 131987 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01540 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $41,484 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 9426767 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8391349 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1035418 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL SPECIALTY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 W FRANK AVE SUITE D-5 | AddressLine1 |
| City | LUFKIN | City |
| State | TX | State |
| ZIP Code | 75904 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Other | LONG-TERM ACUTE CARE HOSPITAL | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEMORIAL SPECIALTY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | true | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | false | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| File Form4720 Report Excise Tax | false | FileForm4720ReportExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200.0000 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 250.0000 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Uninsured Discount | X | UninsuredDiscount |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | false | ActionsOnNonpayment |
| Collection Activities | true | CollectionActivities |
| Other Actions | X | OtherActions |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | true | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 VI, LINE 1 - PART I, LINE 7, COLUMN (F) IN ACCORDANCE WITH THE INSTRUCTIONS, $53,754 IN REVENUE FROM NON PATIENT SERVICES INCLUDED IN PART VIII, LINE 12, COLUMN A HAS 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 $8,606,333 LESS: REVENUE FROM NON-PATIENT CARE ACTIVITIES ( 53,754) ADJUSTED PATIENT CARE COSTS $8,552,759 | |
| 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 SPECIALTY HOSPITAL IS ABLE TO PROVIDE CARE FOR CRITICALLY ILL, MEDICALLY COMPLEX PATIENTS WHOSE NEEDS CANNOT BE MET IN OTHER POST-ACUTE CARE ENVIRONMENTS. | |
| Part VI - Explanation Of How Organization Furthers Its Exempt Purpose | THE HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY THROUGH PARTICIPATION IN HEALTHCARE EDUCATION OUTREACHES SUCH AS DIABETES EXPO, SENIOR LIFESTYLE EXPO, AND WOMEN'S LIFESTYLE EXPO. IN ADDITION, THE HOSPITAL PARTNERS WITH ANGELINA COLLEGE, STEPHEN F. AUSTIN STATE UNIVERSITY AND TYLER COUNTY NURSING PROGRAMS TO PROVIDE EDUCATION AND CLINICAL ROTATIONS, AND WITH AREA HIGH SCHOOLS HEALTH CAREERS PROGRAMS WHICH ALLOW HIGH SCHOOL STUDENTS TO PARTICIPATE IN CLINICAL STUDIES AT THE HOSPITAL. | |
| 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; 18.4% OF PERSONS IN ANGELINA COUNTY ARE BELOW THE POVERTY LEVEL. APPROXIMATELY 6% OF OUR PATIENT BASE IS UNINSURED, APPROXIMATELY 1% OF OUR PATIENT BASE IS MEDICAID RECIPIENTS, AND APPROXIMATELY 86% OF OUR PATIENT BASE IS MEDICARE RECIPIENTS. THE HOSPITAL IS LOCATED IN ANGELINA COUNTY AND IS THE ONLY LONG-TERM ACUTE CARE HOSPITAL IN 13 CONTIGUOUS COUNTIES.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 ADMINISTRATION HEALTH CLINIC, THREE MUSEUMS AND A ZOO. | |
| Part VI - Patient Education of Eligibility for Assistance | PATIENT BILLS HAVE INFORMATION AND WORDING IN THEM WHICH STATES FOR THEM TO CALL THE BUSINESS OFFICE FOR POSSIBLE DISCOUNTS FOR UNINSURED PATIENTS. FOR PATIENTS ARRIVING THROUGH MEMORIAL HEALTH SYSTEM OF EAST TEXAS, THERE ARE SIGNS IN THE EMERGENCY DEPARTMENT AND 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 IT 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. ADDITIONALLY, INFORMATION REGARDING FINANCIAL ASSISTANCE IS LOCATED IN THE COMMON AREAS OF THE HOSPITAL AND SPECIFIC FINANCIAL ASSISTANCE GUIDANCE IS PROVIDED TO PATIENTS AND FAMILY MEMBERS THROUGH THE BUSINESS OFFICE. | |
| 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. | |
| 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 SERVICE 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 SpecialtyHospital | 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 | Number of Hospital Faciltiy - 1 |
| 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 WILL BE PURSUED ON A CHARITY ACCOUNT AFTER SUCH DETERMINATION IS MADE. | |
| Part III, Line 4 - Bad Debt Expense | THE HOSPITAL DOES NOT REPORT BAD DEBTS 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 BKD, 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 UNCOLLECTIBLE ACCOUNTS." | |
| 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 FOR WORKSHEET 2 - "RATIO OF PATIENT CARE COST-TO-CHARGES". THE HOSPITAL ACCOUNTS FOR DISCOUNTS AS DEDUCTIONS FROM GROSS PATIENT REVENUE AND WHERE APPLICABLE, PAYMENT OF PATIENTS' ACCOUNTS AS DEDUCTIONS FROM UNCOLLECTIBLE (BAD DEBTS EXPENSE) ACCOUNTS. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PATIENT SERVICE REVENUE RECONCILIATION: | PATIENT SERVICE REVENUE SHOWN ON FORM 990, PART VIII, LINE 2A WAS DETERMINED AS FOLLOWS: GROSS CHARGES TO PATIENTS $65,969,625 LESS: MEDICARE CONTRACTUAL ADJUSTMENTS (43,539,121) MEDICAID CONTRACTUAL ADJUSTMENTS (7,173) INDUSTRY/MANAGED CARE ADJUSTMENTS (7,216,200) OTHER DISCOUNTS (2,380) UNCOLLECTIBLE ACCOUNTS (320,095) CHARITY DEDUCTIONS (1,018,420) PATIENT SERVICE REVENUE $13,866,236 | |
| FORM 990 - PART V - QUESTION 1A: | MEMORIAL HEALTH SYSTEM OF EAST TEXAS (MHSET) PAYS THE HOSPITAL'S BILLS FOR SERVICES THAT WOULD REQUIRE THE PREPARATION OF FORMS 1099 AND THE RELATED FORM 1096, AND REPORTS SUCH PAYMENTS UNDER ITS FEDERAL IDENTIFICATION NUMBER (75-0755367). THE HOSPITAL REIMBURSES MHSET FOR SUCH PAYMENTS. | |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | ORGANIZATIONAL DOCUMENTS, APPLICATION FOR EXEMPTION, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS OF THE CORPORATION ARE AVAILABLE FOR INSPECTION AND COPYING IN THE OFFICE OF THE CHIEF FINANCIAL OFFICER OF MEMORIAL HEALTH SYSTEM OF EAST TEXAS 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 19 |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | THE SALARY OF THE ADMINISTRATOR OF THE CORPORATION IS SET BY THE CHIEF EXECUTIVE OFFICER OF MEMORIAL HEALTH SYSTEM OF EAST TEXAS WHO IS AN EMPLOYEE OF COMMUNITY HOSPITAL CONSULTING, INC. (CHC). AN APPROPRIATE SALARY IS ESTABLISHED FROM CHC'S INTERNAL COMPENSATION POLICY WHICH INCLUDES THE ASSISTANCE OF A COMPENSATION CONSULTANT, COMPETIVE MARKET ANALYSIS, JOB DESCRIPTION AND SCOPE OF RESPONSIBILITY. | Form 990, Part VI, Line 15b |
| 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 INTERESTS POLICY, A STATEMENT ACKNOWLEDGING ITS RECEIPT, AND DISCLOSURE OF OUTSIDE INTEREST AND ACTIVITIES. THE POLICY IS DISCUSSED WITH THE BOARD AND OFFICER. EACH BOARD MEMBER AND OFFICER COMPLETES THE FORMS PROVIDED AND RETURNS THEM TO THE CHIEF EXECUTIVE OFFICER. THE C. E. O. AND THE GENERAL COUNSEL REVIEW EACH STATEMENT ACKNOWLEDGING RECEIPT OF THE POLICY AND THE DISCLOSURES TO FAMILIARIZE THEMSELVES WITH THE POTENTIAL CONFLICTS. | Form 990, Part VI, Line 12c |
| Form 990, Part VI, Line 11b: Form 990 Review Process | EACH YEAR, THE BOARD OF DIRECTORS DETERMINES WHETHER THE FORM 990 WILL BE REVIEWED BY ALL DIRECTORS, AN EXISTING COMMITTEE, OR A SPECIAL COMMITTEE APPOINTED FOR THE PURPOSE OF REVIEWING THE FORM 990 PRIOR TO FILING. THE COMPLETED FORM 990 IS PROVIDED TO THE DIRECTORS OR THE COMMITTEE RESPONSIBLE FOR THE REVIEW, EITHER INDIVIDUALLY OR IN A JOINT SESSION. INDIVIDUALS RESPONSIBLE FOR THE FILING ARE AVAILABLE TO RESPOND TO QUESTIONS OR PROVIDE BACKGROUND AS NEEDED. ONCE THE DIRECTORS RESPONSIBLE FOR REVIEWING THE FORM 990 ARE SATISFIED THAT THE FORM 990 IS COMPLETE, THE RETURN IS FILED. SUBSEQUENTLY, THE RETURN IS MADE AVAILABLE TO ALL DIRECTORS NOT A PART OF THE PREVIOUS REVIEW. | Form 990, Part VI, Line 11b |
| Form 990, Part VI, Line 3: Description of Delegated Duties to Management Company | MEMORIAL HEALTH SYSTEM OF EAST TEXAS PROVIDES MANAGEMENT AND FINANCIAL SERVICES TO THE CORPORATION, INCLUDING BILLING AND COLLECTION OF CHARGES FOR PATIENT SERVICES, DATA PROCESSING, KEEPING OF FINANCIAL RECORDS, PAYMENT OF SALARIES AND MONTHLY BILLS.IN AUGUST 2011, THE SYSTEM ENGAGED COMMUNITY HOSPITAL CONSULTING, INC. 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. | Form 990, Part VI, Line 3 |