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MEMORIAL MEDICAL CENTER LIVINGSTON: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MEMORIAL MEDICAL CENTER LIVINGSTON (EIN 76-0436439)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-13
IRS object ID
201333179349301788
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

FieldValueIRS element (for citing)
Timestamp2013-11-13T08:29:12-08:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Axley & Rode LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11307 S 1st StAddressLine1
CityLufkinCity
StateTXState
ZIP Code759014717ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN760436439EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Memorial Medical Center - LivingstonBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMEMONameControl
Phone9366348111Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1P O Box 1447AddressLine1
CityLufkinCity
StateTXState
ZIP Code75902ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGARY N LOOPERName
TitleCEOTitle
Date Signed2013-11-12DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJ LEON MANNING CPAName
PTINP00045819PTIN
Phone9366346621Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGARY N LOOPERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1156 MAGNOLIA BENDAddressLine1
CityLUFKINCity
StateTXState
ZIP Code75904ZIPCode
FieldValueIRS element (for citing)
Gross Receipts39440985GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1994YearFormation
State Legal DomicileTXStateLegalDomicile
Activity Or Mission DescriptionTHE ORGANIZATION OPERATES A GENERAL ACUTE CARE HOSPITAL WITH 66 LICENSED BEDS AND PROVIDES SERVICES TO PATIENTS IN POLK AND SURROUNDING COUNTIES.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees366TotalNbrEmployees
Total Nbr Volunteers32TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year10163ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year40453166ProgramServiceRevenuePriorYear
Program Service Revenue CY39403701ProgramServiceRevenueCY
Investment Income Prior Year-43004InvestmentIncomePriorYear
Investment Income Current Year-12875InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year40420325TotalRevenuePriorYear
Total Revenue Current Year39390826TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year16407297SalariesEtcPriorYear
Salaries Etc Current Year18080011SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year23638020OtherExpensePriorYear
Other Expenses Current Year24014278OtherExpensesCurrentYear
Total Expenses Prior Year40045317TotalExpensesPriorYear
Total Expenses Current Year42094289TotalExpensesCurrentYear
Revenues Less Expenses Prior Year375008RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-2703463RevenuesLessExpensesCY
Total Assets BOY37841817TotalAssetsBOY
Total Assets EOY37416296TotalAssetsEOY
Total Liabilities BOY39373303TotalLiabilitiesBOY
Total Liabilities EOY41591099TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-1531486NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-4174803NetAssetsOrFundBalancesEOY
Mission DescriptionTHE MISSION OF MMC-LIVINGSTON IS TO SUPPORT, MANAGE, AND FURNISH FACILITIES TO PROVIDE QUALITY ACUTE HEALTHCARE SERVICES FOR THE CITIZENS OF POLK AND SURROUNDING COUNTIES, REGARDLESS OF RACE, COLOR, GENDER, AGE, NATIONAL ORIGIN, OR, TO THE EXTENT OF ITS AVAILABLE RESOURCES, ABILITY TO PAY, AND TO FACILITATE AND ENCOURAGE EDUCATIONAL AND TRAINING ACTIVITIES TO INFORM AND PROMOTE THE GENERAL HEALTH AND WELFARE OF THOSE CITIZENS.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense36194428Expense
Revenue39400278Revenue
DescriptionHOSPITAL SERVICES PROVIDED TO PATIENTS IN POLK COUNTY, INCLUDING 2,852 ADMISSIONS, 42,772 OUTPATIENT VISITS, 22,629 EMERGENCY ROOM VISITS AND 9,609 PATIENT DAYS.Description
Total Program Service Expense36194428TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingfalseComplianceWithBackupWitholding
Number Of Employees366NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonGARY N LOOPERNamePerson
Telephone Number9366348111TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11201 W FRANKAddressLine1
CityLUFKINCity
StateTXState
ZIP Code75901ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
JUDY B COCHRAN
Secretary0.000.00X000
REV CURTIS HESTER
Director0.000.00X000
JUDGE JOHN P THOMPSON
Director0.000.00X000
C K MANI M D
CHIEF OF STAFF0.000.00X000
BEN R OGLETREE JR
Director0.000.00X000
HENRY AGER III
Director0.000.00X000
MOLLY LOCKE
DIRECTOR0.000.00X000
H E STRIEDEL
Chairman0.000.00X000
CHARLENE SMITH MD
Director0.000.00X000
SOUAD YOUSSEF M D
V. CHIEF OF STF2.000.00X000
CLARKE EVANS
Director0.000.00X000
GARY N LOOPER
SYSTEM CEO5.0035.00X0050000
TINA BATTISE
Director0.000.00X000
CORKY EVANS
Director0.000.00X000
JANIS HEARN
PRES-AUXILIARY0.000.00X000
DAVID LEMONTE
ADMINISTRATOR42.000.00298858019223X
GRACE LUNA
PHARMACIST36.000.00126546015398X
JOHN WEYERSMILLER
RN/ICU49.000.0010749205216X
GORDON HANKS
RN/ICU56.000.0011274704623X
STEPHEN L ECKERT
PHARMACIST36.000.0010901306777X
FieldValueIRS element (for citing)
Total Reportable Comp From Org754656TotalReportableCompFromOrg
Total Other Compensation101237TotalOtherCompensation
Number Individuals GT100 K5NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SODEXO SERVICES
P O BOX 536922ATLANTAGA303536922ENV SERVICES493446
WILLIAM BASSUKCLINICAL ENGINEERING
1606 DOE CRESTSAN ANTONIOTX78248EQUIP MAINTENANCE595276
PINEYWOODS RADIOLOGY PLLC
12102 PECAN GROVEMAGNOLIATX77354RADIOLOGY163237
MORRISON MANAGEMENT SPECIALISTS
P O BOX 102289ATLANTAGA303862289DIETARY663614
H B ANESTHESIOLOGY GROUP PA
P O BOX 4502LONGVIEWTX75606MEDICAL1240989
FieldValueIRS element (for citing)
Number Of Contractors GT100 K11NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
VENDING REVENUE6219902448$2,448
PATIENT SERVICE REVENUE6219903866728738667287
OTHER HOSPITAL SERVICES6219901586115861
MEDICAL RECORDS INCOME6219002782227822
ELECTRONIC HEALTH RECORDS621990689308689308

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column975TotalRevenueColumn
Exclusion$975ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue39403701TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column9696TotalRevenueColumn
Exclusion$9,696ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other27588Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other50159Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-22571Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-22571TotalRevenueColumn
Exclusion-$22,571ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column39390826TotalRevenueColumn
Related Or Exempt Function Income39400278RelatedOrExemptFunctionIncome
Exclusion-$9,452ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total304816Total
Management And General304816ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total13180099Total
Program Services12838542ProgramServices
Management And General341557ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total328542Total
Program Services312858ProgramServices
Management And General15684ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3298867Total
Program Services3088052ProgramServices
Management And General210815ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total967687Total
Program Services921490ProgramServices
Management And General46197ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total127925Total
Management And General127925ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total32880Total
Management And General32880ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total37762Total
Management And General37762ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5921402Total
Program Services5071630ProgramServices
Management And General849772ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total60875Total
Program Services6970ProgramServices
Management And General53905ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total219632Total
Program Services5149ProgramServices
Management And General214483ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total625751Total
Program Services625751ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total69005Total
Program Services31142ProgramServices
Management And General37863ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total3105969Total
Program Services3105969ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2780141Total
Program Services2780141ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total262462Total
Program Services132430ProgramServices
Management And General130032ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
REPAIRS & MAINTENANCE3634033606422761
RENTS & LEASES - EQUIP43111141110320008
HOME OFFICE COST ALLOCATION33947463394746
PATIENT CARE SUPPLIES64810936481093

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total100121Total
Program Services21466ProgramServices
Management And General78655ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total42094289Total
Program Services36194428ProgramServices
Management And General5899861ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY47866BOY
EOY90492EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY195797BOY
EOY117151EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4290060BOY
EOY4666153EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1142039BOY
EOY1040386EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY78999BOY
EOY32353EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis58175027LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec27314081LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY31367511BOY
EOY30860946EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY719545BOY
EOY608815EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY37841817BOY
EOY37416296EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1904311BOY
EOY4521877EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY37468992BOY
EOY37069222EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY39373303BOY
EOY41591099EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-1727283BOY
EOY-4291954EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY195797BOY
EOY117151EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-1531486BOY
EOY-4174803EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY37841817BOY
EOY37416296EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-2703463ReconcilationRevenueExpenses
Reconcilation Other Changes60146ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteefalseAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis132600OtherCostOrOtherBasis
Book Value132600BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis42472692OtherCostOrOtherBasis
Depreciation16728362Depreciation
Book Value25744330BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1375892OtherCostOrOtherBasis
Depreciation394219Depreciation
Book Value981673BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis14193843OtherCostOrOtherBasis
Depreciation10191500Depreciation
Book Value4002343BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings30860946TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
PENSION PLAN PAYABLE$1,687,433
LEASE PAYABLE$1,628,002
INSURANCE RESERVE PAYABLE$2,244,690
DUE TO AFFILIATE$31,509,097
FieldValueIRS element (for citing)
Total Of Amounts37069222TotalOfAmounts

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1144425TotalCommunityBenefitExpense
Net Community Benefit Expense1144425NetCommunityBenefitExpense
Percent Of Total Expense0.02720PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense6278887TotalCommunityBenefitExpense
Direct Offsetting Revenue5146578DirectOffsettingRevenue
Net Community Benefit Expense1132309NetCommunityBenefitExpense
Percent Of Total Expense0.02690PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense7423312TotalCommunityBenefitExpense
Direct Offsetting Revenue5146578DirectOffsettingRevenue
Net Community Benefit Expense2276734NetCommunityBenefitExpense
Percent Of Total Expense0.05410PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense25319TotalCommunityBenefitExpense
Net Community Benefit Expense25319NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense25319TotalCommunityBenefitExpense
Net Community Benefit Expense25319NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense7448631TotalCommunityBenefitExpense
Direct Offsetting Revenue5146578DirectOffsettingRevenue
Net Community Benefit Expense2302053NetCommunityBenefitExpense
Percent Of Total Expense0.05470PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$4,767,691BadDebtExpenseAmount
Amount Attributable To2383845AmountAttributableTo
Amount Reimbursed By Medicare12073437AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare14622421CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-2548984MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1MMC - LIVINGSTONBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11717 HWY 59 BYPASSAddressLine1
CityLIVINGSTONCity
StateTXState
ZIP Code77351ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MMC - LIVINGSTONBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedtrueCHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into AccounttrueTakeIntoAccount
Other FacilitiestrueOtherFacilities
CHNA Widely AvailabletrueCHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs AddressedfalseAllNeedsAddressed
Organization Incur Excise TaxfalseOrganizationIncurExciseTax
File Form4720 Report Excise TaxfalseFileForm4720ReportExciseTax
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent200.0000FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent250.0000FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Uninsured DiscountXUninsuredDiscount
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymentfalseActionsOnNonpayment
Collection ActivitiestrueCollectionActivities
Other ActionsXOtherActions
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargestrueGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (18 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part VI - Additional InformationPART VI, LINE 1 - PART I, LINE 7, COLUMN (F):IN ACCORDANCE WITH THE INSTRUCTIONS, COMMUNITY BENEFITS EXPENSE TOTALING $25,319 INCLUDED IN PART IX, LINE 25, COLUMN A AND $44,658 IN MISCELLANEOUS INCOME 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 $42,094,289 LESS: COMMUNITY BENEFITS EXPENSE ( 25,319) REVENUE FROM NON-PATIENT CARE ACTIVITIES ( 44,658) ADJUSTED PATIENT CARE COSTS $42,024,312
Part VI - Affilated Health Care System Roles and PromotionIN 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. THE LUFKIN HOSPITAL (MEMORIAL HEALTH SYSTEM OF EAST TEXAS) IS ABLE TO ACCEPT TRANSFERS OF MORE MEDICALLY COMPLEX CASES FROM THE OTHER SYSTEM HOSPITALS.
Part VI - Explanation Of How Organization Furthers Its Exempt PurposeTHE HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY THROUGH PARTICIPATION IN DIABETIC EDUCATION, ORTHOPEDIC EDUCATION, AND BASIC LIFE SUPPORT. THE HOSPITAL PARTICIPATES IN HEALTH FAIRS AT THE HOSPITAL, HEALTH FAIRS AT ESCAPEES, HEALTH FAIRS AT THE MULTI-CULTURAL FESTIVAL, SPEAKING AT ROTARY, LIONS CLUB AND OTHER AREA ORGANIZATIONS, PARTICIPATING IN BUSINESS AFTER HOURS, RELAY FOR LIFE, MONTHLY WOMEN'S POWER LUNCHEONS AND THE ALZHEIMER'S MEMORY WALK. THE HOSPITAL ALSO SUPPORTS THE FOLLOWING COMMUNITY GROUPS: CANCER SUPPORT GROUP, WEIGHT WATCHERS, TOPS (TAKING OFF POUNDS SENSIBLY) ANGELINA COLLEGE LVN AND RN NURSING PROGRAMS AND OTHER CLINICAL STUDIES, TYLER COUNTY NURSING PROGRAM, AND AREA HIGH SCHOOLS' HEALTH CAREERS PROGRAMS WHICH ALLOW HIGH SCHOOL STUDENTS TO PARTICIPATE IN CLINICAL STUDIES AT THE HOSPITAL.
Part VI - Community InformationPOLK COUNTY HAS AN APPROXIMATE POPULATION OF 45,656 AS OF 2012, IS CONSIDERED A RURAL COUNTY AND ALSO A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA. THE MEDIAN INCOME PER HOUSEHOLD, AS OF 2011, IS $36,073; 19.9% OF PERSONS IN POLK COUNTY ARE BELOW THE POVERTY LEVEL. APPROXIMATELY 12% OF OUR PATIENT BASE IS UNINSURED, APPROXIMATELY 15% OF OUR PATIENT BASE IS MEDICAID RECIPIENTS, AND APPROXIMATELY 51% OF OUR PATIENT BASE IS MEDICARE RECIPIENTS. THE HOSPITAL IS THE ONLY ACUTE CARE FACILITY IN POLK COUNTY, AND IS THEREFORE THE ONLY HOSPITAL WHICH DIRECTLY SERVES OUR COMMUNITY.WITH THE CITY OF LIVINGSTON BEING THE COUNTY SEAT, WE SERVE AS THE MEDICAL HUB OF POLK COUNTY. WE SERVE AS THE PRIMARY HEALTH CARE FACILITY FOR THE ALABAMA-COUSHATTA TRIBE OF TEXAS, WHO RESIDE IN POLK COUNTY. WITH LAKE LIVINGSTON BEING THE SECOND LARGEST LAKE IN TEXAS, THE HOSPITAL SERVES A LARGE POPULATION OF RETIREES, SNOWBIRDS AND VACATIONERS. IN 2012, THE POPULATION OF 65 YEARS AND OLDER WAS 19.5%.
Part VI - Patient Education of Eligibility for AssistanceTHE HOSPITAL INFORMS AND EDUCATES PATIENTS BY PROVIDING PATIENT HANDBOOKS WHICH CONTAIN INFORMATION FOR UNINSURED PATIENTS AS WELL AS FINANCIAL COUNSELOR INFORMATION. PATIENT BILLS HAVE INFORMATI0N AND WORDING IN THEM WHICH STATES FOR THEM 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 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.
Part VI - Needs AssessmentIN 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 ServicesALL PATIENTS ARE CHARGED EQUALLY. PATIENTS WHO FILE AN APPLICATION FOR FINANCIAL ASSISTANCE ARE NOT BILLED UNLESS IT IS LATER DETERMINED THAT THEY DO NOT QUALIFY FOR FINANCIAL ASSISTANCE.Number of Hospital Faciltiy - 1
Part V, Line 20d - Other Billing Determination of Individuals Without InsurancePATIENTS 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 EngagedACCIDENT 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 WhyFollowing 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 AssessmentThe 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 CommunityInterview 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 CountyNumber of Hospital Faciltiy - 1
Part III, Line 9b - Provisions On Collection Practices For Qualified PatientsAS 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 8 - Explanation Of Shortfall As Community BenefitTHE HOSPITAL BELIEVES THAT THE SHORTFALL SHOWN ON LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT. ALTHOUGH THE HOSPITAL IS NOT REQUIRED TO FILE AN ANNUAL COMMUNITY BENEFIT REPORT WITH THE STATE OF TEXAS, THE STATE INCLUDES THE UNREIMBURSED COST APPLICABLE TO MEDICARE PATIENTS AS 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 ExpenseTHE 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 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 3 - Methodology of Estimated Amount & Rationale for Including in Community BenefitTHE AMOUNT SHOWN ON LINE 3 IS BASED ON THE HOSPITAL'S ESTIMATE THAT 50% OF THE ACCOUNTS RECORDED AS BAD DEBT EXPENSE WOULD HAVE BEEN CLASSIFIED AS CHARITY (COMMUNITY BENEFIT) HAD THE APPROPRIATE INFORMATION BEEN OBTAINED. IN 2012, UNCOMPENSATED CARE CHARGES FOR CHARITY ACCOUNTS DECREASED APPROXIMATELY $11 MILLION FROM THE PREVIOUS YEAR, WHEREAS UNCOMPENSATED CARE CHARGES FOR UNCOLLECTIBLE ACCOUNTS (BAD DEBTS) INCREASED APPROXIMATELY $13.5 MILLION. IN 2012, CHARITY ACCOUNTS WERE ONLY 2.7% OF GROSS PATIENT SERVICES REVENUE (GPSR) WHEREAS IN THE PRIOR TWO YEARS, CHARITY ACCOUNTS WERE AT LEAST 7.5% OF GPSR. IN ADDITION, THIS ESTIMATE IS BASED ON POLK COUNTY'S POPULATION MEDIAN INCOME PER HOUSEHOLD OF $36,073, THAT 19.9% OF POLK COUNTY RESIDENTS ARE BELOW THE POVERTY LEVEL AND THAT 61% OF GROSS PATIENT SERVICES REVENUE WAS FROM OUTPATIENTS. THERE ARE ALSO OTHER REASONS WHY ADEQUATE INFORMATION WAS NOT OBTAINED. THESE REASONS INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: LANGUAGE BARRIERS WITH THE SPANISH SPEAKING POPULATION THE 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. 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 ExpenseTHE HOSPITAL USED THE COSTING METHODOLOGY DERIVED FROM WORKSHEET 2 - "RATIO OF PATIENT CARE COST-T0-CHARGES" TO CALCULATE THE AMOUNT SHOWN ON LINE 2. THE HOSPITAL ACCOUNTS FOR DISCOUNTS AS DEDUCTIONS FROM GROSS PATIENT REVENUE AND WHERE APPLICABLE, PAYMENTS ON PATIENTS' ACCOUNTS AS DEDUCTIONS FROM UNCOLLECTIBLE ACCOUNTS (BAD DEBTS EXPENSE).
Part I, Line 6a - Related Organization Community Benefit ReportINFORMATION RELATED TO THE ORGANIZATION IS INCLUDED IN THE "REPORT TO THE COMMUNITY" PREPARED ANNUALLY BY MEMORIAL HEALTH SYSTEM OF EAST TEXAS. AS THE HOSPITAL IS IN A COUNTY WITH LESS THAN 50,000 POPULATION AND IS IN A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA, IT IS NOT REQUIRED TO PREPARE AND FILE AN ANNUAL COMMUNITY BENEFIT REPORT WITH THE STATE OF TEXAS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonDAVID LEMONTENamePerson
TitleADMINISTRATORTitle
Base Compensation Filing Org144661BaseCompensationFilingOrg
Other Compensation Filing Org154197OtherCompensationFilingOrg
Deferred Comp Filing Org2356DeferredCompFilingOrg
Nontaxable Benefits Filing Org16867NontaxableBenefitsFilingOrg
Total Compensation Filing Org318081TotalCompensationFilingOrg

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PATIENT SERVICE REVENUE RECONCILIATION:PATIENT SERVICE REVENUE SHOWN ON FORM 990, PART VIII, LINE 2A WAS DETERMINED AS FOLLOWS: GROSS CHARGES TO PATIENTS $263,220,408 LESS: MEDICARE CONTRACTUAL ADJUSTMENTS (108,021,540) MEDICAID CONTRACTUAL ADJUSTMENTS ( 24,026,607) INDUSTRY/MANAGED CARE ADJUSTMENTS ( 54,099,560) CHARITY DEDUCTIONS ( 7,166,090) UNCOLLECTIBLE ACCOUNTS ( 29,854,045) OTHER DISCOUNTS ( 1,385,279) PATIENT SERVICE REVENUE $ 38,667,287
FORM 990 - PART V - QUESTION 1AMEMORIAL 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. THE HOSPITAL REIMBURSES MHSET FOR SUCH PAYMENTS.
Other Changes In Net Assets Or Fund Balances - Other IncreasesRESTRICTED FUND INTEREST INCOME = $146Form 990, Part XI, Line 9
Other Changes In Net Assets Or Fund Balances - Other IncreasesRESTRICTED FUND CONTRIBUTIONS = $60000Form 990, Part XI, Line 9
Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableORGANIZATIONAL DOCUMENTS, APPLICATIONS 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, TEXAS 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 15a: Compensation Review & Approval Process - CEO, Top ManagementTHE SALARIES OF THE ADMINISTRATOR AND COO/CNO OF THE CORPORATION ARE 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 15a
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsANNUALLY, 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 INTEREST AND ACTIVITIES FORM AND RETURNS THEM TO THE CHIEF EXECUTIVE OFFICER (CEO) OF MEMORIAL HEALTH SYSTEM OF EAST TEXAS (MHSET). THE CEO AND MHSET'S GENERAL COUNSEL REVIEW EACH STATEMENT ACKNOWLEDGING RECEIPT OF THE POLICY AND DISCLOSURES TO FAMILIARIZE THEMSELVES WITH POTENTIAL CONFLICTS.Form 990, Part VI, Line 12c
Form 990, Part VI, Line 11b: Form 990 Review ProcessA COMMITTEE OF THE BOARD OF DIRECTORS OF MEMORIAL MEDICAL CENTER - LIVINGSTON REVIEWS THE FORM 990 BEFORE FILING.Form 990, Part VI, Line 11b
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or ShareholdersTHE MEMBER (MEMORIAL HEALTH SYSTEM OF EAST TEXAS) HAS FINAL APPROVAL OF ALL ACTIONS OF THE BOARD OF DIRECTORS OF MMC-LIVINGSTON, EXCEPT THOSE RELATED TO CREDENTIALING AND PATIENT CARE QUALITY ASSURANCE.Form 990, Part VI, Line 7b
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing BodyTHE MEMBER (MEMORIAL HEALTH SYSTEM OF EAST TEXAS) APPROVES THE INDIVIDUALS SELECTED TO THE BOARD OF DIRECTORS OF MMC-LIVINGSTON AND THE MANAGEMENT OF MHSET PROVIDES OVERSITE OF FINANCIAL AND CLINICAL OPERATIONS.Form 990, Part VI, Line 7a
Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderMEMORIAL HEALTH SYSTEM OF EAST TEXAS IS THE SOLE MEMBER.Form 990, Part VI, Line 6
Form 990, Part VI, Line 3: Description of Delegated Duties to Management CompanyMEMORIAL HEALTH SYSTEM OF EAST TEXAS PROVIDES MANAGEMENT AND FINANCIAL ASSISTANCE TO MMC-LIVINGSTON, TO INCLUDE ATTENDANCE AT MONTHLY MEETINGS OF THE BOARD OF DIRECTORS, BILLING AND COLLECTION OF CHARGES FOR PATIENT SERVICES, DATA PROCESSING SERVICES, 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
Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, EtBOARD MEMBER RELATIONSHIPS: CLARKE EVANS AND CORKY EVANS - FAMILY RELATIONSHIP CORKY EVANS AND JOHN P. THOMPSON - BUSINESS RELATIONSHIP CORKY EVANS AND JUDY COCHRAN - BUSINESS RELATIONSHIP CORKY EVANS AND H. E. STRIEDEL - BUSINESS RELATIONSHIPForm 990, Part VI, Line 2

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
LUFKIN VISION ACQUISITIONS
1201 FRANK AVENUELUFKINTX75904820563768PROVIDES OFFICE SPACE FOR HEALTH CARE PROFESSIONALSTX501(C)(3)11CMEMORIAL HEALTH SYSTEM OF EAST TEXASfalse
MEMORIAL MULTISPECIALTY ASSOCIATES
1201 FRANK AVENUELUFKINTX75904752721155PROVIDES PHYSICIANS TO NON PROFIT HOSPITALSTX501(C)(3)11cMEMORIAL HEALTH SYSTEM OF EAST TEXASfalse
MEMORIAL MEDICAL CENTER - SAN AUGUSTINE
511 E HOSPITAL STSAN AUGUSTINETX75972752663904LICENSED HOSPITALTX501(C)(3)(3) HOSPITALMEMORIAL HEALTH SYSTEM OF EAST TEXASfalse
MEMORIAL HEALTH SYSTEM OF EAST TEXAS
1201 W FRANK AVELUFKINTX75904750755367LICENSED HOSPITALTX501(c)(3)(3) HOSPITALfalseN/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg