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MOTHER FRANCES HOSPITAL JACKSONVILLE: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MOTHER FRANCES HOSPITAL JACKSONVILLE (EIN 75-1976930)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-10-12
IRS object ID
201222869349301212
Schema version
2010v3.7
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)
Timestamp2012-10-12T16:05:34-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12800 Post Oak Blvd Ste 3200AddressLine1
CityHOUSTONCity
StateTXState
ZIP Code77056ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN751976930EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MOTHER FRANCES HOSPITAL - JACKSONVILLEBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMOTHNameControl
Phone9035315764Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11315 DOCTORS DRIVEAddressLine1
CityTYLERCity
StateTXState
ZIP Code75701ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOYCE HESTERName
TitleCFOTitle
Date Signed2012-08-31DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAmanda MayaName
Phone7134994600Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeXAddressChange
Amended ReturnXAmendedReturn
Name Of Principal Officer PersonB RAY THOMPSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1910 E HOUSTON SUITE 500AddressLine1
CityTYLERCity
StateTXState
ZIP Code75702ZIPCode
FieldValueIRS element (for citing)
Gross Receipts37780716GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.TMFHS.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2000YearFormation
State Legal DomicileTXStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE THE COMMUNITY WITH A FULL RANGE OF COMPREHENSIVE HEALTHCARE SERVICES WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members3NbrIndependentVotingMembers
Total Nbr Employees214TotalNbrEmployees
Total Nbr Volunteers3TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year35911468ProgramServiceRevenuePriorYear
Program Service Revenue CY37733895ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year27775OtherRevenuePriorYear
Other Revenue Current Year46821OtherRevenueCurrentYear
Total Revenue Prior Year35939243TotalRevenuePriorYear
Total Revenue Current Year37780716TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year541691GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY946111GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year9478248SalariesEtcPriorYear
Salaries Etc Current Year9569354SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year24067806OtherExpensePriorYear
Other Expenses Current Year25172933OtherExpensesCurrentYear
Total Expenses Prior Year34087745TotalExpensesPriorYear
Total Expenses Current Year35688398TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1851498RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2092318RevenuesLessExpensesCY
Total Assets BOY12235284TotalAssetsBOY
Total Assets EOY23941694TotalAssetsEOY
Total Liabilities BOY1816931TotalLiabilitiesBOY
Total Liabilities EOY11431023TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY10418353NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY12510671NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE THE COMMUNITY WITH A FULL RANGE OF COMPREHENSIVE HEALTHCARE SERVICES WITHOUT REGARD TO RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense31826234Expense
Grants946111Grants
Revenue37733895Revenue
DescriptionTHE HOSPITAL'S OPERATING PLAN INCORPORATES PROVISIONS FOR INDIVIDUALS WHO DO NOT POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. OUR COMMITMENT TO OUR COMMUNITY EXTENDS TO FREE OR SUBSIDIZED INDIVIDUAL CARE, SUBSIDIZED EDUCATION OF HEALTHCARE PROFESSIONALS, DISCOUNTED FEES FOR PARTICIPANTS IN GOVERNMENT PROGRAMS, COMMUNITY HEALTH EDUCATION AND DONATIONS TO OTHER COMMUNITY AGENCIES. SPECIFIC COMMUNITY SERVICES AND PROGRAMS INCLUDE: WELLNESS AND PREVENTION EDUCATION PROGRAMS, COMMUNITY DIAGNOSTIC SCREENING PROGRAMS, SENIOR CITIZEN HEALTH AWARENESS PROGRAMS, AWARENESS PROGRAMS FOR YOUTH AT RISK, AND AWARENESS PROGRAMS FOR PERSONS WITH SPECIAL PHYSICAL OR MENTAL NEEDS.Description
Total Program Service Expense31826234TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
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 AssetstrueReportOtherAssets
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 OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
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
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees214NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members3NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
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 BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMOTHER FRANCES HOSP ACCTG DEPTNamePerson
Telephone Number9035315764TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11315 DOCTORS DRIVEAddressLine1
CityTYLERCity
StateTXState
ZIP Code75701ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
THOMAS N CAMMACK JR
CEO/DIRECTOR/SECRETARY/TREAS.40.0XX274979013258
MATTHEW A VIERKANT MD
DIRECTOR10.0X049866321356
RAY THOMPSON
SYS EXEC VP/CEO/DIRECTOR1.0XX01194193476648
GLEN T HAMILTON
DIRECTOR/VICE CHAIR10.0XX000
WILLIAM MILAWSKI MD
DIRECTOR10.0X023564717894
DICK STONE
DIRECTOR1.0X000
RANDY GORHAM
DIRECTOR1.0X000
J LINDSEY BRADLEY JR
SYSTEM PRESIDENT/DIRECTOR1.0XX0175128213611
MICHAEL LEWIS
COO1.0X123995013309
PAM VUKOVICH
INTERIM CFO1.0X000
BARRY L THIBODEAUX
CRNA40.023345405745X
JACK CAPPS
CRNA40.0226443015825X
BEN BEATHARD
ECC NURSE40.0105651011726X
KLEANTHE CARUSO
CNO40.011501301978X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1079535TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3679785TotalReportableCompFrmRltdOrgs
Total Other Compensation591350TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
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
CARDIAC IMAGING SERVICES
1737 DOMINION PLAZATYLERTX75703CARDIAC IMAGING390719
COMPLETE RX LTD
3100 S GESSNER SUITE 640HOUSTONTX77063PHARMACY SERVICES672497
TRINCARE CLINICAL LABORATORIES
3200 TROUP HWYTYLERTX75701LAB SERVICES313583
SIEMENS MEDICAL SOLUTIONS
PO BOX 120001DALLASTX75312SOFTWARE MAINTENANCE292904
VIRTUAL RADIOLOGIC
DEPT 7080CAROL STREAMIL60122RADIOLOGIC IMAGING188130
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE6211103470872734708727
OTHER REVENUE90009930251683025168
FieldValueIRS element (for citing)
Total Program Service Revenue37733895TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Personal46737Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Personal0Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Personal46737Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column46737TotalRevenueColumn
Exclusion$46,737ExclusionAmount

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

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

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMEDICAL RECORDS FEESDescription
Business Code900099BusinessCode
Total Revenue Column84TotalRevenueColumn
Exclusion$84ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue84TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column37780716TotalRevenueColumn
Related Or Exempt Function Income37733895RelatedOrExemptFunctionIncome
Exclusion$46,821ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total946111Total
Program Services946111ProgramServices

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)
Total425542Total
Program Services345476ProgramServices
Management And General80066ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7315804Total
Program Services5939337ProgramServices
Management And General1376467ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1828008Total
Program Services1484210ProgramServices
Management And General343798ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total687567Total
Program Services23018ProgramServices
Management And General664549ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

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)
Total10834422Total
Program Services9832199ProgramServices
Management And General1002223ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total71854Total
Management And General71854ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total169615Total
Program Services107015ProgramServices
Management And General62600ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total25795Total
Program Services10439ProgramServices
Management And General15356ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2735693Total
Program Services2598908ProgramServices
Management And General136785ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total6866Total
Program Services3193ProgramServices
Management And General3673ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total15338Total
Program Services6453ProgramServices
Management And General8885ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total465207Total
Program Services441947ProgramServices
Management And General23260ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT EXPENSE67666576766657
MEDICAL SUPPLIES2693205265302740178
FOOD1090611046134448
REPAIRS AND MAINTENANCE5047095014913218
MINOR EQUIPMENT51067485182549

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total35877Total
Program Services13622ProgramServices
Management And General22255ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total35688398Total
Program Services31826234ProgramServices
Management And General3862164ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY124336BOY
EOY118507EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3426703BOY
EOY4311646EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY233509BOY
EOY158986EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY66289BOY
EOY104529EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis8850847LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec7781743LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1155074BOY
EOY1069104EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY7229373BOY
EOY18178922EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12235284BOY
EOY23941694EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1189888BOY
EOY1639796EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY36113BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY590930BOY
EOY9791227EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1816931BOY
EOY11431023EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY10418353BOY
EOY12510671EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10418353BOY
EOY12510671EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12235284BOY
EOY23941694EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses2092318ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationstrueGrantsOtherOrganizations
Grants Other Organizations$1,947GrantsOtherOrganizationsAmount
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB1947TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
LandLand
BuildingsBuildings
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis8850847OtherCostOrOtherBasis
Depreciation7781743Depreciation
Book Value1069104BookValue
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildings
Total Of Book Value Land Buildings1069104TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionDUE FROM AFFILIATESDescription
Book Value18178922BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets18178922TotalBookValueOtherAssets
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
THIRD PARTY PAYOR LIABILITIES$1,271,479
DUE TO AFFILIATES$8,251,148
ESTIMATED SELF INSURANCE COSTS$268,600
FieldValueIRS element (for citing)
Total Of Amounts9791227TotalOfAmounts
Total Revenue37780716TotalRevenue
Total Expenses35688398TotalExpenses
Excess Or Deficit For Year2092318ExcessOrDeficitForYear
Excess Or Deficit Per FS2092318ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt37780716TotRevenueEtcAuditedFinclStmt
Revenue Subtotal37780716RevenueSubtotal
Total Revenue Per Form99037780716TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt35688398TotExpensesEtcAuditedFinclStmt
Expenses Subtotal35688398ExpensesSubtotal
Total Expenses Per Form99035688398TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierFIN 48 DISCLOSUREIdentifier
ExplanationMANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1397686TotalCommunityBenefitExpense
Net Community Benefit Expense1397686NetCommunityBenefitExpense
Percent Of Total Expense0.04830PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense5154789TotalCommunityBenefitExpense
Direct Offsetting Revenue5979187DirectOffsettingRevenue

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense32197TotalCommunityBenefitExpense
Direct Offsetting Revenue34617DirectOffsettingRevenue

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense6584672TotalCommunityBenefitExpense
Direct Offsetting Revenue6013804DirectOffsettingRevenue
Net Community Benefit Expense1397686NetCommunityBenefitExpense
Percent Of Total Expense0.04830PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense17991TotalCommunityBenefitExpense
Net Community Benefit Expense17991NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense169564TotalCommunityBenefitExpense
Net Community Benefit Expense169564NetCommunityBenefitExpense
Percent Of Total Expense0.00590PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense946111TotalCommunityBenefitExpense
Net Community Benefit Expense946111NetCommunityBenefitExpense
Percent Of Total Expense0.03270PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1133666TotalCommunityBenefitExpense
Net Community Benefit Expense1133666NetCommunityBenefitExpense
Percent Of Total Expense0.03920PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense7718338TotalCommunityBenefitExpense
Direct Offsetting Revenue6013804DirectOffsettingRevenue
Net Community Benefit Expense2531352NetCommunityBenefitExpense
Percent Of Total Expense0.08750PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$1,496,111BadDebtExpenseAmount
Amount Reimbursed By Medicare11378285AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare11064461CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall313824MedicareSurplusOrShortfall

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 Line1MOTHER FRANCES HOSPITAL - JACKSONVILLEBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11026 S JACKSON STREETAddressLine1
CityJACKSONVILLECity
StateTXState
ZIP Code75766ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MOTHER FRANCES HOSPITAL - JACKSONVILLEBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
PART III, LINE 4:PATIENT ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL, CLINIC, JACKSONVILLE AND WINNSBORO PROVIDE AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THIRD-PARTY PAYERS ARE BILLED DIRECTLY AND BILLS ARE SENT TO THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELIQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. THE AMOUNT REPORTED ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS AFTER APPLYING THE COST-TO-CHARGE RATIO. THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK.
PART III, LINE 8:THE MEDICAL CENTER USES MEDICARE COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS (ROOM AND BOARD) BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES.
PART III, LINE 9B:THE ORGANIZATION HAS A WRITTEN POLICY COVERING PROCEDURES FOR COLLECTING AND WRITING OFF BAD DEBTS. ACCORDING TO THE POLICY, IF A PATIENT APPEARS TO BE INDIGENT, ACCOUNTS SHOULD BE REVIEWED, AT ANY TIME DURING THE COLLECTION PROCESS, FOR POSSIBLE CONSIDERATION AS A CHARITY CASE IN ACCORDANCE WITH THE ORGANIZATION'S CHARITY CARE POLICY.
NEEDS ASSESSMENT:THE HOSPITAL'S COMMUNITY HEALTH PROFILES PROVIDE A SNAPSHOT OF SUBURBAN, URBAN, AND RURAL SERVICE AREAS WITHIN TEXAS USING KEY HEALTH INDICATORS, WHICH FACILITATE COMPARISONS LOCALLY, REGIONALLY, AND OVER TIME. COMMUNITY HEALTH PROFILES ARE INTENDED TO ASSIST INTERNAL STAKEHOLDERS, COMMUNITY HEALTH COUNCIL MEMBERS, AND THE COMMUNITY HEALTH IMPROVEMENT DEPARTMENT IN DECIDING WHERE TO ALLOCATE RESOURCES AND ADDRESS HEALTH INEQUALITIES. ALL ENTITY ADVOCATES USE NATIONAL, STATE, AND LOCAL SECONDARY AND PRIMARY DATA SOURCES TO PROVIDE A CURRENT OVERVIEW OF LOCAL HEALTH NEEDS, FACTORS IMPACTING DISEASE AND INJURY BURDEN, SOCIOECONOMIC STATUS, ACCESS TO HEALTH CARE, AGE DISTRIBUTION, INDICATORS AND LIFESTYLE BEHAVIORS. THIS DATA IS USED TO GALVANIZE JOINT COMMUNITY HEALTH EFFORTS TO IMPROVE HEALTH AND REDUCE HEALTH INEQUALITIES AND TO EMPOWER THE GREATER COMMUNITY.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY AND CONTACT INFORMATION IS POSTED IN VARIOUS AREAS OF THE HOSPITAL INCLUDING ADMISSIONS & REGISTRATION, EMERGENCY, AND OUTPATIENT DEPARTMENTS. ADDITIONALLY, FINANCIAL ASSISTANCE INFORMATION IS PROVIDED, VERBALLY AND IN WRITTEN BROCHURES, TO ALL SELF PAY PATIENTS BY FINANCIAL COUNSELORS. FINANCIAL ASSISTANCE INFORMATION IS ALSO INCLUDED IN EVERY PATIENT BILL. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO THE PATIENT BY FINANCIAL COUNSELORS WHO ALSO SCREEN SELF PAY PATIENTS FOR POTENTIAL ELIGIBILITY FOR OTHER GOVERNMENTAL ASSISTANCE PROGRAMS. IF IT IS DETERMINED THAT THE PATIENT IS POTENTIALLY ELIGIBLE FOR GOVERNMENTAL ASSISTANCE, THE FINANCIAL COUNSELOR WILL ASSIST THE PATIENT IN COMPLETING ANY FORMS NECESSARY TO APPLY FOR THE ASSISTANCE. AT THE SAME TIME, THE PATIENTS ARE PROVIDED WITH A CHARITY CARE APPLICATION AND INFORMATIONAL FLYER. THE PATIENT IS INFORMED THAT MOTHER FRANCES HOSPITAL-JACKSONVILLE IS A NON-PROFIT CHARITABLE ORGANIZATION OFFERING FINANCIAL ASSISTANCE TO PATIENTS WHO ARE DEEMED MEDICALLY OR FINANCIALLY INDIGENT. THE FINANCIAL COUNSELORS WILL THEN ASSIST THE PATIENT IN COMPLETING THE CHARITY CARE APPLICATION AND OBTAIN ANY AVAILABLE VERIFICATIONS. ONCE THE PATIENT IS DISCHARGED, THE FINANCIAL COUNSELORS WILL CONTINUE TO CONTACT THE PATIENT TO ENSURE ALL NEEDED FORMS AND VERIFICATIONS NEEDED TO FILE AN APPLICATION FOR GOVERNMENTAL ASSISTANCE AND CHARITY CARE HAVE BEEN PROVIDED.
COMMUNITY INFORMATION:MOTHER FRANCES HOSPITAL-JACKSONVILLE IS A 25-BED ACUTE CARE MEDICARE CERTIFIED CRITICAL ACCESS HOSPITAL. CHEROKEE COUNTY, THE PRIMARY SERVICE AREA FOR MFH-JACKSONVILLE, HAS A POPULATION OF APPROXIMATELY 57,000 AND IS PRIMARILY 48,000 IN A 1,052 SQUARE MILE AREA. THE SECONDARY SERVICE AREA INCLUDES THE SOUTHERN PART OF SMITH COUNTY.
PROMOTION OF COMMUNITY HEALTH:MOTHER FRANCES HOSPITAL-JACKSONVILLE PROMOTES HEALTHCARE AND WELLNESS EDUCATION BY OFFERING OUTREACH PROGRAMS AND SPECIAL INITIATIVES THAT IMPROVE THE QUALITY OF LIFE AND HEALTH IN THE COMMUNITIES SERVED. COMMUNITY BENEFIT IS PROVIDED THROUGH MANY REDUCED PRICE SERVICES AND FREE PROGRAMS TO THE COMMUNITY. THESE SERVICES ARE ESSENTIAL TO PROVIDE COMPLETE HEALTHCARE TO THE COMMUNITIES SERVED, SOME OF THESE PROGRAMS INCLUDE THE FOLLOWING: CHEROKEE COUNTY RELAY FOR LIFE: PROVIDED SPONSORSHIP AND STAFFING SUPPORT FOR CHEROKEE COUNTY RELAY FOR LIFE. STAFF PLANNED ACTIVITIES FOR THE ALL-NIGHT EVENT AND MANNED THE EVENT. THE PURPOSE OF THE EVENT WAS TO INCREASE AWARENESS ABOUT CANCER IN THE COUNTY WHICH HAS AN ABOVE AVERAGE RATE OF CANCER. FAMILY CARE CENTER - WOMEN'S SERVICES: OVER 319 VISITS FOR GYNECOLOGICAL SERVICES AT THE LOCAL CLINIC WERE PROVIDED FOR WOMEN THAT DID NOT HAVE A PRIMARY CARE OR SPECIALTY MEDICAL HOME. IN ADDITION, SURGERIES WERE PERFORMED BY FAMILY CARE PHYSICIANS AT MFH-JACKSONVILLE. JACKSONVILLE RODEO: HANDED OUT FANS AND WATER TO PARTICIPANTS AND SPECTATORS AT THE RODEO. HELPED EDUCATE PARTICIPANTS ABOUT THE DANGERS OF EXCESSIVE HEAT AND INJURIES CAUSED BY EXTENSIVE HEAT. REACHED OVER 1,500 PEOPLE WITH HEAT PREVENTION INFORMATION AND MEDICAL SUPPORT ON SITE. JACKSONVILLE ROTARY, ACCESS, AND OTHERS: PROVIDED SPONSORSHIP, STAFFING, AND DEVELOPMENT OF PROGRAMS AND EVENTS FOR THE LOCAL COMMUNITY. ORGANIZATIONS WHICH BENEFITED INCLUDED JACKSONVILLE LITERACY COUNCIL, LIONS CLUB, ROTARY, RED CROSS, ACCESS, HOPE CENTER, UNITED FUND, AND AMERICAN CANCER SOCIETY. MEMBERS OF THE STAFF SERVE IN LEADERSHIP POSITIONS ON VARIOUS BOARDS AND NON-PROFITS IN THE COMMUNITY. COMMUNITY HEALTH INFORMATION AND SCREENINGS: A VARIETY OF COMMUNITY EVENTS WERE HELD INCLUDING OPPORTUNITIES FOR SCREENINGS AT THE CHEROKEE COOP COUNTY HEALTH FAIR AND AT VARIOUS EDUCATIONAL FACILITIES. THESE ACTIVITIES REACHED OVER 1,000 PEOPLE HELPING TO EDUCATE AND IDENTIFY INDIVIDUALS AT RISK AND PROVIDING WAYS TO IMPROVE THEIR HEALTH. KID FEST: THE HOSPITAL CO-SPONSORED A COMMUNITY PROGRAM WHICH WAS HELD TO EDUCATE FAMILIES AND CHILDREN ON THE IMPORTANCE OF BICYCLE SAFETY. OVER 100 CHILDREN PARTICIPATED IN THE PROGRAM.
AFFILIATED HEALTH CARE SYSTEM:MOTHER FRANCES HOSPITAL-JACKSONVILLE IS PART OF AN AFFILIATED HEALTH CARE SYSTEM CALLED TRINITY MOTHER FRANCES HEALTH SYSTEM. TRINITY MOTHER FRANCES IS A FAITH-BASED ORGANIZATION DEDICATED TO CREATING HEALTHY LIVES FOR PEOPLE AND COMMUNITIES. MFH-JACKSONVILLE AND ITS AFFILIATES PROMOTE THE HEALTH OF THE COMMUNITIES SERVED BY PROVIDING ACUTE CARE FACILITIES AND CRITICAL ACCESS FACILITIES, WHOSE OPERATIONS CONSIST PRIMARILY OF PROVIDING INPATIENT AND OUTPATIENT ACUTE CARE AND MEDICAL SERVICES TO PATIENTS RESIDING IN EAST TEXAS.
STATE FILING OF COMMUNITY BENEFIT REPORTTX,990 SCHEDULE H, PART VI

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1SERVICE ORGANIZATION OF PINEY WOODSBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12950 50TH STREETAddressLine1
CityLUBBOCKCity
StateTXState
ZIP Code79314ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient260468622EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant946111AmountOfCashGrant
Purpose Of GrantCOMMUNITY HEALTHCAREPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S.Identifier
Return ReferencePART I, LINE 2ReturnReference
ExplanationGRANT RECIPIENTS ARE REQUIRED TO ACKNOWLEDGE PRIOR TO THE ISSUANCE OF GRANT FUNDS THAT THE GRANT WILL BE USED IN ACCORDANCE WITH THE STATED PURPOSE OF THE GRANT APPLICATION AND ANY UNUSED FUNDS RELATED TO THE SPECIFIC PURPOSE OF THE GRANT WILL BE RETURNED TO THE ORGANIZATION. THE ORGANIZATION MONITORS AND REVIEWS THE FINANCIAL DATA OF RECIPIENTS TO ENSURE THAT THE GRANTED FUNDS ARE BEING USED PROPERLY.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
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

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
THOMAS N CAMMACK JR
2321730428060004283089750288237000
MATTHEW A VIERKANT MD
037634101223220004900016456052001900
RAY THOMPSON
039486104124140386918046793708711016708410386918
BARRY L THIBODEAUX
233454000004293014520239199000
JACK CAPPS
2264430000046610111640242268000
WILLIAM MILAWSKI MD
01854240502230004124013770025354100
J LINDSEY BRADLEY JR
090462608466560004900087110176489300

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierPARTICIPATION IN OR PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANIdentifier
Return ReferencePART I, QUESTION 4BReturnReference
ExplanationPARTICIPANTS IN SERP REPORTED IN W-2 DEFERRED COMPENSATION -------------------- --------------- --------------------- RAY THOMPSON $386,918 $463,037Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (15 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIBE REVIEW PROCESS OF FORM 990FORM 990, PART VI, QUESTION 11ATHE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS PRIOR TO FILING.
DESCRIBE THE ORGANIZATION'S MEMBERS OR STOCKHOLDERSFROM 990, PART VI, QUESTION 6TRINITY MOTHER FRANCES HEALTH SYSTEM IS THE SOLE MEMBER OF MOTHER FRANCES HOSPITAL - JACKSONVILLE.
MEMBERS OR STOCKHOLDERS WHO MAY ELECT MEMBERS OF THE GOVERNING BOARDFORM 990, PART VI, QUESTION 7ATHE SOLE MEMBER, TRINITY MOTHER FRANCES HEALTH SYSTEM, APPOINTS ALL DIRECTORS AND THEIR SUCCESSORS TO THE GOVERNING BOARD.
DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBERFORM 990, PART VI, QUESTION 7BTHE MEMBER HAS THE RIGHT TO APPROVE OR DISAPPROVE CERTAIN ACTIONS THAT HAVE BEEN APPROVED BY THE BOARD OF DIRECTORS.
HOW DOES THE ORGANIZATION MONITOR AND ENFORCE COMPLIANCE WITH POLICYFORM 990, PART VI, QUESTION 12CTHE BOARD REVIEWS AND RESOLVES, IF NECESSARY, ANY TRANSACTIONS AS THEY ARISE THROUGHOUT THE YEAR IN ACCORDANCE WITH POLICY STANDARDS.
PROCESS FOR DETERMINING COMPENSATION OF CEO, OFFICERS, OR KEY EMPLOYEESFORM 990, PART VI, QUESTIONS 15A & 15BTHE ORGANIZATION USES COMPENSATION CONSULTANTS AND NATIONAL COMPENSATION SURVEYS TO DETERMINE COMPENSATION OF EMPLOYEES. COMPENSATION IS APPROVED BY THE ORGANIZATION'S GOVERNING BODY.
DESCRIBE WHETHER THE ORGANIZATION MAKES ITS DOCUMENTS AVAILABLE TO PUBLICFORM 990, PART VI, QUESTION 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
COMPENSATION FROM RELATED ORGANIZATIONSFORM 990, PART VII & SCHEDULE JTHE GOVERNING BOARD OF TRINITY MOTHER FRANCES HEALTH SYSTEM, UPON ADVICE FROM NATIONALLY RECOGNIZED COMPENSATION CONSULTANTS, WHO PERIODICALLY REVIEW ALL EXECUTIVE COMPENSATION, APPROVED A DEFERRED COMPENSATION PLAN THAT PROVIDES A 65% TOTAL RETIREMENT BENEFIT FOR SENIOR EXECUTIVES THAT SERVE 20 YEARS OR MORE. THIS PROGRAM HAS BOTH RETENTION AND NON-COMPETITION CLAUSES THAT CREATE A RISK OF FORFEITURE. DEFERRED COMPENSATION IS SUBJECT TO A RISK OF FORFEITURE BASED ON RETENTION, NON-COMPETITION AND OTHER CONTRACTUAL FACTORS. ACCRUALS OF DEFERRED COMPENSATION ARE NOT INCLUDIBLE IN W-2 COMPENSATION UNTIL PAID. OTHER EMPLOYEE BENEFITS INCLUDE QUALIFIED PENSION PLANS. HEALTH, DENTAL AND LIFE INSURANCE PLANS, DISABILITY INSURANCE, ETC. TAXABLE EXPENSES ARE INCLUDED IN THE W-2 PAID COMPENSATION SALARY AMOUNT.
1099S REPORTED BY ORGANIZATIONFORM 990, PART V, QUESTION 1NO 1099S WERE ISSUED BY THE FILING ORGANIZATION. THE ORGANIZATION'S 1099S ARE ISSUED BY A RELATED ORGANIZATION, MOTHER FRANCES HOSPITAL REGIONAL HEALTH CARE CENTER, WHO REPORTS ALL 1099S FOR THE ENTIRE SYSTEM AND ALLOCATES EXPENSES TO THE APPROPRIATE RELATED ORGANIZATION; THEREFORE, THIS QUESTION IS ANSWERED AS "NONE" FOR THIS FILING ORGANIZATION.
AMENDMENT OF 2010 FORM 990AFTER FILING THE 2010 FORM 990, THE TAXPAYER DISCOVERED ERRORS IN THEIR COMPENSATION INFORMATION. THE TAXPAYER IS AMENDING TO CORRECT THE COMPENSATION REPORTED ON THE FORM 990.
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:MATTHEW A VIERKANT MD TITLE:DIRECTOR HOURS:30
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:RAY THOMPSON TITLE:SYS EXEC VP/CEO/DIRECTOR HOURS:42
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:DICK STONE TITLE:DIRECTOR HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:J. LINDSEY BRADLEY, JR. TITLE:SYSTEM PRESIDENT/DIRECTOR HOURS:42
HOURS DEVOTED FOR RELATED ORGANIZATIONFORM 990 PART VIINAME:PAM VUKOVICH TITLE:INTERIM CFO HOURS:42

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
CHAMPION EMERGENCY SERVICES LLC
2201 S MOBBERLY AVELONGVIEWTX75602752747708AMBULANCE SVCTX501(C)(3)11ANA
MOTHER FRANCES HOSP REGIONAL HC CENTER
1315 DOCTORS DRIVETYLERTX75701750818167HOSPITALTX501(C)(3)3NA
TRINITY MOTHER FRANCES HEALTH SYSTEM FDN
1315 DOCTORS DRIVETYLERTX75701752028241SUPPORTTX501(C)(3)11CNA
REGIONAL MEDICAL SERVICES ASSOCIATION
1315 DOCTORS DRIVETYLERTX75701752511459HEALTHCARETX501(C)(3)3NA
TRINITY MOTHER FRANCES HEALTH SYSTEM
1315 DOCTORS DRIVETYLERTX75701752616975HEALTHCARETX501(C)(3)11CNA
TRINITY CLINIC
1315 DOCTORS DRIVETYLERTX75701752616977HEALTHCARETX501(C)(3)3NA
MOTHER FRANCES HOSPITAL - WINNSBORO
1315 DOCTORS DRIVETYLERTX75701752771569HOSPITALTX501(C)(3)3NA

Form990 Schedule R Part IV Form990ScheduleRPartIV (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnershipAddress Line1AddressForeign/AddressLine1Province Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryLegal Domicile Foreign CountryLegalDomicileForeignCountry
TRI-STATE FINANCIAL LLC
1315 DOCTORS DRIVETYLERTX75701752728318COLLECTION AGENCYTXNAC-CORPORATION000.00000
TRINCARE INC
1315 DOCTORS DRIVETYLERTX75701752161369RETAIL HEALTH SVCTXNAC-CORPORATION000.00000
HEALTHPLAN OF TEXAS INC
514 S BECKHAMTYLERTX75701752636832THIRD PARTY ADMINTXNAC-CORPORATION000.00000
REGIONAL HEALTHCARE ALLIANCE
1315 DOCTORS DRIVETYLERTX75701752484109PREFER PROVIDERTXNAC-CORPORATION000.00000
TEXAS HEALTH FACILITIES INSUR CORP LTD
980136025INSURANCENAC-CORPORATION000.00000PO BOX 1109 BWIGRAND CAYMANCJCJ
CONCORDIUM HEALTH LLC
1315 DOCTORS DRIVETYLERTX75701702811022INACTIVETXNAC-CORPORATION000.00000
EMPLOYER SERVICES INC
1315 DOCTORS DRIVETYLERTX75701752602556INACTIVETXNAC-CORPORATION000.00000
HERITAGE HEALTH PLANS OF TX
1315 DOCTORS DRIVETYLERTX75701752622622INACTIVETXNAC-CORPORATION000.00000
QUALITY CARE ALLIANCE
1315 DOCTORS DRIVETYLERTX75701752662965INACTIVETXNAC-CORPORATION000.00000
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
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 OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg