2011-11-09T07:44:13-08:00 2010-12-31 Axley & Rode LLP 1307 S 1st St Lufkin TX 759014717 990 2010-01-01 752492741 Memorial Specialty Hospital MEMO 9366397975 P O Box 1447 Lufkin TX 75902 KRISTI GAY 2011-11-07 J LEON MANNING CPA 9366346621 2010 2016-02-24 21:20:13Z BRENDA BROADWAY 1201 W FRANK LUFKIN TX 75901 10865617 false false X N/A X 1992 TX THE ORGANIZATION OPERATES A SPECIALTY HOSPITAL THAT PROVIDES EXTENDED ACUTE HEALTH CARE SERVICES TO PATIENTS FROM ANGELINA AND SURROUNDING COUNTIES. 10 9 131 0 0 11917394 10865509 105 108 0 11917499 10865617 0 0 3734759 5044249 0 0 3994371 3952370 7729130 8996619 4188369 1868998 16895814 18657011 1157317 1049516 15738497 17607495 The mission of Memorial Specialty Hospital is to support, manage, and furnish facilities to provide quality acute long term healthcare services for the citizens of Angelina, Polk, San Augustine and the surrounding counties of deep East Texas. false false 7806876 10865509 HOSPITAL SERVICES TO PATIENTS, INCLUDING 7423 PATIENT DAYS AND 261 ADMISSIONS TO THE HOSPITAL. 7806876 true false false false false false false false false false true false false true true false false true false false false false false false false false true false false false true false false false false false false false false false false false false false false false false false false false false false true 0 0 false 131 true false false false false false false false false false false false 0 false false false false false false false false false false false X 10 9 false true false false false false false true true false false false true true true true true true true true false false X BRENDA BROADWAY 9366397161 1201 W FRANK LUFKIN TX 75901 VAN WATSON 0.00 X 0 0 0 TERRY MORGAN 0.00 X 0 0 0 ROBERT HALLETT M D 0.00 X 0 0 0 PHIL MEDFORD 0.00 X 0 0 0 KAREN PITTMON 50.00 X 111815 0 4094 DAVID TODD M D 0.00 X 0 0 0 DAVID PERKINS 0.00 X 0 0 0 BRYANT H KRENEK 0.00 X 0 0 0 BRENDA BROADWAY 40.00 X X 145957 0 18211 BOB BROWN 0.00 X 0 0 0 ARTIE BEDARD 0.00 X 0 0 0 257772 22305 2 false true false SODEXO SERVICES P O BOX 536922 ATLANTA GA 303536922 DIETARY/ENVIROMENTAL 197061 REMEDY WORKS LLC P O BOX 150237 LUFKIN TX 75915 MEDICAL 171048 AMN HEALTHCARE INC FILE 56157 LOS ANGELES CA 900746157 AGENCY NURSES 410149 ADVANCED TEMPORARIES INC P O BOX 8022 TYLER TX 75711 AGENCY NURSES 114106 4 0 PATIENT SERVICE REVENUE 621990 10864531 10864531 MISCELLANEOUS REVENUE 621990 978 978 10865509 108 108 0 0 0 0 0 0 0 0 10865617 10865509 108 0 0 0 0 107827 107827 0 4194066 3869417 324649 68130 61291 6839 407769 367148 40621 266457 239708 26749 0 1585 1585 10779 10779 0 0 0 460420 446623 13797 0 4401 4401 4566 4566 0 99843 99843 8340 1574 6766 0 0 0 0 271842 271842 -203313 -203313 UNCOLLECTIBLE ACCOUNTS 25192 25192 RENTS & LEASES - EQUIP 291970 284693 7277 PATIENT CARE SUPPLIES 1137281 1137281 OTHER OPERATING EXPENSES 1230869 1196711 34158 HOME OFFICE COST ALLOCATION 599412 599412 9183 8866 317 8996619 7806876 1189743 0 25867 0 0 0 3440132 1725909 0 0 0 62284 85134 18723 7627 2324327 1661299 640447 663028 0 0 0 0 12708361 16175313 16895814 18657011 579263 544216 578054 505300 1157317 1049516 X 15738497 17607495 15738497 17607495 16895814 18657011 1868998 X false true false X false false X 108106 100169 7937 2216221 1561130 655091 663028 DUE FROM MEMORIAL HEALTH SYSTEM 16175313 16175313 THIRD PARTY SETTLEMENTS 184000 PENSION PLAN PAYABLE 91256 INSURANCE RESERVE PAYABLE 230044 505300 true true true X true X true true true false true true 298998 298998 0.03330 298998 298998 0.03330 298998 298998 0.03330 false 3721 7302524 8323218 -1020694 X true true 1 0 MEMORIAL SPECIALTY HOSPITAL

1201 W FRANK AVE SUITE D-5 LUFKIN TX 75904

X LONG-TERM ACUTE CARE HOSPITAL MEMORIAL SPECIALTY HOSPITAL 1 false true true 200.0000 true 250.0000 true X X X X true true X X X false true X X X X X true X false true Part VI - Additional Information PART I, LINE 7 - THE HOSPITAL USED A COST-TO-CHARGE RATIO TO CALCULATE THE AMOUNTS REPORTED IN THIS TABLE. THIS COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 - "RATIO OF PATIENT CARE COST-TO-CHARGES".PART III - SECTION A - BAD DEBTS EXPENSE:THE AMOUNT SHOWN ON LINE 2 WAS DETERMINED BY USING THE COSTING METHODOLOGY DERIVED FOR WORKSHEET 2 - "RATIO OF PATIENT CARE COST-TO-CHARGES". THE HOSPITAL ACCOUNTS FOR DISCOUNTS AS DEDUCTIONS FROM GROSS PATIENT REVENUE AND WHERE APPLICABLE, PAYMENT ON PATIENTS ACCOUNTS AS DEDUCTIONS FROM UNCOLLECTIBLE (BAD DEBTS EXPENSE) ACCOUNTS.PART VI, LINE 1 - PART I, LINE 7, COLUMN (F) (BAD DEBT DISCLOSURES)IN ACCORDANCE WITH THE INSTRUCTIONS, UNCOLLECTIBLE ACCOUNTS (BAD DEBTS) TOTALING $25,192 INCLUDED IN PART IX, LINE 25, COLUMN A AND $978 IN REVENUE FROM NON PATIENT SERVICES 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 $8,996,619 LESS: UNCOLLECTIBLE ACCOUNTS (BAD DEBTS) ( 25,192) REVENUE FROM NON-PATIENT CARE ACTIVITIES ( 978) ADJUSTED PATIENT CARE COSTS $8,970,449 Part VI - States Where Community Benefit Report Filed TX Part VI - Affilated Health Care System Roles and Promotion IN ADDITION TO THE CUSTOMIZED OUTREACH IN EACH INDIVIDUAL COMMUNITY, THE CORPORATE STRUCTURE PROVIDES EACH HOSPITAL IN ANGELINA, POLK AND SAN AUGUSTINE COUNTIES WITH IMPROVED MEDICAL TECHNOLOGY THROUGH A COMMON COMPUTER SYSTEM, COMMUNICATION TO ALL COMMUNITIES THROUGH THE CORPORATE MARKETING DEPARTMENT, AND COORDINATION OF MEDICAL TRAINING FOR ALL CLINICAL EMPLOYEES. MEMORIAL SPECIALTY HOSPITAL IS ABLE TO PROVIDE CARE FOR CRITICALLY ILL, MEDICALLY COMPLEX PATIENTS WHOSE NEEDS CANNOT BE MET IN OTHER POST-ACUTE CARE ENVIROMENTS. Part VI - Explanation Of How Organization Furthers Its Exempt Purpose THE HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY THROUGH PARTICIPATION IN HEALTHCARE EDUCATION OUTREACHES SUCH AS DIABETES EXPO, SENIOR LIFESTYLE EXPO, AND WOMEN'S LIFESTYLE EXPO. IN ADDITION, THE HOSPITAL PARTNERS WITH ANGELINA COLLEGE, STEPHEN F. AUSTIN STATE UNIVERSITY AND TYLER COUNTY NURSING PROGRAMS TO PROVIDE EDUCATION AND CLINICAL ROTATIONS, AND WITH AREA HIGH SCHOOLS HEALTH CAREERS PROGRAMS WHICH ALLOW HIGH SCHOOL STUDENTS TO PARTICIPATE IN CLINICAL STUDIES AT THE HOSPITAL. Part VI - Community Information ANGELINA COUNTY HAS AN APPROXIMATE POPULATION OF 86,771 AS OF 2010, AND IS A FEDERALLY DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREA. THE POPULATION MEDIAN INCOME PER HOUSEHOLD, AS OF 2009, IS $38,752; 17% OF PERSONS IN ANGELINA COUNTY ARE BELOW THE POVERTY LEVEL. APPROXIMATELY 7.34% OF OUR PATIENT BASE IS UNINSURED, APPROXIMATELY 0.46% OF OUR PATIENT BASE IS MEDICAID RECIPIENTS, AND APPROXIMATELY 82.34% OF OUR PATIENT BASE IS MEDICARE RECIPIENTS. THE HOSPITAL IS THE ONLY LONG-TERM ACUTE CARE FACILITY IN ANGELINA COUNTY, SERVING 13 CONTIGUOUS COUNTIES.WITH THE CITY OF LUFKIN BEING THE COUNTY SEAT, WE SERVE AS THE MEDICAL AND RETAIL HUB OF ANGELINA AND SURROUNDING COUNTIES. WITH PROXIMITY TO TWO NATIONAL FORESTS AND LAKE SAM RAYBURN, WHICH IS THE LARGEST LAKE COMPLETELY IN TEXAS, THE HOSPITAL SERVES A LARGE POPULATION OF RETIREES AND RECREATIONAL LAND USERS. ANGELINA COUNTY IS HOME TO ANGELINA COLLEGE, A VETERAN'S ADMINISTRATION HEALTH CLINIC, THREE MUSEUMS AND A ZOO. Part VI - Patient Education of Eligibility for Assistance THE HOSPITAL INFORMS AND EDUCATES PATIENTS BY PROVIDING PATIENT HANDBOOKS TO INPATIENTS THAT CONTAIN INFORMATION FOR UNINSURED PATIENTS AS WELL AS FINANCIAL COUNSELOR INFORMATION. PATIENT BILLS HAVE INFORMATION AND WORDING IN THEM WHICH STATES FOR THEM TO CALL THE BUSINESS OFFICE FOR POSSIBLE DISOUNTS FOR UNINSURED PATIENTS. WE ALSO PROVIDE LITERATURE FOR THE PUBLIC TITLED "NEED HELP WITH HOSPITAL BILLS?" THAT LIST POSSIBLE PROGRAMS AND FINANCIAL COUNSELOR HOURS OF OPERATION.FOR PATIENTS ARRIVING THROUGH MEMORIAL HEALTH SYSTEM OF EAST TEXAS, THERE ARE SIGNS IN THE EMERGENCY DEPARTMENT AND REGISTRATION AREAS NOTIFYING PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE AND GIVES INSTRUCTIONS FOR CONTACTING FINANCIAL COUNSELORS. WE ALSO HAVE A THIRD PARTY ELIGIBILITY CONTRACTOR WHOSE ROLE IT IS TO SCREEN SELF PAY PATIENTS AND QUALIFY THEM FOR GOVERNMENT PROGRAMS AND TO FORWARD POTENTIAL CHARITY PATIENTS TO OUR FINANCIAL COUNSELORS. THE HOSPITAL HAS AN ON-SITE MEDICAID ELIGIBILITY SPECIALIST TO HELP PATIENTS COMPLETE PAPERWORK AND EXPEDITE APPLICATION PROCESSING. ADDITIONALLY, INFORMATION REGARDING FINANCIAL ASSISTANCE IS LOCATED IN THE COMMON AREAS OF THE HOSPITAL. SPECIFIC FINANCIAL ASSISTANCE GUIDANCE IS PROVIDED INDIVIDUALLY TO OUR PATIENTS AND FAMILY MEMBERS THROUGH OUR BUSINESS OFFICE ASSISTANT. Part VI - Needs Assessment 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. IN LUFKIN, WE HAVE A STRONG AFFILIATION WITH THE ANGELINA COUNTY AND CITIES HEALTH DISTRICT WHICH MEETS THE NEEDS OF UNDERSERVED CITIZENS. Number of Hospital Faciltiy - 0 Part V, Line 21 - Charge Patients Amount Equal Gross Charge for Services ALL PATIENTS ARE EQUALLY CHARGED. PATIENTS WHO FILE AN APPLICATION FOR FINANCIAL ASSISTANCE ARE NOT BILLED UNLESS IT IS LATER DETERMINED THAT THEY DO NOT QUALIFY FOR ASSISTANCE. Number of Hospital Faciltiy - 0 Part V, Line 19d - Other Billing Determination of Individuals Without Insurance PATIENTS WITHOUT INSURANCE ARE BILLED USING THE SAME RATES FOR SERVICES AS ALL OTHER PATIENTS. Number of Hospital Faciltiy - 0 Part V, Line 16e - Other Collection Actions by Facility or Third Party Engaged ACCIDENT LIABILITY CASE LIENS FILED AGAINST FUTURE SETTLEMENT. Part III, Line 9b - Provisions On Collection Practices For Qualified Patients AS SOON AS SUFFICIENT INFORMATION IS AVAILABLE CONCERNING THE PATIENT'S FINANCIAL RESOURCES AND ELIGIBILITY FOR GOVERNMENT ASSISTANCE, A DETERMINATION IS MADE CONCERNING THE PATIENT'S ELIGIBILITY FOR CHARITY. NO COLLECTION EFFORTS WILL BE PURSUED ON A CHARITY ACCOUNT AFTER SUCH DETERMINATION IS MADE. Part III, Line 8 - Explanation Of Shortfall As Community Benefit THE HOSPITAL BELIEVES THAT THE SHORTFALL OF $1,020,694 SHOWN ON LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT. IN THE STATE OF TEXAS'S ANNUAL COMMUNITY BENEFIT REPORT, THE UNREIMBURSED COSTS APPLICABLE TO MEDICARE PATIENTS IS A PART OF THE DETERMINATION THAT A HOSPITAL MEETS THE STATE'S REQUIREMENT THAT THE COST OF PROVIDING CHARITY CARE IS EQUAL TO AT LEAST 5% OF NET PATIENT SERVICE REVENUE. ALSO, IRS 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. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. APPROXIMATELY 80% OF OUR PATIENT BASE ARE MEDICARE RECIPIENTS AND THERE ARE A NUMBER OF LOW-INCOME CONSUMERS RECEIVING MEDICARE BENEFITS. Part III, Line 4 - Bad Debt Expense THE HOSPITAL DOES NOT REPORT BAD DEBT EXPENSE (UNCOLLECTIBLE ACCOUNTS) IN ACCORDANCE WITH HFMA STATEMENT NO. 15. THE HOSPITAL ACCOUNTS FOR ANY LOSSES ON ACCOUNTS RECEIVABLE USING THE ALLOWANCE METHOD. THE HOSPITAL IS A MEMBER OF A GROUP (SYSTEM) WITH CONSOLIDATED FINANCIAL STATEMENTS AUDITED BY BKD, LLP. THE CONSOLIDATED FINANCIAL STATEMENT FOOTNOTE TO PATIENT ACCOUNTS RECEIVABLE INCLUDES THE FOLLOWING: "THE SYSTEM REPORTS ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL (UNCOLLECTIBLE) ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT." X X false false false false false true false false false false BRENDA BROADWAY 96583 42800 6574 2893 15318 164168 PATIENT SERVICE REVENUE RECONCILIATION: PATIENT SERVICE REVENUE SHOWN ON FORM 990, PART VIII, LINE 2A WAS DETERMINED AS FOLLOWS: GROSS CHARGES TO PATIENTS $60,743,614 LESS: MEDICARE CONTRACTUAL ADJUSTMENTS (44,400,963) INDUSTRY/MANAGED CARE ADJUSTMENTS (3,422,474) OTHER DISCOUNTS (31,286) CHARITY DEDUCTIONS (2,024,360) PATIENT SERVICE REVENUE $10,864,531 PART IV, LINE 20B: THE HOSPITAL'S TAX YEAR DID NOT BEGIN AFTER MARCH 23, 2010, THEREFORE, IN ACCORDANCE WITH THE INSTRUCTIONS FOR FORM 990, A COPY OF THE MOST RECENT "AUDITED FINANCIAL STATEMENTS" IS NOT REQUIRED TO BE ATTACHED. FORM 990 - PART V - QUESTION 1A: MEMORIAL HEALTH SYSTEM OF EAST TEXAS (MHSET) PAYS THE HOSPITAL'S BILLS FOR SERVICES THAT WOULD REQUIRE THE PREPARATION OF FORMS 1099 AND THE RELATED FORM 1096, AND REPORTS SUCH PAYMENTS UNDER ITS FEDERAL IDENTIFICATION NUMBER (75-0755367). THE HOSPITAL REIMBURSES MHSET FOR SUCH PAYMENTS. Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available ORGANIZATIONAL DOCUMENTS, APPLICATION FOR EXEMPTION, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS OF THE CORPORATION ARE AVAILABLE FOR INSPECTION AND COPYING IN THE OFFICE OF THE CHIEF FINANCIAL OFFICER OF MEMORIAL HEALTH SYSTEM OF EAST TEXAS LOCATED AT 1201 W. FRANK AVENUE, LUFKIN, TX 75904 ON ORAL OR WRITTEN REQUEST DURING REGULAR BUSINESS HOURS, OR SUCH OTHER TIMES AS ARE SCHEDULED DIRECTLY WITH THE CHIEF FINANCIAL OFFICER. Form 990, Part VI, Line 15b Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees THE SALARY OF THE ADMINISTRATOR IS SET BY BRYANT H. KRENEK, AN EX-OFFICIO BOARD MEMBER, BASED ON THE RECOMMENDATION OF THE CHIEF OPERATING OFFICER OF MEMORIAL HEALTH SYSTEM OF EAST TEXAS THAT IS DETERMINED BY UTILIZING NATIONALLY PUBLISHED COMPARABLES FOR INDIVIDUALS WITH SIMILAR RESPONSIBILITIES IN INSTITUTIONS OF A SIMILAR SIZE, AND EVALUATION OF PERFORMANCE RELATIVE TO ESTABLISHED GOALS AND OBJECTIVES. INFORMATION USED FOR COMPARISON PURPOSES IS PROVIDED, AS NEEDED, BY THE VICE PRESIDENT OF HUMAN RESOURCES OF MEMORIAL HEALTH SYSTEM OF EAST TEXAS. Form 990, Part VI, Line 12c Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts PRIOR TO THE INITIAL MEETING OF THE CALENDAR YEAR, EACH MEMBER OF THE BOARD AND OFFICER OF THE CORPORATION IS PROVIDED A COPY OF THE CONFLICTS OF INTERESTS POLICY, A STATEMENT ACKNOWLEDGING ITS RECEIPT, AND DISCLOSURE OF OUTSIDE INTEREST AND ACTIVITIES. THE POLICY IS DISCUSSED WITH THE BOARD AND OFFICER. EACH BOARD MEMBER AND OFFICER COMPLETES THE FORMS PROVIDED AND RETURNS THEM TO THE CHIEF EXECUTIVE OFFICER. THE C. E. O. AND THE GENERAL COUNSEL REVIEW EACH STATEMENT ACKNOWLEDGING RECEIPT OF THE POLICY AND THE DISCLOSURES TO FAMILIARIZE THEMSELVES WITH THE POTENTIAL CONFLICTS. Form 990, Part VI, Line 11 Form 990, Part VI, Line 11: Form 990 Review Process EACH YEAR, THE BOARD OF DIRECTORS DETERMINES WHETHER THE FORM 990 WILL BE REVIEWED BY ALL DIRECTORS, AN EXISTING COMMITTEE, OR A SPECIAL COMMITTEE APPOINTED FOR THE PURPOSE OF REVIEWING THE FORM 990 PRIOR TO FILING. THE COMPLETED FORM 990 IS PROVIDED TO THE DIRECTORS OR THE COMMITTEE RESPONSIBLE FOR THE REVIEW, EITHER INDIVIDUALLY OR IN A JOINT SESSION. INDIVIDUALS RESPONSIBLE FOR THE FILING ARE AVAILABLE TO RESPOND TO QUESTIONS OR PROVIDE BACKGROUND AS NEEDED. ONCE THE DIRECTORS RESPONSIBLE FOR REVIEWING THE FORM 990 ARE SATISFIED THAT THE FORM 990 IS COMPLETE, THE RETURN IS FILED. SUBSEQUENTLY, THE RETURN IS MADE AVAILABLE TO ALL DIRECTORS NOT A PART OF THE PREVIOUS REVIEW. Form 990, Part VI, Line 3 Form 990, Part VI, Line 3: Description of Delegated Duties to Management Company MEMORIAL HEALTH SYSTEM OF EAST TEXAS PROVIDES MANAGEMENT AND FINANCIAL SERVICES TO THE CORPORATION, INCLUDING BILLING AND COLLECTION OF CHARGES FOR PATIENT SERVICES, DATA PROCESSING, KEEPING OF FINANCIAL RECORDS, PAYMENT OF SALARIES AND MONTHLY BILLS.