2011-05-13T07:30:33-05:00 2010-06-30 BKD LLP 2800 Post Oak Blvd Ste 3200 HOUSTON TX 77056 990 2009-07-01 752616977 TRINITY CLINIC TRIN 9035315764 1021 E IDEL TYLER TX 75701 JOYCE HESTER 2011-05-16 M Paige Gerich 7134994600 2009 2016-02-24 21:20:13Z DAVID TEEGARDEN 910 E HOUSTON TYLER TX 75701 126839468 false X WWW.TMFHS.ORG X 1995 TX TO PROVIDE PHYSICIAN SERVICES WITH A FULL RANGE OF COMPREHENSIVE HEALTH CARE SERVICES WITHOUT REGARD TO THE PATIENT'S RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. 15 0 1269 2 -68169 -84696 0 0 142253883 125907687 -595938 188027 -864399 -165225 140793546 125930489 0 5000 0 0 31505217 23583713 0 0 0 130291163 124099321 161796380 147688034 -21002834 -21757545 78021144 81057788 85497233 93327362 -7476089 -12269574 TO PROVIDE PHYSICIAN SERVICES WITH A FULL RANGE OF COMPREHENSIVE HEALTH CARE SERVICES WITHOUT REGARD TO THE PATIENT'S RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. false false 132241883 5000 125825560 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, AWARENESS PROGRAMS FOR PERSONS WITH SPECIAL PHYSICAL OR MENTAL NEEDS, CHILDREN WITH DIABETES SUMMER CAMP, SPORTS CARE PROGRAMS, SAFETY TRAINING FOR LOCAL BUSINESSES, AND RESEARCH PROGRAMS. 132241883 true false false false false false false false true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 1269 true true true false false false false false false false false 15 0 false false false false true false true true true false false true true true true true true true true false X MOTHER FRANCES HOSP ACCTG DEPT 9035315764 1315 DOCTORS DRIVE TYLER TX 75701 STEVEN KEUER MD 20.0 X X 357429 238286 2999546 DAVID TEEGARDEN MD 20.0 X X 512840 341893 15851 ROBERT MCKINNEY MD 40.0 X 533955 0 4900 GIFFORD ECKHOUT MD 40.0 X 616287 0 16762 MELISSA GERDES MD 40.0 X 224544 0 17288 ROGER FOWLER MD 40.0 X 363746 0 15144 KENT WEBB MD 40.0 X 780289 0 4900 WILLIAM HOBBS MD 40.0 X 667922 0 4900 JIM STANFORD MD 40.0 X 324491 0 18062 GREGORY STOVALL 40.0 X 415505 0 18062 KAI XIA MD 40.0 X 983161 0 4900 JAMES CACCITOLO MD 40.0 X 400871 0 4900 HAMPTON WILLIAMS MD 40.0 X 561941 0 15851 JAMES ROGERS MD 40.0 X 246626 0 17643 STEVEN HELF MD 40.0 X 209223 0 16899 ORAN FERRELL 40.0 X 319157 0 15412 LORETTA SWAN 40.0 X 169256 0 12925 KIRT WOOLSEY 40.0 X 143457 0 13607 DAVID LINDZEY MD 40.0 X 413663 0 18062 RICHARD KRONENBERG MD 40.0 X 261401 0 4967 JAMES CABELL MD 40.0 X 1179022 0 4900 VIVEK MEHTA MD 40.0 X 1788286 0 4900 PETER SIRIANNI MD 40.0 X 1084693 0 18062 SAUYU LIN MD 40.0 X 1127448 0 4900 LAURA O'HALLORAN 40.0 X 1061313 0 4900 MATTHEW VIERKANT MD 30.0 X 507270 0 18062 STEVE WALLING MD 40.0 X 204720 0 14740 MARK HIATT MD 40.0 X 315133 0 4900 BRIAN ROBINSON 40.0 X 218568 0 13642 MEG REITMEYER 40.0 X 248138 0 20918 16240355 580179 3350505 256 true true false THOMAS CURTIS MD 5879 HWY 64 W HENDERSON TX 75652 PHYSICIAN SERVICES 372150 CLINTON CARTER MD PA 4048 CHARLESTON PARK TYLER TX 75652 PHYSICIAN SERVICES 328950 QUEST DIAGNOSTICS PO BOX 841725 DALLAS TX 75284 TESTING/LAB SERVICES 384002 ARAMARK MANAGEMENT SERVICES 101 MARKET ST 19TH FLOOR PHILADELPHIA PA 19107 MANAGEMENT SERVICES 243237 SUHEL PATEL MD 2249 HOMESTEAD LANE TYLER TX 75701 PHYSICIAN SERVICES 201360 31 0 NET PATIENT REVENUE 621500 117355302 117273175 82127 OTHER OPERATING REVENUE 900099 8552385 8552385 125907687 236320 236320 0 0 503669 668894 -165225 -165225 -165225 191792 240085 -48293 -48293 14929 -63222 0 0 0 0 125930489 125825560 -68169 173098 5000 5000 0 0 0 10540186 6948498 3591688 0 0 0 809994 403421 406573 358188 358188 0 8929874 7998732 931142 2945471 2921791 23680 993270 823007 170263 24639 5451 19188 476 476 0 0 0 96288788 90480925 5807863 608285 60317 547968 1144271 946315 197956 2400608 46896 2353712 0 2026069 1223044 803025 133770 59317 74453 0 796924 792794 4130 201234 198619 2615 0 2470652 2278089 192563 831153 803045 28108 MEDICAL SUPPLIES 7448817 7448817 BAD DEBT EXPENSE 6509694 6509694 REPAIRS & MAINTENANCE 615269 601618 13651 PERFORMANCE STANDARDS 376929 376929 REGIONAL DEVELOPMENT 276972 276972 951501 951376 125 147688034 132241883 15446151 0 2813717 1788938 11246667 11019876 642423 327818 18552 67085 262875 406733 11450668 4471940 8092124 6978728 16129832 18113542 802519 577039 38012435 41778029 78021144 81057788 12545925 12637326 8789526 6431813 64161782 74258223 85497233 93327362 X -7476089 -12269574 -7476089 -12269574 78021144 81057788 X false true true X false X 414414 1790794 4305 500 2209013 413932 239 243 414414 0.04858 0.95142 false true true 4749991 1187498 3562493 486988 93240 393748 6211589 3191202 3020387 2100 2100 6978728 DUE FROM AFFILIATES 41690217 OTHER ASSETS 87812 41778029 0 DUE TO AFFILIATES 53482102 ACCRUED PENSION LIABILITY 8132563 ESTIMATED SELF INSURANCE COSTS 4289433 DEFERRED COMPENSATION 8354125 74258223 125930489 147688034 -21757545 228319 228319 -21529226 126352810 732116 732116 125620694 309795 309795 125930489 147882036 732116 732116 147149920 538114 538114 147688034 RECONCILIATION OF CHANGES IN NET ASSETS SCH D, PART XI, LINE 8 LOSS ON DISCONTINUED OPERATIONS NOT INCLUDED IN AUDIT 228,319 RECONCILIATION OF AUDITED FINANCIAL STATEMENTS TO FORM 990 SCH D, PART XII AND XIII REVENUE ON BOOKS, NOT ON RETURN: LOSS ON SALE OF ASSETS IN EXPENSE PER AUDIT, REVENUE PER RETURN 63,222 RENTAL EXPENSES INCLUDED WITH REVENUE ON RETURN 668,894 ----------- 732,116 REVENUE ON RETURN, NOT ON BOOKS: MISC CLASSIFICATION DIFFERENCES 75,695 DONATION EXPENSE INCLUDED IN REVENUE PER AUDIT 5,000 INTEREST INCOME NETTED WITH EXPENSE PER AUDIT 229,100 ---------- 309,795 EXPENSES ON BOOKS, NOT ON RETURN: LOSS ON SALE OF ASSETS IN EXP PER AUDIT, REV PER RETURN 63,222 RENTAL EXPENSES INCLUDED WITH REVENUE ON RETURN 668,894 ----------- 732,116 EXPENSES ON RETURN, NOT ON BOOKS: MISC CLASSIFICATION DIFFERENCES 75,695 LOSS ON DISCONTINUED OPERATIONS NOT INCLUDED ON AUDIT 228,319 DONATION EXPENSE INCLUDED IN REVENUE PER AUDIT 5,000 INTEREST INCOME NETTED WITH EXPENSE PER AUDIT 229,100 --------- 538,114 FIN 48 DISCLOSURE MANAGEMENT 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. INTENDED USES OF THE ORGANIZATIN'S ENDOWMENT FUNDS SCH D, PART V, QUESTION 4 THE ORGANIZATION HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR THE ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICATBLE STREAM OF FUNDING TO PROGRAMS AND ITEMS SUPPORTED BY THE ENDOWMENT WHILE SEEKING TO MAINTAIN ITS PURCHASING POWER. X X X X X false true false false false true false false false STEVEN KEUER MD 211410 232517 137366 0 8653 5769 1793158 1195438 6570 4380 2157157 1438104 0 DAVID TEEGARDEN MD 260042 336252 244337 0 8461 5641 2940 1960 6570 4380 522350 348233 0 ROBERT MCKINNEY MD 533955 0 0 0 0 0 4900 0 0 0 538855 0 0 0 GIFFORD ECKHOUT MD 616287 0 0 0 0 0 3600 0 13162 0 633049 0 0 0 MATTHEW VIERKANT MD 507270 0 0 0 0 0 4900 0 13162 0 525332 0 0 0 STEVE WALLING MD 204720 0 0 0 0 0 3790 0 10951 0 219461 0 0 0 MELISSA GERDES MD 224544 0 0 0 0 0 4126 0 13162 0 241832 0 0 0 ROGER FOWLER MD 363746 0 0 0 0 0 4900 0 10244 0 378890 0 0 0 KENT WEBB MD 780289 0 0 0 0 0 4900 0 0 0 785189 0 0 0 WILLIAM HOBBS MD 667922 0 0 0 0 0 4900 0 0 0 672822 0 0 0 JIM STANFORD MD 324491 0 0 0 0 0 4900 0 13162 0 342553 0 0 0 GREGORY STOVALL 365732 0 49773 0 0 0 4900 0 13162 0 433567 0 0 0 KAI XIA MD 983161 0 0 0 0 0 4900 0 0 0 988061 0 0 0 MARK HIATT MD 315133 0 0 0 0 0 4900 0 0 0 320033 0 0 0 JAMES CACCITOLO MD 400871 0 0 0 0 0 4900 0 0 0 405771 0 0 0 ORAN FERRELL 280307 0 38850 0 0 0 4900 0 10512 0 334569 0 0 0 LORETTA SWAN 147572 0 21684 0 0 0 3030 0 9896 0 182182 0 0 0 JAMES CABELL MD 1179022 0 0 0 0 0 4900 0 0 0 1183922 0 0 0 VIVEK MEHTA MD 1788286 0 0 0 0 0 4900 0 0 0 1793186 0 0 0 PETER SIRIANNI MD 1084693 0 0 0 0 0 4900 0 13162 0 1102755 0 0 0 SAUYU LIN MD 1127448 0 0 0 0 0 4900 0 0 0 1132348 0 0 0 LAURA O'HALLORAN 1061313 0 0 0 0 0 4900 0 0 0 1066213 0 0 0 BRIAN ROBINSON 218568 0 0 0 0 0 2840 0 10802 0 232210 0 0 0 MEG REITMEYER 248138 0 0 0 0 0 4538 0 16380 0 269056 0 0 0 HAMPTON WILLIAMS MD 561941 0 0 0 0 0 4900 0 10951 0 577792 0 0 0 JAMES ROGERS MD 246626 0 0 0 0 0 4481 0 13162 0 264269 0 0 0 STEVEN HELF MD 209223 0 0 0 0 0 3737 0 13162 0 226122 0 0 0 KIRT WOOLSEY 136713 0 6744 0 0 0 2824 0 10782 0 157063 0 0 0 DAVID LINDZEY MD 364163 0 49500 0 0 0 4900 0 13162 0 431725 0 0 0 RICHARD KRONENBERG MD 261401 0 0 0 0 0 4900 0 67 0 266368 0 0 0 PARTICIPATION IN OR PAYMENT FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCH J, PART 1, QUESTION 4B PARTICIPANTS IN 457(F) REPORTED IN W-2 ---------------------- ----------------- STEVEN KEUER MD NONE DAVID TEEGARDEN MD NONE PARTICIPANTS IN SERP REPORTED IN W-2 DEFERRED COMPENSATION -------------------- ---------------- --------------------- STEVEN KEUER MD NONE 2,983,696 DAVID TEEGARDEN MD NONE NONE COMPENSATION CONTINGENT ON THE NET EARNINGS OF THE ORGANIZATION SCH J, PART I, QUESTION 6A SOME PHYSICIANS ARE PAID BASED ON THE COMPENSATION FORMULA OF THEIR INDIVIDUAL RESPECTIVE DEPARTMENTS. DESCRIBE REVIEW PROCESS OF FORM 990 FORM 990, PART VI, QUESTION 11A THE ORGANIZATION ENGAGES AN OUTSIDE ACCOUNTING FIRM TO PREPARE FORM 990. ONCE PREPARED, THE FORM IS REVIEWED BY THE ORGANIZATION'S INTERNAL ACCOUNTANTS AND BOARD PRIOR TO FILING. DESCRIBE THE ORGANIZATION'S MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 TRINITY MOTHER FRANCES HEALTH SYSTEM IS THE SOLE MEMBER OF TRINITY CLINIC. DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBER FORM 990, PART VI, QUESTION 7B THE MEMBER HAS THE AUTHORITY TO APPROVE OR DISAPPROVE CERTAIN MATTERS PREVIOUSLY APPROVED BY THE BOARD OF DIRECTORS. HOW DOES THE ORGANIZATION MONITOR AND ENFORCE COMPLIANCE WITH THE POLICY FORM 990, PART VI, QUESTION 12C THE BOARD REVIEWS AND RESOLVES, IF NECESSARY, ANY TRANSACTIONS AS THEY ARISE THROUGHOUT THE YEAR IN ACCORDANCE WITH POLICY STANDARDS. DESCRIBE WHETHER THE ORGANIZATION MAKES ITS DOCUMENTS AVAILABLE TO PUBLIC FORM 990, PART VI, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. PROCESS FOR DETERMINING COMPENSATION OF CEO, OFFICERS, OR KEY EMPLOYEES FORM 990, PART VI, QUESTIONS 15A & 15B THE ORGANIZATION USES COMPENSATION CONSULTANTS AND NATIONAL COMPENSATION SURVEYS TO DETERMINE COMPENSATION OF EMPLOYEES. COMPENSATION IS APPROVED BY THE ORGANIZATION'S GOVERNING BODY AND ULTIIMATELY APPROVED BY TRINITY MOTHER FRANCES HEALTH SYSTEM. COMPENSATION FROM RELATED ORGANIZATION FORM 990, PART VII & SCH J THE 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. AVERAGE HOURS WORKED FOR RELATED ORGANIZATIONS FORM 990, PART VII AVG HOURS WORKED FOR RELATED ORG STEVEN KEUER MD 21 DAVID TEEGARDEN MD 21 1099S REPORTED BY ORGANIZATION FORM 990, PART V, QUESTION 1 NO 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. CHAMPION EMERGENCY SERVICES LLC 2201 S MOBBERLY AVE LONGVIEW TX 75602 752747708 AMBULANCE SVC TX 501(C)(3) 11 NA MOTHER FRANCES HOSPITAL REGIONAL HC CTR 1021 E IDEL TYLER TX 75701 750818167 HOSPITAL TX 501(C)(3) 3 NA MOTHER FRANCES HOSPITAL- JACKSONVILLE 1021 E IDEL TYLER TX 75701 751976930 HOSPITAL TX 501(C)(3) 3 NA TRINITY MOTHER FRANCES HEALTH SYSTEM FDN 1021 E IDEL TYLER TX 75701 752028241 SUPPORT TX 501(C)(3) 11 NA REGIONAL MEDICAL SERVICES ASSOCIATION 1021 E IDEL TYLER TX 75701 752511459 HEALTHCARE TX 501(C)(3) 3 NA TRINITY MOTHER FRANCES HEALTH SYSTEM 1021 E IDEL TYLER TX 75701 752616975 HEALTHCARE TX 501(C)(3) 11 NA MOTHER FRANCES HOSPITAL- WINNSBORO 1021 E IDEL TYLER TX 75701 752771569 Hospital TX 501(c)(3) 3 NA TRI-STATE FINANCIAL LLC 1021 E IDEL TYLER TX 75701 752728318 COLLECTION AGENCY TX NA C-CORPORATION 0 0 0.00000 TRINCARE INC 1021 E IDEL TYLER TX 75701 752161369 MANAGEMENT SVCS TX NA C-CORPORATION 0 0 0.00000 HEALTHPLAN OF TEXAS INC 514 S BECKHAM TYLER TX 75701 752636832 THIRD PARTY ADMIN TX NA C-CORPORATION 0 0 0.00000 THE REGIONAL HEALTHCARE ALLIANCE 1021 E IDEL TYLER TX 75701 752484109 PREFER. PROVIDER TX NA C-CORPORATION 0 0 0.00000 TEXAS HEALTH FACILITIES INSUR CORP LTD PO Box 1109 BWI CAYMAN ISLANDS CJ 980136025 INSURANCE CJ NA C-CORPORATION 0 0 0.00000 CONCORDIUM HEALTH LLC 1021 E IDEL TYLER TX 75701 702811022 INACTIVE TX NA C-CORPORATION 0 0 0.00000 EMPLOYERS SERVICES INC 1021 E IDEL TYLER TX 75701 752602556 INACTIVE TX NA C-CORPORATION 0 0 0.00000 HERITAGE HEALTH PLANS OF TX 1021 E IDEL TYLER TX 75701 752622622 INACTIVE TX NA C-CORPORATION 0 0 0.00000 QUALITY CARE ALLIANCE 1021 E IDEL TYLER TX 75701 752662965 INACTIVE TX NA C-CORPORATION 0 0 0.00000 false false false false false false true false false true true true false false false false false true