2011-11-04T14:08:25-05:00 2010-12-31 EIDE BAILLY LLP 5601 GREEN VALLEY DRIVE STE 700 MINNEAPOLIS MN 554371145 990 2010-01-01 751912147 UNITED REGIONAL HEALTH CARE SYSTEM UNIT 9407648253 1600 ELEVENTH STREET WICHITA FALLS TX 76301 PHYLLIS COWLING 9407648253 2011-10-31 1 KIM HUNWARDSEN CPA 9529446166 2011-10-31 2010 2016-03-07 17:11:31Z PHYLLIS COWLING 1600 ELEVENTH STREET WICHITA FALLS TX 76301 285884052 0 X WWW.URHCS.ORG X 1983 TX ORGANIZED AND OPERATED FOR THE PURPOSE OF DEVELOPING AND OPERATING AN INTEGRATED HEALTH CARE SYSTEM TO IMPROVE THE HEALTH STATUS OF THE COMMUNITIES OF GREATER WICHITA FALLS, TEXAS AND NORTHERN TEXAS. OPERATES ONE HOSPITAL ON TWO CAMPUSES IN WICHITA FALLS, TEXAS. 13 9 2001 373 0 0 6536745 2292694 265315282 281673415 1537869 1730536 101068 187407 273490964 285884052 0 8805187 0 0 101387308 111668169 0 0 0 142265808 134199162 243653116 254672518 29837848 31211534 406963512 432245520 160297937 144503145 246665575 287742375 X TO OPERATE NONPROFIT HOSPITALS OR HOSPITAL FACILITIES, CLINICS, AND RELATED MEDICAL AND SURGICAL SERVICES BY PROVIDING SUCH SERVICES TO PERSONS THAT DO HAVE THE ABILITY TO PAY, AND TO THEREBY PROVIDE CHARITABLE MEDICAL, SURGICAL, AND HOSPITAL CARE FOR SICK, INJURED, AFFLICTED, INFIRM, DISABLED, OR DESTITUTE PERSONS THAT DO NOT HAVE THE ABILITY TO PAY. 0 0 226942882 8805187 281673415 UNITED REGIONAL HEALTH CARE SYSTEM, A 325-BED HOSPITAL, PROMOTES THE HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF HEALTH CARE SERVICES. IN ADDITION TO INPATIENT BEDS, THERE ARE 20 NEWBORN BASSINETTES AND 31 ER BEDS. IN 2010, INPATIENTS RECEIVED 62,879 PATIENT DAYS OF CARE AND 124,096 OUTPATIENT AND EMERGENCY OCCURRENCES OF SERVICE. ADDITIONAL PROGRAMS WHICH BENEFIT THE COMMUNITY INCLUDE:RESIDENCY/HEALTH PROFESSIONS TRAINING: AT ANY ONE TIME, THERE MAY BE UP TO 24 RESIDENTS IN TRAINING AT UNITED REGIONAL HEALTH CARE SYSTEM. THEY ARE PART OF THE UNITED REGIONAL HEALTH CARE SYSTEM PROGRAM IN PARTNERSHIP WITH THE WICHITA FALLS FAMILY PRACTICE RESIDENCY PROGRAM (THROUGH AN AFFILIATION WITH THE SOUTHWESTERN SCHOOL OF MEDICINE). STUDENTS IN NURSING, PHARMACY, LABORATORY TECHNOLOGY, RADIOLOGY, RESPIRATORY THERAPY AND OTHER ASSOCIATED HEALTH SCIENCES PROFESSIONS ALSO STUDY HERE.PREVENTIVE CARE A PRIORITY: UNITED REGIONAL HEALTH CARE SYSTEM HAS TAKEN STEPS TO ENHANCE PREVENTIVE CARE FOR PEOPLE OF ALL AGES THROUGH THE DEVELOPMENT OF LOW COST SCREENING PROGRAMS, VACCINATION CLINICS AS WELL AS OTHER OUTREACH EDUCATION SERVICES. THESE SERVICES ARE PROVIDED THROUGH THE UNITED REGIONAL REFERENCE LAB BOTH FEE-FOR-SERVICE SCREENINGS AND FREE SCREENINGS AT COMMUNITY HEALTH FAIRS (CHOLESTEROL, PSA, TRIGLYCERIDES, ETC.).DESIGNATED TRAUMA CENTER: UNITED REGIONAL HEALTH CARE SYSTEM IS A DESIGNATED LEVEL 3 TRAUMA CENTER FOR THE REGION. IN 2010, 642 PATIENTS WERE SEEN AT UNITED REGIONAL CARE SYSTEM AND RECORDED IN OUR TRAUMA REGISTRY. UNITED REGIONAL HEALTH CARE SYSTEM'S EMERGENCY DEPARTMENT IS STAFFED 24 HOURS A DAY/7 DAYS A WEEK MEETING THE NEEDS OF THE COMMUNITY WITH AN AVERAGE OF 192 VISITS PER DAY.COMMUNITY CONNECTIONS: UNITED REGIONAL HEALTH CARE SYSTEM REACHES OUT TO PEOPLE AND COMMUNITIES THROUGHOUT ITS PRIMARY SERVICE AREA IN NORTH CENTRAL TEXAS AND SOUTHERN OKLAHOMA. THROUGH COOPERATIVE AGREEMENTS WITH LOCAL GOVERNMENTS AND HOSPITALS, UNITED REGIONAL PROVIDES FUNDING FOR A NUMBER OF SERVICES. COMMUNITY EDUCATION: UNITED REGIONAL HEALTH CARE SYSTEM PROVIDES THE FOLLOWING TYPES OF COMMUNITY EDUCATION: COMMUNITY EDUCATION SEMINARS WITH PRESENTATIONS BY PHYSICIANS ON HEALTH ISSUES AND TREATMENT OPTIONS; HEALTHY YOU NEWSLETTER, SENT TO APPROXIMATELY 30,000 HOUSEHOLDS, PROVIDING HEALTH PROMOTION AND DISEASE PREVENTION INFORMATION, AS WELL AS HOSPITAL SERVICES; 55-ADVANTAGE SENIOR PROGRAM, PROVIDING SPEAKERS ON A VARIETY OF HEALTH-RELATED TOPICS; AND PARTICIPATION IN A VARIOUS OF COMMUNITY HEALTH FAIRS AND EVENTS PROMOTING GENERAL HEALTH AND PROVIDING HEALTH SCREENINGS.CHARITY CARE: UNITED REGIONAL HEALTH CARE SYSTEM PROVIDES MEDICAL CARE TO MEMBERS OF THE COMMUNITY REGARDLESS OF ABILITY TO PAY. FINANCIAL ASSISTANCE AT COST IN THE AMOUNT OF $17,078,253 (FORM 990 SCHEDULE H COST) WAS PROVIDED IN THE CURRENT YEAR AND UNREIMBURSED COST OF PROVIDING MEANS TESTED PUBLIC HEALTHCARE PROGRAMS OF $6,520,121. COMMUNITY BENEFITS: CLIENT ESTIMATES THE COST OF THE PROVISION OF ADDITIONAL COMMUNITY BENEFITS TO BE $7,095,388 INCLUDING:UNREIMBURSED COST OF EMERGENCY AND TRAUMA CARE $ 2,997,339UNREIMBURSED COST OF FREE STANDING CLINICS $ 4,036,412DONATIONS MADE BY THE HOSPITAL TO AREA CHARITABLEORGANIZATIONS $ 8,296,637TOTAL $15,330,388SOURCE: 2010 ANNUAL STATEMENT OF COMMUNITY BENEFIT STANDARDS (STATE OF TEXAS MANDATORY REPORT) 226942882 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 140 0 1 2001 1 0 0 0 0 0 0 0 0 0 0 X 13 9 1 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X ROBERT M PERT 9407648253 1600 ELEVENTH STREET WICHITA FALLS TX 76301 LEO LANE 1.00 X X 0 0 0 DOYLE BENTLY 1.00 X X 0 0 0 BARBARA HANSON 1.00 X X 0 0 0 DR PAUL BICE 1.00 X 0 0 0 MIKE ELYEA 1.00 X 0 0 0 CAROL GUNN 1.00 X 0 0 0 DOUG KUNKLE 1.00 X 0 0 0 DR GARY OZIER 1.00 X 26000 0 0 DR ALI MOSHTAGHI 1.00 X 0 0 0 ANN POPEJOY 1.00 X 0 0 0 DR KEVIN THOMAS 1.00 X 113967 0 0 DR HOWARD FARRELL 1.00 X 0 0 0 DON HAMLIN 1.00 X 0 0 0 DR JOHN MARTINEZ 1.00 X 0 0 0 DR ASHVINHUMAR PATEL 1.00 X 0 0 0 PHYLLIS COWLING 40.00 X X 558482 0 66121 ROBERT PERT 40.00 X 320770 0 35897 NANCY TOWNLEY 40.00 X 335446 0 35002 DR JOHN SCOTT HOYER 40.00 X 287614 0 31065 PAMELA BRADSHAW 40.00 X 228063 0 32312 STEPHANIE JO BROWN 40.00 X 201714 0 19797 RICHARD CARPENTER 40.00 X 201971 0 30285 JERRY MARSHALL 40.00 X 141762 0 30263 KIMBERLY STRINGFELLOW 40.00 X 125666 0 27895 BRANDON OLINGER 40.00 X 130736 0 8871 SHELLEY MOSER 40.00 X 125736 0 23831 KIMBERLY CHOATE 40.00 X 123367 0 27941 2921294 0 369280 58 0 1 0 COMPLETE RX LTD 3100 S GESSNER RD STE 640 HOUSTON TX 77063 PHARMACY MANAGEMENT 15988991 ARAMARK SERVICES INC PO BOX 651009 CHARLOTTE NC 28625 DIETARY SERVICES 4400704 CLINICAL PARTNERS PA PO BOX 4502 LONGVIEW TX 75606 ANESTHESIOLOGY SERVICES 3404266 COGENT HEALTHCARE PO BOX 645037 CINCINNATI OH 45264 HOSPITALIST/PHYSICIAN SERVICES 2622655 FULBRIGHT & JAWORSKI 2200 ROSS AVE STE 2800 DALLAS TX 75201 LEGAL SERVICES 2087725 50 2292694 2292694 PATIENT SERVICE REVENU 621110 281172900 281172900 SUPPORTING REVENUE 900099 500515 500515 281673415 1637251 1637251 350211 350211 350211 350211 93285 93285 93285 93285 LOSS ON 2003 BONDS 900099 -162804 -162804 -162804 285884052 281673415 0 1917943 8805187 8805187 2591320 1200953 1390367 129697 129697 90929168 78748500 12180668 2593441 2329867 263574 9329686 8013358 1316328 6094857 5193019 901838 1910733 1910733 30231992 23152288 7079704 700411 686715 13696 51817208 49614736 2202472 131153 131153 4578993 4547640 31353 606916 347485 259431 64917 16598 48319 5505708 5505708 21983430 21983430 2145558 2145558 BAD DEBT EXPENSE 14519081 14519081 3062 3062 254672518 226942882 27729636 0 40591505 52394796 10426466 10226096 5584184 6897272 2171200 2481762 358454805 188222014 173220787 170232791 159342049 169965527 31190 15596131 20047276 406963512 432245520 34996344 34890957 111339492 94722844 13962101 14889344 160297937 144503145 X 246665575 287742375 246665575 287742375 406963512 432245520 X 31211534 9865266 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10332769 10332769 165656054 65753252 99902802 173631741 121770987 51860754 8834241 697775 8136466 170232791 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 14889344 14889344 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: URHCS UNDERGOES AN ANNUAL ANALYSIS OF ITS VARIOUS TAX POSITIONS ASSESSING THE LIKELIHOOD OF THESE POSITIONS BEING UPHELD UPON EXAMINATION WITH RELEVANT TAX AUTHROITIES, AS DEFINED BY THE ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA (GAAP). URHCS BELIEVES THAT THEY ARE COMPLIANT WITH ALL IRS TAX REGULATIONS AND AS OF DECEMBER 31, 2010 HAVE NOT RECORDED ANY UNRECOGNIZED TAX BENEFIT OR LIABILITIES FOR INCOME TAXES. URHCS WILL RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX LIABILITIES IN INCOME TAX EXPENSE IF INCURRED. URHCS IS NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2007. 1 1 X 1 X 175.000000000000 1 X 1 1 1 0 1 1 25869365 8791112 17078253 0.07130 26202955 19842365 6360590 0.02650 684511 524980 159531 0.00070 52756831 29158457 23598374 0.09850 630047 630495 -448 0.00000 14673901 7640150 7033751 0.02940 8296637 0 8296637 0.03460 23600585 8270645 15329940 0.06400 76357416 37429102 38928314 0.16250 925356 925356 0.00390 925356 925356 0.00390 0 3252002 325200 79332569 92410826 -13078257 X 1 1 1 1 UNITED REGIONAL HEALTH CARE SYSTEM

1600 ELEVENTH STREET WICHITA FALLS TX 76301

X X X X UNITED REGIONAL HEALTH CARE SYSTEM 1 2 WICHITA FALLS ENDOSCOPY CENTER

1500 TENTH STREET WICHITA FALLS TX 76301

AMBULATORY SURGERY CENTER TEXOMA CANCER CENTER

5400 KELL WEST BLVD WICHITA FALLS TX 76301

CANCER TREATMENT CENTER PART I, LINE 6A: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT CAN BE OBTAINED BY REQUEST FROM UNITED REGIONAL ADMINISTRATION OFFICES OR COMMUNITY BENEFITS OFFICES. THE COMMUNITY BENEFIT REPORT IS ALSO ON FILE WITH THE HEALTH AND HUMAN SERVICES COMMISSION OF THE STATE OF TEXAS. PART I, LINE 7: THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET 2 WAS USED TO DETERMINE COST FOR LINES 7A, 7B AND 7C. ACTUAL COST PER GENERAL LEDGER WAS USED TO DETERMINE AMOUNTS ON LINE 7F, 7G AND 7I. PART I, LINE 7G: COSTS OF $10,696,838 WERE INCLUDED IN SUBSIDIZED HEALTH SERVICES ON LINE 7G FOR COMMUNITY CLINICS. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES TO DETERMINE THE PERCENTAGE ON LINE 7 WAS $14,519,081. PART II: UNITED REGIONAL HEALTH CARE SYSTEM IS LOCATED IN A FEDERALLY DESIGNATED PHYSICIAN SHORTAGE AREA. THE AMOUNT INCLUDED ON PART II, LINE 8 FOR RECRUITMENT OF PHYSICIANS INCLUDES SIGN-ON BONUS AMOUNTS, STIPENDS, RELOCATION EXPENSES, AGENCY FEES, TRAVEL, INTERVIEW EXPENSES AND STAFF CONDUCTING THE INTERVIEWS. PART III, LINE 4: THE ORGANIZATION'S BAD DEBT EXPENSE AT COST WAS CALCULATED USING THE EXPENSE REPORTED ON THE FINANCIAL STATEMENTS AND APPLYING AN OVERALL COST-TO-CHARGE RATIO CALCULATED FROM WORKSHEET 2.THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY WAS DETERMINED BY ESTIMATING 10% OF THE BAD DEBT AT COST WOULD LIKELY BE CHARITY CARE. THIS IS THE APPROXIMATE PERCENTAGE OF PATIENTS NOT COMPLETING THE PAPER WORK TO APPLY FOR CHARITY CARE.BAD DEBT EXPENSE REPRESENTS GROSS CHARGES ADJUSTED FOR APPROPRIATE DISCOUNTS AND PAYMENTS ON ACCOUNTS.FINANCIAL STATEMENT FOOTNOTE: ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE VALUE. URHCS MAINTAINS ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS FOR ESTIMATED LOSSES RESULTING FROM A PAYOR'S INABILITY TO MAKE PAYMENTS ON ACCOUNTS. URHCS USES A BALANCE SHEET APPROACH TO VALUE THE ALLOWANCE ACCOUNT BASED ON HISTORICAL WRITE-OFFS AND THE AGING OF THE ACCOUNTS. ACCOUNTS ARE WRITTEN OFF WHEN COLLECTION EFFORTS HAVE BEEN EXHAUSTED. FURTHERMORE, MANAGEMENT CONTINUALLY MONITORS AND ADJUSTS ITS ALLOWANCES ASSOCIATED WITH ITS RECEIVABLE. PART III, LINE 8: THE CURRENT TEXAS COMMUNITY BENEFIT STANDARD RECOGNIZES THAT MEDICARE DOES NOT PAY THE FULL COST OF SERVICES PROVIDED UNDER THE MEDICARE PROGRAM. COMMUNITY BENEFIT REPORTING FOR THE STATE INCLUDES ALL MEDICARE SHORTFALLS AS COMMUNITY BENEFIT. THE HOSPITAL BELIEVES THE SAME RATIONALE SHOULD APPLY FOR IRS PURPOSES. COSTING METHODOLOGY: THE MEDICARE ALLOWABLE COST WAS DETERMINED USING THE MEDICARE COST REPORT. PART III, LINE 9B: HOSPITAL PERSONNEL MAKE GOOD FAITH EFFORTS TO INFORM PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE, GOVERNMENTAL PROGRAMS AND ASSISTANCE IN APPLYING. SECTION 6.6 OF THE CHARITY AND BAD DEBT POLICY STATES:"AS SOON AS SUFFICIENT INFORMATION IS AVAILABLE CONCERNING THE PATIENT'S FINANCIAL RESOURCES AND ELIGIBILITY FOR GOVERNMENTAL ASSISTANCE, A DETERMINATION WILL BE MADE CONCERNING THE PATIENT'S ELIGIBILITY FOR CHARITY. IN MOST CASES, THE DETERMINATION DECISION WILL BE MAKE WITHIN 10 BUSINESS DAYS. A WRITTEN NOTICE WILL BE MAILED TO THE PATIENT INFORMING THEM OF THE DETERMINATION DECISION. NO COLLECTION EFFORTS WILL BE PURSUED ON A CHARITY ACCOUNT FOR THE ELIGIBLE AMOUNT AFTER SUCH DETERMINATION IS MADE." PART VI, LINE 7: URHCS FILES AN ANNUAL STATEMENT OF COMMUNITY BENEFIT STANDARDS (ASCBS) WITH THE STATE OF TEXAS. THE CALCULATION OF COMMUNITY BENEFIT FOR THE ASCBS DIFFER FROM THE CALCULATIONS REQUIRED FOR IRS SCHEDULE H REPORTING. THEREFORE, THE INFORMATION REPORTED IN THE TWO REPORTS IS INCONSISTENT. PART VI, LINE 2: UNITED REGIONAL HEALTH CARE SYSTEM PROVIDES EMERGENCY, TRAUMA, OUTPATIENT AND SHORT TERM GENERAL ACUTE CARE INPATIENT CARE IN THE WICHITA FALLS AREA. IN CONJUNCTION WITH OTHER INTERESTED ORGANIZATIONS, IT UNDERTAKES PROJECTS TO ASSESS THE HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES. FOR EXAMPLE, URHCS COLLABORATES WITH OTHER COMMUNITY HEALTH ORGANIZATIONS TO CREATE A "HEALTHY WICHITA" REPORT WHICH IS UPDATED PERIODICALLY. THIS REPORT ASSESSES THE HEALTHCARE SERVICES PROVIDED IN THE COMMUNITY TO COMPARE THE OUTCOMES TO STATE AND FEDERAL OUTCOMES AND DETERMINE IF THE COMMUNITY HEALTH NEEDS ARE BEING MET. PART VI, LINE 3: THE HOSPITAL INFORMS EACH PATIENT OF THE CHARITY CARE PROGRAM AND HOW TO APPLY FOR CHARITY CARE. THIS IS DONE BY POSTING NOTICES IN EACH PATIENT REGISTRATION AREA AND PROVIDING A WRITTEN NOTICE TO EACH PATIENT. ALL PATIENT STATEMENTS HAVE AN ASSISTANCE APPLICATION ON THE REVERSE SIDE AND AN ALERT ON THE FRONT FOR THOSE ELIGIBLE OR INTERESTED IN APPLYING. THIS INCLUDES ALL STATEMENT NOTIFICATIONS AND NOT JUST PATIENT SHARE STATEMENTS.FURTHERMORE, IT IS THE POLICY OF URHCS TO ASSIST PATIENTS WITH INFORMATION AND RESOURCES FOR POTENTIALLY QUALIFYING FOR GOVERNMENTAL OR OTHER FINANCIAL ASSISTANCE PROGRAMS. THE BUSINESS OFFICE WILL REFER THOSE PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE FROM A GOVERNMENTAL PROGRAM TO THE APPROPRIATE PROGRAM, SUCH AS MEDICAID, COUNTY INDIGENT, CRIME VICTIMS ETC, OR TO THE HOSPITAL'S CONTRACTED ELIGIBILITY VENDOR FOR SCREENING FOR GOVERNMENTAL PROGRAM COVERAGE. PART VI, LINE 4: URHCS PRIMARY SERVICE AREA IS MADE UP OF THE CBSA OF WICHITA, ARCHER AND CLAY COUNTIES. WICHITA COUNTY CONTAINS THE CITY OF WICHITA FALLS WHERE URHCS IS LOCATED. ACCORDING TO THE HUMAN RESOURCES AND SERVICES ADMINISTRATION, US DEPARTMENT OF HEALTH AND HUMAN SERVICES, WICHITA COUNTY HAS SEVERAL CENSUS TRACTS FEDERALLY DESIGNATED AS MEDICALLY UNDERSERVED, INCLUDING CENSUS TRACT 102 WHERE URHCS IS LOCATED. ARCHER AND CLAY COUNTIES HAVE BEEN DECLARED TO BE MEDICALLY UNDERSERVED COUNTIES.2010 CENSUS DATA FOR WICHITA COUNTY IS AS FOLLOWS:MEDIAN HOUSEHOLD INCOME(2009): $41,862PER CAPITA INCOME(2009): $22,529UNDER AGE 18 CHILDREN BELOW POVERTY LEVEL: 20.9%MEDIAN EARNINGS OF FULL-TIME WORKERS, FEMALE: $21,885PERSONS BELOW POVERTY LEVEL(2008): 15.4%URHCS SERVES A DISPORTIONATE SHARE OF LOW INCOME PATIENTS AND QUALIFIES AS A DISPORTIONATE SHARE HOSPITAL FOR BOTH THE MEDICARE AND MEDICAID PROGRAMS. PART VI, LINE 6: THE HOSPITAL IS GOVERNED BY A BOARD OF DIRECTORS THAT REPRESENTS THE COMMUNITIES IN WHICH THE ORGANIZATION OPERATES. URHCS EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. UNITED REGIONAL OPERATES A LEVEL 3 TRAUMA UNIT FOR THE REGION. THE HOSPITAL CONTRACTS WITH A FAMILY RESIDENCY PROGRAM TO ASSIST IN TRAINING PRIMARY CARE PHYSICIANS AS WELL AS TRAINING COURSES FOR NURSING AND ALLIED HEALTH PROFESSIONALS FOR THE COMMUNITIES IT SERVES. THE HOSPITAL PARTICIPATES IN MEDICAID AND IS THE MANDATED COUNTY HEALTHCARE FACILITY. URHCS REINVESTS SURPLUS FUNDS IN THE FACILITIES TO ENSURE PATIENTS ARE PROVIDED WITH STATE OF THE ART MEDICAL CARE. REPORTS FILED WITH STATES PART VI, LINE 7 TX 1 WICHITA COUNTY MEDICAL ALLIANCE PO BOX 1030 WICHITA FALLS TX 76307 352173373 501(C)(3) 20000 HAITI AND PAKISTAN RELIEF UNITED WAY 1105 HOLIDAY WICHITA FALLS TX 76301 750950126 501(C)(3) 8750 CAMPAIGN MIDWESTERN STATE UNIVERSITY 3410 TAFT BLVD WICHITA FALLS TX 76308 756001738 115(1) 5000 FUNDRAISING EVENT UNITED REGIONAL HEALTH CARE FOUNDATION 1600 ELEVENTH STREET WICHITA FALLS TX 76301 752761467 501(C)(3) 532687 DONATION SERVICE ORGANIZATION OF NORTH TEXAS 2950 50TH STREET LUBBOCK TX 79413 800368789 501(C)(3)APPLIED FOR 8235000 DONATION 4 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: UNITED REGIONAL HEALTH CARE SYSTEM PROVIDES GENERAL CONTRIBUTIONS TO THE COMMUNITY AND NATIONAL CHARITIES FOR THE FURTHERANCE OF THEIR MISSION. THE ORGANIZATIONS MAKE THEIR REQUESTS IN WRITING. THESE CONTRIBUTIONS ARE REVIEWED AND APPROVED BY APPROPRIATELY AUTHORIZED BOARD ACTION; OR OFFICERS; OR EMPLOYEES AS APPROPRIATE IN THE CIRCUMSTANCE IN EACH INSTANCE OF SUCH CONTRIBUTION BEING MADE. UNITED REGIONAL FOLLOWS UP WITH EACH ORGANIZATION TO MAKE SURE EACH CONTRIBUTION WAS USED FOR ITS INTENDED PURPOSE. X 1 1 X X X 0 1 0 0 0 1 0 0 0 PHYLLIS COWLING 441582 0 94547 0 22353 0 57500 0 8843 0 624825 0 0 0 ROBERT PERT 246422 0 56827 0 17521 0 14700 0 21409 0 356879 0 0 0 NANCY TOWNLEY 260536 0 57359 0 17551 0 14700 0 20524 0 370670 0 0 0 DR JOHN SCOTT HOYER 251408 0 18174 0 18032 0 10334 0 20953 0 318901 0 0 0 PAMELA BRADSHAW 189497 0 24411 0 14155 0 11581 0 20892 0 260536 0 0 0 STEPHANIE JO BROWN 161111 0 25765 0 14838 0 9796 0 10139 0 221649 0 0 0 RICHARD CARPENTER 160700 0 26694 0 14577 0 9602 0 20826 0 232399 0 0 0 JERRY MARSHALL 129642 0 11526 0 594 0 8292 0 22082 0 172136 0 0 0 KIMBERLY STRINGFELLOW 107152 0 18452 0 62 0 7164 0 20826 0 153656 0 0 0 KIMBERLY CHOATE 111760 0 11560 0 47 0 7210 0 20798 0 151375 0 0 0 PART I, LINE 1A DUES FOR THE WICHITA FALLS COUNTRY CLUB ARE PAID FOR THE FOLLOWING STAFF MEMBERS IN ORDER FOR THE HOSPITAL TO HAVE USE OF THE FACILITIES FOR BUSINESS USE SINCE MEMBERSHIPS CANNOT BE HELD IN A COMPANY NAME. THE DUES ARE $426.51 PER MONTH, OR $5,118.12 PER YEAR. ANY PERSONAL CHARGES INCURRED ARE REQUIRED TO BE PAID BY THE EMPLOYEE. PHYLLIS COWLING RICHARD CARPENTER ROBERT PERT PART I, LINE 4B PHYLLIS COWLING $42,800 URHCS OFFERS A DEFERRED COMPENSATION PLAN. CERTAIN MANAGEMENT AND HIGHLY COMPENSATED EMPLOYEES MAY ELECT TO PARTICIPATE, IF ELIGIBLE, IN A DEFERRED COMPENSATION PLAN WHICH IS IN COMPLIANCE WITH THE IRC SECTION 457(F), ELIGIBLE DEFERRED COMPENSATION PLAN SPONSORED BY A TAX EXEMPT ORGANIZATION. PART I, LINE 6 A RANGE BETWEEN 20% AND 25% OF ANNUAL BONUS IS BASED ON NET OPERATING INCOME. OTHER BONUS CRITERIA INVOLVE QUALITY SCORES, SERVICE SCORES AND INDIVIDUAL GOALS. NORTH TEXAS HEALTHCARE FACILITIES DEVELOPMENT CORPORATION 900049824 662823BS1 2003-08-13 34519436 EXPAND CARDIOLOGY SERVICES AND OTHER RENOVATIONS 0 0 0 NORTH TEXAS HEALTHCARE FACILITIES DEVELOPMENT CORPORATION 900049824 662823CG6 2007-07-12 93891074 CONSTRUCTION OF BRIDWELL TOWER AND CONSOLIDATE CAMPUS SERVICES, REFUNDING 0 0 0 34519436 3477883 476750 30564803 2006 0 0 1 1 93891074 4384937 26749095 2757042 60000000 2006 0 1 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 BRANDON TOWNLEY SON OF OFFICER 90549 EMPLOYEE COMPENSATION 0 WICHITA FALLS DIALYSIS CENTER PARTIALLY OWNED BY BOARD MEMBER 692323 DIALYSIS SERVICES 0 LESLIE THOMAS DAUGHTER-IN-LAW OF BOARD MEMBER 39148 EMPLOYEE COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIR, SECRETARY, TREASURER, PRESIDENT/CHIEF EXECUTIVE OFFICER, FIVE MEMBERS WHO ARE DIRECTORS, AND ONE ADDITIONAL DIRECTOR. THE EXECUTIVE COMMITTEE HAS AUTHORITY TO TRANSACT ALL BUSINESS OF THE BOARD IN THE MANAGEMENT OF THE CORPORATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD, SUBJECT TO LIMITATIONS SET FORTH IN THE BYLAWS AND ANY LIMITATIONS OTHERWISE IMPOSED BY THE BOARD. THE EXECUTIVE COMMITTEE COORDINATES RECOMMENDATIONS FROM OTHER COMMITTEES OF THE BOARD, MAKE RECOMMENDATIONS TO THE BOARD ON ALL MATTERS OF POLICY, AND KEEPS THE BOARD ADVISED AT ALL TIMES CONCERNING THE STATE OF AFFAIRS OF THE CORPORATION. THE EXECUTIVE COMMITTEE ACTS IN ALL PERSONNEL MATTERS INVOLVING EXECUTIVE AND MEDICAL STAFF PERSONNEL, INCLUDING SEARCH, SELECTION, EMPLOYMENT, COMPENSATION, MANAGEMENT PERFORMANCE REVIEW, CONTRACTS, AND BENEFITS, AND MAY APPOINT AN AD HOC COMMITTEE TO MAKE RECOMMENDATIONS TO IT IN ANY PARTICULAR SITUATION. FORM 990, PART VI, SECTION A, LINE 2 PHYLLIS COWLING, NANCY TOWNLEY, AND ROBERT PERT HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 7B THE JOINT CITY-COUNTY BOARD HAS APPROVAL REGARDING BOND FINANCING AND APPROVAL OF BUDGET. FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE COMMITTEE CHARTER, AS APPROVED BY THE UNITED REGIONAL HEALTH CARE SYSTEM BOARD, DELEGATES THE REVIEW OF 990S TO THE EXECUTIVE COMMITTEE. ALL MEMBERS OF THE COMMITTEE ARE PROVIDED A COPY OF THE FORM 990 PRIOR TO FILING WITH THE IRS. THE 990 IS REVIEWED BY MANAGEMENT OFFICIALS OF THE HOSPITAL AND THE EXECUTIVE COMMITTEE OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY. THE FORMS ARE REVIEWED INITIALLY BY THE CHIEF COMPLIANCE OFFICER AND THE CEO FOR POTENTIAL CONFLICTS. ANY ACTUAL CONFLICTS ARE REVIEWED BY THE BOARD OF DIRECTORS. A PERSON WITH A CONFLICT IS RESTRICTED FROM VOTING ON RELATED MATTERS. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE PERFORMS AN ANNUAL REVIEW FOR THE CEO AND MAKES FINAL RECOMMENDATIONS REGARDING COMPENSATION. AN ANNUAL REVIEW IS PERFORMED BY THE CEO FOR ALL OTHER OFFICERS OF THE ORGANIZATION. THE EXECUTIVE COMMITTEE REVIEWS THE ANNUAL COMPENSATION OF ALL OFFICERS. A COMPENSATION CONSULTANT PROVIDES MARKET COMPARISONS ON AN EVERY OTHER YEAR BASIS. THIS WAS COMPLETED IN 2009 AND WILL BE COMPLETED AGAIN IN 2011. FORM 990, PART VI, SECTION C, LINE 19 AN AD IS RUN IN THE LOCAL PAPER ON AN ANNUAL BASIS INFORMING THE COMMUNITY THE FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE OTHER DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 10,478,384. INVESTMENT EXPENSES: -616,177. PRIOR PERIOD ADJUSTMENTS: 3,059. FORM 990, PART VII, SECTION A: THE FOLLOWING INDIVIDUALS DEVOTED TIME PROVIDING SERVICES TO THE FOLLOWING RELATED ORGANIZATIONS. UNITED REGIONAL PROFESSIONAL SERVICES CORPORATION PHYLLIS COWLING .50 HOURS PER WEEK ROBERT PERT .50 HOURS PER WEEK NANCY TOWNLEY .50 HOURS PER WEEK UNITED REGIONAL PHYSICIAN GROUP PHYLLIS COWLING 2 HOURS PER WEEK ROBERT PERT 2 HOURS PER WEEK NANCY TOWNLEY 2 HOURS PER WEEK JOHN SCOTT HOYER 2 HOURS PER WEEK UNITED REGIONAL HEALTH CARE FOUNDATION 1600 ELEVENTH STREET WICHITA FALLS TX 76301 752761467 TO SUPPORT AND PROMOTE THE EFFICIENT DISTRIBUTION OF HEALTH CARE SERVICES TX 501(C)(3) 11A N/A 1 RATHGEBER HOSPITALITY HOUSE 1615 12TH STREET WICHITA FALLS TX 76301 752811394 PROVIDE LODGING FOR PATIENT FAMILIES OF UNITED REGIONAL HEALTH CARE TX 501(C)(3) 7 N/A 1 UNITED REGIONAL PHYSICIAN GROUP 1600 ELEVENTH STREET WICHITA FALLS TX 76301 752925491 PROVIDE PHYSICIAN AND HEALTH CARE SERVICES FOR UNITED REGIONAL HEALTH CARE TX 501(C)(3) 9 N/A 1 CITY OF WICHITA FALLS-WICHITA COUNTY HOSPITAL BOARD 1300 7TH STREET WICHITA FALLS TX 76301 756002771 OVERSIGHT OF HEALTH CARE SYSTEM TX N/A N/A N/A 0 UNITED REGIONAL HEALTH CARE SYSTEM AUXILIARY 1600 ELEVENTH STREET WICHITA FALLS TX 76301 756004656 PROVIDE BENEVOLENT SERVICES TO UNITED REGIONAL HEALTH CARE SYSTEM TX 501(C)(3) 11A N/A 0 UNITED REGIONAL PROFESSIONAL SERVICES CORPORATION 1600 EIGHTH STREET WICHITA FALLS TX 76301 752549298 MANAGEMENT SERVICES TX N/A C 1825207 4367123 1.00000 TEXOMA INSURANCE AGENCY 1600 EIGHTH STREET WICHITA FALLS TX 76301 422683761 INSURANCE TX N/A C 1337 127782 1.00000 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 UNITED REGIONAL HEALTH CARE FOUNDATION C 2267553 GENERAL LEDGER UNITED REGIONAL PHYSICIAN GROUP P 325047 GENERAL LEDGER RATHGEBER HOSPITALITY HOUSE TEXOMA INSURANCE AGENCY UNITED REGIONAL HEALTH CARE FOUNDATION B 532687 GENERAL LEDGER UNITED REGIONAL PHYSICIAN GROUP A 46774 GENERAL LEDGER UNITED REGIONAL PROFESSIONAL SERVICES CORPORATION P 231789 GENERAL LEDGER