2023-10-18T12:35:10-05:00 2022-12-31 FORVIS LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2022-01-01 742912643 Fredericksburg Hospice No 1 % CHRIS SEMMLER FRED 8309971297 PO Box 1339 Fredericksburg TX 78624 JAYNE POPE HOSPITAL CEO 9727028262 2023-11-15 true JAYNE POPE 999009999 Jeanette Verrelli P00742631 9727028262 3 2022 2023-04-26 12:10:37Z X JAYNE POPE PO Box 1339 FREDERICKSBURG TX 78624 6667690 false X N/A X 1999 TX TO PROVIDE CARE TO TERMINALLY ILL PATIENTS BY TREATING THEIR PAIN AND SYMPTOMS AND EASING THEIR EMOTIONAL AND SPIRITUAL SUFFERING. 3 0 42 10 0 0 550491 0 7169323 6582217 6476 85473 0 0 7726290 6667690 0 0 0 0 3547405 3212131 0 0 0 2326910 2414060 5874315 5626191 1851975 1041499 6285603 7231772 518808 423477 5766795 6808295 Create Healthy Management's VISION IS EMPOWER OTHERS, CREATE HEALTHY. THE ORGANIZATION'S VALUES ARE: COMPASSION, OWNERSHIP, INNOVATION, AND EXCELLENCE. false false 4615360 6582217 PROVIDED 1,535 PATIENTS WITH CARE DURING 2022 FOR A TOTAL OF 36,459 PATIENT DAYS. 4615360 true false false false false false false false false false true false false false true false 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 true false false false true 10 0 true 42 true false false false false false false false false false false false false X 3 0 false false true false true true true true true false false true true true true false true false false false X CHRIS SEMMLER 8309971297 200 W WINDCREST FREDERICKSBURG TX 78624 X JAYNE POPE HOSPITAL CEO 0.25 39.75 X X 0 492937 24606 Clinton Kotal CHIEF INTEGRATION OFFICER 4.0 36.0 X X 0 383678 48946 Susan Neves CFO 0.25 39.75 X X 0 378955 30715 Maureen O Polivka HOSPITAL CNO 0.0 40.0 X 0 279741 20286 Kevin Shane Dickinson IT Director 5.0 35.0 X 0 181027 37914 Katelyn Vinklarek Administrative Director 20.0 20.0 X 0 175503 42324 0 1891841 204791 0 true true false WINDCREST NURSING AND REHAB 210 WEST WINDCREST FREDERICKSBURG TX 78624 NURSING HOME 276743 FREDERICKSBURG NURSING AND REHAB 1117 S ADAMS FREDERICKSBURG TX 78624 NURSING HOME 187395 KNOPP 1 HEALTHCARE AND REHAB 1208 N LLANO FREDERICKSBURG TX 78624 NURSING HOME 127876 LBJ MEDICAL CENTER 206 HALEY JOHNSON CITY TX 78636 NURSING HOME 121281 YVONNE HAUG MD 1305 N LLANO FREDERICKSBURG TX 78624 MEDICAL DIRECTOR 109086 5 0 Net Patient Revenue 621110 6582217 6582217 6582217 85473 85473 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6667690 6582217 85473 X 0 0 0 0 0 0 2468301 1974641 493660 68310 54648 13662 483572 386858 96714 191948 153558 38390 0 0 6550 6550 0 0 0 1451502 1166442 285060 7746 6197 1549 14182 11345 2837 65977 52782 13195 0 219823 175858 43965 46719 37375 9344 0 987 790 197 0 0 8212 6570 1642 1635 1308 327 Hospice Supplies 572036 572036 Licenses and Permits 764 611 153 Dues and Subscriptions 15877 12702 3175 . 0 2050 1639 411 5626191 4615360 1010831 0 60000 60000 5635830 6603986 0 0 582015 561322 0 0 0 0 0 0 0 0 0 0 192562 186098 7758 6464 0 0 0 0 0 0 0 0 0 0 6285603 7231772 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 518808 423477 518808 423477 X 5766795 6808295 0 0 5766795 6808295 6285603 7231772 1041499 1 X false true X true false X SCHEDULE A, PART I, LINE 3 Reason for PUBLIC CHARITY STATUS: Fredericksburg Hospice No 1 IS CLASSIFIED AS A HOSPITAL FOR EXEMPT PURPOSES ONLY. THE ORGANIZATION IS NOT A LICENSED HOSPITAL UNDER TEXAS STATE LAW AND THEREFORE NOT REQUIRED TO COMPLETE SCHEDULE H. 192562 186098 6464 6464 0 Due to Hospital 423477 423477 schedule d, part x, line 2 ASC 740 Footnote: 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. false false false false false false false false false JAYNE POPE HOSPITAL CEO 410935 82002 0 11600 13006 517543 0 Susan Neves CFO 313955 65000 0 0 30715 409670 0 Clinton Kotal CHIEF INTEGRATION OFFICER 316242 67436 0 11600 37346 432624 0 Katelyn Vinklarek Administrative Director 150303 25200 0 6059 36265 217827 0 Kevin Shane Dickinson IT Director 177420 3607 0 7203 30711 218941 0 Maureen O Polivka HOSPITAL CNO 233290 46451 0 8769 11517 300027 0 SCHEDULE J, PART I, LINE 3 EXECUTIVE COMPENSATION: Create Healthy Management, A RELATED ORGANIZATION, DETERMINES COMPENSATION OF THE Hospice'S President THROUGH THE USE OF THE FOLLOWING: - COMPENSATION COMMITTEE - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 6 CLASSES OF MEMBERS OR STOCKHOLDERS: Fredericksburg Hospice No 1 IS A MEMBER ORGANIZATION FOR CORPORATE MEMBERS THAT OPERATE HOSPITAL FACILITIES. THE SOLE MEMBER IS Create Healthy Management. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OR STOCKHOLDERS WHO CAN ELECT MEMBERS OF THE GOVERNING BODY: THE BOARD OF DIRECTORS OF Fredericksburg Hospice No 1 SHALL NOT EXCEED 15 TOTAL DIRECTORS THAT MEET THE QUALIFICATIONS OF A DIRECTOR AS SET OUT IN THE BY-LAWS OF THE HOSPICE, AND HAVE BEEN SELECTED BY THEIR RESPECTIVE MEMBER ORGANIZATIONS, AND SUCH OTHER DIRECTORS AS ELECTED BY MAJORITY VOTE OF THE BOARD OF DIRECTORS OF THE HOSPICE. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUBJECT TO APPROVAL BY THE MEMBERS OR STOCKHOLDERS: THE FOLLOWING DECISIONS ARE RESERVED TO THE MEMBERS FOR APPROVAL: CONFIRMATION OF THE ANNUAL OPERATING AND CAPITAL BUDGETS; CONFIRMATION OF APPOINTMENT AND REMOVAL OF OFFICERS; DISSOLUTION OF THE ORGANIZATION; AND ALTERATION, AMENDMENT OR REPEAL OF THE BY-LAWS. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: CREATE HEALTHY MANAGEMENT'S BOARD WILL REVIEW THE FORM 990 BEFORE FILING. THE CFO DISCUSSES EACH SECTION WITH THE BOARD AND DISCUSSES ANY ISSUES THAT NEED TO BE ADDRESSED FOR FUTURE YEARS. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: CONFLICT OF INTEREST FORMS ARE COMPLETED BY BOARD MEMBERS, OFFICERS, KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, AND ALL DEPARTMENT DIRECTORS ON AN ANNUAL BASIS. ALL DISCLOSURES ARE REVIEWED BY THE BOARD GOVERNANCE COMMITTEE AND REPORTED TO THE SYSTEM BOARD. BOARD MEMBERS MUST RECUSE THEMSELVES FROM VOTING ON ISSUES RELATED TO THEIR CONFLICT. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: THE ORGANIZATION'S GOVERNING DOCUMENTS INCLUDING BYLAWS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE ON REQUEST. THE FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART VI, SECTION A, LINE 4 SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS: THE ORGANIZATION CHANGED ITS NAME FROM GREATER HILL COUNTRY HOSPICE TO FREDERICKSBURG HOSPICE NO 1. THE GOVERNING DOCUMENTS WERE UPDATED TO REFLECT THE NEW NAME AND THAT OF ITS RELATED ORGANIZATIONS. FORM 990 PART IX LINE 11G DESCRIPTION:NURSING HOME CHARGES TOTAL FEES:892208 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:559294 CREATE HEALTHY FOUNDATION PO Box 1339 FREDERICKSBURG TX 78624 742557105 FUNDRAISING TX 501(C)(3) 12 TYPE III NA false CREATE HEALTHY MANAGEMENT PO Box 1339 FREDERICKSBURG TX 78624 746083124 HOSPITAL TX 501(C)(3) 3 NA false FREDERICKSBURG PHYSICIANS NO 1 PO Box 1339 FREDERICKSBURG TX 78624 272860109 HEALTHCARE TX 501(C)(3) 3 CHM true FREDERICKSBURG PHYSICIANS NO 2 PO Box 1339 FREDERICKSBURG TX 78624 262553196 HEALTHCARE TX 501(C)(3) 12, TYPE I CHM true false false false false false false false false false false true false true true true true false false false