2023-10-18T12:30:42-05:00 2022-12-31 FORVIS LLP 14241 DALLAS PARKWAY STE 1100 DALLAS TX 75254 990 2022-01-01 746083124 Create Healthy Management % CHRIS SEMMLER CREA 8309971297 PO Box 1339 Fredericksburg TX 78624 JAYNE POPE CEO 9727028262 2023-11-15 true Susan Neves 999009999 Jeanette Verrelli P00742631 9727028262 2023-11-15 2 2022 2023-04-26 12:10:37Z JAYNE POPE PO BOX 1339 FREDERICKSBURG TX 78624 103611514 false X WWW.CREATEHEALTHY.ORG X 1966 TX MISSION IS REMARKABLE ALWAYS - TO PROVIDE REMARKABLE HEALTH CARE SERVICES TO THE HILL COUNTRY AREA THROUGH THE OPERATION AND MAINTENANCE OF A COMMUNITY HOSPITAL. 11 11 706 30 0 0 9736209 7817603 89602371 95161603 3294591 1617172 156886 -3464773 102790057 101131605 0 63105 0 0 34432264 36972787 0 0 0 56440121 62417181 90872385 99453073 11917672 1678532 246858307 231936244 24200924 21861780 222657383 210074464 X CREATE HEALTHY MANAGEMENT'S VISION IS EMPOWER OTHERS, CREATE HEALTHY. THE ORGANIZATION'S VALUES ARE: COMPASSION, OWNERSHIP, INNOVATION, EXCELLENCE false false 75405014 63105 87716312 MEDICAL CARE SERVICES - PROVIDED HEALTH CARE SERVICES TO LOCAL RESIDENTS. DAYS OF CARE INCLUDED: ROUTINE AND OB - 3,780; INTENSIVE AND CRITICAL CARE UNITS - 978; NURSERY - 640; EMERGENCY ROOM CARE WAS PROVIDED FOR 12,710 VISITS; 239,994 LABORATORY TESTS WERE PERFORMED; 37,880 IMAGING PROCEDURES (ALL MODALITIES) WERE PERFORMED; 11,043 PHYSICAL/OCCUPATIONAL/SPEECH THERAPY VISITS WERE PROVIDED; 4,353 OPERATIONS AND 4,182 OUTPATIENT PROCEDURES WERE PERFORMED AND 394 BABIES WERE DELIVERED. 3126721 2911559 HOME CARE SERVICES - PROVIDE NURSES AND THERAPISTS TO ASSIST PATIENTS IN THEIR HOMES WITH EDUCATION, ASSESSMENT AND OBSERVATION OF WOUNDS, RESPIRATORY STATUS, CARDIAC STATUS AND OTHER BODY SYSTEMS. NURSES ALSO ADMINISTER IVS, WOUND CARE, COLOSTOMY CARE, AND CATHETER CARE. A TOTAL OF 11,469 HOME CARE VISITS WERE MADE. 1510228 757442 WELLNESS CENTER - PROMOTES HEALTH AND WELLNESS BY PROVIDING FITNESS EQUIPMENT AND CLASSES; CONDUCTING HEALTH SEMINARS AND CPR/FIRST AID CLASSES; PROVIDING NUTRITION INFORMATION THROUGH EDUCATION CLASSES AND DIETARY CONSULTATIONS; CONDUCTING HEALTH AND FITNESS SCREENINGS, FREE BLOOD PRESSURE CHECKS AND COUNSELING SEMINARS; AND OFFERING BREAST FEEDING SUPPLIES AND BREAST PUMP RENTALS, CHILDCARE AND YOUTH DAY CAMPS AS WELL AS MASSAGE THERAPY. DURING 2022 THERE WERE 77,224 VISITS IN WELLNESS CENTER PROGRAMS. 368397 402316 WIC PROGRAM 67827 541740 CLINIC RENT INCOME 2215732 1304352 SURGERY CENTER INCOME 1743032 1725275 ACO SERVICE REVENUE 4394988 3973683 84436951 true true false true false false false false false true true true false true true false false true false false false false false false false false true true true false true false false false false false false false false true false false false true true true true false false true 112 0 true 706 true false false false false false false false false false false false false X 11 11 false false true false false false false true true false false true true true true false true true true false X CHRIS SEMMLER 8309971297 200 W WINDCREST FREDERICKSBURG TX 78624 X JAYNE POPE CEO 39.0 1.0 X 492937 0 24606 CLINTON KOTAL CHIEF INTEGRATION OFFICER 15.75 24.25 X 383678 0 48946 SUSAN NEVES CFO 39.0 1.0 X 378955 0 30715 MAUREEN POLIVKA CNO 40.0 0.0 X 279741 0 20286 AMANDA STEVENS CHIEF STRATEGY OFFICER 20.0 20.0 X 107676 107676 41309 JAMES PARTIN CMO 40.0 0.0 X 234103 0 0 LEANN MYERS DIRECTOR OF ANCILLARY SERVICES 40.0 0.0 X 204250 0 20827 KEVIN SHANE DICKINSON IT DIRECTOR 25.0 15.0 X 181027 0 37914 KATELYN VINKLAREK DIRECTOR POST ACUTE SERVICES 20.0 20.0 X 175503 0 42324 CHRISTINE DAMEWOOD NURSING DIRECTOR 40.0 0.0 X 166597 0 35796 SHANNA WILLIAMS NURSING DIRECTOR 40.0 0.0 X 186215 0 0 JENNY WEISER PHD CHAIRMAN 0.85 1.0 X X 0 0 0 Penny McBride Director 0.56 1.0 X 0 0 0 JOEL JUNKER SECRETARY 0.5 1.0 X X 0 0 0 DAN SECHRIST DIRECTOR 0.5 1.0 X 0 0 0 CARLIN FRIAR DIRECTOR 0.5 1.0 X 0 0 0 Dale Crenwelge DIRECTOR 0.5 1.0 X 0 0 0 DR KEVIN GALLAGHER DIRECTOR 0.5 1.0 X 0 0 0 DR MICHAEL JOHNSON DIRECTOR 0.5 1.0 X 0 0 0 DRAKE MCLEAN DIRECTOR 0.5 1.0 X 0 0 0 JANE MORGAN DIRECTOR 0.5 1.0 X 0 0 0 JOHN WILLOME DIRECTOR 0.5 1.0 X 0 0 0 2790682 107676 302723 68 false true false TEXAS SELECT STAFFING LLC PO BOX 577 WEST BEND WI 53095 AGENCY NURSING 862461 ENDEAVOR HEALTHCARE 28 HUNTERS POINT NEW BRAUNFELS TX 28260 REVENUE CYCLE SVC 795649 ACCESS PHYSICIANS PLLC PO BOX 670347 DALLAS TX 52670 PHYSICIAN STAFFING 236600 ETTAIN GROUP 127 W WORTHINGTON AVE SUITE 100 CHARLOTTE NC 28203 COMPUTER AGENCY SVC 401227 REED CLAYMON MEEKER HARGETT 5608 PARKCREST DRIVE SUITE 200 AUSTIN TX 78731 ATTORNEY SERVICES 383158 15 439613 250000 7127990 300000 7817603 Net Patient Hospital Revenue 621110 87518949 87518949 Home Health Care Revenue 621610 2911559 2911559 Wellness Center Service Revenue 624100 757442 757442 WIC Program Revenue 624100 402316 402316 Clinic Rent Revenue 531120 541710 541710 3029627 3029627 95161603 1142186 1142186 0 0 0 0 0 2713371 2471 2240856 472515 2471 474986 474986 0 0 0 0 0 0 404317 239053 159198 159198 AUXILIARY REVENUE 900099 37525 37525 MEDICAL RECORDS 561000 940 940 GOODWILL IMPAIRMENT 900099 -3666640 -3666640 4204 4204 -3623971 101131605 95359266 -2045264 X 63105 63105 0 0 0 2022297 2022297 0 27494788 23580837 3913951 784913 683338 101575 4625006 4139528 485478 2045783 1663463 382320 0 819545 819545 243407 243407 0 0 0 17596938 14918238 2678700 622092 43545 578547 1472519 941155 531364 303004 299284 3720 0 10378810 8404274 1974536 85970 82429 3541 0 128854 114431 14423 88313 18253 70060 0 4660048 3872817 787231 526701 443765 82936 Medical Supplies 19699012 19699012 Bad Debt Expense 5194001 5194001 RECRUITMENT & RECOGNITION 135087 36448 98639 DUES & SUBSCRIPTIONS 124311 52955 71356 338569 186073 152496 99453073 84436951 15016122 0 30837297 7478630 50992001 54512803 550040 0 9084074 8789526 0 0 0 0 0 0 2509372 2810440 6638626 6491190 126565437 81647731 44849794 44917706 0 0 38716555 33491388 0 0 0 0 62680548 73444561 246858307 231936244 11500722 13980095 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12700202 7881685 24200924 21861780 X 183940828 176583076 38716555 33491388 222657383 210074464 246858307 231936244 X 1678532 -5773190 -8488261 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 4703 4703 false Schedule C, Part II-B, Line 1i LOBBYING EXPENSES: CREATE HEALTHY MANAGEMENT PAID DUES TO ORGANIZATIONS, A PORTION OF WHICH IS DESIGNATED FOR LOBBYING EXPENSES. DUES LOBBYING % LOBBYING $ THA $47,821 9.03% $4,318 TORCH 3,850 10.00% 385 ----------------------------------------------------------- TOTAL $51,671 $4,703 24315719 14850 -4318366 589538 19422665 21012569 20555 3534951 252356 24315719 18879729 7535 2307819 182514 21012569 15042722 113054 3679370 -44583 18879729 17720826 24451 -1760145 942311 99 15042722 0.19000 0.46000 0.35000 false true true 8786007 8786007 53620709 35661433 17959276 1174293 1174293 57052442 45986298 11066144 5931986 5931986 44917706 INTEREST IN NET ASSETS OF FDN 33491388 F 33491388 DEFERRED COMP PLAN INVESTMENT 1097483 Due from Affiliates 64850928 EST AMOUNTS FROM 3RD PARTIES 1031157 ROU ASSET 6464993 73444561 0 DEFERRED COMP PLAN LIABILITY 1097482 Estimated Self Insurance COsts 262660 LEASE LIABILITY 6521543 7881685 SCHEDULE D, PART V, LINE 4 INTENDED USE OF ENDOWMENT FUNDS: CREATE HEALTHY FOUNDATION HOLDS AND MAINTAINS THE ENDOWMENT FUNDS FOR THE BENEFIT OF THE ORGANIZATION. THERE ARE ENDOWMENTS DESIGNATED FOR THE FOLLOWING: EQUIPMENT AND TECHNOLOGY AT CHM; CHM NURSE STIPENDS, SCHOLARSHIPS, AND CERTIFICATIONS; AND STROKE EDUCATION AND AWARENESS. ADDITIONALLY, THERE ARE SEVERAL ENDOWMENT FUNDS ESTABLISHED AT THE FOUNDATION FOR CHM WHICH ARE UNRESTRICTED FOR PURPOSE. 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. true true X true X 300. true X 500. true true true false true true 4214476 4214476 0.04470 2506674 2835764 0.00000 124131 79524 44607 0.00050 6845281 2915288 4259083 0.04520 898318 41367 856951 0.00910 9230612 6026704 3147908 0.02450 63105 63105 0.00070 10192035 6068071 4067964 0.03430 17037316 8983359 8327047 0.07950 false 5194001 27083906 33461711 -6377805 X true true 1 1 CREATE HEALTHY MANAGEMENT PO BOX 1339 FREDERICKSBURG TX 78624 WWW.CREATEHEALTHY.ORG 00219 X X X CREATE HEALTHY MANAGEMENT 1 false false true X X X X X X X X X 22 true false false true X true 22 false true false true X 300. 500. X X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM PERSONS WHO RESPRESENT THE COMMUNITY: In April 2022, Create Healthy Management began a Community Health Needs Assessment for Gillespie, Blanco and Kendall Counties and sought input from persons who represent the broad interests of the community using several methods: -Information gathering, using secondary public health sources, occurred in June - July 2022. -23 community members participated in individual interviews for their perspectives on community health needs and issues from July 25-29, 2022. -423 surveys were completed: 178 landline phone, 97 cell phone, 148 Web-based (23 via SurveyMonkey) from July 1-August 19, 2022. -Videos were produced to educate the board and community about the secondary community health data as well as the results of the community interviews and surveys. -Input of medically underserved, low-income and minority populations was received though interviews and the community survey. Agencies representing these population groups were intentionally invited to the interviews. The community survey was representative of the whole community - by age, income, and education. -The Texas Department of Health participated in the interviews. BELOW IS A LIST OF ALL THE ORGANIZATIONS THAT GAVE INPUT INTO THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN: -BETHANY PRESCHOOL, SCHOOL DISTRICT, RED CROSS, GOLDEN HUB, ST. BARNABAS EPISCOPAL CHURCH, BETHANY LUTHERAN CHURCH, GILLESPIE COUNTY VETERANS SERVICE OFFICER, ECONOMIC DEVELOPMENT COMMISSON, EMERGENCY MEDICAL SERVICES, TEXAS A&M EXTENSION, GOOD SAMARITAN CLINIC, POLICE CHIEF, VICTORY FELLOWSHIP, ST. THOMAS ORTHODOX CHURCH, MAYOR, HOLY GHOST LUTHERAN CHURCH, CHAMBER OF COMMERCE, GILLESPIE COUNTY HEALTH DIVISION, EMERGENCY SERVICES DISTRICT BOARD, FREDERICKSBURG CITY COUNCIL; ST. BARNABAS EPISCOPAL CHURCH, NEEDS COUNCIL, FREDERICKSBURG INDEPENDENT SCHOOL DISTRICT, AND EMERGENCY SERVICES. SCHEDULE H, PART V, SECTION B, LINE 11 NEEDS ADDRESSED AND NOT ADDRESSED: BASED ON THE RESULTS OF THE CHNA, CHM HAS SELECTED FOUR OF THE IDENTIFIED SIGNIFICANT HEALTH NEEDS TO ADDRESS. 1. Access to Affordable Care and Insurance A) Focus, develop, and implement healthcare resources and healthcare literacy for the underserved 1. Have an action fair with insurance providers to provide information, improve literacy, and increase prevention- translate into multiple languages, include CHIP program, Medicare Advantage, etc. 2. Select a community expert/educator to provide community education on healthcare access, coverage, resources, etc. 3. Utilize Medicare Advantage community liaisons to help educate people on Medicare options 4. Write regular articles for the newspaper to improve health and health insurance literacy B) Increase access to healthcare outside the hospital 1. Develop a coalition for transportation with a focus on geriatric care and family support 2. Create a list of volunteers to bridge the gap of care and support to improve senior socialization 2. Behavioral/Mental Health A) Increase the number of Behavioral Health providers 1. Form relationships with established facilities in Austin, Kerrville, and San Antonio to provide possible services (Texas Advisory Council in San Antonio) 2. Explore tele-health options and education, including school counselors, jails, and other members of the community 3. Integrate Behavioral Health into primary care offices to increase access and decrease stigma 4. Provide mental health first aid in the community - police, schools, public B) Improve suicide prevention education 1. Review the current suicide prevention education process and explore new opportunities for communication 2. Find resources and make connections 3. Share the information and make one central facility/organization for referrals and navigation for providers and the public. Create a shared information center: "one call, that's all". 3. Healthy Eating - Active Living A) Increase nutrition education for the youth and families- educate 1,500 youth and families on nutrition, shopping, simple meals, etc. 1. Invite major employers to create a health council 2. Catalog existing resources and work with MDs to create access to families with education sessions on healthy eating B) Increase knowledge of the access and resources available. Create an exercise fair with new exercise opportunities across the community. Make a cultural change for physical activity. 1. Create an online resource of all exercise groups/opportunities 2. Encourage employers to incentivize exercise in families 3. Encourage MDs to write prescriptions for exercise 4. Integrate with insurance plans for discounts 4. Environmental Factors A) Increase education on vaping among youth within 3 years 1. Increasing youth to youth education to reduce/prevent substance abuse/misuse by utilizing Healthy Texan Youth Ambassadors. Increase number of bilingual ambassadors 2. Encourage youth to educate community, parents, grandparents. B) Reduce injury and poor health outcomes related to substance abuse among adults within 3 years 1. Catalog available resources, explore grants, expand available resources, services, and donations 2. Collaborate with Behavioral Health providers, law enforcement, faith-based communities and medical providers. Linkage to treatment for the addicted C) Housing Goal - Increase percentage of housing stock that is affordable at 30% of the median household income. 1. Create/focus on multi-family income-based housing 2. Recruit outside investments such as philanthropy, city development, construction groups to increase supply of appropriate lot types 3. Increase broadband supply and recruit alternative industries to increase job diversity D) Water Quality Goal - Evaluate water quality needs across the counties. 1. Identify areas that need support. E) Childcare Goal - Open more than 300 spaces in pre-schools/day cares. 1. Obtain funding from state and foundations for childcare efforts 2. Partner with churches, businesses, and organizations for expanded and newly informed programs. Create incentives for employees F) Health Literacy for seniors Goal - Establish a community liaison program to prevent isolation and perform wellness checks 1. Ask the local Mayor's office to establish a grid system to create reps in each grid for communication 2. Hire a community liaison to coordinate programs and be the eyes and ears across the community. Create Healthy Management does NOT intend to address the following significant health needs due to lack of expertise and resources: 1. Access to care and insurance is a health need that HCM cannot directly impact at this time. Create Healthy Management will continue to provide more access to affordable healthcare by recruiting primary care doctors to expand access and continuing to offer its financial assistance program. 2. Substance Use: Due to resource limitations, Create Healthy Management is not directly addressing substance abuse/addition health needs at this time. Create Healthy Management will continue to partner with local rehabilitation centers and social services better positioned to directly address this health need. 3. Affordable housing: While this is important to our community it is a difficult item for HCM to directly address. Create Healthy Management will continue to partner with local government and community leaders seeking solutions to make affordable housing available in the community. 4. Child Care: While we agree that this is a need in our community, we see others in our community better-positioned to fill the gap at this time. Create Healthy Management will continue to offer children's programming during certain school holidays at our Wellness Center and continue to collaborate with social services focusing on children. 5. Senior Care: Due to resource limitations, we are not addressing geriatric healthcare services at this time. Create Healthy Management will continue to partner with local senior services and community leaders seeking solutions to make geriatric healthcare services available in the community. SCHEDULE H, PART V, SECTION B, LINE 13H OTHER FACTORS USED IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE: THE NUMBER OF MEMBERS OF A HOUSEHOLD ARE ALSO CONSIDERED IN CALCULATING THE ELIGIBILITY FOR FINANCIAL ASSISTANCE. SCHEDULE H, PART V, SECTION B, LINES 18 & 19 BILLING AND COLLECTIONS UNDER FACILITY'S FAP: NEITHER CREATE HEALTHY MANAGEMENT, NOR THIRD PARTIES AUTHORIZED BY CREATE HEALTHY MANAGEMENT, TAKE ANY ACTIONS UPON NON-PAYMENT FROM A PATIENT BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART V, SECTION B, LINE 7 & 10 AVAILABILITY TO THE PUBLIC: At the beginning of the 2023 tax year, Create Healthy Management completed its sale of the hospital. As the organization is not currently a hospital, these documents are no longer posted to the website. SCHEDULE H, PART V, SECTION B, LINE 16 MEANS BY WHICH HOSPITAL PUBLICIZED POLICY: At the beginning of the 2023 tax year, Create Healthy Management completed its sale of the hospital. As the organization is not currently a hospital, these documents are no longer posted to the website. 1 HCM HOME CARE 808 REUBEN STREET FREDERICKSBURG TX 78624 HOME HEALTH SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT: FOR GENERAL LEDGER PURPOSES, CREATE HEALTHY MANAGEMENT ESTIMATES THE BAD DEBTS EXPENSE BASED ON HISTORY. A MONTHLY REPORT DETERMINES THE PERCENTAGE OF COLLECTIONS ON EVERY PAYOR FOR THE LAST SIX MONTHS. THIS HISTORY OF THE PERCENTAGE OF UNCOLLECTIBLE CHARGES IS USED TO ESTIMATE THE BAD DEBT EXPENSE. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER FINANCIAL ASSISTANCE POLICY: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT FOOTNOTE: NOT APPLICABLE DUE TO ADOPTION OF ASU 606 REVENUE FROM CONTRACTS WITH CUSTOMERS. SCHEDULE H, PART III, SECTION B, LINE 8 COSTING METHODOLOGY: THE HOSPITAL USES COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. THE ORGANIZATION HAD A MEDICARE SHORTFALL IN THE AMOUNT OF $6,377,805. THE STATE OF TEXAS TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT FOR MEETING STATUTORY REQUIREMENTS FOR CHARITY CARE AND COMMUNITY BENEFIT. SCHEDULE H, PART III, SECTION C, LINE 9B PROVISIONS ON COLLECTION PRACTICES FOR QUALIFIED PATIENTS: CREATE HEALTHY MANAGEMENT'S COLLECTION POLICY EXCLUDES PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. OTHER FACTORS ARE USED IN DETERMINING AMOUNTS CHARGED TO PATIENTS. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: CREATE HEALTHY MANAGEMENT ASSESSES THE NEEDS OF THE COMMUNITIES IT SERVES THROUGH A TRIENNIAL COMPREHENSIVE COMMUNITY NEEDS ASSESSMENT, CONDUCTED BY A THIRD PARTY IN COLLABORATION WITH INTERNAL STAKEHOLDERS. ADDITIONALLY, CREATE HEALTHY MANAGEMENT ACCESSES AND REVIEWS THE COMMUNITY HEALTH NEEDS ASSESSMENTS PUBLICALLY POSTED BY HEALTH ENTITIES IN OUR MORE DISTANT SERVICE AREAS. THESE ITEMS ARE INCORPORATED INTO OUR STRATEGIC PLAN. FINALLY, CREATE HEALTHY MANAGEMENT CONDUCTS ANNUAL SWOT ASSESSMENTS WITH MORE THAN 100 KEY STAKEHOLDERS TO DETERMINE HEALTHCARE NEEDS BEFORE SETTING ITS ANNUAL STRATEGY. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: CREATE HEALTHY MANAGEMENT PATIENTS SPEAK WITH A CREATE HEALTHY MANAGEMENT BUSINESS OFFICE REPRESENTATIVE BEFORE CARE TO DETERMINE IF THEY ARE ELIGIBLE FOR ASSISTANCE UNDER THE FEDERAL, STATE AND LOCAL GOVERNMENT PROGRAMS OR THE ORGANIZATION'S CHARITY CARE POLICY. THE PATIENT'S ELIGIBILITY IS ASSESSED AND CAREFULLY MANAGED, SO THAT IF HE/SHE OVERPAYS, HE/SHE IS REIMBURSED THE RECONCILING AMOUNT. UPON DISCHARGE, PATIENTS ARE GIVEN THE INFORMATION, AND IT IS THEIR DECISION WHETHER OR NOT TO CONTACT THE HOSPITAL. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: The population of the three counties is projected to increase from 2021 to 2026 (2.57% per year). Texas is projected to increase 1.5% per year. The U.S. is projected to increase 0.70% per year. The three counties had a higher median age (48.7 median age) than TX (35.3) and the U.S. (38.8). In the three counties the percentage of the population 65 and over was 26%, higher than the U.S. population 65 and over at 17.2%. The three counties' median household income at $74,906 was higher than TX ($63,524) and the U.S. ($64,730). The rates of poverty in Gillespie, Blanco and Kendall respectively were 9.2%, 9.8% and 6.7% which were all lower than TX (13.4%) and the U.S. (11.9%). The household income distribution of the three counties was 37% higher income (over $100,000), 51% middle income, and 12% lower income (under $25,000). The largest income group is the 19% making $50,000 to $74,999. The health care index measures how much the populations spent out-of-pocket on health care services including insurance premiums. The U.S. index was 100. The three counties' index was 122, indicating 22% more spent out of pocket than the average U.S. household on medical care (doctor's office visits, prescriptions, hospital visits) and insurance premiums. The racial and ethnic make-up of Gillespie, Blanco and Kendall Counties was 89% White, 1% Black, 1% American Indian, 1% Asian, 25% Hispanic origin, 2% more than one race, and 7% other. (These percentages total to over 100% because Hispanic is an ethnicity, not a race.) SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: CREATE HEALTHY MANAGEMENT'S VISION IS TO EMPOWER OTHERS, CREATE HEALTHY. ENCOURAGING WELLNESS IS AN INVESTMENT IN OUR COMMUNITIES' HEALTH. WE EMPOWER OTHERS BY HOLDING EDUCATIONAL/COMMUNITY EVENTS. 2022 WAS A CHALLENGING YEAR FOR CREATING HEALTHY WITH THE END OF OUTBREAK OF COVID 19 IN OUR WORLD. THE HEALTHYU PROGRAM, HYPERTENSION MANAGEMENT THROUGH BEHAVIORAL CHANGES, CONTINUED WITH 150 PARTICIPANTS WITH REMOTE WEBINARS, NUTRITIONAL CONSULTATIONS, OFF SITE FITNESS ACTIVITIES. CHM WELLNESS CENTER COMPLIED WITH PANDEMIC SAFETY PROTOCOLS TO PROVIDE A RESOURCE FOR WELLNESS ACTIVITIES; OUTDOOR GROUP EXERCISE CLASSES, SMALLER AQUA CLASSES, FITNESS EQUIPMENT SANITATION PROTOCOLS, AND TWO HOUR RESERVATION BLOCKS TO REDUCE THE USER INTERACTION. EMBRACING ITS VALUE OF OWNERSHIP, CHM PROACTIVELY INITIATED THE HILL COUNTRY COMMUNITY RESPONSE TO COVID-19 BY ORGANIZING REGULAR STAKEHOLDER MEETINGS WITH KEY COMMUNITY LEADERS; DISSEMINATING TRANSPARENT, RESEARCH BASED EDUCATION; IMPLEMENTING INNOVATIVE AND EXPANDED APPROACHES TO ACCESS CARE; AND SHARING BEST PRACTICES AT THE LOCAL, STATE, AND NATIONAL LEVEL. THESE MEETINGS CONTINUED INTO 2022. CHM COLLABORATES WITH CITY AND COUNTY OFFICIALS TO PREPARE FOR EMERGENCY SCENARIOS. CHM INVITES CITY AND COUNTY EMERGENCY OFFICIALS TO PARTICIPATE IN MOCK EMERGENCY SITUATIONS TO PREPARE FOR ACTUAL, LIKELY EMERGENCY BASED ON THE GEOGRAPHIC PROXIMITY OF THE HOSPIAL, SUCH AS A TORNADO OR MAJOR CHEMICAL SPILL. STARTING IN EARLY 2022 CHM HAS BEEN COLLABORATING WITH THOSE AGENCIES TO PREPARE FOR THE POTENTIAL HEALTH NEEDS OF THE INFLUX OF TENS OF THOUSANDS OF VISITORS FOR THE PARTIAL ECLIPSE IN FALL OF 2023 AND THE TOTAL ECLIPSE IN APRIL OF 2024 AS FREDERICKSBURG IS IN THE DIRECT PATH OF THE VIEWING AREA. CHM'S PURPOSE IS TO SERVE AND PARTNER WITH OTHERS TO CREATE HEALTHY COMMUNITIES FOR GENERATIONS TO COME. THE ORGANIZATION DOES THIS BY HAVING AN OPEN MEDICAL STAFF AND COMMUNITY BOARD. CHM ALSO PROVIDES MILLIONS OF DOLLARS OF CHARITY CARE EACH YEAR. AS A NOT-FOR PROFIT HEATLH CARE ORGANIZATION, OUR EARNINGS ARE INVESTED BACK INTO THE ORGANIZATION FOR IMPROVEMENTS TO THE FACILITIES, TECHNOLOGY AND THOSE WHO DELIVER CARE. IN 2022, CHM INVESTED IN CATH LAB AND SURGERY EQUIPMENT, NEW IT EQUIPMENT AND OPENED THE DEBBYE DOOLEY SIMULATION LAB TO TRAIN MEDICAL TEAMS THROUGHOUT THE HILL COUNTRY. FOR ADDITIONAL INFORMATION ABOUT ACTIVITIES THE HOSPITAL CONDUCTED TO PROMOTE COMMUNITY HEALTH, SEE THE SCHEDULE H, PART V, SECTION B, LINE 11 DISCLOSURE. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: THE HOSPITAL IS PART OF A SYSTEM WHICH INCLUDES SIX ORGANIZATIONS. CREATE HEALTHY MANAGEMENT PROVIDES HEALTHCARE; CREATE HEALTHY FOUNDATION PROVIDES FUNDRAISING; FREDERICKSBURG PHYSICIANS NO 1 PROVIDES HEALTHCARE; FREDERICKSBURG PHYSICIANS NO 2 PROVIDES HEALTHCARE; AND FREDERICKSBURG HOSPICE NO 1 PROVIDES HOSPICE SERVICE. FREDERICKSBURG ACO, LLC & MARBLE FALLS ASC, LLC ARE FULLY OWNED BY THE HOSPITAL. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: TEXAS SCHEDULE H, PART I, LINE 7 COLUMN F FINANCIAL ASSISTANCE & CERTAIN OTHER COMMUNITY BENEFITS AT COST: THE AMOUNT OF BAD DEBT EXPENSES REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT PERCENTAGE WAS $5,194,001. SCHEDULE H, PART I, LINE 3C FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING OTHER CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: -ASSET LEVEL -MEDICAL INDIGENCY -INSURANCE STATUS -UNDERINSURANCE STATUS -NUMBER OF HOUSEHOLD MEMBERS SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. THE COST COMPUTED ON IRS WORKSHEET 4 FROM THE GOOD SAMARITAN CENTER IS BASED ON CHARGES WRITTEN OFF. ALL OTHER ACTIVITY IS ACTUAL CASH COSTS. WORKSHEET 6 PULLED THE DATA FROM THE COST ACCOUNTING SYSTEM CONSISTING OF ACTUAL CHARGES AND RECEIPTS, ACTUAL COSTS AND OVERHEAD COSTS. WORKSHEET 8 IS CALCULATED USING THE INCOME STATEMENT AND INTERNAL COSTS SYSTEM. true GOOD SAMARITAN CENTER 140 INDUSTRIAL LOOP FREDERICKSBURG TX 78624 912129853 501C(3) 40000 FUND INDIGENT CARE UNINSURED 1 SCHEDULE I, PART I, LINE 2 PROCEDURES TO MONITOR THE USE OF GRANT FUNDS IN THE U.S.: THE BOARD OF DIRECTORS COLLABORATED AND DECIDED TO DONATE TO THE CHARITABLE ORGANIZATION LISTED AS THEIR PROGRAMS FILL A GAP IN THE COMMUNITY BY SERVING IN THE UNINSURED THROUGH CHARITABLE MEDICAL, DENTAL AMD MENTAL HEALTH-CLINICS THROUGH DIRECT CARE AND COMMUNITY PARTNERSHIPS. THE HOSPITAL IS ONE OF THOSE PARTNERS AND BY PROVIDING COMMUNITY ACCESS GRANT WE ARE HELPING KEEP PATIENTS OUT OF OUR ER BY GIVING THEM ACCESS TO MORE TIMELY, APPROPRIATE CARE. THE MONEY IS TRACKED AND MONITORED AND IS USED FOR DIAGNOSTIC TESTING PREDOMINANTLY LAB AND IMAGING. X X X false false false false false false false false false JAYNE POPE CEO 410935 0 82002 0 0 0 11600 0 13006 0 517543 0 0 0 SUSAN NEVES CFO 313955 0 65000 0 0 0 0 0 30715 0 409670 0 0 0 CLINTON KOTAL CHIEF INTEGRATION OFFICER 316242 0 67436 0 0 0 11600 0 37346 0 432624 0 0 0 MAUREEN POLIVKA CNO 233290 0 46451 0 0 0 8769 0 11517 0 300027 0 0 0 JAMES PARTIN CMO 191987 0 42116 0 0 0 0 0 0 0 234103 0 0 0 LEANN MYERS DIRECTOR OF ANCILLARY SERVICES 177150 0 27100 0 0 0 7126 0 13701 0 225077 0 0 0 SHANNA WILLIAMS NURSING DIRECTOR 166215 0 20000 0 0 0 0 0 0 0 186215 0 0 0 KEVIN SHANE DICKINSON IT DIRECTOR 177420 0 3607 0 0 0 7203 0 30711 0 218941 0 0 0 KATELYN VINKLAREK DIRECTOR POST ACUTE SERVICES 150303 0 25200 0 0 0 6059 0 36265 0 217827 0 0 0 CHRISTINE DAMEWOOD NURSING DIRECTOR 146597 0 20000 0 0 0 5085 0 30711 0 202393 0 0 0 AMANDA STEVENS CHIEF STRATEGY OFFICER 89176 89176 18500 18500 0 0 3690 3689 16965 16965 128331 128330 0 0 X 1 300000 FMV false true false SCHEDULE M, PART I, COLUMN B NUMBER OF CONTRIBUTIONS OR ITEMS RECEIVED: THE AMOUNT REFLECTED IN THIS COLUMN IS THE NUMBER OF CONTRIBUTIONS RECEIVED. SCHEDULE M, PART I, LINE 31 GIFT ACCEPTANCE POLICY: ALTHOUGH CREATE HEALTHY MANAGEMENT DOES NOT HAVE ITS OWN GIFT ACCEPTANCE POLICY, IT FOLLOWS THE POLICY OF THE FOUNDATION, A RELATED ORGANIZATION. THEREFORE, WE HAVE MARKED THIS YES. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: THE CREATE HEALTHY MANAGEMENT BOARD MEMBERS ARE PROVIDED ELECTRONIC ACCESS TO THE FORM 990 IN ADVANCE OF A BOARD MEETING. FORMAL REVIEW IS THEN HELD AT A MEETING PRIOR TO FILING. 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, HIGHLY COMPENSATED EMPLOYEES, AND ALL DEPARTMENT DIRECTORS ON AN ANNUAL BASIS. ALL DISCLOSURES ARE REVIEWED BY THE BOARD GOVERNANCE COMMITTEE AND REPORTED TO THE HOSPITAL BOARD. BOARD MEMBERS MUST RECUSE THEMSELVES FROM VOTING ON ISSUES RELATED TO THEIR CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION REVIEW AND APPROVAL PROCESS FOR CEO: HE CEO COMPENSATION AND EVALUATION COMMITTEE OF THE BOARD REVIEWS RELEVANT WAGE SURVEY AND DATA TO DETERMINE CEO COMPENSATION. DATA AND SURVEYS ARE SUPPLIED BY THE HUMAN RESOURCE DIRECTOR AND REPORTED TO THE BOARD. THE REVIEW IS CONDUCTED ANNUALLY AND DOCUMENTED IN THE MINUTES. FORM 990, PART VI, SECTION B, LINE 15B COMPENSATION REVIEW AND APPROVAL PROCESS FOR OTHER OFFICERS AND KEY EMPLOYEES: THE CEO REVIEWS WAGE DATA AND SURVEYS SUPPLIED BY THE HUMAN RESOURCE DIRECTOR. THE REVIEWS ARE CONDUCTED ANNUALLY AND DOCUMENTED IN THE HR FILES. 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. FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC, HOWEVER CERTAIN SUMMARY FINANCIAL INFORMATION MAY BE AVAILABLE IN THE ORGANIZATION'S ANNUAL REPORT TO THE COMMUNITY. FORM 990, PART VI, SECTION A, LINE 1 DELEGATION OF AUTHORITY: THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRMAN, VICE-CHAIRMAN, SECRETARY AND ONE AT-LARGE TRUSTEE. THE CEO AND CHIEF OF THE HOSPITAL'S MEDICAL STAFF SHALL BE EX-OFFICIO, NON-VOTING MEMBERS OF THE EXECUTIVE COMMITTEE. THE COMMITTEE SHALL HAVE THE POWER TO TRANSACT BUSINESS OF THE CORPORATION AND THE ORGANIZATION SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD. THE EXECUTIVE COMMITTEE SHALL HAVE SUCH ADDITIONAL DUTIES AND RESPONSIBILITIES AS MAY BE SET FORTH IN THE BYLAWS. ACTIONS OF THE EXECUTIVE COMMITTEE SHALL BE BROUGHT TO THE BOARD AT THE NEXT REGULAR MEETING FOR RATIFICATION. FORM 990, PART III, LINE 4D DESCRIPTION OF OTHER PROGRAM SERVICES: WIC PROGRAM - PROVIDE NUTRITIONAL EDUCATION, BREAST FEEDING SUPPORT, WIC FOODS AND SOCIAL SERVICE REFERRALS FOR WOMEN AND CHILDREN MEETING WIC ELIGIBILITY REQUIREMENTS; AND COMMUNITY HEALTH PROGRAMS SUCH AS IMMUNIZATIONS FOR Children. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: UNDISTRIBUTED PORTION OF CHANGE IN INTEREST IN NET ASSETS OF CREATE HEALTHY FOUNDATION $(5,225,167) CLOSING RECEIVABLE FROM DISREGARDED ENTITY (1,850,728) NET ASSETS FROM MAPLE FALLS ASC (1,412,366) -------------- TOTAL $(8,488,261) FORM 990, PART VI, SECTION A, LINE 4 SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS: THE ORGANIZATION CHANGED ITS NAME FROM HILL COUNTRY MEMORIAL HOSPITAL TO CREATE HEALTHY MANAGEMENT. THE GOVERNING DOCUMENTS WERE UPDATED TO REFLECT THE NEW NAME AND THAT OF ITS RELATED ORGANIZATIONS. FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:17596938 FREDERICKSBURG ACO LLC PO BOX 1339 FREDERICKSBURG TX 78624 833115572 ACO TX 1725275 4593 CHM MARBLE FALLS ASC LLC PO BOX 1339 FREDERICKSBURG TX 78624 331039828 SURGERY CTR TX 1407820 532255 CHM CREATE HEALTHY FOUNDATION PO BOX 1339 FREDERICKSBURG TX 78624 742557105 FUNDRAISING TX 501(C)(3) 12 TYPE III NA false FREDERICKSBURG HOSPICE NO 1 PO BOX 1339 FREDERICKSBURG TX 78624 742912643 HOSPICE 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 FREDERICKSBURG PHYSICIANS NO 1 PO BOX 1339 FREDERICKSBURG TX 78624 272860109 HEALTHCARE TX 501(C)(3) 3 CHM true false false true true false false false false false true false false true true true false true true true FREDERICKSBURG HOSPICE NO 1 Q 5715097 ACTUAL CASH FREDERICKSBURG PHYSICIANS NO 1 R 10156577 FMV