2024-11-15T08:08:16-06:00 2023-12-31 990 2023-01-01 831869297 Texas Health Hospital Mansfield TEXA 6823415004 2300 Lone Star Road Mansfield TX 76063 Lynn C Addiscott Assistant Secretary 4073572194 2024-10-30 0 2023 2024-10-15 13:58:12Z Eulanie Lashley 2300 Lone Star Road Mansfield TX 76063 74397669 0 X www.texashealth.org/texas-health-mansfield X 2018 TX The provision of medical care to the community through the operation of a 59 bed hospital. 10 5 0 25 0 0 0 0 49024559 74279407 65816 76524 0 0 49090375 74355931 44369 63614 0 0 28871167 1587513 0 0 0 37615885 76326964 66531421 77978091 -17441046 -3622160 159857630 158629529 24621083 27786035 135236547 130843494 Our mission is to extend the healing ministry of Christ by identifying and meeting the health needs of our community, providing quality, costumer oriented, and cost effective services, and ensuring access to those services. 0 0 72012758 63614 74279407 Operation of a hospital totaling 59 beds with 1,925 patient admissions, 5,094 patient days, and 26,012 outpatient visits in the current year. 72012758 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 5 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X Stephanie Nelson 6823415003 2300 Lone Star Road Mansfield TX 76063 X Sultana MD Nazia Hospital Board Member/Chief of Staff 4.40 0.00 X 0 21451 0 Stoecker Jennifer Hospital Board Member 0.20 0.00 X 0 0 0 Schroeder Jennifer Hospital Board Member 0.20 50.00 X 0 424355 84919 Sanchez Priscilla Hospital Board Member (End 12/23) 0.20 0.00 X 0 0 0 King James Kirk Trustee/THR 0.20 50.00 X 0 1271947 369248 Jackson David Trustee/THR 0.20 50.00 X 0 515108 165877 Griffith Buddy Hospital Board Member 0.20 0.00 X 0 0 0 Craft Brian Trustee/THR 0.20 50.00 X 0 560964 128379 Carroll RJ Hospital Board Member (End 09/23) 0.20 0.00 X 0 0 0 Bacon Kenneth Trustee (End 10/23) 0.20 0.00 X 0 0 0 Banks David Trustee (Beg. 11/23) 0.20 0.00 X 0 0 0 Randolph Karsten Trustee 0.20 0.00 X 0 0 0 Rose Kenneth CEO 50.00 0.20 X 414119 0 100504 Nelson Stephanie CFO 50.00 0.20 X 298413 0 41132 Johnson Penny Regional CEO 10.00 31.00 X 278710 864000 146620 Ford MD Ronny CMO 12.50 37.50 X 121153 363458 114244 Sutton Kristen CNO 50.00 0.20 X 225135 0 44022 1337530 4021283 1194945 5 0 1 1 Sound Physicians of Texas III PO Box 742936 Los Angeles CA 900742936 Physician Services 1338580 Pediatrix Medical Group of Florida Inc PO Box 277279 Atlanta GA 303847279 Physician Services 1057444 Texas Health Resources 612 E Lamar Blvd Ste 600 Arlington TX 76011 Clinical Services 877837 Northstar Anesthesia II PA PO Box 650252 Dallas TX 752650252 Anesthesia Services 519691 True North Custom Publishing LLC PO Box 116575 Atlanta GA 30369 Advertising Services 339660 18 X Net Patient Revenue 622110 72872320 72872320 Medical Office Building 622110 1153364 1153364 Cafeteria Revenue 622110 239274 239274 14449 14449 74279407 118262 118262 41738 -41738 -41738 -41738 74355931 74279407 0 76524 X 63614 63614 1587513 1587513 300 300 14549 14549 44388666 41721821 2666845 665404 665404 1401903 940214 461689 3816413 3470168 346245 2585479 2585479 98870 98870 23238 23238 762055 762055 9801411 9801411 69353 50716 18637 Medical Supplies 8411613 8411613 Repairs & Maintenance 2289627 2289627 State Tax Indigent Asse 1869763 1869763 Dues & Memberships 66381 66381 61939 46277 15662 77978091 72012758 5965333 0 X 1400 1400 1746220 4582947 6937858 9073811 1898074 2111505 603096 155300 165149418 29854027 144875655 135295391 1216210 689435 2579117 6719740 159857630 158629529 1753857 2040446 22867226 25745589 24621083 27786035 X 135236547 130843494 135236547 130843494 159857630 158629529 X -3622160 240678 -1011571 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 450 450 0 Part II-B, Line 1: Dues were paid to the Texas Hospital Association. 10064275 10064275 96658057 8664174 87993883 58267706 21143806 37123900 159380 46047 113333 135295391 Due to Related 19091327 Credit Balances in A/R 571377 Payable to Third Parties 75156 Operating Lease Liability 2186342 Other Liabilities 179944 Other Deferred Revenue 3634616 Accrued Interest Payable 6827 25745589 X Part X, Line 2: The Consolidated Audited Financial Statements for the twelve-month period ended 12/31/2023 include the filing organization, its member tax-exempt hospital, Texas Health Huguley Hospital (THH or the Company), and two of THH's subsidiaries: Huguley Medical Associates (HMA), a nonprofit, tax-exempt physician group and Texas Health Huguley Surgery Center, an LLC Surgery Center treated as a partnership. These Consolidated audited financial statements contain the following FIN 48 footnote: The Company is exempt from state and federal income taxes. Accordingly, the Company and its tax-exempt affiliates are not subject to federal, state, or local income taxes, except for any net unrelated business taxable income. For the years ended December 31, 2023 and 2022, unrelated business income activities conducted by the Company and its tax-exempt affiliates did not generate a material amount of combined federal, state, or local income tax. The Company follows the Income Taxes Topic of the Accounting Standards Codification (ASC) 740, Income Taxes (ASC 740), which prescribes the accounting for uncertainty in income tax positions recognized in financial statements. ASC 740 prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken, or expected to be taken, in a tax return. There were no material uncertain tax positions as of December 31, 2023 and 2022. 1 1 X 1 X 1 X 1 1 1 0 1 1 4975703 4975703 0.06380 8711081 7849301 861780 0.01110 13686784 7849301 5837483 0.07490 13686784 7849301 5837483 0.07490 80373 80373 0.00100 80373 80373 0.00100 0 7168268 456264 6297641 7476498 -1178857 X 1 1 1 1 Texas Health Hospital Mansfield 2300 Lone Star Road Mansfield TX 76063 www.texashealth.org/texas-health-mansf 100524 X X X Texas Health Hospital Mansfield 1 0 0 1 X X X X X X X X X 22 1 1 0 1 X See Part V, Page 8 X X 1 23 1 See Part V, Page 8 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X X 1 X 0 X X X X 1 X 0 0 Texas Health Hospital Mansfield Part V, Section B, Line 5: Texas Health Hospital Mansfield (THHM or the Hospital) operates a licensed 59-bed acute care hospital and an 80,000 square foot medical staff office building that houses primary care and specialty practices, as well as an outpatient center offering lab, therapy, and imaging services. Hospital services include an emergency department, cardiovascular, orthopedics, general surgery, and women's services. Texas Health Hospital Mansfield (THHM) is owned by Texas Health Huguley, Inc. and therefore operates as a part of the joint venture between Texas Health Resources and AdventHealth. Texas Health Hospital Mansfield believes that total health is achieved through a balance of physical, mental, social, and spiritual well-being. The 2022 CHNA is the first for THHM. References in the regional CHNA to "building upon the 2019 CHNA" reflects THR's historical process for completing a system-wide assessment.The development of Texas Health's CHNA was a collective approach that included Texas Health employees, community-serving organizations, and community members from within areas of focus that gave us input and knowledge of issues and solutions and those who share our commitment to improve health and quality of life. The 2022 CHNA planning effort pushed Texas Health beyond our traditional primary service area to directly impact prioritized health needs in areas of the community with greatest health needs. This was an integral step to ensuring our ability to understand the needs of the community and develop programs and services that will positively impact the health and well-being of those we serve.For the 2022 CHNA process, Texas Health built on key findings and achievements from the 2019 CHNA process and Implementation Strategy. This process included over 463 ZIP codes within the Texas Health primary and secondary service areas. Texas Health, with the support of five regional community councils, utilized primary and secondary data to narrow the geography down to 56 prioritized ZIP codes. These communities were experiencing disproportionate health outcomes in the areas of Chronic Disease, Behavioral Health and Awareness, and Health Literacy and Navigation.The communities' health needs were assessed through key informant interviews, community focus groups, and listening sessions that included online surveys and virtual discussions. Key informant interviews (KIIs) were conducted with leaders and staff from organizations that provide services directly to the community and officials that represent governmental and non-governmental entities. Interviewees invited to participate were recognized as having expertise in public health, special knowledge of community health needs, representing the broad interests of the community served by the hospital, and/or being able to speak to the needs of medically underserved or vulnerable populations. Spanning across all regions, the 41 KIIs took placefrom October 2021 through March 2022 and focused on the interviewee's background and organization, the biggest perceived health needs and barriers of concern in the community, and the impact of health issues on the populations they serve.Organizations participating in the KIIs that had specific familiarity with the needs of the primary service area of the hospital included, Cleburne Fire Department, Johnson County Family Crisis Center, North Texas Behavioral Health Authority, Alzheimer's Association, Mansfield Mission Center, SafeHaven of Tarrant County, and the Texas Department of State Health Services. Texas Health and Conduent HCI conducted focus groups to gain deeper insight into perceptions, attitudes, experiences, or beliefs held by community members about their health. A total of 19 virtual and in-person focus groups were conducted from November 2021 through May 2022 across all regions. An array of residents and employees from the Tarrant/Parker Region provided insights when facilitators asked a series of nine questions to prompt discussion on top community health issues, barriers/challenges to health, and the impact of COVID-19. The relative importance of health and/or social need was determined, in part, by the frequency of the topic or issue discussed across all three focus groups.Texas Health and Conduent HCI conducted an online survey with key community stakeholders to capture quantitative data in relation to Texas Health 2019 CHNA and Implementation Plan. Conduent HCI hosted a follow-up virtual discussion with the stakeholders to capture qualitative insights and feedback. The main goal of the listening session was to determine opportunities to strengthen collaborations within the communities served by Texas Health Resources Health System. Invited community leaders were from the following sectors: education, non-profit, philanthropy, for-profit, and healthcare. Texas Health Hospital Mansfield Part V, Section B, Line 6a: The primary service area of the hospital was included in two regional community health needs assessments (CHNAs) in cooperation with Texas Health Resources and Conduent Health Communities Institute (HCI). The hospital facilities included in each of the regional CHNAs are as follows:Southern Region - Texas Health Cleburne (THC), Texas Health Stephenville (THS), Texas Health Kaufman (THK), and Texas Health Huguley Hospital Fort Worth SouthTarrant/Parker Region - Texas Health Alliance (THAL), Texas Health Arlington Memorial (THAM), Texas Health Fort Worth (THFW), Texas Health Specialty Hospital (THSH), Texas Health Southwest Fort Worth (THSW), Texas Health HEB (THHEB), Texas Health Azle (THAZ), AMH Cath Labs (AMHH), Texas Health Southlake (THSL), USMD at Arlington (USMD-Arl), USMD at Fort Worth (USMD-FW), and Texas Health Hospital Mansfield (THHM). Texas Health Hospital Mansfield Part V, Section B, Line 7d: The Hospital has adopted a policy that addresses the public posting requirements of the Community Health Needs Assessment. Under this policy, the Community Health Needs Assessment Reports must be posted on the Hospital's website at least until the date the Hospital facility has made widely available on its website its two subsequent Community Health Needs Assessment Reports. The Hospital will also make a paper copy of its Community Health Needs Assessment Report available for public inspection upon request and without charge, at least until the date the Hospital facility has made available for public inspection its two subsequent Community Health Needs Assessment Reports. Part V, Section B, Line 7a: The CHNA report can be found at URL:https://www.texashealthmansfield.org/hospital-and-emergency-rooms/texas-health-hospital-mansfield/community-health-improvement Schedule H, Part V, Section B, Line 10: The Hospital's most recently adopted implementation strategy can be found at URL:https://www.texashealthmansfield.org/hospital-and-emergency-rooms/texas-health-hospital-mansfield/community-health-improvement Schedule H, Part V, Section B, Line 11: 2023 Schedule H Line 11 for Texas Health Hospital MansfieldTexas Health Hospital Mansfield will be referred to in this document as Texas Health Hospital Mansfield or "The Hospital". The Hospital is a wholly owned subsidiary of Texas Health Huguley, Inc. dba Texas Health Huguley Hospital Fort Worth South (THH). THH was organized in 2012 as a joint venuture hospital between Texas Health Resources (THR) and Adventist Health System/Sunbelt, Inc. (AHSSI), a wholey owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). THR owns 51% of the membership of THH with AHSSI owning the remaining 49%. AHSSHC manages the daily operation of THH and the filing organization. AHSSHC is the 501(c)(3) parent organization of a hospital and healthcare system known as AdventHealth. This is the first-year update for the Hospital's 2023-2025 Community Health Plan/Implementation Strategy. The Hospital developed this plan and posted it in May 2023 as part of its 2022 Community Health Needs Assessment process.For the development of both the Community Health Needs Assessment and the Community Health Plan/Implementation Strategy, Texas Health Hospital Mansfield worked to define and address the needs of low-income, minority and underserved populations in its service area. The Community Health Needs Assessment used primary data interviews and surveys; secondary data from local, regional, and national health-related sources; and Hospital prevalence data to help the Hospital determine the health needs of the community it serves. Once the data was gathered, the health issues identified in the community health needs assessment were prioritized by community and Hospital stakeholders, who then selected key priorities for the Hospital to address in its Community Health Plan. The first-year progress on the Community Health Plan is noted below. The narrative describes the priorities identified in 2022 and gives an update on the strategies addressing those prioritized needs. There is also a description of the identified needs that the Hospital did not prioritize to address.The Hospital's chosen priorities are listed below.1. Mental Health2. High Blood Pressure3. Food Insecurity4. Health Care Access and QualityPriority 1: Mental Health2022 Description of the Priority: Mental illnesses are conditions that affect a person's thinking, feeling, mood or behavior, such as depression, anxiety, bipolar disorder, or schizophrenia. Such conditions may be occasional or long-lasting (chronic) and affect someone's ability to relate to others and function each day. In Texas Health Huguley's and Texas Health Hospital Mansfield's PSA, 21.6% of adults have depression which is higher than both the state (18.4%) and national (19.6%) rates. Additionally, 14.6% of adults in the community indicated they had poor mental health. Poor mental health is defined as 14 or more days during the past 30 days during which mental health was not good. 2023 Update:Goal 1.1: Improve awareness and support around mental illness and grief through education. Objective 1.1.1: By December 31, 2025, train 100 lay chaplains in the basics of pastoral care and grief to provide mental health support for community members who access services at the Mansfield Mission Center (MMC).In 2023, a total of 25 lay chaplains were trained. Additional workshops are scheduled for 2024.Objective 1.1.2: By December 31, 2025, facilitate 20 "Good God, I Grieve" educational seminars from a baseline of 5 in churches and other community-based organizations to address the grief and loss issues in crucial zip codes in Johnson and Parker Counties.In 2023, a total of eight educational seminars were hosted. Additional seminars are scheduled for 2024. Priority 2: High Blood Pressure2022 Description of the Priority: High blood pressure, or hypertension, is when the force of the blood pushing against the walls of your blood vessels is consistently too high. The higher your blood pressure levels, the more risk you have for other health problems, such as heart disease, heart attack, and stroke. In 2019 31.6% of adults had high blood pressure which is slightly lower than the 2017 rate of 33% of adults.2023 Update:Goal 2.1: Improve awareness about high blood pressure through community education.Objective 2.1.1: By December 31, 2025, increase awareness regarding the Dietary Approaches to Stop Hypertension (DASH) diet by facilitating seven workshops and cooking schools through the Mansfield Seventh Day Adventist. The Hospital met with Mansfield Seventh Day Adventist church and scheduled six of the seven workshops to take place in 2024.Objective 2.1.2: By December 31, 2025, facilitate Dietary Approaches to Stop Hypertension (DASH) diet workshops and cooking schools to 300 community members from zero baseline.The workshops will take place in 2024 and a final workshop in 2025. Priority 3: Food Insecurity2022 Description of the Priority: Food insecurity is a lack of consistent access to affordable and nutritious food for every person in a household to live an active, healthy life. People who are food insecure may be at an increased risk of negative health outcomes. As of 2020, 13.9% of residents in the community have experienced food insecurity which is higher than the state (13%) and national (11.5%) rates.2023 Update:Goal 3.1: Improve access to healthy foods for children and families in food deserts.Objective 3.1.1: By December 31, 2025, increase the percentage of children and families residing in low-income apartments who access the Market 2 Go program from 5% (2022) to 10%. In July 2022, the Hospital piloted the 'Market 2 Go' program in South Arlington to address food insecurity for children and families. This initiative sought to bring fresh produce, groceries, toiletries, and other resources to the community to overcome transportation barriers for those needing additional food resources. In addition, families were invited to a lunch at the apartment pool where healthy eating information was shared. Blood pressure checks were provided and free follow up care was offered by Mansfield Mission Center.In 2023, 7.5% of children and families residing in low-income apartments accessed the Market 2 Go program.Objective 3.1.2: By December 31, 2025, provide $4,000 to Harvesting in Mansfield Center Food Bank to support the launch of Fresh Market which allows guest to shop for free groceries, especially fresh fruits and vegetables. Year one will be spent planning, and the market will launch year two. The Hospital donated $4,000 to Harvesting in Mansfield Center Food Bank in 2023.Priority 4: Health Care Access and Quality2022 Description of the Priority: Many people face barriers that prevent or limit access to needed health care services, which may increase the risk of poor health outcomes and health disparities. Inadequate health insurance coverage is one of the largest barriers to health care access, and the unequal distribution of coverage contributes to disparities in health. The PSA has a higher percentage of residents without health insurance (15%) compared to the United States (8.7%). Lack of transportation is another barrier impacting access and can lead to missed or delayed health care appointments and overall poorer health outcomes. Access to a primary care provider or having an established medical home is one way to improve health outcomes because people can see the same provider who is familiar with their medical history and can monitor their personal health over years. 2023 Update: Goal 4.1: Increase access to healthcare services by educating communities about health insurance.Objective 4.1.1: By December 31, 2025, establish three locations in Johnson county where Texas Health Huguley's mobile health unit will provide education about health insurance and primary healthcare access to uninsured residents.The Hospital met with colleagues at Texas Health Huguley to schedule locations where the mobile health unit will serve in 2024 when the new mobile unit becomes available for use.Priorities Not Addressed by the Hospital:The Community Health Needs Assessment identified multiple health needs through the collection of primary and secondary data. After reviewing the data, the Hospital and community stakeholders conducted a prioritization process. Listed below are the priorities not addressed and the reason why they were not selected to be addressed.1. Housing: The Hospital did not perceive the ability to have a measurable impact on this issue within the three years allotted for the Community Health Plan with the current resources available to the Hospital at this time.*** See Cotinuation of Part V, Section B, Line 11 Schedule H, Part V, Section B, Line 11 Continuation: 2. Employment: The Hospital did not perceive the ability to have a measurable impact on this issue within the three years allotted for the Community Health Plan with the current resources available to the Hospital at this time. Part V, Section B, Line 16a, b, c: 16a. FAP website:https://www.texashealthmansfield.org/hospital-and-emergency-rooms/texas-health-hospital-mansfield/billing-and-financial-services16b. FAP Application Website:https://www.texashealthmansfield.org/hospital-and-emergency-rooms/texas-health-hospital-mansfield/billing-and-financial-services16c. Plain Language Summary of FAP Website:https://www.texashealthmansfield.org/hospital-and-emergency-rooms/texas-health-hospital-mansfield/billing-and-financial-services Part I, Line 3c: Under the Hospital facility's Financial Assistance Policy, an individual is eligible for a 100% reduction from applicable charges if the individual's household income is at or below 200% of the current Federal Poverty Guidelines. Alternatively, a patient may also qualify for a 100% reduction from charges when the unpaid portion of a patient's bill exceeds 25% of the individual's annual household income and where the total annual household income is less than 500% of the Federal Poverty Guidelines. Medicare recipients may also be eligible for financial assistance under the Hospital's Financial Assistance Policy depending upon the individual's income and resources. Resources are generally defined as assets such as money in checking or savings accounts, stocks, and bonds. Part I, Line 6a: The filing organization was a partially owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC) during its current tax year. During the current year, AHSSHC served as a parent organization to 33 tax-exempt 501(c)(3) hospital organizations and other subsidiary health care organizations that operated in 12 states within the U.S. The system of organizations under the control and ownership of AHSSHC is known as "AdventHealth".All hospital organizations within AdventHealth collect, calculate, and report the community benefits they provide to the communities they serve. AdventHealth organizations exist solely to improve and enhance the local communities they serve. AdventHealth has a system-wide community benefits accounting policy that provides guidelines for its health care provider organizations to capture and report the costs of services provided to the underprivileged and to the broader community. Each AdventHealth hospital facility reports their community benefits to their Board of Directors and strives to communicate their community benefits to their local communities. Additionally, the filing organization's most recently conducted community health needs assessment and associated implementation strategy can be accessed on the filing organization's website.The filing organization prepares an annual community benefit report on a separate entity basis for the hospital(s) that it owns and operates. The separate annual community benefit report is generally utilized for state community benefit reporting and/or for other local community purposes. Part I, Line 7: The amounts of costs reported in the table in line 7 of Part I of Schedule H were determined by utilizing a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges, contained in the Schedule H instructions. Part III, Line 2: The amount of bad debt expense reported on line 2 of Section A of Part III is recorded in accordance with Healthcare Financial Management Association Statement No. 15. Discounts and payments on patient accounts are recorded as adjustments to revenue, not bad debt expense. Part III, Line 3: Methodology for Determining the Estimated Amount of Bad Debt Expense that May Represent Patients who Could Have Qualified under the Filing Organization's Financial Assistance Policy:Self-pay patients may apply for financial assistance by completing a Financial Assistance Application Form (FAA Form). If an individual does not submit a complete FAA Form within 240 days after the first post-discharge billing statement is sent to the individual, an individual may be considered for presumptive eligibility based upon a scoring tool that is designed to classify patients into groups of varying economic means. The scoring tool uses algorithms that incorporate data from credit bureaus, demographic databases, and hospital specific data to infer and classify patients into respective economic means categories. Individuals who earn a certain score on the scoring tool are considered to qualify as eligible for the most generous financial assistance under the filing organization's Financial Assistance Policy. As determined by the filing organization, a nominal amount of such a patient's bill is written off as bad debt expense, while the remaining portion of the patient's bill is considered non-state charity. The amount written off as bad debt expense for those patients who potentially qualify as non-state charity using the scoring tool is the amount shown on line 3 of Section A of Part III. Rationale for Including Certain Bad Debts in Community Benefit:The filing organization is dedicated to the view that medically necessary health care for emergency and non-elective patients should be accessible to all, regardless of age, gender, geographic location, cultural background, physician mobility, or ability to pay. The filing organization treats emergency and non-elective patients regardless of their ability to pay or the availability of third-party coverage. By providing health care to all who require emergency or non-elective care in a non-discriminatory manner, the filing organization is providing health care to the broad community it serves. As a 501(c)(3) hospital organization, the filing organization maintains one or more 24/7 emergency room(s) providing care to all whom present. When a patient's arrival and/or admission to the facility begins within the Emergency Department, triage and medical screening are always completed prior to registration staff proceeding with the determination of a patient's source of payment. If the patient requires admission and continued non-elective care, the filing organization provides the necessary care regardless of the patient's ability to pay. The filing organization's operation of a 24/7 Emergency Department that accepts all individuals in need of care promotes the health of the community through the provision of care to all whom present. Current Internal Revenue Service guidance that tax-exempt hospitals maintain such emergency rooms was established to ensure that emergency care would be provided to all without discrimination. The treatment of all at the filing organization's Emergency Department is a community benefit. Under the filing organization's Financial Assistance Policy, every effort is made to obtain a patient's necessary financial information to determine eligibility for financial assistance. However, not all patients will cooperate with such efforts and a financial assistance eligibility determination cannot be made based upon information supplied by the individual. In this case, a patient's portion of a bill that remains unpaid for a certain stipulated time period is wholly or partially classified as bad debt. Bad debts associated with patients who have received care through the filing organization's Emergency Department should be considered community benefit as charitable hospitals exist to provide such care in pursuit of their purpose of meeting the need for emergency medical care services available to all in the community. Part II, Line 9: THHM invested $80,373 in community support initiatives to further our mission outside of the hospital walls, meeting community members where they are, and serving and uplifting the local population. This expenditure includes direct donations to nonprofits and charitable organizations that align with our commitment to addressing community needs and enhancing quality of life. Additionally, we provided in-kind donations to support programs and services that address essential community needs, such as healthcare, education, and social services. Part III, Line 4: Financial Statement Footnote Related to Accounts Receivable and Allowance for Uncollectible Accounts:The financial information of the filing organization is included in a consolidated audited financial statement for the current year.The applicable footnote from the attached consolidated audited financial statements that addresses accounts receivable, the allowance for uncollectible accounts, and the provision for bad debts can be found on pages 8 - 10. Please note that dollar amounts on the attached consolidated audited financial statements are in thousands. Part III, Line 8: Costing Methodology: Medicare allowable costs were calculated using a cost-to-charge ratio.Rationale for Including a Medicare Shortfall as Community Benefit:As a 501(c)(3) organization, the filing organization provides emergency and non-elective care to all regardless of ability to pay. All hospital services are provided in a non-discriminatory manner to patients who are covered beneficiaries under the Medicare program. As a public insurance program, Medicare provides a pre-established reimbursement rate/amount to health care providers for the services they provide to patients. In some cases, the reimbursement amount provided to a hospital may exceed its costs of providing a particular service or services to a patient. In other cases, the Medicare reimbursement amount may result in the hospital experiencing a shortfall of reimbursement received over costs incurred. In those cases where an overall shortfall is generated for providing services to all Medicare patients, the shortfall amount should be considered as a benefit to the community. Tax-exempt hospitals are required to accept all Medicare patients regardless of the profitability, or lack thereof, with respect to the services they provide to Medicare patients. The population of individuals covered under the Medicare program is sufficiently large so that the provision of services to the population is a benefit to the community and relieves the burdens of government. In those situations where the provision of services to the total Medicare patient population of a tax-exempt hospital during any year results in a shortfall of reimbursement received over the cost of providing care, the tax-exempt hospital has provided a benefit to a class of persons broad enough to be considered a benefit to the community. Despite a financial shortfall, a tax-exempt hospital must and will continue to accept and care for Medicare patients. Typically, tax-exempt hospitals provide health care services based upon an assessment of the health care needs of their community as opposed to their taxable counterparts where profitability often drives decisions about patient care services that are offered. Patient care provided by tax-exempt hospitals that results in Medicare shortfalls should be considered as providing a benefit to the community and relieving the burdens of government. Part III, Line 9b: The hospital filing organization's collection practices are in conformity with the requirements set forth in the 2014 Final Regulations regarding the requirements of Internal Revenue Code Section 501(r)(4)-(r)(6). No extraordinary collection actions (ECA's) are initiated by the hospital filing organization in the 120-day period following the date after the first post-discharge billing statement is sent to the individual (or, if later, the specified deadline given in a written notice of actions that may be taken, as described below). Individuals are provided with at least one written notice (notice of actions that may be taken) and a copy of the filing organization's Plain Language Summary of the Financial Assistance Policy that informs the individual that the hospital filing organization may take actions to report adverse information to credit reporting agencies/bureaus if the individual does not submit a Financial Assistance Application Form (FAA Form) or pay the amount due by a specified deadline. The specified deadline is not earlier than 120 days after the first post-discharge billing statement is sent to the individual and is at least 30 days after the notice is provided. A reasonable attempt is also made to orally notify an individual about the filing organization's Financial Assistance Policy and how the individual may obtain assistance with the Financial Assistance application process. If an individual submits an incomplete FAA Form during the 240-day period following the date on which the first post-discharge billing statement was sent to the individual, the hospital filing organization suspends any reporting to consumer credit reporting agencies/bureaus (or ceases any other ECA's) and provides a written notice to the individual describing what additional information or documentation is needed to complete the FAA Form. This written notice contains contact information including the telephone number and physical location of the hospital facility's office or department that can provide information about the Financial Assistance Policy, as well as contact information of the hospital facility's office or department that can provide assistance with the financial assistance application process or, alternatively, a nonprofit organization or governmental agency that can provide assistance with the financial assistance application process if the hospital facility is unable to do so. If an individual submits a complete FAA Form within a reasonable time-period as set forth in the notice described above, the hospital filing organization will suspend any adverse reporting to consumer credit reporting agencies/bureaus until a financial assistance policy eligibility determination can be made. Schedule H, Part III, Section B: Supplemental Schedule to Schedule H, Part III, Section B, Line 8Reconciliation of Schedule H Reported Medicare Surplus/(Shortfall) to Unreimbursed Medicare Costs Associated with the Provision of ServicesTo All Medicare Beneficiaries:The Medicare revenue and allowable costs of care reported in Section B of Part III of Schedule H are based upon the amounts reported in the filing organization's Medicare cost report in accordance with the IRS instructions for Schedule H. On an annual basis, the filing organization also determines its total unreimbursed costs associated with providing services to all Medicare patients. Unreimbursed costs are considered a community benefit to the elderly and are combined into an annual Community Benefit Statement prepared by AdventHealth. The primary reconciling items between the Medicare surplus/(shortfall) shown on line 7 of Section B of Part III of Schedule H and the filing organization's unreimbursed costs of services provided to all Medicare patients are as follows:- Medicare surplus/(shortfall) shown on line 7 of Section B of Schedule H: $ (1,178,857)- Difference in costing methodology: (1,110,517)- Unreimbursed costs incurred for services provided to Medicare patients that are not included in the organization's Medicare cost report: (6,435,661) -------------Total Unreimbursed costs of serving all Medicare patients per the filing organization's communitybenefit reporting $ (8,725,035)As indicated above, the primary differences between the Medicare surplus/(shortfall) reported on Schedule H, Part III, Section B, line 7 and the filing organization's portion of the Company's annual community benefit statement is due to a difference in the costing methodology and differences in the population of Medicare patients within the calculation. The cost methodology utilized in calculating any Medicare surplus/(shortfall) for purposes of the annual community benefit reporting is based upon the cost-to-charge ratio outlined in Worksheet 2 of the Schedule H instructions. The same cost-to-charge ratio is used to determine the costs associated with services provided to charity care patients and Medicaid patients as reported in Schedule H, Part I, line 7. In addition, the Medicare cost report excludes services provided to Medicare patients for physician services, services provided to patients enrolled in Medicare HMOs, and certain services provided by outpatient departments of the filing organization that are reimbursed on a fee schedule. The Company's own community benefit statement captures the unreimbursed cost of providing services to all Medicare beneficiaries throughout the organization. Part VI, Line 2: The Hospital conducts community health needs assessments (CHNA) every three years. Its 2022 CHNA was the first for Texas Health Hospital Mansfied and it was adopted by its governing board by December 31, 2022, the end of the Hospital's taxable year in which it conducted the CHNA. The Hospital's 2022 CHNA complied with the guidance set forth by the IRS in Final Regulation Section 1.501(r)-3. In addition to the CHNA discussed above, a variety of practices and processes are in place to ensure that the filing organization is responsive to the health needs of its community.Such practices and processes involve the following:1. A hospital operating/community board composed of individuals broadly representative of the community, community leaders, and those with specialized medical training and expertise;2. Post-discharge patient follow-up related to the on-going care and treatment of patients who suffer from chronic diseases; 3. Sponsorship and participation in community health and wellness activities that reach a broad spectrum of the filing organization's community; and 4. Collaboration with other local community groups to address the health care needs of the filing organization's community. Part VI, Line 3: The Financial Assistance Policy (FAP), Financial Assistance Application Form (FAA Form), and the Plain Language Summary of the Financial Assistance Policy (PLS) of the filing organization's hospital facility are transparent and available to all individuals served at any point in the care continuum. The FAP, FAA Form, PLS, and contact information for the hospital facility's financial counselors are prominently and conspicuously posted on the filing organization's hospital facility's website. The website indicates that a copy of the FAP, FAA Form, and PLS is available and how to obtain such copies in the primary languages of any populations with limited proficiency in English that constitute the lesser of 1,000 individuals or 5% of the members of the community served by the hospital facility (referred to below as LEP defined populations). Signage is displayed in public locations of the filing organization's hospital facility, including at all points of admission and registration and the Emergency Department. The signage contains the hospital facility's website address where the FAP, FAA Form, and PLS can be accessed and the telephone number and physical location that individuals can call or visit to obtain copies of the FAP, FAA Form and PLS or to obtain more information about the hospital facility's FAP, FAA Form and PLS. Paper copies of the hospital facility's FAP, FAA Form and PLS are available upon request and without charge, both in public locations in the hospital facility and by mail. Paper copies are made available in English and in the primary languages of any LEP defined populations. The filing organization's hospital facility's financial counselors seek to provide personal financial counseling to all individuals admitted to the hospital facility who are classified as self-pay during the course of their hospital stay or at time of discharge to explain the FAP and FAA Form and to provide information concerning other sources of assistance that may be available, such as Medicaid. A paper copy of the hospital facility's PLS will be offered to every patient as a part of the intake or discharge process. A conspicuous written notice is included on all billing statements sent to patients that notifies and informs recipients about the availability of financial assistance under the filing organization's financial assistance policy, including the following: 1) the telephone number of the hospital facility's office or department that can provide information about the FAP and the FAA Form; and 2) the website address where copies of the FAP, FAA Form and PLS may be obtained. Reasonable attempts are made to inform individuals about the hospital facility's FAP in all oral communications regarding the amount due for the individual's care. Copies of the PLS are distributed to members of the community in a manner reasonably calculated to reach those members of the community who are most likely to require financial assistance. Part VI, Line 4: The filing organization currently operates Texas Health Hospital Mansfield (THHM) opened on December 1, 2020. THHM serves the communities of Tarrant County, Parker County, and the surrounding areas. This is one of the fastest growing areas in North Texas with a growing need for available healthcare. Texas Health Hospital Mansfield believes that total health is achieved through a balance of physical, mental, social, and spiritual well-being. Texas Health Hospital Mansfield includes a licensed 59-bed acute care hospital and an 80,000 square foot medical staff office building that houses primary care and specialty practices, as well as an outpatient center offering lab, therapy, and imaging services. Hospital services include an emergency department, cardiovascular, orthopedics, general surgery, and women's services.During 2023, the Hospital's patient percentage population was made up of self-pay patients and patients covered under commercial insurance. In 2023, about 52.2% of the Hospital's in-patients were admitted through the Hospital's Emergency Department. - Medicare Patients 33.9% - Medicaid Patients 9.1% - Self-Pay Patients 8.6% The demographic makeup of the Hospital's community is as follows: - Population (approximately) 579,705 - Population over 65 (approximately) 11.8% - Poverty (Below 100% FPL) 9.3% - High School Graduation Rate 88.3% - Uninsured Adults 15.3% - Food Insecurity Rate 13.9% - Pop. with Low Food Access 64.6% Part VI, Line 5: The provision of community benefit is central to the Hospital's mission of service and compassion. Restoring and promoting the health and quality of life of those in the communities served by the Hospital is a function of "extending the healing ministry of Christ and embodies the Hospital's commitment to its values and principles. The Hospital commits substantial resources to provide a broad range of services to both the underprivileged as well as the broader community. In addition to the community benefit and community building information provided in Parts I, II and III of this Schedule H, the Hospital captures and reports the benefits provided to its community through faith-based care. Examples of such benefits include the cost associated with chaplaincy care programs and mission peer reviews and mission conferences. During the current year, the Hospital provided $138,233 of benefit with respect to the faith-based and spiritual needs of the community in conjunction with its operation of a community hospital. The Hospital also provides benefits to its community's infrastructure by investing in capital improvements to ensure that facilities and technology provide the best possible care to the community. During the current year, the Hospital expended $669,942 in new capital improvements. As a faith-based mission-driven community hospital, the Hospital is continually involved in monitoring its community, identifying unmet health care needs and developing solutions and programs to address those needs. In accordance with its conservative approach to fiscal responsibility, surplus funds of the Hospital are continually being invested in resources that improve the availability and quality of delivery of health care services and programs to its community. Part VI, Line 6: As explained in our response to Form 990, Part VI, Section A, line 6, Texas Health Hospital Mansfield (THHM or the Hospital) has one member. The sole member of THHM is Texas Health Huguley, Inc. (THH). The members of THH are Texas Health Resources and Adventist Health System/Sunbelt, Inc. (AHSSI). AHSSI is a wholly-owned subsidiary of Adventist Health System Sunbelt Healthcare Corporation. THHM is able to draw upon the expertise and leadership of both of THH's health system members in its effort to create excellent patient experiences and offer a broad spectrum of health services needed in its community.During its current tax year, THHM was managed by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is an organization exempt from federal income tax under IRC Section 501(c)(3). AHSSHC and its subsidiary organizations operate 50 hospitals throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC and its subsidiaries also operate other ancillary health care provider facilities, such as ambulatory surgery centers and diagnostic imaging centers. Pursuant to a management services agreement, AHSSHC provides management and certain consulting services to Texas Health Hospital Mansfield. Management and consulting services include personnel administration, procurement, health information management, maintenance and security, contracts, financial accounting systems and budget development.The reader of this Form 990 should keep in mind that this reporting entity may differ in certain areas from that of a stand-alone hospital organization due to its inclusion in a larger system of healthcare organizations. As a part of a system of hospital and other health care organizations, the filing organization benefits from reduced costs due to system efficiencies, such as large group purchasing discounts, and the availability of internal resources such as internal legal counsel. Each AdventHealth subsidiary pays a management fee to AHSSHC for the internal services provided by AHSSHC. As a result, management fee expense reported by an AdventHealth subsidiary organization may appear greater in relation to management fee expense that may be reported by a single stand-alone hospital. The single stand-alone hospital would likely report costs associated with management and other professional services on various expense line items in its statement of revenue and expense as opposed to reporting such costs in one overall management fee expense. As the reporting of the Form 990 is done on an entity by entity basis, there is no single Form 990 that captures the programs and operations of AdventHealth as a whole. The reader is directed to visit the web-site of AdventHealth at www.adventhealth.com to learn more about the mission and operations of AdventHealth. Part VI, Line 7, Reports Filed With States TX 1 Mansfield ISD Education Foundation 609 E Broad St Mansfield TX 76063 752765533 501(c)(3) 5500 0 General Support Pantego Christian Academy Inc 2201 West Park Row Drive Arlington TX 760137414 752379341 501(c)(3) 18000 0 General Support 2 0 Part I, Line 2: Grants are generally made only to related organizations that are exempt from Federal Income Tax under 501(c)(3), other 501(c)(3) organizations that are a part of the group exemption ruling issued to the General Conference of Seventh-Day Adventists, or to other 501(c)(3) community organizations involved in health-related causes. Accordingly, the filing organization has not established specific procedures for monitoring the use of grant funds in the United States as the filing organization does not have a grant making program that would necessitate such procedures. X X X 1 1 0 1 0 0 0 0 0 0 0 King James Kirk Trustee/THR 0 744380 0 379709 0 147858 0 316307 0 52941 0 1641195 0 182417 Johnson Penny Regional CEO 144797 448872 46059 142782 87854 272346 27562 85442 8199 25417 314471 974859 22633 70162 Craft Brian Trustee/THR 0 375500 0 133572 0 51892 0 77594 0 50785 0 689343 0 59425 Jackson David Trustee/THR 0 348305 0 117613 0 49190 0 125200 0 40677 0 680985 0 53142 Ford MD Ronny CMO 96633 289898 19179 57538 5341 16022 19425 58274 9136 27409 149714 449141 0 0 Rose Kenneth CEO 316359 0 77162 0 20598 0 65293 0 35211 0 514623 0 0 0 Schroeder Jennifer Hospital Board Member 0 332468 0 50226 0 41661 0 55618 0 29301 0 509274 0 0 Nelson Stephanie CFO 236928 0 44077 0 17408 0 15521 0 25611 0 339545 0 0 0 Sutton Kristen CNO 175320 0 32093 0 17722 0 10417 0 33605 0 269157 0 0 0 Part I, Line 1a As disclosed in our response to Form 990, Part VI, Section A, Line 3, individuals who serve as officers of the filing organization in the roles of Regional CEO, CEO, CFO, CNO, and CMO are compensated by and on the payroll of Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), the parent organization of the healthcare system known as AdventHealth. AHSSHC is exempt from federal income tax under IRC Section 501(c)(3). The filing organization reimburses AHSSHC for the salary and benefit cost of those executives on the payroll of AHSSHC. At the direction of AHSSHC, and in accordance with the reserved powers in the filing organization's governing documents, the executive team listed on Part VII provides services to the filing organization. Travel for companions: AHSSHC has a Corporate Executive Policy that provides a benefit to allow for a traveling AHSSHC executive to have his or her spouse accompany the executive on certain business trips each year. Typically, reimbursement is only provided to certain executive leaders and is usually limited to one business trip per year beyond the annual AdventHealth President's Council business meeting and other meetings where the spouse is specifically invited. The AHSSHC Corporate Executive Spousal Travel Policy was originally approved and reviewed by the AHSSHC Board Compensation Committee, an independent body of the AHSSHC Board of Directors. All spousal travel costs reimbursed to the executive are considered taxable compensation to the executive. Tax Indemnification and gross-up payments: AdventHealth has a system-wide policy addressing gross-up payments provided in connection with employer-provided benefits/other taxable items. Under the policy, certain taxable business-related reimbursements (i.e. taxable business-related moving expenses, taxable items provided in connection with employment) provided to any employee may be grossed-up at a 25% rate upon approval by the filing organization's CEO and CFO. Additionally, employees at the Director level and above are eligible for gross-up payments on gifts received for board of director services. Discretionary spending account: Occasional discretionary spending amounts are periodically provided to eligible executives who attend annual business meetings such as the AdventHealth President's Council, CFO Conference or the CMO/CNO business meeting. Payments provided to each executive are considered taxable compensation to the executive. Part I, Line 3 The individual who serves as the CEO of the filing organization is appointed and compensated by Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). Compensation and benefits provided to this individual are determined pursuant to policies, procedures, and processes of AHSSHC that are designed to ensure compliance with the intermediate sanctions laws as set forth in IRC Section 4958. AHSSHC has taken steps to ensure that processes are in place to satisfy the rebuttable presumption of reasonableness standard as set forth in Treasury Regulation Section 53.4958-6 with respect to its active executive-level positions. The AHSSHC Board Compensation Committee (the Committee) serves as the governing body for all executive compensation matters. The Committee is composed of certain members of the Board of Directors (the Board) of AHSSHC. Voting members of the Committee include only individuals who serve on the Board as independent representatives, who hold no employment positions with AHSSHC and who do not have relationships with any of the individuals whose compensation is under their review that impacts their best independent judgment as fiduciaries of AHSSHC. The Committee's role is to review and approve all components of the executive compensation plan of AHSSHC. As an independent governing body with respect to executive compensation, it should be noted that the Committee will often confer in executive sessions on matters of compensation policy and policy changes. In such executive sessions, no members of management of AHSSHC are present, other than the Chief People Officer, who remains at the request of the Chairman/committee to provide assistance/information as needed. The Committee is advised by an independent third-party compensation advisor. This advisor prepares all the benchmark studies for the Committee. Compensation levels are benchmarked with a national peer group of other not-for-profit healthcare systems and hospitals of similar size and complexity to AdventHealth and each of its affiliated entities. The following principles guide the establishment of individual executive compensation: - The salary of the President/CEO of AdventHealth will not exceed the 50th percentile of comparable salaries paid by similarly situated organizations; and - Other executive salaries shall be established using market medians. The compensation philosophy, policies, and practices of AHSSHC are consistent with the organization's faith-based mission and conform to applicable laws, regulations, and business practices. As a faith-based organization sponsored by the Seventh-day Adventist Church (the Church), AHSSHC's philosophy and principles with respect to its executive compensation practices reflect the conservative approach of the Church's mission of service and were developed in counsel with the Church's leadership. Part I, Line 4b Sch J, Part I, Line 4b Nonqualified Retirement Plan: Nonqualified Retirement Plan - Texas Health Resources Certain members of the Board of Trustees are compensated by Texas Health Resources (THR), a related entity to the filing organization, and are covered by a nonqualified retirement plan. Participation in the plan is made available to a select group of management and highly compensated employees who are providing services in key positions of management and/or responsibility and who are determined by the THR Board of Trustees. For the active restoration account (Account balances after 12/31/2009) SERP benefits vest while the participant is employed if the participant: - Reaches age 65 - Becomes disabled or dies, - Reaches the following years of service: 2 Years 25%; 3 Years 50%; 4 Years 75% and 5 or more years 100% Participants must be employed on Dec 1 to qualify for the current year's SERP Benefit unless separation is due to death, disability, retirement (Age 65) or early retirement (separation from service at or after age 55 with 75 years of combined age and service with the system.) SERP benefits are calculated each Dec 1. Vested balances are taxed to the employee and the net balances begin accruing earnings. Vested balances are paid in cash lump sum within a 90-day period commencing on the earlier of death, disability, or separation from service. The deferred portion is included in Schedule J, Part II, column C. In frozen restoration accounts (account balances prior to 1/1/2010), the participant or beneficiary shall be taxed on his or her vested SERP benefits upon the earliest of: - Continued employment in THR until age 68 - Termination of employment for disability or death - Involuntary termination of employment without reasonable cause; or - Satisfying a 24 month non-compete period following his/her termination of employment. Payment follows the before mentioned events, except in the case of involuntary separation when the participant must wait 24 months to receive the previously taxed benefit. The Long Term Incentive Plan covers 2, 3 or 4 years. Payouts are made over 2, 3, or 4 years after key performance goals are met. Benefits vest if they are employed at the end of the year the payout is made. Payments can also be made if separation is due to death, disability, retirement (Age 65) or early retirement (separation from service at or after age 55 with 75 years of combined age and service with the system.) In the case of retirement and early retirement, CEO approval must be obtained and a non-compete must be satisfied prior to the end of year payout. A retention agreement may be offered to an executive in a key position or based on succession planning needs of the system. The length of the retention period will be dependent upon the needs of the organization to retain the key executive. Payments are made within 2.50 months following the end of the retention period. Payouts to the following employees were made during the year for all the plans listed above. The amounts below are included in the amount reported on Sch J, Part II, Column B(iii) and Column (F). King, James Kirk - 182,417 Craft, Brian - 59,425 Jackson, David - 53,142 NONQUALIFIED RETIREMENT PLAN - ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION Penny Johnson, Kenneth Rose, Stephanie Nelson, Kristen Sutton, and Ronny Ford received compensation from Adventist Health System Sunbelt Healthcare Corporation (AHSSHC), the top-tier parent of the the 49% owner of the filing organization and the parent organization of the healthcare system known as AdventHealth. In recognition of the contribution that each executive makes to the success of AdventHealth, AdventHealth provides supplemental executive retirement benefit plans to eligible executives. As the supplemental executive retirement benefit plans were updated in 2020 and certain individuals still participate as grand-fathered participants in certain plans, the narrative below discusses all plans in which there were any participants in 2023. The SERP III plan effectively replaces the prior SERP II plan, the Executive Flex Benefit Program Plan, and the Senior Executive Death Benefit Plan for qualified executives except for certain grandfathered executive employees. Part I, Line 4b (Continued): SERP III Plan: The SERP III plan provides eligible executives a percentage of their base pay, which is credited to a deferred compensation account. The plan also provides for compensation deferral and selection of life insurance coverage and long-term care insurance. To be eligible to participate in the SERP III plan, executives must be on the AHSSHC corporate payroll and be either a CEO of an AdventHealth entity, an AHSSHC Vice President (VP) or VP of an AdventHealth entity with a base salary of at least $330,000 in 2023 (adjusted annually by the same percentage as IRC Section 401(a)(17) limit increases), or other leader specifically approved by the AdventHealth President. Eligible executives do not include grandfathered executives, meaning those executives who would satisfy all the eligibility requirements of the SERP II plan prior to Dec 31, 2027, had the plan not been amended and restated as of Jan. 1, 2020. Contribution credits will be established and maintained by class year accounts for each participant using tiered contribution credit percentages of annual base compensation. Contribution credit percentages range between 15% and 19% of base compensation. Contribution credits will be made each quarter in 25% increments with reductions in contributions if the executive is also a grandfathered FLEX participant (see below). SERP III provides for a class year vesting and payment schedule (7 years for each class year) with respect to amounts accumulated in the executive's deferred compensation account. Upon attainment of a normal retirement age (age 62), or upon certain other circumstances as defined in the SERP III plan document, all deferred amounts are paid immediately to the participant. For any executives working beyond the normal retirement age, future employer contributions will be made quarterly from SERP III directly to the participant as a taxable cash bonus. SERP II Plan: The SERP II plan is a defined benefit, non-tax-qualified deferred compensation plan for certain executives who have provided lengthy service to AdventHealth and/or to other Seventh-day Adventist Church hospitals or health care institutions. Under the provisions of the SERP II plan, benefits are provided to qualifying executive participants on a pro-rata schedule beginning with 20 years of service as an employee of AdventHealth and/or another hospital or health care institution controlled by the Seventh-day Adventist Church and who satisfy certain other qualifying criteria. Eligible employees are restricted to those executives who, as of January 1, 2020, satisfied, or if employment continues, will satisfy the eligibility requirements of SERP II prior to December 31, 2027. This supplemental executive retirement plan (SERP II) was designed to provide eligible executives with the economic equivalent of an annual income beginning at normal retirement age equal to 60% of the average of the participant's three, five or seven highest years of base salary from AdventHealth active employment inclusive of income from all other Seventh-day Adventist Church healthcare employer-financed retirement income sources and investment income earned on those contributions through social security normal retirement age as defined in the plan. The number of years included in highest average compensation is determined by the individual's year of entry to SERP II and by the individual's year of entry to the AdventHealth Executive FLEX Benefit Program. FLEX Plan: The Flex Plan was originally designed to provide eligible executives an opportunity to select from among a variety of supplemental benefits, including a split dollar life insurance policy and long-term care insurance, to individually tailor a benefits program appropriate to each executive's needs. In 2020, the Flex Plan was amended to exclude employed executives who are hired or promoted after a certain date from being eligible to participate in the Flex Plan except for certain insurance coverage features of the plan. The Flex Plan provides eligible participants a pre-determined benefits allowance credit that is equal to a percentage of the executive's base pay from which the cost of mandatory and elective employee benefits is deducted. The benefits allowance credit percentage for any plan year shall not be greater than the maximum dollar amount or the percentage of compensation as determined by the AdventHealth Benefits Administration Committee. For grandfathered eligible employees, the annual pre-determined Flex allowance is contributed and any funds that remain after the cost of mandatory and elective benefits are subtracted are, at the employee's option, contributed to either an IRC 457(f) deferred compensation account or to an IRC 457(b) eligible deferred compensation plan. Upon attainment of age 65, all previous 457(f) deferred amounts are paid immediately to the participant and any future employer contributions are made quarterly from the Plan directly to the participant. The Plan provides for a class year vesting schedule (2 years for each class year) with respect to amounts accumulated in the executive's 457(f) deferred compensation account. Distributions could also be made from the executive's 457(f) deferred compensation account upon attainment of age 65 or upon an involuntary separation. The account will be forfeited by the executive upon a voluntary separation. With respect to grandfathered participants, the Flex Plan documents define eligible employees to include the Chief Executive Officers of AdventHealth entities and Vice Presidents of all AdventHealth entities whose base salary was at least equal to the Internal Revenue Code Section 401(a)(17) compensation limit each year. FLEX Plan FLEX Plan SERP II SERP III Contr. Distr.* Contr./Distr. Contr. Johnson, Penny $ 98,468 $ 85,565 $ 245,198 $ 0 Ford, Ronny $ 0 $ 0 $ 0 $ 59,971 Rose, Kenneth $ 0 $ 0 $ 0 $ 47,599 * Including Investment Earnings Form 990, Part VII, Section A, Line 5: The Regional CEO, Penny Johnson, CEO, Kenneth Rose, CFO, Stephanie Nelson, CMO, Ronny Ford, and CNO, Kristen Sutton were compensated by AHSSHC, an unrelated IRC Section 501(c)(3) entity, during 2023 for services provided to the filing organization and its affiliates. Please see our response to Form 990, Part VI, Section A, Line 3 for a discussion concerning the filing organization's affiliation with AHSSHC. Compensation for Penny Johnson, Kenneth Rose, Stephanie Nelson and Kristen Sutton pertaining to the filing organization and its related affiliates, is disclosed in Schedule J, Part II. Compensation for Penny Johnson reflects compensation for services provided to the filing organization and related entities. This executive also provides services to AHHSSHC affiliates, which are unrelated, and are not reflected in this return. Form 990, Part V, Line 1a: The sole member of the filing organization is Texas Health Huguley, Inc. (THH). THH is 49% owned by Adventist Health System/Sunbelt, Inc. (AHSSI). The parent corporation and sole top-tier member of AHSSI is Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is a Florida, not-for-profit corporation that is exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). AHSSHC has established a shared service center to centralize the Accounts Payable (A/P) function for all AHSSHC subsidiary organizations. The filing organization has entered "0" in Part V, Line 1a because the filing organization does not issue Form 1099 returns, rather, all such returns are filed by and under the name and EIN of AHSSHC as the payor subject to the information reporting requirements of Section 6041. The facts and circumstances support a position that AHSSHC, as a payor on behalf of its subsidiary organizations in a shared service environment, will have sufficient management and oversight in connection with the subsidiary organizations' payments to meet the standard set forth in Treas. Reg. Section 1.6041-1(e). AHSSHC will not merely be making payments at the direction of its subsidiary organizations. Accordingly, AHSSHC is considered the payor subject to the information reporting requirements of Section 6041. Form 990, Part VI, Section A, line 1a The members of the Board of Trustees listed on Part VII of this Form 990 include the filing organization's Governing Board and members of the filing organization's Hospital Board. The Board of Trustees is primarily responsible for the overall management of the filing organization. The Hospital Board is primarily responsible for matters of the hospital including the following: - Oversight of Medical Staff (including the review and approval of Medical Staff Bylaws and approval of appointments to the Medical Staff), care of patients, quality assessment and improvement programs implemented at the hospital, and risk management functions; - Participation in the development and review of the filing organization's short and long-term plans (including strategic plans, capital plans, and annual budgets); and - Monitoring of compliance with regulatory requirements. Form 990, Part VI, Section A, line 3 Effective January 1, 2012, Texas Health Huguley (THH), the sole member of Texas Health Hospital Mansfield (the filing organization) entered into a Management Services Agreement with Adventist Health System Sunbelt Healthcare Corporation (AHSSHC). AHSSHC is the parent organization of a system of tax-exempt hospitals and other health care provider organizations that operate 50 hospitals throughout the U.S., primarily in the Southeastern portion of the U.S. AHSSHC is exempt from federal income tax under Internal Revenue Code Section 501(c)(3). Under the Management Services Agreement (the Agreement), AHSSHC must follow the policies of the filing organization's Board of Directors. Managerial services provided by AHSSHC include oversight and day to day management of the filing organization, including the following functions: a) Personnel administration, including recruitment, hiring, training, promoting, directing and terminating personnel; b) Procurement, including the acquisition of food and beverage items, supplies, devices, furniture, and medical equipment; c) Health Information Management; d) Maintenance and Security; e) Contracting for services and consulting services; f) Financial accounting systems; g) Development of operational and capital budgets; h) Billing and collection of receivables and remittances of payables; i) Patient safety and quality systems; j) Marketing; k) Regulatory compliance; l) Administration - Policies and Procedures, including appointment of the C-Suite Personnel. The individuals who served as officers and key employees of the filing organization in the role of CEO, CFO, CMO, and CNO are listed in Part VII, Section A. These individuals were compensated by and on the payroll of AHSSHC for services rendered to the filing organization and its affiliate. Form 990, Part VI, Section A, line 6 Texas Health Hospital Mansfield (THHM) has one member. The sole member of THHM is Texas Health Huguley, Inc. (THH). THH is a hospital exempt from federal income tax under IRC Section 501(c)(3). There are no other classes of membership in the filing organization. Form 990, Part VI, Section A, line 7a The sole member of the filing organization is THH. Trustees of the filing organization are appointed by the two members of THH, Texas Health Resources (THR) and Adventist Health System/Sunbelt, Inc. (AHSSI). THR has the right to designate and maintain at all times three (3) trustees, and AHSSI has the right to designate and maintain at all times two (2) trustees. Form 990, Part VI, Section A, line 7b Notwithstanding anything to the contrary contained in the Certificate of Formation or the Bylaws, the authority to undertake, or cause the filing organization to undertake, certain matters (Member Reserved Matters) is expressly and exclusively reserved to THH, the sole member. In undertaking any of the listed actions, THH shall consult with AHSSI and THR as required by THH's certificate of formation and bylaws and includes the following matters: (a) any fundamental change in the purposes of the filing organization as set forth in Article Five of the Certificate of Formation; (b) any fundamental change in the philosphy, mission, or vision of the filing organization; (c) any amendment, restatement, or repeal of the Certificate of Formation or the Bylaws; (d) any entry into or consummation of any merger, consolidation, dissolution, sale, or other transfer of all or substantially all of the assets of the filing organization or any material subsidiary or entity controlled by the filing organization, or other change in corporate form, that in case of any of the foregoing would constitute or otherwise result in a fundamental reorganization of the filing organization or any material subsidiary or entity controlled by the filing organization; (e) any admission of any additional members to the filing organization; (f) the incurrence or issuance of any debt that would require the guaranty of the member; (g) any change to the name of the filing organization; (h) the creation of affiliates or subsidiaries of the filing organization or the entry by the filing organization into any joint venture; (i) the confession of a judgment against the filing organization or any agreement to compromise or settle claims above $100,000; (j) the approval of a decision for the filing organization to file a voluntary petition for bankruptcy; (k) the discontinuation of the operations of a licensed health care facility controlled by the filing organization; (l) the approval of any capital expenditure in excess of $1,000,000; (m) the incurrence or issuance of any non-guaranteed debt in excess of $200,000; (n) the voluntary prepayment or extension of debt in excess of $200,000; (o) the renewal, extension, or termination for cause of any management services agreement related to the operations of the hospital and related facilities; and (p) the approval of any managed care contract that is materially inconsistent with managed care contracts executed by THR on behalf of its other non-wholly owned or controlled acute care health facilities. In addition to the Member Reserved Matters, certain matters are reserved exclusively for AHSSI or exclusively for THR. Both are described in the following three paragraphs. Notwithstanding anything to the contrary contained in the Certificate of Formation or Bylaws, AHSSI shall have the authority to prevent the filing organization from undertaking: i) any changes to operational policies, plans, procedures that are specifically related to the Corporation's religious affiliation with the Seventh-day Adventist Church; ii) any activities of the filing organization that are determined by AHSSI in good faith to be inconsistent with the compliance by AHSSI with the requirements of AHSSI's tax-exempt status including those activities the filing organization is required to perform under Section 501(r); and iii) any activities of the filing organization that are determined by AHSSI in good faith to be inconsistent with the compliance of Sunbelt with the requirements of covenants associated with any outstanding AHSSI indebtedness. Notwithstanding anything to the contrary contained in the Certificate of Formation or Bylaws, THR shall have the authority to prevent the filing organization from undertaking: i) any activities of the filing organization that are determined by THR in good faith to be inconsistent with the compliance by THR with the requirements of THR's tax-exempt status including those activities the filing organization is required to perform under Section 501(r); ii) any activities of the filing organization that are determined by THR in good faith to be inconsistent with the compliance by THR with the requirements of covenants associated with any outstanding THR indebtedness; and iii) any change in the name of any hospital or health care facility owned by the Corporation. Notwithstanding anything to the contrary contained in the Certificate of Formation or Bylaws, THR shall have the authority to approve: i) the filing organization's contracts with insurance and other payers for payments for services provided by the filing organization subject to the requirements outlined in (p) above. Form 990, Part VI, Section B, line 11b The filing organization's current year Form 990 was reviewed by the Board Chairman, Board Finance Committee Chairman, CEO, and CFO prior to its filing with the IRS. The review conducted by the Board Chairman, Board Finance Committee Chairman, CEO, and CFO did not include the review of any supporting workpapers that were used in preparation of the current year Form 990, but did include a review of the entire Form 990 and all supporting schedules. Form 990, Part VI, Section B, line 12c The Conflict of Interest Policy of the filing organization applies to members of its Board of Trustees and its principal officers (to be known as Interested Persons). In connection with any actual or possible conflicts of interest, any member of the Board of Trustees of the filing organization or any principal officer of the filing organization (i.e. Interested Persons) must disclose the existence of any financial interest with the filing organization and must be given the opportunity to disclose all material facts concerning the financial interest/arrangement to the Board of Trustees of the filing organization or to any members of a committee with board delegated powers that is considering the proposed transaction or arrangement. Subsequent to any disclosure of any financial interest/arrangement and all material facts, and after any discussion with the relevant Board member or principal officer, the remaining members of the Board of Trustees or committee with board delegated powers shall discuss, analyze, and vote upon the potential financial interest/arrangement to determine if a conflict of interest exists. According to the filing organization's Conflict of Interest Policy, an Interested Person may make a presentation to the Board of Trustees (or committee with board delegated powers), but after such presentation, shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that results in a conflict of interest. Each Interested Person, as defined under the filing organization's Conflict of Interest Policy, shall annually sign a statement which affirms that such person has received a copy of the Conflict of Interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the filing organization is a charitable organization that must primarily engage in activities which accomplish one or more of its exempt purposes. The filing organization's Conflict of Interest Policy also requires that periodic reviews shall be conducted to ensure that the filing organization operates in a manner consistent with its charitable purposes. Form 990, Part VI, Section B, line 15 The filing organization's CEO is not compensated by the filing organization. This individual was compensated by Adventist Health System Sunbelt Healthare Corporation (AHSSHC), an unrelated entity disclosed in our response to Form 990, Part VI, Section A, Line 3. Please see the discussion concerning the process followed by AHSSHC in determining executive compensation in our response to Schedule J, Line 3. Form 990, Part VI, Section C, line 19 The financial statements of the filing organization, its governing documents, and its Conflict of Interest Policy are not generally made available to the public as a whole. Part VII, Section A, Column (E) & (F): For those Board of Trustee members and officers who devote less than full-time to the filing organization (based upon the average number of hours per week shown in column (B) on page 7 of the return) the compensation amounts shown in columns (E) and (F) on page 7 were provided in conjunction with that person's responsibilities and roles in serving in an executive leadership position within Texas Health Huguley, Inc. (sole member) and Texas Health Resources, Inc. (majority member of THH). Additionally, compensation for Penny Johnson does not reflect services provided to affiliates of AHSSHC, which are not related to the filing organization. Part VIII, Lines 7a, b and c: The amounts shown in Part VIII, Line 7, column (i) of the Form 990 represent an allocated share of capital gain/(loss) from a system wide, corporate administered, investment program. Form 990, Part IX, line 11g Payments to Healthcare Professionals : Program service expenses 5,870,337. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,870,337. Professional Fees: Program service expenses 1,115,190. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,115,190. Purchased Medical Services: Program service expenses 748,198. Management and general expenses 0. Fundraising expenses 0. Total expenses 748,198. Environmental Services: Program service expenses 113,737. Management and general expenses 0. Fundraising expenses 0. Total expenses 113,737. Transcription Services: Program service expenses 2,972. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,972. Recruiting: Program service expenses 328,849. Management and general expenses 0. Fundraising expenses 0. Total expenses 328,849. Lease Personnel Costs: Program service expenses 33,160,998. Management and general expenses 0. Fundraising expenses 0. Total expenses 33,160,998. Miscellaneous Purchased Services : Program service expenses 381,540. Management and general expenses 0. Fundraising expenses 0. Total expenses 381,540. AdventHealth Management Fees: Program service expenses 0. Management and general expenses 1,252,181. Fundraising expenses 0. Total expenses 1,252,181. Billing & Collection Services: Program service expenses 0. Management and general expenses 414,708. Fundraising expenses 0. Total expenses 414,708. AdventHealth Shared Services Fees: Program service expenses 0. Management and general expenses 676,214. Fundraising expenses 0. Total expenses 676,214. Lease Personnel Costs Mgmt: Program service expenses 0. Management and general expenses 323,742. Fundraising expenses 0. Total expenses 323,742. Form 990, Part X, Line 2: The amounts shown on line 2 of Part X of this return include the filing organization's interest in a central investment pool maintained by Adventist Health System Sunbelt Healthcare Corporation, the filing organization's top-tier parent. The investments in the central investment pool are recorded at market value. Form 990, Part XI, line 9: Transfer to Huguley Medical Associates, Inc. -1,011,571. Form 990, Part XII, Line 3b: Although the taxpayer is not required to undergo an audit as set forth in the Single Audit Act and OMB Circular A-133, the taxpayer is part of a controlled group of organizations that comprise a consolidated financial statement audit. The controlled group's sole member is Texas Health Huguley, Inc. (THHI). For the year ended December 31, 2023, THHI will file a consolidated Single Audit which will include all entities that are part of the controlled group. Huguley Medical Associates 11801 South Freeway Burleson TX 76028 752547668 Phys. Clinic TX 501(c)(3) Line 3 TH Huguley 1 North Texas Healthy Communities 612 E Lamar Blvd Arlington TX 76011 464513182 Comm Support TX 501(c)(3) Line 7 TH Resources 0 Southwestern Health Resources JOC 5323 Harry Hines Blvd Dallas TX 75390 811575989 Management Org. TX 501(c)(3) Line 12b TH Resources 0 Texas Health Arlington Memorial Hospital 800 West Randol Mill Rd Arlington TX 76012 750972805 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Back Care 9250 Amberton Pkwy Dallas TX 75243 474724257 Phys. Clinic TX 501(c)(3) Line 10 TH Phys Group 0 Texas Health Harris Methodist Hospital Alliance 10864 Texas Health Trail Fort Worth TX 76244 451502252 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Harris Methodist Hospital Azle 108 Denver Trail Azle TX 76020 751748586 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Harris Methodist Hospital Cleburne 201 Walls Dr Cleburne TX 76033 751977850 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Harris Methodist Hospital Fort Worth 1301 Pennsylvania Ave Fort Worth TX 76104 756001743 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Harris Methodist Hospital Hurst-Euless-Bedford 1600 Hospital Parkway Bedford TX 76022 751438726 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Harris Methodist Hospital Southwest Fort Worth 6100 Harris Parkway Fort Worth TX 76132 752678857 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Harris Methodist Hospital Stephenville 411 Belknap Street Stephenville TX 76401 751752253 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Hospital Frisco 12400 Dallas Pkwy Frisco TX 75033 831954982 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Hospital Mansfield 2300 Lone Star Rd Mansfield TX 76063 831869297 Hospital TX 501(c)(3) Line 3 TH Huguley 1 Texas Health Huguley Inc 11801 S Freeway Burleson TX 76028 452694620 Hospital FL 501(c)(3) Line 3 TH Resources 0 Texas Health Medical Support 612 E Lamar Blvd Arlington TX 76011 812833150 Spec Drugs TX 501(c)(3) Line 10 TH Resources 0 Texas Health Physicians Group 9250 Amberton Pkwy Dallas TX 75243 752613493 Phys. Clinic TX 501(c)(3) Line 10 TH Resources 0 Texas Health Presbyterian Hospital Allen 1105 Central Expressway N Allen TX 75013 752890358 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Presbyterian Hospital Dallas 8200 Walnut Hill Ln Dallas TX 75231 751047527 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Presbyterian Hospital Denton 3000 North Interstate 35 Denton TX 76201 432008974 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Presbyterian Hospital Kaufman 850 Ed Hall Drive Kaufman TX 75142 752771437 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Presbyterian Hospital Plano 6200 W Parker Rd Plano TX 75093 752770738 Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Recovery and Wellness Center 240 Miller Road Mansfield TX 76063 812813227 Resd Trmt Ctr TX 501(c)(3) Line 3 TH Resources 0 Texas Health Research & Education Institute 612 E Lamar Blvd Arlington TX 76011 752562191 Educ & Research TX 501(c)(3) Line 4 TH Resources 0 Texas Health Resources 612 E Lamar Blvd Arlington TX 76011 752702388 System Management TX 501(c)(3) Line 12c N/A 0 Texas Health Resources Foundation 612 E Lamar Blvd Arlington TX 76011 752022128 Fundraising TX 501(c)(3) Line 7 TH Resources 0 Texas Health Specialty Hospital Fort Worth 1301 Pennsylvania Ave Fort Worth TX 76104 751648589 LT Hospital TX 501(c)(3) Line 3 TH Resources 0 Texas Health Urgent Care 3805 W University Park 100 McKinney TX 75071 814317635 Urgent Care Ctr TX 501(c)(3) Line 3 TH Resources 0 Texas Health Virtual Care 612 E Lamar Blvd Arlington TX 76011 873611585 Virtual Care TX 501(c)(3) Line 3 TH Resources 0 WW Ward Endowment Fund Trust 612 E Lamar Blvd Arlington TX 76011 756196065 Nursing Grants TX 501(c)(3) Line 12a TH Foundation 0 Adventist Health SystemTexas Inc 11801 South Freeway Burleson TX 76028 742578952 Employee Leasing of Personnel to Affiliated Hospitals TX 501(c)(3) Line 12c N/A 0 AMH Cath Labs LLC 811 Wright Street Arlington TX 76012 203003947 Hospital TX N/A 0 0 Arlington Surgery Center LLC 918 N Davis Drive Arlington TX 76012 752055800 Amb Surg Ctr TX N/A 0 0 Castle Hills Surgicare LLC 4221 Medical Parkway Ste 100 Carrollton TX 75010 813020487 Amb Surg Ctr TX N/A 0 0 Cleburne Surgical Center LLC 2010 W Katherine P Raines Blvd Ste Cleburne TX 76033 203742012 Amb Surg Ctr TX N/A 0 0 Cross Timbers Surgery Center LLC 1001 N Waldrop Drive Ste 705 Arlington TX 76102 752862780 Amb Surg Ctr TX N/A 0 0 Denton Surgery Center LLC 207 North Bonnie Brae Street Denton TX 76201 470926556 Amb Surg Ctr TX N/A 0 0 Flower Mound Hospital Prts LLC 4400 Long Prairie Road Flower Mound TX 75028 260684968 Hospital TX N/A 0 0 Fort Worth Endoscopy Center LLC 900 W Magnolia Avenue 101 Fort Worth TX 76104 770368346 Endoscopy Center TX N/A 0 0 Greenville Surgery Center LLC 7150 Greenville Avenue Ste 200 Dallas TX 75231 742411643 Amb Surg Ctr TX N/A 0 0 Health Imaging Partners LLC 8610 Explorer Drive Ste 300 Colorado Springs CO 80920 271385885 Medical Imaging TX N/A 0 0 Mansfield Endoscopy Center LLC 647 N Miller Road Mansfield TX 76063 861354607 Endoscopy Center TX N/A 0 0 North Dallas Surgical Center LLC 17980 Dallas Parkway Ste 100 Dallas TX 75287 272248103 Amb Surg Ctr TX N/A 0 0 Opthalmology Surgery Center of Dallas 10740 N Central Expy Dallas TX 75231 261914835 Amb Surg Ctr TX N/A 0 0 Park Hill Surgery Center LLC 3455 Locke Avenue Fort Worth TX 76107 451484375 Amb Surg Ctr TX N/A 0 0 Physician Medical Center LLC 6020 W Parker Road Plano TX 75093 481281376 Hospital TX N/A 0 0 Presbyterian Cancer Center-Dallas LLC PO Box 819067 Dallas TX 75381 260422749 Cancer Ctr TX N/A 0 0 Rockwall Regional Hospital LLC 3150 Horizon Road Rockwall TX 75032 202848116 Hospital TX N/A 0 0 South Arlington Surgical Providers LLC 350 E Interstate 20 Ste 200 Arlington TX 76018 752723958 Amb Surg Ctr TX N/A 0 0 Southlake Specialty Hospital LLC 1545 E Southlake Blvd Southlake TX 76092 020555370 Hospital TX N/A 0 0 Surgical Caregivers of Fort Worth LLC 2001 W Rosedale Street Fort Worth TX 76104 751925497 Amb Surg Ctr TX N/A 0 0 Texas Health Craig Ranch Surgery Center LLC 8080 State Hwy 121 Ste 100 McKinney TX 75070 383897811 Amb Surg Ctr TX N/A 0 0 Texas Health Huguley Surgery Center LLC 12001 S Freeway Burleson TX 76028 821289045 Amb Surg Ctr TX N/A 0 0 Texas Health Orthopedic Surgery Center Alliance LLC 9848 N Beach Street Fort Worth TX 76244 814977249 Amb Surg Ctr TX N/A 0 0 Texas Health Spine Surgery Center Allen LLC 1120 Raintree Circle Ste 100 Allen TX 75013 300957868 Amb Surg Ctr TX N/A 0 0 Texas Health Supply Chain Services LLC 612 E Lamar Blvd Ste 600 Arlington TX 76011 841833532 Purchasing Co TX N/A 0 0 Texas Health Surgery Center Alliance LLC 10840 Texas Health Trail Ste 100 Fort Worth TX 76244 822296081 Amb Surg Ctr TX N/A 0 0 Texas Health Surgery Center Bedford LLC 1605 Airport Freeway Ste 100 Bedford TX 76021 821307876 Amb Surg Ctr TX N/A 0 0 Texas Health Surgery Center Irving LLC 2120 N MacArthur Blvd Ste 200 Irving TX 75061 831085415 Amb Surg Ctr TX N/A 0 0 Texas Health Surgery Center Waxahachie LLC 1434 US Hwy 287 Bypass Ste 100 Waxahachie TX 75165 831464243 Amb Surg Ctr TX N/A 0 0 Texas Health Surgery Center Willow Park LLC 612 E Lamar Blvd Ste 600 Arlington TX 76011 841953918 Inactive TX N/A 0 0 Texas Hlth Spine Surgery Center Alliance LLC 1545 E Southlake Blvd Ste 100 Southlake TX 76092 320571301 Amb Surg Ctr TX N/A 0 0 Texas Institute for Surgery LLP 7115 Greenville Avenue Ste 100 Dallas TX 75231 770628004 Hospital TX N/A 0 0 TH Flower Mound Orthopedic Surgery Center LLC 5000 Long Prairie Road Flower Mound TX 75028 800866449 Amb Surg Ctr TX N/A 0 0 TH Surgery Center Chisholm Trail LLC 5900 Altamesa Blvd Fort Worth TX 76132 851225852 Amb Surg Ctr TX N/A 0 0 TH Surgery Center Forney LLC 612 E Lamar Blvd Ste 600 Arlington TX 76011 923847064 Inactive TX N/A 0 0 TH Surgery Center Preston Plaza LLC 17950 Preston Road Ste 75 Dallas TX 75252 203991622 Amb Surg Ctr TX N/A 0 0 TH Surgery Center Rockwall LLC 3144 Horizon Road Ste 120 Rockwall TX 75032 474425996 Amb Surg Ctr TX N/A 0 0 TH Surgery Center SW Fort Worth LLC 6317 Harris Parkway Ste 200 Fort Worth TX 76132 843814490 Amb Surg Ctr TX N/A 0 0 THR-STT Rockwall ASC LLC 1545 E Southlake Blvd Southlake TX 76092 262429878 Amb Surg Ctr TX N/A 0 0 THR-STT Southlake ASC LLC 1545 E Southlake Blvd Southlake TX 76092 201728912 Amb Surg Ctr TX N/A 0 0 USMD Hospital at Arlington LP 801 I -20 West Arlington TX 76017 731662763 Hospital TX N/A 0 0 USMD Hospital at Fort Worth LP 5900 Altamesa Blvd Fort Worth TX 76132 203571243 Hospital Closed TX N/A 0 0 Walnut Hill Surgery Center LLC 5494 Glen Lakes Drive Dallas TX 75231 364499777 Amb Surg Ctr TX N/A 0 0 Willow Park Endoscopy Center LLC 130 Jimma Drive Willow Park TX 76087 881643733 Amb Surg Ctr TX N/A 0 0 Wilson Creek Surigcal Center LLC 8855 Synergy Drive McKinney TX 75070 274816583 Amb Surg Ctr TX N/A 0 0 Women's Specialty Surgery Center of Dallas LLC 8230 Walnut Hill Lane Ste 101 Dallas TX 75231 262310072 Amb Surg Ctr TX N/A 0 0 Grace Indemnity Company SPC Ltd 1159 Caribbean Plaza Grand Cayman CJ 981209573 Captive Insurance CJ N/A C 0 Texas Health Biomedical Advancement Center Inc 612 E Lamar Blvd Arlington TX 76011 752636884 Research TX N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 Texas Health Huguley Inc M 309425 Cost Texas Health Resources M 877837 Cost Texas Health Huguley Inc P 1965060 Cost Texas Health Huguley Inc Q 132683 Cost Texas Health Huguley Inc R 2922560 Actual Amount Given Texas Health Huguley Inc S 1788350 Actual Amount Received