2024-11-12T06:27:35-06:00 2023-12-31 990 2023-01-01 752678857 Texas Health Harris Methodist Hospital Southwest Fort Worth % DAVID JACKSON TEXA 8174335000 6100 Harris Parkway Fort Worth TX 76132 David Jackson Asst Secretary 6822367900 2024-11-11 true 2023 2024-10-15 13:58:12Z Ajith Pai 6100 Hospital Parkway Fort Worth TX 76132 411056002 false X www.texashealth.org X 1987 TX A faith-based organization whose mission is to improve the health of the people in the communities it serves regardless of their ability to pay. 15 13 1881 61 36535 0 1580191 1942354 362412167 407072383 -117042 -294320 1691088 2027040 365566404 410747457 90898 1730590 0 0 144544841 144923594 0 0 0 184164850 204996605 328800589 351650789 36765815 59096668 222940654 237167073 27064400 28747659 195876254 208419414 X A FAITH-BASED ORGANIZATION WHOSE MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE IN THE COMMUNITIES IT SERVES REGARDLESS OF THEIR ABILITY TO PAY. false false 279894597 1730590 407292314 Located in the southwest sector of Fort Worth since 1987, Texas Health Harris Methodist Hospital Southwest Fort Worth (THSW) is a 261-bed acute care hospital. THSW provides a wide array of comprehensive services including surgical and imaging services, a 24-hour emergency department, orthopedics and sports therapy, adult critical care, breast care center, women's services and a Level III neonatal intensive care unit. THSW has a Level III Trauma Designation and Level III Maternal Designation with the State of Texas, and received its second Magnet Designation in nursing. THSW has a CMS 5-star rating for overall quality and is Heart Failure, Stroke, Chest Pain, and Advanced Total Hip & Knee Replacement certified by The Joint Commission. More than 1,430 employees work at the hospital and more than 740 physicians are practicing on the medical staff. During the year, THSW had 61,334 patient days, 15,717 discharges, 92,493 outpatient encounters, 67,867 emergency room visits and 3,291 births. THSW provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. The hospital provides care to persons covered by governmental programs including Medicare and Medicaid for reimbursement that does not always cover the cost of providing the care. Recognizing its mission to the community, services are provided to both financially indigent and medically indigent patients. 279894597 true true false true false false false false false false true false false false true false false true false false false false false false false false true true true false true false false false false false false false false false false false false false true false false false true X 0 0 1881 true true true false false false false false false false false false false false X 15 13 true false false false true true true true true false false true true true true true true false false false X X DAVID JACKSON 6822367900 612 E LAMAR BLVD Arlington TX 76011 X BerdanBarclay E THR CEO/Trustee 0.64 49.36 X X 0 3605445 1016271 McWhorterRicky E Former Officer 0.0 50.0 X 0 1515772 325006 KramerKenneth J Assistant Secretary 0.05 49.5 X 0 1206803 235245 DeLeonJoseph C Former Officer 0.0 40.0 X 0 704680 158571 TuckerRebecca D Former Officer 0.0 40.0 X 0 634720 176067 JacksonDavid W Assistant Secretary 0.5 39.5 X 0 515108 165877 MontgomeryGary Mark Chief Qual & Med Officer THSW 40.0 0.0 X 581756 0 77619 PaiAjith President THSW 40.0 0.0 X 421491 0 121521 CantuStacy G Corporate Secretary 0.5 39.5 X 0 353188 71659 HuntGretchen L CNO Term Sept 2023 40.0 0.0 X 307950 0 43283 PriceMonica L Grp Finan Officer THSW-THC-THS 28.0 12.0 X 310922 0 25406 GordonMarva Marie DIR SR PROF & SUPPRT SVCS THSW 40.0 0.0 X 223596 0 49805 ChristensonSusan O SUPV NRSG 40.0 0.0 X 219117 0 51378 WilliamsPhilip A PHARMACIST CLIN 40.0 0.0 X 204389 0 49443 HernandoApril Joy Almiran SUPV NRSG 40.0 0.0 X 192800 0 55426 WallaceGary D DIR NRSG EMERGENCY/NRSG OPS 40.0 0.0 X 196877 0 48207 BerenzweigHarold Karl Former Officer 0.0 20.0 X 0 166694 0 DonovanLori Jo Chief Nursing Officer THSW 40.0 0.0 X 106385 35652 20659 KirkhamBrett Daniel VP Professional Svcs Term 4/20 40.0 0.0 X 111809 0 17276 Chhutani MD Sheila Trustee 0.03 8.39 X 0 76638 0 Vigness MD Richard Chair 0.03 1.4 X 0 0 0 Hunt Hunter Vice Chair 0.03 1.4 X 0 0 0 Wilder Jr Charles Immediate Past Chair 0.03 1.4 X 0 0 0 Bernstein Kenneth Trustee 0.03 1.4 X 0 0 0 Braun JD Vianei Lopez Trustee 0.03 1.4 X 0 0 0 Guyton Michael Trustee 0.03 1.4 X 0 0 0 Haggar III Joseph Trustee 0.03 1.4 X 0 0 0 Hum MD Lawrence Trustee 0.03 1.4 X 0 0 0 Iruegas Javier Trustee 0.03 1.4 X 0 0 0 Montgomery Lynn Trustee 0.03 1.4 X 0 0 0 Nunez MD Ignacio Trustee 0.03 1.4 X 0 0 0 Reeves Kenneth Trustee 0.03 1.4 X 0 0 0 Weeks DNP Susan Trustee 0.03 1.4 X 0 0 0 2877092 8814700 2708719 297 true true false Texas Health Resources 612 E Lamar Blvd ARLINGTON TX 76011 Management Fee 53394947 Texas Health Physicians Group 9250 Amberton Pkwy DALLAS TX 75243 Physician Services 9206938 Crothal Healthcare Inc 1301 Pennsylvania Ave FORT WORTH TX 76104 HOUSEKEEPING SVCS 5115405 Supplemental Health Care Svc 6955 Union Park Center Dr STe 400 COTTONWOOD HEIGHTS UT 84047 Contract Labor 3764548 Balfour Beatty Constructions 500 Main St 1100 FORT WORTH TX 76102 Construction 1925391 43 583012 1359342 1942354 PATIENT SERVICES 622110 403285027 403285027 MEDICARE/MEDICAID ADJ 622110 2036401 2036401 NON GOVERNMTL PERFORMANCE 622110 1193031 1193031 DSRP REVENUE 622110 473102 473102 AFFILIATED REVENUE 622110 75948 75948 8874 8874 407072383 0 14225 14225 28846 28846 5022 0 0 5022 5022 5022 0 308545 -308545 -308545 -308545 8471 0 8471 8471 0 0 0 0 0 0 CAFETERIA REVENUE 722514 1482295 1482295 BUSINESS INTERRUPTION/OTHER INSURANCE 621511 202247 202247 RETAIL SALES 622110 185900 185900 114259 12662 36535 65062 1984701 410747457 407292314 36535 1476254 1730590 1730590 0 0 0 2143190 2143190 0 0 116499928 115662912 837016 4740812 4724533 16279 13330875 13226267 104608 8208789 8066675 142114 53394972 53394972 0 0 0 0 0 30484158 18873747 11610411 532978 38493 494485 588488 523104 65384 652613 618098 34515 0 3908781 3798860 109921 44678 39389 5289 0 53372 36363 17009 5738619 5738619 0 14722046 12284558 2437488 4019582 4019582 MEDICAL SUPPLIES 71928369 71928172 197 UHRIP 7153869 7153869 LPPF 2638632 2638632 NON-CAPITAL EQUIPMENT 2098442 2061943 36499 7037006 6730191 306815 351650789 279894597 71756192 0 -278 16996 0 0 0 0 57629443 73555028 0 0 0 0 206945 286420 6399386 6713699 575186 561690 346153397 190804181 157363981 155349216 0 0 0 0 0 0 0 0 765991 684024 222940654 237167073 18681077 22202239 0 0 6780610 3486829 0 0 0 0 0 0 0 0 0 0 1602713 3058591 27064400 28747659 X 195876254 208419414 0 0 195876254 208419414 222940654 237167073 X 59096668 -46553508 X X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true true false true false false false false false false Schedule C, Part II-B - Additional Information Officers and/or Board Members of the corporation may, to an insubstantial degree, make comments or statements concerning legislation that may affect either the healthcare industry or the health status of the communities the Corporation serves. In pursuing this activity, Officers and/or Board Members may engage in conversations and/or write letters to various federal, state, and local officials regarding such matters on a personal level, and not as a representative of the organization. The amount of time and money involved in these activities is negligible. In no case has either the Corporation, or any person acting on behalf of the Corporation, intervened in any political campaign. 10414255 10414255 108180402 28183557 79996845 96397528 72049086 24348442 127580956 90571538 37009418 3580256 3580256 155349216 0 ESTIMATED 3RD PARTY SETTLEMENT 2631047 OPERATING LEASE 427544 3058591 true true X true X true X 500. true true false true true 11592697 327944 11264753 0.03200 32371594 64926671 0 0.00000 43964291 65254615 11264753 0.03200 193102 193102 0.00050 1231150 1231150 0.00350 1701224 1701224 0.00480 3125476 3125476 0.00880 47089767 65254615 14390229 0.04080 30682 30682 0.00010 38467 38467 0.00010 69149 69149 0.00020 true 31911566 0 59781290 66220442 -6439152 X true true 1 1 Texas Health Southwest 6100 Harris Parkway Fort Worth TX 76132 www.texashealth.org TDH #000627 X X X Texas Health Southwest 1 false false true X X X X X X X X X 22 true true false true X See Section C X true 23 true See Section C false true X 200. 500. X X X X true true X X X true X See Section C X See Section C X See Section C X X X X X X true X false X X X X true X false false Part V, Section B Part V. Section B, Line 3e The significant health needs of the community are in line with the significant health needs that have been prioritized and identified in the current CHNA. Part V. Section B, Line 5 Texas Health Harris Methodist Southwest's (THSW) 2022 CHNA was a collaborative process utilizing qualitative and quantitative methods to assess the health needs of persons within the service areas in the Tarrant/Parker Counties region. The 2022 CHNA was conducted at the Tarrant/Parker Counties regional level to generate community-driven solutions for better integration in addressing the clinical and social needs of individuals living in North Texas. Between June 2021 and May 2022, the community's health needs were assessed through key informant interviews, secondary data analysis, focus groups and an asset-map. Key informants and focus group participants included, but were not limited to faith community representatives, public health officials, lay community members, school officials and city administration. The organization engaged twenty-four community members with interests specific to the health of individuals in the Tarrant/Parker Counties region in the CHNA development process. Sixteen of these community members were engaged across three separate focus groups held in zip-codes that were identified as underserved areas. Eight community members served as key informants. Listening sessions were additionally held to understand opportunities for strengthening community collaborations. Through focus groups, key informant interviews and listening sessions, a community asset map was developed to provide an inventory of resources. To gain a comprehensive understanding of the health needs and priorities of individuals in this region, Texas Health used focus group sessions and key informant interviews to engage the medically underserved, low-income or minority populations along with representatives from the following community organizations: Alzheimer's Association, Arlington Police Department, Cooper Street YMCA, Cornerstone Assistance Network, Eastside Ministries, Mansfield Mission Center, Meadowbrook Poly UMC and SafeHaven of Tarrant County. Findings from all data sources (secondary data, interviews and focus groups, and asset mapping) were compared. Recurring themes were pulled and analyzed to stratify the top medical and social determinant of health needs. The outlined needs/barriers will inform the development of the 2023-2025 CHNA implementation plan, which will leverage integrated strategies across THR's internal and external stakeholders to enhance its service and program delivery in the target communities. Part V. Section B, Line 6a The 2022 CHNA for the Tarrant/Parker Counties Region was conducted in collaboration with 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 Huguley. Part V. Section B, Lines 7a and 10a The most recently adopted implementation strategy and the CHNA is widely available on the following website at: https://www.texashealth.org/Community-Health/Community-Health-Needs-Assess ment Part V. Section B, Line 11 The 2023 - 2025 implementation strategy focused on reforming the delivery of our services in the target communities. The hospital is part of the Texas Health Resources (THR) healthcare system, which developed a system-wide community benefit strategy to increase its hospitals' ability to impact the community health needs of the target areas with a higher focus on three health priorities. Through the prioritization process these three health priorities from the 2022 CHNA were determined to be ongoing issues that THR hospitals needed to address: 1. Behavioral Health 2. Chronic Disease Prevention & Management 3. Access to Health Services and Healthcare Navigation & Literacy In 2023, Texas Health Southwest (THSW) addressed significant health needs identified in the 2022 CHNA using the following approaches: 1. Behavioral Health 1a. Texas Health Community Impact 1a1. Through a request for proposal (RFP) process by Texas Health Resources through its Texas Health Community Impact (THCI) Initiative, three agencies in Tarrant and Parker Counties were awarded grants to address depression, anxiety, and food insecurity among underserved individuals in specific zip-codes in the hospital's region. The agencies awarded were Eastside Ministries, Taste Project and Parker County Center of Hope. 2. Chronic Disease Prevention & Management 2a. Healthy Education Lifestyle Program (HELP) 2a1. The Healthy Education Lifestyle Program (HELP) is an innovative way of delivering diabetes and hypertension management to uninsured populations. Every HELP visit is comprised of three key components: an individual visit with a mid-level practitioner, including necessary lab testing; an education session by the nurse to increase health literacy; and a support group facilitated by a nurse, which is crucial for establishing and ensuring accountability for improved health outcomes. The goal of HELP is to increase the percentage of diabetic patients whose A1c levels were improved, and the percentage of patients whose blood pressure were controlled based in the management/treatment guidelines. The implementation of the HELP clinical at THSW increased their ability to serve eligible patients and report clinical outcomes of improved A1c levels and blood pressure. 2b. Mobile Health 2b1. The Mobile Health program aims to improve access to quality preventive care services to adults 18+ years across Texas Health's service areas. Patients are seen across the several service types offered, including Mammograms, Wellness for Life (WFL), and Healthy Education Lifestyles Program (HELP). The WFL program provides colon cancer screenings, well adult exams, including cervical cancer screenings, and blood work to test for diabetes and cholesterol. The Mammogram service type provides mammograms and breast cancer screening services for women. The HELP program provides chronic disease management services to uninsured patients. 3. Access, Literacy, and Navigation (ALN) 3a. Health Workshops 3a1. Child Automobile Safety Initiative (CASI) is a program focused on protecting children from injury in motor vehicle collisions by providing free car seat safety checks and community-based education. 3a2. Flu vaccination clinics were offered to local parishes and city residents by the Faith Community Nurses. 3b. Faith Community Nursing 3b1. Faith Community Nursing is a system-wide program offered by Texas Health to link faith communities with health-related resources that focus on holistic care for the body, mind, and spirit. Emphasis is placed on equipping faith-based communities with the tools and resources to offer prevention and wellness support to care for the people they serve. The Texas Health Faith Community Nursing program offers classes and trainings in a variety of topics. These courses are taught to community partners/stakeholders, faith leaders, FCNs, HPs, and Texas Health Resources staff. 3b2. Flu vaccine clinics provided by the Texas Health Resource Faith Community Nurses focus on serving people and communities who would otherwise not have access to vaccines. Fulfilling our Mission to meet our consumers' needs where they work, live, play and pray is exemplified in the care provided in communities of faith and faith based organizations across our service areas. Faith Community Nursing organizes clinics with the primary focus of serving people who do not have access to flu vaccines. Services are aligned with food pantries, congregations in CHNA zip codes, senior community members, and outreach ministries to underserved communities. Each site is open to the community. Through these efforts, thousands of individuals receive flu shots who otherwise would not have had access to one. All the priority health needs identified are being addressed by the hospital in the category listed above. Part V. Section B, Line 13 h Although a patient may have been notified of the Financial Assistance Policy, there are times when the patient chooses not to complete the Financial Assistance Application. Texas Health routinely screens uninsured patients using an independent third party for financial assistance eligibility. Part V. Section B, Lines 16 a, b & c The FAP, FAP Application and the Plain Language Summary of the FAP were widely available at this website: https://www.texashealth.org/Costs-and-Billing/Financial-Assistance Part VI Supplemental Information Part I, Line 3c - Patient Eligibility Patients with family income at or below 200% of applicable Federal Poverty Guidelines (FPG) may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. Patients with a family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income, as determined on a sliding scale based on FPG, may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income in relation to FPG. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's financial assistance application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a financial assistance application. Part I, Line 7 - Cost-to-Charge Ratio A cost-to-charge ratio is used to compute the amounts reported on Lines 7a-7c. The cost-to-charge ratio is derived from Worksheet 2 - Ratio of Patient Care Cost-to-Charges, as found in the Schedule H Instructions. The amounts reported on Lines 7e-7i were computed using direct costs, as determined by a cash outlay. Part II - Community Building The organization participates in community building activities that aim to address the disparities in the social determinants of health factors that influence the overall health and wellbeing of individuals in the communities Texas Health serves. As identified in the community health needs assessment, there are areas of need that are not aligned with the traditional operations of a hospital system. Our volunteerism, collaborations and partnership opportunities with various community-based organizations and coalitions foster our ability to address the social and environmental needs for the purpose of providing for the whole person beyond the clinical services. Part III, Lines 2, 3 & 4 - Bad Debts Bad debt expense is not included for purposes of reporting community benefits. Each patient qualifying for charity care is treated as a charity patient and no charges related to that patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THR's annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. On pages 13-14 of the attached audited financial statements of THR, which includes the activity of the organization, is a footnote regarding Accounts Receivable and Net Patient Service Revenue. Part III, Line 8 - Medicare Shortfall The state of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care & community benefit. For state purposes, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost-to-charge ratio (with costs determined in accordance with generally accepted accounting principles) to billed charges. The shortfall amount reported to the state of Texas for 2023 is $68,635,691. Sch H requires a different method to calculate the Medicare shortfall shown on Part III, Lines 5-7. Part III, Line 9b - Debt Collection During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Financial Assistance Policy. Part VI, Line 2 - Needs Assessment In 2022, Texas Health Resources (Texas Health) completed a community health needs assessment (CHNA) for 27 facilities across 5 regions using the following steps: - Demographic analysis by region - Secondary data analysis of health indicators to identify zip codes of highest-needs within each region and prioritize zip codes for the community impact initiative - Primary data collection via key informant interviews, focus groups, and a windshield survey - Synthesis of secondary and primary data to identify the most pressing health needs by region - Prioritization of health needs that Texas Health would focus on within the current CHNA cycle, resulting in the identification of these health needs: Behavioral health; Chronic disease prevention and management; and access, navigation, and health literacy. In addition to the CHNA, a community readiness assessment was conducted in 2023 to identify zip codes/communities that were ready to address the health and social needs in their communities within the next 3 years. Though this assessment key informant interviews were conducted across five regions. The interviews were then compiled, scored and analyzed to determine strengths and barriers within communities. To assess hospital utilization and health outcomes, a diagnosis code and hospital utilization dashboard was created. This dashboard compiles data from all major hospitals within the Dallas-Fort Worth region. The dashboard allows us to analyze demographics, insurance status, charge data and diagnoses codes by patient zip codes. Though this analysis, we have been able to assess which populations have a higher hospital utilization as well as determining which populations have a higher prevalence of certain diagnoses. The dashboard was recently used to determine zip codes where stroke education should be prioritized based on overall prevalence of stroke cases along with the percentage of patients that were self-pay. Additionally, the data was used to review hospital utilization among homeless individuals in Tarrant County. This project was requested to be used to strategically plan for implementation of a medical respite unit within Tarrant County. Through the CHNA report, transportation was identified for further assessment given that community members reported transportation as a barrier to healthcare access and other health-related issues. In 2023, an analysis of the availability of household transportation and the access to the public transportation system was completed to better understand transportation needs in our communities. This analysis has been compiled into a report that is being disseminated to various stakeholders to build appropriate action plans. Part VI, Line 3 - Patient Education A description of the Financial Assistance Policy (FAP), the Plain Language Summary of the FAP (PLS) and the FAP application are available on the THR website at www.TexasHealth.org in English and other languages. Financial assistance information is included in the patient's admission packets. Signs alerting patients of financial assistance and related contact information are posted in various areas of the hospital including admissions & registration and the emergency room. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms necessary to apply for the assistance. At the same time, patients are provided with a financial assistance application. The patient is informed that the hospital is offering financial assistance to patients deemed medically or financially indigent. The PLS is included on the back of our patient bills. The patient is informed of how to qualify for financial assistance, how to ask for help, necessary documentation, and THR's collection process. The onsite financial counselors may assist the patient in completing the application and obtain available verification information. The counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and financial assistance have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the FAP. Each bill sent for hospital services also contains contact information alerti true Gary Patterson Foundation PO Box 101852 Fort Worth TX 76185 270025657 501(c)(3) 10000 cash General Purpose Junior League of Fort Worth 255 Bailey Ave Fort Worth TX 76107 756022377 501(c)(3) 7500 cash General Purpose Tarrant Safety Net Support Corporation 612 E Lamar Blvd Arlington TX 76011 823171862 501(c)(3) 73390 Cash Indigent Health Care Leukemia & Lymphoma Society 8111 LBJ Freeway Ste 425 Dallas TX 75251 135644916 501(c)(3) 10000 cash General Purpose March of Dimes Foundation PO Box 18819 Atlanta GA 31126 131846366 501(c)(3) 6000 Cash General Purpose Texas Health Physicians Group 9250 Amberton Pkwy Dallas TX 75243 752613493 501(c)(3) 1600000 Cash Charity Care 6 0 Part I, Line 2 - Monitoring Grants Texas Health Southwest (THSW) is a member of the Texas Health Resources (THR) Healthcare system. The majority of the grants distributed by the system are to related tax exempt organizations. The hospital does not specifically monitor the use of grants paid to related organizations since THR administration monitors the use of these grants on a system basis for all members of the THR healthcare system. Grants to non-related tax exempt organizations are generally given to entities that are in the hospital's community and/or service area or to certain organizations which will specifically impact the hospital's community. These grants are typically monitored by hospital personnel who are working closely with the non-related nonprofit organization. X X true true false true false false false false false false false BerdanBarclay E THR CEO/Trustee 0 1860563 0 1414089 0 330793 0 963751 0 52520 0 4621716 0 731476 KramerKenneth J Assistant Secretary 0 705551 0 359141 0 142111 0 193789 0 41456 0 1442048 0 174260 JacksonDavid W Assistant Secretary 0 348305 0 117613 0 49190 0 125200 0 40677 0 680985 0 53142 CantuStacy G Corporate Secretary 0 278238 0 41945 0 33005 0 17934 0 53725 0 424847 0 0 MontgomeryGary Mark Chief Qual & Med Officer THSW 417065 0 120662 0 44029 0 24750 0 52869 0 659375 0 47863 0 PaiAjith President THSW 291160 0 86666 0 43665 0 70990 0 50531 0 543012 0 35776 0 PriceMonica L Grp Finan Officer THSW-THC-THS 245007 0 35702 0 30213 0 15422 0 9984 0 336328 0 0 0 HuntGretchen L CNO Term Sept 2023 196130 0 89651 0 22169 0 15314 0 27969 0 351233 0 32920 0 DonovanLori Jo Chief Nursing Officer THSW 103315 19494 0 0 3070 16158 7870 1398 9900 1491 124155 38541 0 16158 McWhorterRicky E Former Officer 0 932223 0 437883 0 145666 0 285038 0 39968 0 1840778 0 197608 BerenzweigHarold Karl Former Officer 0 166444 0 250 0 0 0 0 0 0 0 166694 0 0 TuckerRebecca D Former Officer 0 433437 0 142623 0 58660 0 126197 0 49870 0 810787 0 54881 DeLeonJoseph C Former Officer 0 448653 0 175559 0 80468 0 101563 0 57008 0 863251 0 77394 GordonMarva Marie DIR SR PROF & SUPPRT SVCS THSW 214335 0 8811 0 450 0 9974 0 39831 0 273401 0 0 0 ChristensonSusan O SUPV NRSG 206200 0 6022 0 6895 0 11422 0 39956 0 270495 0 0 0 WilliamsPhilip A PHARMACIST CLIN 202940 0 1000 0 449 0 15351 0 34092 0 253832 0 0 0 WallaceGary D DIR NRSG EMERGENCY/NRSG OPS 189459 0 7418 0 0 0 10557 0 37650 0 245084 0 0 0 HernandoApril Joy Almiran SUPV NRSG 183350 0 5012 0 4438 0 12168 0 43258 0 248226 0 0 0 SCHEDULE J, PART I, LINE 1A - DISCRETIONARY SPENDING ACCOUNT Each executive at the vice president level and above receives a perk allowance and flexible benefit allowance which is included in the taxable compensation of the employee. The perk allowance covers costs such as business use of their personal vehicles in lieu of reimbursement for auto mileage. The flexible benefit allowance can be used to purchase executive benefits on an after-tax basis. Schedule J, Part I, Line 1A - Gross Up Payments Certain imputed income is grossed-up to include employment taxes paid on the listed person's behalf. All tax indemnification payments provided to the employees are included in the taxable compensation of the employee. Schedule J, Part I, Line 3 - CEO Compensation The organization relied on Texas Health Resources (THR), a related 501(c)(3) organization with centralized compensation professionals to use the following methods to establish the compensation of the organization's top executive officer who is responsible for the daily operations of the hospital. * The Governance committee (which includes independent persons) performs reviews and makes recommendations to the THR Board to approve the overall payment philosophy. * An Independent compensation consultant may be hired. * Compensation surveys or studies are utilized. * Board or Governance committee approves the executive compensation parameters within the executive compensation philosophy. The President is a corporate officer providing oversight of the COO/CNO and whose compensation is paid and determined by THR. Schedule J, Part I, Line 4b - Nonqualified Retirement Plan Participation in the THR plans is made available to a select group of management and highly compensated employees as determined by the THR Board of Trustees, who are providing services in a key position of management and responsibility. SERP: 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 a 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. LTIP: The Long Term Incentive Plan covers 2,3,or 4 years. Payouts are made over 2,3, or4 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 much be obtained and a non-compete must be satisfied prior to the end of the year payout. Retention: 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 1/2 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). Berdan,Barclay E. 731,476 DeLeon,Joseph C. 77,394 Hunt,Gretchen L. 54,535 Jackson,David W. 53,142 Kramer,Kenneth J. 174,260 McWhorter,Ricky E. 197,608 Montgomery,Gary Mark 47,863 Pai,Ajith 35,776 Tucker,Rebecca D 54,881 990, Part VI, Section A, Line 1a - Number reported in Box 3 of Form 1096 The taxpayer is a part of a healthcare system that centralizes all payments and Form 1099 filings under the parent, Texas Health Resources (THR). This is part of the System's effort toward overall centralization of vendor relations and other shared services as well as seeking to consolidate where and how its vendors are paid. This service is included in the management service agreement that THR has with its subsidiaries. 990, Part VI, Section A, Line 2 - Business Relationship Texas Health Resources (THR) and its related organizations included in the THR healthcare system encourage employees to become involved in philanthropic endeavors in their communities. As a result, THR healthcare system employees who are serving as officers, board members, or key employees may, from time to time, also serve on the boards of various community organizations such as church boards, United Way, etc. There may be a business relationship as a result of multiple THR employees serving on the same community boards. THR employees serve as the corporate officers of each subsidiary organization. As THR system employees, all officers have a business relationship within the organizations of the THR healthcare system. THR also appoints system officers to the boards of various controlled joint ventures. As THR system employees, various officers of the organization may have a business relationship through serving on THR controlled joint venture boards. 990, Part VI, Section A, Line 6&7a - Members Texas Health Resources (THR) is the sole member of the organization. 990, Part VI, Section A, Line 7b - Governance Decisions Reserved The following actions require the approval of Texas Health Resources (THR): (a) Amendment, restatement or repeal of the Certificate of Formation or these Bylaws. (b) Sale, exchange, lease or other transfer of all or substantially all of the assets of the Corporation. (c) Merger or consolidation of the Corporation. (d) Dissolution of the Corporation. (e) Election of members of the Board of Trustees (f) Removal of a member of the Board of Trustees (g) Creation of affiliates or subsidiaries and approval of the initial governing documents. (h) Incurrence of debt not included in the budgets. (i) Discontinuing the operations of a licensed health care facility controlled by the corporation. (j) Activities involving winding up, distribution, conversion or exchange under Chapter 11 990, Part VI, Section B, Lines 11b - Form 990 Filing The Texas Health Resources (THR) tax department staff prepares the Forms 990 for THR and all of its wholly controlled affiliates. In order to accurately prepare the returns, the tax staff works closely with various other departments to gather and review the information needed to complete the return. The departments involved in this process include, but are not limited to accounting, finance, treasury, human resources, payroll, legal, governance, and corporate compliance. The returns are then reviewed twice within the tax department before being given to the Financial Reporting department to review and to ensure that the financial information is accurate and up to date. All THR System Forms 990 are provided to members of the Audit and Compliance Committee of the THR Board, giving them an opportunity to review, comment and ask questions regarding the Forms 990. The tax department Vice President provides an overview presentation to the committee highlighting various areas of the Form 990. A resolution to approve all of the returns is voted upon at this meeting. Once the Audit and Compliance Committee has approved the returns, each return is then reviewed and signed by the Chief Accounting Officer/Assistant Secretary. The members of the governing Boards are provided a copy of the Form 990 for their respective entity before the Form 990 is filed. 990, Part VI, Section B, Lines 12c - Conflict of Interest Texas Health Resources (THR) has adopted a Conflict of Interest Policy that applies to THR and all of its wholly owned or wholly controlled affiliates. During the year, a Duality and Conflict of Interest Statement Form is distributed by the THR Chief Compliance Officer to all board members, officers, contracted medical directors, employees with a title of manager or above, employed physicians, and certain committee members and other employees based upon function. All disclosed conflicts are reviewed by the THR Chief Compliance Officer. A report, listing each reported Duality of Interest or Conflict of Interest is given to both the Chair of the Governing body and the President of the Corporation with which the reporting person is affiliated. The THR Board of Trustees receives a report when the Annual Disclosure process is complete. Progressive corrective action is taken for any identified noncompliance which may include removal from a board or committee or physician/employee counseling if the person fails to provide the disclosure. In addition, THR monitors physician payments through a public database implemented by CMS. Management plans are executed as needed based upon disclosures. THR also educates the Boards and workforce annually through either a web based or live compliance training. Part VI, Section B, Lines 15 a&b - Compensation Determination The organization relied on Texas Health Resources (THR) with centralized compensation professionals to review and establish the compensation of the organization's officers. A more in-depth discussion of executive compensation review can be found on Schedule J, Part III. 990, Part VI, Section C, Line 19 - Public Disclosure The organization does not make its governing documents or conflict of interest policy available to the public. The consolidated financial statements of Texas Health Resources (THR) are made available to the public on the website www.dacbond.com. Consolidated financial statements are posted to this website quarterly and the audited financial statements are posted annually. The financial statements of the wholly controlled affiliates of THR are not posted to the website nor are they generally made available to the public in any other manner. 990, Part XI, Line 9 - Other Changes in Net Assets Adjustment for Intercompany Transactions of a Controlled Group $(46,553,508) The intercompany adjustment eliminated the receivable/payable balance as of the end of the year between Texas Health Resources (THR) and all wholly controlled tax-exempt entities included in the THR Healthcare System. The adjustment represents current year activity. The THR Healthcare System records all related transactions through the intercompany Receivable/Payable accounts for each entity. The types of transactions recorded in the Intercompany accounts include management fees charged by the parent organization, services purchased between related organizations, supplies purchased by a centralized purchasing department, daily cash sweeps and similar transactions. 990, Part XII, Line 2c - Consolidated Financial Statements Texas Health Resources (THR) prepares consolidated financial statements with its related entities. The THR Board appoints an audit and compliance sub-committee that assumes responsibility for oversight of the consolidated audit for all related entities. The related entities do not have a separate audit committee but abide by the THR committee's oversight. There has been no change during the year in the organizations oversight selection process. Huguley Medical Assoc Inc 11801 South Freeway Burleson TX 76028 752547668 Phys Clinic TX 501(c)(3) 3 TH Huguley false North Texas Healthy Communities 612 E Lamar Blvd Arlington TX 76011 464513182 Comm Support TX 501(c)(3) 7 TH Resources false Southwestern Health Resources JOC 5323 Harry Hines Blvd Dallas TX 75390 811575989 Mgmt Org TX 501(c)(3) 12b TH Resources false Texas Health Arlington Memorial Hospital 800 West Randol Mill Rd Arlington TX 76012 750972805 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Back Care 9250 Amberton Pkwy Dallas TX 75243 474724257 Phys. Clinic TX 501(c)(3) 10 TH Phys Grp false Texas Health Alliance 10864 Texas Health Trail Fort Worth TX 76244 451502252 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Azle 108 Denver Trail Azle TX 76020 751748586 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Cleburne 201 Walls Dr Cleburne TX 76033 751977850 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Fort Worth 1301 Pennsylvania Ave Fort Worth TX 76104 756001743 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Hurst-Euless-Bedford 1600 Hospital Parkway Bedford TX 76022 751438726 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Southwest Fort Worth 6100 Harris Parkway Fort Worth TX 76132 752678857 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Stephenville 411 Belknap Stephenville TX 76401 751752253 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Frisco 12400 Dallas Parkway Frisco TX 75033 831954982 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Mansfield 2300 Lone Star Rd Mansfield TX 76063 831869297 Hospital TX 501(c)(3) 3 TH Huguley false Texas Health Huguley Inc 11801 S Freeway Burleson TX 76028 452694620 Hospital FL 501(c)(3) 3 TH Resources false Texas Health Medical Support 612 E Lamar Blvd Arlington TX 76011 812833150 Spec Drugs TX 501(c)(3) 10 TH Resources false Texas Health Physicians Group 9250 Amberton Pkwy Dallas TX 75243 752613493 Phys. Clinic TX 501(c)(3) 10 TH Resources false Texas Health Allen 1105 Central Expressway N Allen TX 75013 752890358 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Dallas 8200 Walnut Hill Ln Dallas TX 75231 751047527 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Denton 3000 North Interstate 35 Denton TX 76201 432008974 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Kaufman 850 Ed Hall Drive Kaufman TX 75142 752771437 Hospital TX 501(c)(3) 3 TH Resources false Texas Health Plano 6200 W Parker Rd Plano TX 75093 752770738 Hospital TX 501(c)(3) 3 TH Resources false TH Recovery and Wellness Center 240 Miller Road Mansfield TX 76063 812813227 Resd Trmt Ctr TX 501(c)(3) 3 TH Resources false TX Health Research & Education Institute 612 E Lamar Blvd Arlington TX 76011 752562191 Edu& Research TX 501(c)(3) 4 TH Resources false Texas Health Resources 612 E Lamar Blvd Arlington TX 76011 752702388 System Mgmt TX 501(c)(3) 12c NA false Texas Health Resources Foundation 612 E Lamar Blvd Arlington TX 76011 752022128 Fundraising TX 501(c)(3) 7 TH Resources false TH Specialty Hospital Fort Worth 1301 Pennsylvania Ave Fort Worth TX 76104 751648589 LT Hospital TX 501(c)(3) 3 TH Resources false TX Health Urgent Care 3805 W University Park 100 McKinney TX 75071 814317635 Urgent Care TX 501(c)(3) 3 TH Resources false TX Health Virtual Care 612 E Lamar Blvd Arlington TX 76011 873611585 Virtual Care TX 501(c)(3) 3 TH Resources false WW Ward Endowment Fund Trust 612 E Lamar Blvd Arlington TX 76011 756196065 Nursing Grant TX 501(c)(3) 12a TH Fndn false Healthy Tarrant County Collaboration PO Box 8040 Fort Worth TX 76124 432087946 Support Org. TX 501(c)(3) 12a NA false AMH Cath Labs LLC 811 Wright St Arlington TX 76012 203003947 Hospital TX NA Arlington Surgery Center LLC 918 N Davis Dr Arlington TX 76012 752055800 Amb Surg Ctr TX NA Castle Hills Surgicare LLC 4221 Medical Parkway ste 100 Carrollton TX 75010 813020487 Amb Surg Ctr TX NA Cleburne Surgical Center LLC 2010 W Katherine P Raines Blvd St Cleburne TX 76033 203742012 Amb Surg Ctr TX NA Cross Timbers Surgery Center LLC 1001 N Waldrop Dr Ste 705 Arlington TX 76012 752862780 Amb Surg Ctr TX NA Denton Surgery Center LLC 207 North Bonnie Brea Denton TX 76201 470926556 Amb Surg Ctr TX NA Flower Mound Hospital Partners LLC 4400 Long Prairie Rd Flower Mound TX 75028 260684968 Hospital TX NA Fort Worth Endoscopy Centers LLC 900 W Magnolia Ave 101 Fort Worth TX 76104 770368346 Endoscopy Center TX NA Greenville Surgery Center LLC 7150 Greenville Ave Ste 200 Dallas TX 75231 742411643 Amb Surg Ctr TX NA Health Imaging Partners LLC 8610 Explorer Drive Ste 300 Colorado Springs CO 80920 271385885 Medical Imaging TX NA Mansfield Endoscopy Center LLC 647 N Miller Rd Mansfield TX 76063 861354607 Endoscopy TX NA North Dallas Surgical Center LLC 17980 Dallas Pkw Ste 100 Dallas TX 75287 272248103 Amb Surg Ctr TX NA Opthalmology Surgery Center of Dallas LL 10740 N Central Expy Dallas TX 75231 261914835 Amb Surg Ctr TX NA Park Hill Surgery Center LLC 3455 Locke Ave Fort Worth TX 76107 451484375 Amb Surg Ctr TX NA Physicians Medical Center LLC 6020 W Parker Rd Plano TX 75093 481281376 Hospital TX NA Presbyterian Cancer Ctr-Dallas LLC PO Box 819067 Dallas TX 75381 260422749 Cancer Ctr TX NA Rockwall Regional Hospital LLC 3150 Horizon Rd Rockwall TX 75032 202848116 Hospital TX NA South Arlington Surgical Providers LLC 350 E Interstate 20 Ste 200 Arlington TX 76018 752723958 Amb Surg Ctr TX NA Southlake Specialty Hospital LLC 1545 E Southlake Blvd Southlake TX 76092 020555370 Hospital TX NA Surgical Caregivers of Fort Worth LLC 2001 W Rosedale St Fort Worth TX 76104 751925497 Amb Surg Ctr TX NA Texas Health Craig Ranch Surgery Center 8080 State Hwy 121 Ste 100 McKinney TX 75070 383897811 Amb Surg Ctr TX NA Texas Health Flower Mound Orthopedic Sur 5000 Long Prairie Rd Flower Mound TX 75028 800866449 Amb Surg Ctr TX NA Texas Health Huguley Surgery Center LLC 12001 S Freeway Burleson TX 76028 821289045 Amb Surg Ctr TX NA Texas Health Orthopedic Surgery Center A 9848 N Beach St Fort Worth TX 76244 814977249 Amb Surg Ctr TX NA Texas Health Spine Surgery Center Allen 1120 Raintree Cir Ste 100 Allen TX 75013 300957868 Amb Surg Ctr TX NA Texas Health Spine Surgery Center Allian 1545 E Southlake Blvd Ste 100 Southlake TX 76092 320571301 Amb Surg Ctr TX NA Texas Health Supply Chain Services LLC 612 E Lamar Blvd Ste 600 Arlington TX 76011 841833532 Purchasing Co TX NA Texas Health Surgery Center Alliance LLC 10840 Texas Health Trail Ste 100 Fort Worth TX 76244 822296081 Amb Surg Ctr TX NA Texas Health Surgery Center Bedford LLC 1605 Airport Freeway Ste 100 Bedford TX 76021 821307876 Amb Surg Ctr TX NA Texas Health Surgery Center Chisholm Tra 5900 Altamesa Blvd Fort Worth TX 76132 851225852 Amb Surg Ctr TX NA Texas Health Surgery Center Forney LLC 612 E Lamar Blvd Ste 600 Arlington TX 76011 923847064 Inactive TX NA Texas Health Surgery Center Irving LLC 2120 N MacArthur Blvd Ste 200 Irving TX 75061 831085415 Amb Surg Ctr TX NA Texas Health Surgery Center Preston Plaz 17950 Preston Road Ste 75 Dallas TX 75252 203991622 Amb Surg Ctr TX NA Texas Health Surgery Center Rockwall LLC 3144 Horizon Rd Ste 120 Rockwall TX 75032 474425996 Amb Surg Ctr TX NA Texas Health Surgery Center Southwest Fo 6317 Harris Parkway Ste 200 Fort Worth TX 76132 843814490 Amb Surg Ctr TX NA Texas Health Surgery Center Waxahachie 1434 US Hwy 287 Bypass Ste 100 Waxahachie TX 75165 831464243 Inactive TX NA Texas Health Surgery Center Willow Park 612 E Lamar Blvd Ste 600 Arlington TX 76011 841953918 Amb Surg Ctr TX NA Texas Institute for Surgery LLP 7115 Greenville Ave Ste 100 Dallas TX 75231 770628004 Hospital TX NA THR-STT Rockwall ASC LLC 1545 E Southlake Blvd Southlake TX 76092 262429878 Amb Surg Ctr TX NA THR-STT Southlake ASC LLC 1545 E Southlake Blvd Southlake TX 76092 201728912 Amb Surg Ctr TX NA USMD Hospital at Arlington LP 801 I -20 West Arlington TX 76017 731662763 Hospital TX NA USMD Hospital at Fort Worth LP 5900 Altamesa Blvd Fort Worth TX 76132 203571243 Hospital Closed TX NA Walnut Hill Surgery Center LLC 5494 Glen Lakes Dr Dallas TX 75231 364499777 Amb Surg Ctr TX NA Willow Park Endoscopy Center LLC 130 Jimma Drive Willow Park TX 76087 881643733 Amb Surg Ctr TX NA Wilson Creek Surigcal Center LLC 8855 Synergy Drive McKinney TX 75070 274816583 Amb Surg Ctr TX NA Women's Specialty Surgery Center of Dall 8230 Walnut Hill Ln Ste 101 Dallas TX 75231 262310072 Amb Surg Ctr TX NA Grace Indemnity Company SPC Ltd 1159 Caribbean Plaza Grand Cayman CJ KY 1-1102 981209573 Captive Insur CJ NA C Corp false Texas Health Biomedical Advancement Cent 612 E Lamar Blvd Arlington TX 76011 752636884 Research TX NA C Corp false false true true false false false false false false true false true false false true true true true See Part VII for Explanation Schedule R, Part V, Line 2 - Related Transactions Texas Health Resources (THR) is the parent organization in a large healthcare system made up of both wholly owned entities as well as related controlled joint ventures as listed on Schedule R. THR's role is to plan, manage and coordinate the activities of the affiliated healthcare system in order to maximize opportunities to deliver cost effective quality medical care to residents of north central Texas. THR provides direction and oversight to its wholly owned affiliates through centralized services. They also provide oversight for the controlled joint ventures. As an integral part of providing centralized services to the affiliates, THR maintains intercompany receivable/payable accounts, most of which do not fall within the scope of IRC Section 512(b)(13). The range of centralized services provided by THR include information services, managed care contracting, Human resources, revenue cycle, billing and collections, patient access/admissions, legal, tax, compliance, supply chain, quality, business development, insurance, treasury, marketing, general accounting, real estate services, coding, transcription, and strategic planning. In addition, THR does daily cash sweeps of all controlled tax-exempt entity cash accounts. As a result, THR has numerous daily transactions with controlled tax-exempt entities, none of which fall within the scope of IRC Section 512(b)(13). A management fee is charged for the centralized services and reported on Form 990, Part VII, Section B as a professional services fee. Transactions with related tax-exempt organizations falling within the meaning of centralized services as described above, are not listed on Schedule R, Part V, Line 2.