Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2015 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | 15000238 |
| Software Version: | 2015v3.0 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | CORKY EVANS AND JUDY COCHRAN - Business relationship, HUNT HUBER, M. D. AND DAVID GLENN, M. D. - Business relationship |
| Form 990, Part VI, Line 6 Classes of members or stockholders | CATHOLIC HEALTH INITIATIVES (CHI), A COLORADO NONPROFIT ORGANIZATION IS THE SOLE CORPORATE MEMBER OF MEMORIAL HEALTH SYSTEM OF EAST TEXAS (DIRECT AFFILIATE) |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | THE SOLE CORPORATE MEMBER (CHI) HAS THE RIGHT TO APPOINT AND REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF MEMORIAL HEALTH SYSTEM OF EAST TEXAS. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | THE SOLE CORPORATE MEMBER (CHI) MUST APPROVE THE FOLLOWING: SUBSTANTIAL CHANGE IN MISSION OR PHILOSOPHICAL DIRECTION, AMENDMENT TO CORPORATE DOCUMENTS, MEMBERS OF GOVERING BOARD, REMOVAL WITH OR WITHOUT CAUSE, OF MEMBERS OF GOVERING BOARD, INCURRENCE OF DEBT, JOINT VENTURES , PARTNERSHIPS, CREATION OF A NEW CORPORATION OR LIMITED LIABILITY COMPANY, MERGERS, AND THE SALE OR DISPOSAL OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE DIRECT AFFILIATE. IN ADDITION, CHI SHALL HAVE THE POWER TO TRANSFER ASSETS TO THE CORPORATE MEMBER . |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE BOARD OF DIRECTORS, BY RESOLUTION, APPOINTS A SPECIAL COMMITTEE TO REVIEW THE FORMS 990 AND 990T PRIOR TO FILING. ONCE THE RETURNS ARE COMPLETED, THEY ARE PROVIDED TO THIS COMMITTEE FOR THEIR REVIEW AND APPROVAL FOR FILING. EMPLOYEES OF THE CORPORATION RESPONSIBLE FOR THE PREPARATION AND REVIEW OF THE RETURNS ARE AVAILABLE TO RESPOND TO QUESTIONS OR PROVIDE BACKGROUND AS NEEDED. ONCE THE DIRECTORS RESPONSIBLE FOR REVIEWING THE RETURNS ARE SATISFIED THAT THEY ARE COMPLETE, THE RETURNS ARE APPROVED TO BE FILED. SUBSEQUENT TO PRESENTATION TO THE BOARD'S COMMITTEE, THE TAX DEPARTMENT FILES THE RETURNS WITH THE IRS, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE COMMITTEE. AFTER FILING, THE RETURNS ARE MADE AVAILABLE TO ALL DIRECTORS FOR THEIR REVIEW. |
| Form 990, Part VI, Line 12c Conflict of interest policy | ANNUALLY, EACH MEMBER OF THE BOARD AND OFFICER OF THE CORPORATION IS PROVIDED A COPY OF THE CONFLICTS OF INTEREST POLICY, A STATEMENT ACKNOWLEDGING ITS RECEIPT, AND DISCLOSURE OF OUTSIDE INTERESTS AND ACTIVITIES FORM. THE POLICY IS DISCUSSED WITH THE BOARD AND EACH OFFICER. EACH BOARD MEMBER AND OFFICER COMPLETES THE DISCLOSURE OF OUTSIDE INTERESTS AND ACTIVITIES FORM AND RETURNS THEM TO THE CHIEF EXECUTIVE OFFICER (CEO). THE CEO AND THE SYSTEM'S GENERAL COUNSEL REVIEW EACH STATEMENT ACKNOWLEDGING RECEIPT OF THE POLICY AND THE DISCLOSURES TO FAMILIARIZE THEMSELVES WITH POTENTIAL CONFLICTS. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR ESTABLISHING COMPENSATION FOR THE PRESIDENT AND CEO AS WELL AS OTHER EXECUTIVES AND KEY MANAGEMENT EMPLOYEES OF THE CORPORATION. AS A PART OF THE MANAGEMENT SERVICES PROVIDED CORPORATION PURSUANT TO THE MANAGEMENT AGREEMENT THAT ENDED ON JUNE 1, 2014, COMMUNITY HOSPITAL CONSULTING, INC. (CHC) ASSISTED THE EXECUTIVE COMMITEE IN ITS REVIEW AND EVALUATION OF COMPENSATION FOR ITS EXECUTIVES, AND ITS KEY MANAGEMENT EMPLOYEES. TO SET COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER, CHC ESTABLISHED AN APPROPRIATE SALARY USING ITS INTERNAL COMPENSATION POLICY AND THEN ENGAGED AN INDEPENDENT NATIONALLY KNOWN COMPENSATION CONSULTANT TO PERFORM A COMPETITIVE MARKET ANALYSIS CONSIDERING THE JOB DESCRIPTION, SCOPE OF RESPONSIBILITY AND CURRENT COMPENSATION OF THE CHIEF EXECUTIVE OFFICER. THE CONSULTANT RECOMMENDED APPROPRIATE COMPARISON DATA, AND USING DATA FROM FOUR MAJOR COMPENSATION SURVEYS, PROVIDED THE DATA AND MADE RECOMMENDATIONS BASED ON THE ARTICULATED COMPENSATION POLICY. THOSE RECOMMENDATIONS AND THE MARKET DATA ON WHICH THEY WERE BASED WAS THEN FORWARDED TO THE EXECUTIVE COMMITTEE OF THE BOARD WHICH ESTABLISHES AN APPROPRIATE COMPENSATION LEVEL FOR THE CHIEF EXECUTIVE OFFICER. OTHER KEY EMPLOYEES' COMPENSATION IS SET IN MUCH THE SAME MANNER USING INFORMATION RELATED TO THEIR POSITIONS AND DATA DEVELOPED WITH THE ASSISTANCE OF CHC FROM MAJOR COMPENSATION SURVEYS, PASSED ON TO THE CHIEF EXECUTIVE OFFICER AND THE EXECUTIVE COMMITTEE OF THE BOARD, WHICH ESTABLISHES COMPENSATION LEVELS AS APPROPRIATE. THIS YEAR, CATHOLIC HEALTH INITIATIVES (CHI) ASSUMED ALL THE PREVIOUS MHSET PAY SCALES AND PAY METHODOLOGY THAT WERE PREVIOUSLY DEVELOPED BY CHC IN 2013. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | See Disclosure for 15A |
| Form 990, Part VI, Line 19 Required documents available to the public | THE ORGANIZATION'S FINANCIAL STATEMENTS , CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST, AT SUCH TIMES THAT ARE SCHEDULED WITH THE CHIEF FINANCIAL OFFICER. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG. |
| Form 990, Part VIII, Line 2a PATIENT SERVICE REVENUE | PATIENT SERVICE REVENUE WAS DETERMINED AS FOLLOWS: GROSS CHARGES TO PATIENTS - $ 800,004,092 LESS: MEDICARE CONTRACTUAL ALLOWANCES - (281,398,730) MEDICAID CONTRACTUAL ALLOWANCES - 8,858,531 MANAGED CARE DISCOUNTS - (261,703,853) CHARITY DEDUCTIONS - (60,441,295) UNCOLLECTIBLE ACCOUNTS - (35,866,572) OTHER DEDUCTIONS - (22,391,362) NET PATIENT SERVICE REVENUE - $ 147,060,811 |
| Form 990, Part VIII, Line 2f Other Program Service Revenue | Coping Rev - Medical records - Total Revenue: 86618, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 86618; RENTAL INC INT DEP - Total Revenue: 12000, Related or Exempt Function Revenue: 12000, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; VENDING INCOME - Total Revenue: 22064, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 22064; |
| Form 990, Part IX, Line 11g Other Fees | OUTSIDE SERVICES - OTHER - Total Expense: 6291722, Program Service Expense: 5472885, Management and General Expenses: 818837, Fundraising Expenses: ; PRO FEES - ANESTHESIA - Total Expense: 1773093, Program Service Expense: 1773093, Management and General Expenses: , Fundraising Expenses: ; CRNA PRO FEES - Total Expense: 404544, Program Service Expense: 404544, Management and General Expenses: , Fundraising Expenses: ; PHYSICIANS' ON-CALL FEES - Total Expense: 2063671, Program Service Expense: 2063671, Management and General Expenses: , Fundraising Expenses: ; HOSPITALISTS' FEES - Total Expense: 4265165, Program Service Expense: 4265165, Management and General Expenses: , Fundraising Expenses: ; NUTRITION SERVICES - Total Expense: 2284266, Program Service Expense: 2284266, Management and General Expenses: , Fundraising Expenses: ; BIOMED SERVICES - Total Expense: 3053804, Program Service Expense: 3053804, Management and General Expenses: , Fundraising Expenses: ; OUTSIDE SERVICES - BUSINESS OFFICE - Total Expense: 743672, Program Service Expense: , Management and General Expenses: 743672, Fundraising Expenses: ; SURGERY - Total Expense: 502788, Program Service Expense: 502788, Management and General Expenses: , Fundraising Expenses: ; DIALYSIS - Total Expense: 455570, Program Service Expense: 455570, Management and General Expenses: , Fundraising Expenses: ; OUTSIDE SERVICES - ADMINISTRATION - Total Expense: 1671092, Program Service Expense: , Management and General Expenses: 1671092, Fundraising Expenses: ; OUTSIDE SERVICES - LAUNDRY - Total Expense: 495279, Program Service Expense: 495279, Management and General Expenses: , Fundraising Expenses: ; ENVIORNMENTAL SERVICES - Total Expense: 1919531, Program Service Expense: 1919531, Management and General Expenses: , Fundraising Expenses: ; MEDICAL TRANSCRIPTION SERVICES - Total Expense: 217838, Program Service Expense: 217838, Management and General Expenses: , Fundraising Expenses: ; OUTSIDE SERVICES - MIS - Total Expense: 505240, Program Service Expense: , Management and General Expenses: 505240, Fundraising Expenses: ; Revenue Cycle Management - Total Expense: 6776371, Program Service Expense: , Management and General Expenses: 6776371, Fundraising Expenses: ; - Total Expense: , Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ; - Total Expense: , Program Service Expense: , Management and General Expenses: , Fundraising Expenses: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Change in defined pension plan - 2003 - -8267365; NET CHANGE IN BENEFICIAL INTEREST TRUST - 85233; NET ASSETS RELEASED FROM RESTRICTIONS - -44026; CONTRIBUTIONS RECEIVED - 4897280; INVESTMENT RETURN - 88; Change in Deferred Gain - -1532761; |
| Software ID: | 15000238 |
| Software Version: | 2015v3.0 |