TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) R BLAIR ABNEY...................................................................... VICE CHAIRMAN	1.5 ................. 0.0	X	X	0	0
(2) VALERIE ALLMAN MD...................................................................... DIRECTOR	30.0 ................. 10.0	X	X	251,939	9,877
(3) RUSSELL J COLLIER...................................................................... PRESIDENT (THRU 1/18)	1.0 ................. 4.0	X	X	380,156	9,723
(4) KEN CUNNINGHAM...................................................................... SECRETARY	1.5 ................. 38.5	X	X	751,064	58,662
(5) KELLYN DRAYER...................................................................... BOARD CHAIRMAN	4.0 ................. 5.25	X	X	0	0
(6) GAYLE ENGLISH...................................................................... DIRECTOR	1.0 ................. 3.75	X		0	0
(7) TODD HANCOCK...................................................................... GSHS PRESIDENT/CEO	1.0 ................. 39.0	X	X	662,266	114,579
(8) KEITH HONEY...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(9) TED HUFFHINES...................................................................... VICE CHAIRMAN	1.0 ................. 1.0	X	X	0	0
(10) MITTIE HUTCHINS...................................................................... DIRECTOR	1.5 ................. 0.0	X		0	0
(11) LESTER LUCY...................................................................... DIRECTOR (THRU 1/18)	3.5 ................. 0.0	X		0	0
(12) GEORGE MEISENHEIMER...................................................................... DIRECTOR	1.5 ................. 0.0	X		0	0
(13) TRUNG NGUYEN MD...................................................................... MEDICAL STAFF VICE PRESIDENT	1.5 ................. 38.5	X	X	191,031	8,785
(14) HOMER ROCKMORE...................................................................... DIRECTOR	3.5 ................. 0.0	X		0	0
(15) JULIE SIMMONS...................................................................... DIRECTOR	1.5 ................. 0.0	X	X	0	0
(16) ALLEN STAGGERS...................................................................... DIRECTOR	1.5 ................. 0.0	X		0	0
(17) THOMAS TIBILETTI...................................................................... DIRECTOR	3.75 ................. 3.75	X		0	0

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) MICHAEL CHEEK........................................................................ CHIEF FINANCIAL OFFICER	12.0 .......................28.0	X				0	296,387	50,468
(19) JASON ADAMS........................................................................ CHIEF OPERATING OFFICER	40.0 .......................0.0		X			0	678,273	97,042
(20) JOHN MCDONALD DO........................................................................ MEDICAL STAFF	30.0 .......................10.0		X			0	267,265	10,571
(21) RICKY A PAUL MD........................................................................ MEDICAL STAFF PRESIDENT	30.0 .......................10.0		X			0	624,351	22,163
(22) LARRY VERFURTH DO........................................................................ CMO(THRU 8/18)	5.0 .......................35.0		X			0	603,793	28,513
(23) DUSTIN MCDERMOTT........................................................................ CRNA	40.0 .......................0.0			X		461,512	0	12,675
(24) RICHARD L HOLLADAY........................................................................ CRNA	40.0 .......................0.0			X		329,369	0	4,135
(25) LEE A HOLLADAY........................................................................ CRNA	40.0 .......................0.0			X		307,422	0	13,542
(26) ZACKARY G LISTER........................................................................ CRNA	40.0 .......................0.0			X		292,362	0	10,509
(27) ROGER C BRYANT JR........................................................................ CRNA	40.0 .......................0.0			X		279,005	0	11,933
(28) STEVE ALTMILLER........................................................................ FORMER GSHS PRESIDENT/CEO	0.0 .......................0.0				X	0	886,253	9,609
(29) RAY DELK........................................................................ VP OPERATIONS	0.0 .......................0.0				X	0	508,499	9,348

(A) Name and business address	(B) Description of services	(C) Compensation
MORRISON MANAGEMENT SPECIALISTS, PO BOX 102289 ATLANTA,GA303682289	CAFETERIA SERVICES	5,657,670
HOSPITAL HOUSEKEEPING SYSTEMS LTD, PO BOX 826 SAN ANTONIO,TX782930826	JANITORIAL SERVICES	4,961,020
UNIVERSITY OF TEXAS HEALTH SCIENCE, 11937 US HIGHWAY 271 TYLER,TX757083154	MEDICAL SERVICES	3,984,526
ACUTE CARE SPECIALIST LLC, 2393 HG MOSLEY BLDG4 LONGVIEW,TX756043665	MEDICAL SERVICES	2,103,266
ALLIANT INSURANCE SERVICES INS, 5847 SAN FELIPE STE 2750 HOUSTON,TX77057	INSURANCE SERVICES	2,078,304
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 34

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

CHRISTUS Good Shepherd Medical Center

Employer identification number

75-0974351

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

CHRISTUS Good Shepherd Medical Center

Employer identification number

75-0974351

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization CHRISTUS Good Shepherd Medical Center

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization CHRISTUS Good Shepherd Medical Center		Employer identification number 75-0974351

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization CHRISTUS Good Shepherd Medical Center			Employer identification number 75-0974351
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

CHRISTUS Good Shepherd Medical Center

Employer identification number

75-0974351

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

887

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

887

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1D	AT THE STATE LEVEL, HAD DIRECT CONTACT WITH MEMBERS OF THE TEXAS LEGISLATURE AND THEIR RESPECTIVE STAFF THROUGH EMAILS, LETTERS, TELEPHONE CALLS AND MEETINGS ON ISSUES RELATED TO MEDICAID REIMBURSEMENT, ACCESS TO HEALTHCARE AND STATE FUNDING FOR SAFETY NET PROVIDERS, GRADUATE MEDICAL EDUCATION, TRAUMA NETWORK AND SERVICES, AND THE 1115 WAIVER PROGRAM. AT THE FEDERAL LEVEL, HAD DIRECT CONTACT WITH MEMBERS AND STAFF THROUGH EMAILS, LETTERS, TELEPHONE CALLS AND MEETINGS TO DISCUSS ISSUES RELATED TO SAFETY-NET PROVIDERS, ACCESS TO CARE, HEALTHCARE REFORM PROPOSALS, QUALITY PROGRAM IMPLEMENTATION, RURAL HOSPITALS, REMOTE MEDICAL TECHNOLOGY, 340B DRUG PROGRAM, CHILDRENS HEALTH ISSUES, CHIP REAUTHORIZATION, RURAL HEALTH PROGRAM REAUTHORIZATION, AND HEALTHCARE FOR VETERANS. EXECUTIVE HOURS 4

Return Reference

Explanation

PART II-B, LINE 1D

AT THE STATE LEVEL, HAD DIRECT CONTACT WITH MEMBERS OF THE TEXAS LEGISLATURE AND THEIR RESPECTIVE STAFF THROUGH EMAILS, LETTERS, TELEPHONE CALLS AND MEETINGS ON ISSUES RELATED TO MEDICAID REIMBURSEMENT, ACCESS TO HEALTHCARE AND STATE FUNDING FOR SAFETY NET PROVIDERS, GRADUATE MEDICAL EDUCATION, TRAUMA NETWORK AND SERVICES, AND THE 1115 WAIVER PROGRAM. AT THE FEDERAL LEVEL, HAD DIRECT CONTACT WITH MEMBERS AND STAFF THROUGH EMAILS, LETTERS, TELEPHONE CALLS AND MEETINGS TO DISCUSS ISSUES RELATED TO SAFETY-NET PROVIDERS, ACCESS TO CARE, HEALTHCARE REFORM PROPOSALS, QUALITY PROGRAM IMPLEMENTATION, RURAL HOSPITALS, REMOTE MEDICAL TECHNOLOGY, 340B DRUG PROGRAM, CHILDRENS HEALTH ISSUES, CHIP REAUTHORIZATION, RURAL HEALTH PROGRAM REAUTHORIZATION, AND HEALTHCARE FOR VETERANS. EXECUTIVE HOURS 4

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CHRISTUS Good Shepherd Medical Center

Employer identification number

75-0974351

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	601,681		601,681
b	Buildings ....	149,415,194	95,814,061	53,601,133
c	Leasehold improvements	5,730,345	4,103,307	1,627,038
d	Equipment ....	75,826,362	69,285,272	6,541,090
e	Other .....	3,802,676	3,338,736	463,940
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				62,834,882

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	0

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)INTERCOMPANY RECEIVABLE				21,379,001
(2)OTHER RECEIVABLES				22,495,604
(3)MALPRACTICE REINSURANCE				389,200
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				44,263,805

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	37,649,634
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
FORM 990, SCHEDULE D, PART X	UNCERTAIN TAX POSITIONS UNDER ASC 740 PER FOOTNOTE 3 IN THE CONSOLIDATED FINANCIAL STATEMENTS, THERE ARE NO MATERIAL UNRECORDED TAX LIABILITIES AS OF SEPTEMBER 30, 2018 AND 2017.

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CHRISTUS Good Shepherd Medical Center

Employer identification number

75-0974351

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	38,953,122		38,953,122	14.380 %
b	Medicaid (from Worksheet 3, column a) . . . . .	44,399,182	55,848,239
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	1,306,081	616,049	690,032	0.250 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	84,658,385	56,464,288	39,643,154	14.630 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .	5,663,655	1,762,442	3,901,213	1.440 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	903,324		903,324	0.330 %
j	Total. Other Benefits . .	6,566,979	1,762,442	4,804,537	1.770 %
k	Total. Add lines 7d and 7j .	91,225,364	58,226,730	44,447,691	16.400 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

-49,600,991

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

99,553,996

Enter Medicare allowable costs of care relating to payments on line 5.....

98,033,481

Subtract line 6 from line 5. This is the surplus (or shortfall)........

1,520,515

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?2Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)						Facility reporting group
1	CHRISTUS GOOD SHEPHERD MEDICAL CENTER 811 SOUTH WASHINGTON AVE MARSHALL,TX75670 www.christushealth.org/good-shepherd 000020	X	X		X	A
2	THE GOOD SHEPHERD HOSPITAL INC 700 E MARSHALL AVE LONGVIEW,TX75601 www.christushealth.org/good-shepherd 000020	X	X	X	X	A

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	A
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V, SECTION C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.%
and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, SECTION C

The FAP application form was widely available on a website (list url):

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	A
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	A
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
FORM 990, SCHEDULE H, PART V, SECTION B, LINE 3E	ADDRESSING SIGNIFICANT COMMUNITY NEEDS IN RESPONSE TO THE RESULTS OF THE 2017 CHNA, THE HOSPITALS BOARD OF DIRECTORS AND MANAGEMENT TEAM DEVELOPED A CHNA IMPLEMENTATION PLAN IN ORDER TO PRIORITIZE AND ADDRESS THE MAJOR COMMUNITY NEEDS. IN REGARDS TO THE #1 COMMUNITY NEED IDENTIFIED IN THE CHNA (LACK OF MENTAL HEALTH PROVIDERS/SERVICES), WE TOOK SEVERAL ACTIONS DURING THE TAX YEAR AND PLAN TO CONTINUE BUILDING UPON THESE STEPS IN THE FUTURE. THESE ACTIONS ARE PRIMARILY TO ADDRESS THE ONGOING ISSUE OF TREATING BEHAVIORAL HEALTH PATIENTS IN OUR EMERGENCY DEPARTMENT AND REFERRING THESE PATIENTS TO OTHER PSYCHIATRIC PROVIDERS. OUR GOAL IS TO BOTH IMPROVE CARE AND PROVIDE SERVICES IN A MORE APPROPRIATE TREATMENT SETTING. FORM 990, SCHEDULE H, PART V, SECTION B, LINE 5 CHRISTUS GOOD SHEPHERD MEDICAL CENTER RECEIVED INPUT FROM REPRESENTATIVES OF THE COMMUNITY WHICH INCLUDED THE FOLLOWING INDIVIDUALS WITH; A.) SPECIALIZED KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH B.) AFFILIATION WITH LOCAL GOVERNMENT, SCHOOLS AND INDUSTRY C.) INVOLVEMENT WITH UNDERSERVED AND MINORITY POPULATIONS. ALL INTERVIEWS WERE CONDUCTED USING A STANDARD QUESTIONNAIRE DEVELOPED BY BKD, LLP, A NATIONAL CPA FIRM THAT PROVIDES TAX AND OTHER ADVISORY SERVICES. THE FOLLOWING INDIVIDUALS PARTICIPATED IN OUR KEY INFORMANT INTERVIEW PROCESS: GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR OF EMERGENCY SERVICES - LONGVIEW GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR GOOD SHEPHERD MEDICAL ASSOCIATES, GASTROENTEROLOGIST GOOD SHEPHERD MEDICAL CENTER, PHARMACY DIRECTOR GOOD SHEPHERD MEDICAL CENTER, DIRECTOR OF REIMBURSEMENT GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR MEDICAL/SURGICAL GOOD SHEPHERD HEALTH SYSTEM, DIRECTOR OF PATIENT ACCESS GOOD SHEPHERD HEALTH SYSTEM, DIRECTOR OF INFECTION CONTROL GOOD SHEPHERD HEALTH SYSTEM, CHIEF INFORMATION OFFICER GOOD SHEPHERD MEDICAL CENTER, DIRECTOR OF EMERGENCY SERVICES (KILGORE) GOOD SHEPHERD HEALTH SYSTEM, EDUCATIONAL SERVICES DIRECTOR GOOD SHEPHERD HEALTH SYSTEM, EMPLOYEE HEALTH DIRECTOR LONGVIEW CITY COUNCILMAN, DISTRICT 5 GOOD SHEPHERD MEDICAL ASSOCIATES, FAMILY NURSE PRACTIONER GOOD SHEPHERD HEALTH SYSTEM, PHYSICIAN SERVICES DIRECTOR GOOD SHEPHERD MEDICAL CENTER, INTERNAL MEDICINE RESIDENCY PROGRAM DIRECTOR GREGG COUNTY HEALTH DEPARTMENT AIR LIFETEAM AIRE RESCUE GOOD SHEPHERD HEALTH SYSTEM, VICE PRESIDENT OF HUMAN RESOURCES COMMUNITY HEALTHCORE, EXECUTIVE DIRECTOR CITY OF LONGVIEW, FIRE CHIEF GOOD SHEPHERD MEDICAL CENTER, IMAGING SERVICES DIRECTOR GOOD SHEPHERD MEDICAL CENTER, LAB SUPERVISOR GOOD SHEPHERD HEALTH SYSTEM, DIRECTOR OF MARKETING COMMUNITY HEALTHCORE, EMPLOYEE RUSK COUNTY HEALTH DISTRICT GOOD SHEPHERD MEDICAL CENTER, PHYSICIAN DIRECTOR OF EMERGENCY SERVICES GOOD SHEPHERD MEDICAL CENTER, INPATIENT REHAB SERVICES DIRECTOR GOOD SHEPHERD MEDICAL ASSOCIATES, PHYSICIAN DIRECTOR INTERNAL MEDICINE CLINIC GOOD SHEPHERD MEDICAL ASSOCIATES, NURSE PRACTIONER LONGVIEW CITY COUNCILWOMAN, DISTRICT 3 GOOD SHEPHERD MEDICAL CENTER, VICE PRESIDENT ANCILLARY SERVICES (MARSHALL) GOOD SHEPHERD MEDICAL CENTER, CHIEF NURSING OFFICER (MARSHALL) LONGVIEW CHAMBER OF COMMERCE, CHIEF EXECUTIVE OFFICER MARSHALL/HARRISON COUNTY HEALTH DISTRICT, EMPLOYEE GOOD SHEPHERD MEDICAL ASSOCIATES, PHYSICIAN LONGVIEW CITY COUNCILWOMAN, DISTRICT 4 GOOD SHEPHERD MEDICAL ASSOCIATES, EXECUTIVE VICE PRESIDENT/COO GOOD SHEPERD MEDICAL CENTER, COMPLIANCE SPECIALIST - QUALITY GOOD SHEPHERD HEALTH SYSTEM, EXECUTIVE DIRECTOR HEALTH & PREVENTION COMMUNITY HEALTHCORE, EMPLOYEE GOOD SHEPHERD MEDICAL CENTER, CHIEF NURSING OFFICER (LONGVIEW) GOOD SHEPHERD MEDICAL CENTER, MEDICAL DIRECTOR SURGICAL SERVICES COMMUNITY HEALTHCORE, EMPLOYEE GOOD SHEPHERD HEALTH SYSTEM, PATIENT EXPERIENCE DIRECTOR GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR ORTHO/NEURO UNIT GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR ONCOLOGY UNIT GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR ANTEPARTUM/MOTHER-BABY UNIT HARRISON COUNTY UNITED WAY GOOD SHEPHERD HEALTH SYSTEM, SENIOR VICE PRESIDENT INTEGRATION & BUSINESS DEVELOPMENT CUMBERLAND PRESBYTERIAN CHURCH OF MARSHALL, REVEREND COMMUNITY HEALTHCORE, EMPLOYEE GOOD SHEPHERD MEDICAL ASSOCIATES, PEDIATRICIAN GOOD SHEPHERD MEDICAL ASSOCIATES, CLINIC DIRECTOR OF OPERATIONS (PRIMARY CARE) GOOD SHEPHERD MEDICAL ASSOCIATES, GASTROENTEROLOGIST GOOD SHEPHERD MEDICAL CENTER, DIRECTOR OF EMERGENCY SERVICES (NORTHPARK) GOOD SHEPHERD MEDICAL CENTER, EMERGENCY MEDICINE PHYSICIAN GOOD SHEPHERD MEDICAL ASSOCIATES, CLINIC DIRECTOR OF OPERATIONS (SPECIALTY CARE) GOOD SHEPHERD MEDICAL CENTER, CLINICAL DIRECTOR LABOR & DELIVERY PINE TREE SCHOOL DISTRICT, SUPERINTENDENT GOOD SHEPHERD HEALTH SYSTEM, CHIEF FINANCIAL OFFICER GOOD SHEPHERD HEALTH SYSTEM, DIRECTOR GOVERNMENT & COMMUNITY RELATIONS GOOD SHEPHERD MEDICAL CENTER, DIRECTOR OF EMERGENCY SERVICES (LONGVIEW) RUSK COUNTY UNITED WAY GOOD SHEPHERD MEDICAL ASSOCIATES, PEDIATRICIAN THE FOLLOWING PRIORITIZED COMMUNITY NEEDS WERE IDENTIFIED THROUGH THE CHNA 1. LACK OF MENTAL HEALTH PROVIDERS/SERVICES 2. OBESITY, DIABETES, HEART DISEASE AND OTHER CHRONIC DISEASES 3. AFFORDABLE PRIMARY AND PREVENTATIVE CARE OPTIONS 4. UNEMPLOYEMENT AND DECREASE IN INCOME IN THE COMMUNITY DUE TO ECONOMIC DOWNTURN 5. HEALTHY BEHAVIORS/LIFESTYLE CHOICES 6. SUBSTANCE ABUSE 7. LACK OF HEALTH KNOWLEDGE/EDUCATION 8. LACK OF COMMUNITY RESOURCES TO PROMOTE HEALTH (FACILITIES, OUTDOOR SPACES) 9. POOR NUTRITION/LIMITED ACCESS TO HEALTHY FOOD OPTIONS 10. UNINSURED/LIMITED INSURANCE DUE TO LACK OF MEDICAID EXPANSION OR HIGH DEDUCTIBLE PLANS 11. ADULT SMOKING/TOBACCO USE 12. CRIME AND VIOLENCE SCHEDULE H, PART V, SECTION B, LINE 6A CHNA CONDUCTED WITH OTHER FACILITIES GOOD SHEPHERD HEALTH SYSTEM OPERATES HOSPITALS IN LONGVIEW AND MARSHALL. THE CHNA WAS CONDUCTED TO INCLUDE BOTH OF THE FOLLOWING SYSTEM HOSPITAL FACILITIES: THE GOOD SHEPHERD HOSPITAL, INC. (D/B/A GOOD SHEPHERD MEDICAL CENTER) HARRISON COUNTY HOSPITAL ASSOCIATION (D/B/A GOOD SHEPHERD MEDICAL CENTER MARSHALL) SCHEDULE H, PART V, SECTION B, LINE 7A THE URLS FOR THE COMMUNITY HEALTH NEEDS ASSESSMENTS ARE: MARSHALL: https://www.christushealth.org/-/media/files/chip/christus-good-shepherd-m arshall-chna-2016 LONGVIEW: https://www.christushealth.org/-/media/files/chip/christus-good-shepherd-l ongview-chna-2016 SCHEDULE H, PART V, SECTION B, LINE 10A THE URLS FOR THE ORGANIZATION'S MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGIES ARE: MARSHALL: https://www.christushealth.org/-/media/files/chip/christus-good-shepherd-m arshall-chip-2017 LONGVIEW: https://www.christushealth.org/-/media/files/chip/christus-good-shepherd-l ongview-chip-2017
FORM 990, SCHEDULE H, PART V, SECTION B, LINE 11	IN RESPONSE TO THE RESULTS OF THE 2017 CHNA, THE HOSPITALS BOARD OF DIRECTORS AND MANAGEMENT TEAM DEVELOPED A CHNA IMPLEMENTATION PLAN IN ORDER TO PRIORITIZE AND ADDRESS THE MAJOR COMMUNITY NEEDS. IN REGARDS TO THE #1 COMMUNITY NEED IDENTIFIED IN THE CHNA (LACK OF MENTAL HEALTH PROVIDERS/SERVICES), WE TOOK SEVERAL ACTIONS DURING THE TAX YEAR AND PLAN TO CONTINUE BUILDING UPON THESE STEPS IN THE FUTURE. THESE ACTIONS ARE PRIMARILY TO ADDRESS THE ONGOING ISSUE OF TREATING BEHAVIORAL HEALTH PATIENTS IN OUR EMERGENCY DEPARTMENT AND REFERRING THESE PATIENTS TO OTHER PSYCHIATRIC PROVIDERS. OUR GOAL IS TO BOTH IMPROVE CARE AND PROVIDE SERVICES IN A MORE APPROPRIATE TREATMENT SETTING. ACTIONS TAKEN TOWARDS ADDRESSING THE #1 NEED INCLUDED: - HIRED A FULL TIME PSYCHIATRIST AND BEHAVIORAL HEALTH TECHNICIANS. - CREATED A NEW CLINICAL DIRECTOR OF BEHAVIORAL HEALTH POSITION THAT IS STAFFED BY A BOARD-CERTIFIED PSYCHIATRIC NURSE. - REMODELED SIX EMERGENCY ROOMS AND SIX INPATIENT ROOMS SPECIFICALLY FOR USE AS A PSYCH-SAFE DELIVERY SPACES. - ENGAGED A TELE-PSYCHIATRY SERVICE PROVIDER TO HELP EXPEDITE PSYCH PATIENT EVALUATIONS - HOSTED THE FIRST ANNUAL BEHAVIORAL HEALTH COLLABORATION CONFERENCE WITH LAW ENFORCEMENT, LOCAL MENTAL HEALTH PROVIDERS AND COUNTY JUDGES. ALSO, CONTINUE TO HOST QUARTERLY COMMUNITY-WIDE BEHAVIORAL HEALTH MEETINGS. - PROVIDED SAME DE-ESCALATION TRAINING TO HELP PREVENT PSYCHIATRIC PATIENT AGGRESSION FROM BEING PHYSICALLY HARMFUL. - PROVIDED 800 PSYCHIATRIC PATIENT TRANSPORTS TO SHORT-TERM REGIONAL CRISIS STABILIZATION CENTERS, LOCAL INPATIENT FACILITIES AND STATE OPERATED PSYCHIATRIC HOSPITALS. - CONTINUED A SPECIAL PROJECT FUNDED THROUGH THE TEXAS MEDICAID WAIVER WITH CMS TO INTEGRATE PSYCHIATRIC PATIENTS INTO OUR PATIENT CENTER MEDICAL HOME WITHIN AN INTERNAL MEDICINE CLINIC. WE ALSO CONTINUE TO EMPLOY PATIENT CARE NAVIGATORS (PCNS) WHO EVALUATE AND REFER PATIENTS TO COMMUNITY HEALTHCORE (THE REGIONAL MENTAL HEALTH AUTHORITY), AND OTHER OUTPATIENT PSYCHIATRIC SERVICE PROVIDERS. - HOSPITAL MANAGERS HAVE ALSO BEGAN PARTICIPATING IN A SPECIAL CITY OF LONGVIEW TASK FORCE DEVELOPED BY THE MAYOR TO ADDRESS ISSUES (INCLUDING PSYCHIATRIC AND SUBSTANCE ABUSE NEEDS) INVOLVING THE CITYS HOMELESS POPULATION. THE AFOREMENTIONED ACTIONS WILL ALSO ADDRESS COMMUNITY NEED #6 (SUBSTANCE ABUSE) AND INDIRECTLY CONTRIBUTE TO A REDUCTION IN NEED #12 (CRIME AND VIOLENCE) DUE TO HIGH CRIME AND VIOLENCE RECIDIVISM OF UNTREATED PSYCHIATRIC AND SUBSTANCE ABUSE PATIENTS. IN REGARDS TO THE REMAINING COMMUNITY NEEDS, THE HOSPITAL WILL CONTINUE TO OFFER A WIDE RANGE OF SERVICES, PROGRAMS, EDUCATION AND TRAINING TO ADDRESS NEED #S 2, 5, 7, AND 11. ISSUE #8 IS PARTIALLY ADDRESSED BY STATE-OF-THE-ART FITNESS CENTER, INCLUDING FITNESS SCHOLARSHIPS OFFERED TO LOW INCOME PATIENTS WITH SIGNIFICANT HEALTH PROBLEM, NEED #S 3 AND 10 ARE ADDRESSED BY SPECIAL IN-HOUSE PROGRAMS TO ASSIST THE UNINSURED, INCLUDING PAYMENT DISCOUNT PROGRAMS, CERTIFIED APPLICATION COUNSELORS TO ASSIST PATIENTS WITH ACCESS TO THE FEDERAL HEALTH INSURANCE MARKETPLACE, CHARITY POLICIES AND REFERRALS TO LOCAL FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS). MORE DETAILS REGARDING OUR CHNA IMPLEMENTATION STRATEGY MAY BE FOUND AT https://www.christushealth.org/about/donate/community-health/community-hea lth-needs-assessment-and-implementation-plan. COMMUNITY NEEDS NOT ADDRESSED: AREAS OF NEED NOT SPECIFICALLY ADDRESSED BY THE HOSPITAL INCLUDE NEED #4 (UNEMPLOYMENT AND DECREASE IN INCOME DUE TO ECONOMIC DOWNTURN), #9 (POOR NUTRITION/LIMITED ACCESS TO HEALTHY FOODS) AND DIRECT ACTION TO MEET #12 (CRIME AND VIOLENCE). WHILE MEMBERS OF HOSPITAL MANAGEMENT PARTICIPATE IN LOCAL GROUPS AND COMMITTEES FORMED TO PROMOTE ECONOMIC GROWTH AND JOBS, THE HOSPITAL DOES NOT CHOOSE TO DIRECTLY ADDRESS ECONOMIC MATTERS OF THE COMMUNITY DUE TO OUR FINANCIAL LIMITATIONS. ALSO, WHILE THE HOSPITAL PROVIDES SOME EDUCATION TO PATIENTS REGARDING PROPER DIET, WE DO NOT HAVE THE RESOURCES OR ABILITY TO ENSURE THAT IMPOVERISHED POPULATIONS ENJOY NUTRITIONAL AND VARIED FOOD OPTIONS DELIVERED TO FOOD DESERTS. FINALLY, IT IS NOT CONSIDERED A HOSPITAL ROLE TO CONFRONT RISING CRIME AND VIOLENCE THROUGH DIRECT ENFORCEMENT ACTIONS. SCHEDULE H, PART V, SECTION B, LINE 16A THE FAP AND PLAIN LANGUAGE SUMMARY WERE WIDELY AVAILABLE AT THE FOLLOWING URL: https://www.christushealth.org/-/media/patient-resources/good-shepherd/lon gview-financial-assistance/plsgoodshepherd_english.ashx?la=en SCHEDULE H, PART V, SECTION B, LINE 16B THE FAP APPLICATION WAS WIDELY AVAILABLE AT THE FOLLOWING URL: https://www.christushealth.org/-/media/Files/Finance-Files/Application-Eng lish SCHEDULE H, PART V, SECTION B, LINE 16C THE PLAIN LANGUAGE SUMMARY WAS WIDELY AVAILABLE AT THE FOLLOWING URL: https://www.christushealth.org/-/media/patient-resources/good-shepherd/lon gview-financial-assistance/plsgoodshepherd_english.ashx?la=en
FORM 990, SCHEDULE H, PART V, SECTION B, LINE 16J	A NOTIFICATION WAS PLACED IN THE NEWSPAPERS WITHIN THE TWO LARGEST CITIES IN THE HOSPITAL SERVICE AREA (LONGVIEW AND MARSHALL) WHICH EXPLAINED THE AVAILABLILITY OF A FINANCIAL ASSISTANCE POLICY AND INCLUDED AN INVITATION TO SPEAK WITH A FINANCIAL COUNSELOR AND ALSO REFERENCED THE WEB-SITE WHICH PROVIDES ADDITIONAL FINANCIAL ASSISTANCE DETAILS. IN ADDITION, IN AN EFFORT TO MORE WIDELY PUBLICIZE OUR FINANCIAL ASSISTANCE WITHIN OUR COMMUNITY, INCLUDING PERSONS MORE LIKELY TO REQUIRE FINANCIAL ASSISTANCE, WE SUBMITTED A COPY OF OUR PLAIN LANGUAGE FINANCIAL ASSISTANCE POLICY TO A NUMBER OF ORGANIZATIONS THAT INTERACT WITH POOR POPULATION GROUPS. THESE ORGANIZATIONS INCLUDE COUNTY HEALTH DEPARTMENTS, FQHCS, VARIOUS NON-PROFITS AND MINISTRIES SUPPORTED BY THE UNITED WAY AND OTHER AGENCIES SERVING THE POOR. FORM 990, SCHEDULE H, PART V, SECTION B, LINE 20E EFFORTS TO INITATE EFFORTS FROM LINE 19 CHRISTUS HEALTH USES AN OUTSIDE VENDOR, PARO DECISION SUPPORT, LLC, WHICH UTILIZES PUBLIC RECORDS TO MODEL PRESUMPTIVE CHARITY. THE VENDORS SOCIO-ECONOMIC MODEL IS DESIGNED TO ELIMINATE BARRIERS MANY PATIENTS FACE TO TRADITIONAL APPLICATION PROCESSES WHICH MIGHT INCLUDE LITERACY AND UNDERSTANDING OF FORMS, DOCUMENTATION, OR CULTURAL BARRIERS THAT PRECLUDE THEM FROM SEEKING ASSISTANCE. THE MODEL PROJECTS FAMILY SIZE AND INCOME LEVELS WHICH IS USED TO PRESUMPTIVELY DETERMINE QUALIFICATION UNDER THE HOSPITAL FINANCIAL ASSISTANCE POLICY; THEREBY, EXTENDING OUR OUTREACH FOR FINANCIAL ASSISTANCE WITHIN OUR COMMUNITIES. FORM 990, SCHEDULE H, PART V, SECTION B, LINE 22D DETERMINATION OF AMOUNTS BILLED THE FINANCIAL ASSISTANCE ELIGIBILITY DISCOUNT GUIDELINES IN PLACE DURING TAX YEAR 2015 STATED, 'ALL UNINSURED PATIENTS WHO QUALIFY FOR LESS THAN 68% FINANCIAL ASSISTANCE AND COMPLETE THE NECESSARY APPLICATION PROCESS, WILL RECEIVED THE DISCOUNT UNDER THE UNINSURED ADJUSTMENT. THIS AMOUNT IS BASED ON AN AVERAGE OF GSHS MANAGED CARE CONTRACTS DEEPEST DISCOUNTS.' IN THE YEAR 2016, THE HOSPITAL CHANGED TO USING MEDICARE RATES TO CALCULATE MAXIMUM AMOUNTS THAT CAN BE CHARGED.

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?6
Name and address		Type of Facility (describe)
1	CHRISTUS Good Shepherd LifeCenter 612 S Grove St Marshall,TX75670	HEALTH CLINIC
2	CHRISTUS Good Shepherd Home Care 401 S Bolivar St Marshall,TX75670	HEALTH CLINIC
3	Marshall Health Clinic 805 Lindsey Drive Marshall,TX75670	Health Clinic
4	East Texas Pediatrics 618 S Grove Street Ste 100 Marshall,TX75670	Health Clinic
5	Marshall Pediatric Clinic 707 S Grove Street Marshall,TX75670	Health Clinic
6	First In Pediatrics 304 University Ste 105 Marshall,TX75670	Health Clinic
7
8
9
10

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
SCHEDULE H, PART I, LINE 3C	CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE THE HOSPITAL FOLLOWS FINANCIAL ASSISTANCE POLICIES OF CHRISTUS HEALTH. THE QUALIFICATION THRESHOLD FOR FINANCIAL ASSISTANCE IS 400% OF FPG. ELIGIBILITY FOR FREE CARE (100% DISCOUNTS) IS AT OR BELOW 200% FPG. SCHEDULE H, PART I, LINE 6A ANNUAL COMMUNITY BENEFIT REPORT A COMMUNITY BENEFIT REPORT IS PREPEARED FOR THE HOSPITAL EACH YEAR AND IS SUBMITTED ALONG WITH AN AHA SURVEY TO THE TEXAS DEPARTMENT OF STATE HEALTH SERVICES WITH A COPY PROVIDED TO HARRISON COUNTY AND GREGG COUNTY.
FORM 990, SCHEDULE H, PART I	RETROACTIVE APPLICATION OF PRESUMPTIVE CHARITY DURING THE CURRENT TAX YEAR, CHRISTUS GOOD SHEPHERD HOSPITALS IN LONGVIEW AND MARSHALL FULLY IMPLEMENTED CHRISTUS HEALTH PRACTICES REGARDING USE OF PRESUMPTIVE CHARITY ELIGIBILITY TO DETERMINE QUALIFICATION FOR FINANCIAL ASSISTANCE. THIS CHANGE NOT ONLY IMPACTED ACTIVE ACCOUNTS IN FISCAL YEAR 2018, BUT ALSO INCLUDED A LOOK BACK OF DATES OF SERVICE STARTING IN JULY 2016 TO DETERMINE PAST ACCOUNTS THAT MAY HAVE BEEN MISCLASSIFIED BETWEEN CHARITY AND BAD DEBT. AS A RESULT A NUMBER OF ACCOUNTS WERE RETROACTIVELY QUALIFIED FOR CHARITY. THIS CHANGE IN CLASSIFICATION RESULTED IN AN INCREASE IN CHARITY DEDUCTIONS FROM $22,462,422 IN FISCAL YEAR 2017 TO $273,083,131 IN FISCAL YEAR 2018 AND A DECREASE IN BAD DEBT PROVISIONS FROM $177,232,621 IN FISCAL YEAR 2017 TO A CREDIT OF $(49,600,991) IN FISCAL YEAR 2018. FORM 990, SCHEDULE H, PART I, LINES 7A & 7B ALLOCATION OF MEDICAID SUPPLEMENTAL PAYMENTS DURING THE CURRENT REPORTING PERIOD, THE STATE OF TEXAS PARTICIPATED IN A SPECIAL 1115 MEDICAID WAIVER WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS). VARIOUS SUPPLEMENTAL PAYMENTS UNDER THE WAIVER ARE INTENDED TO HELP HOSPITALS OFFSET MEDICAID AND UNINSURED LOSSES AND/OR CREATE NEW PROGRAMS DESIGNED TO IMPROVE THE PATIENT CARE EXPERIENCE, ENHANCE HEALTH OUTCOMES AND REDUCE COSTS FOR THESE SAME PATIENT POPULATIONS. SUPPLEMENTAL PAYMENTS ARE CAPPED BY MEDICAID AND UNINSURED LOSSES DETERMINED FROM A SPECIAL UNCOMPENSATED CARE (UC) TOOL DESIGNED BY THE TEXAS HEALTH AND HUMAN SERVICES COMMISSION (HHSC). IN FISCAL YEAR 2018, THE HOSPITAL RECOGNIZED $26,775,022 OF SUPPLEMENTAL PAYMENT INCOME UNDER THE MEDICAID WAIVER. FOR PURPOSES OF IRS FORM 990 SCHEDULE H REPORTING, CONSISTENT WITH CHRISTUS HEALTH POLICY, 100% OF NET MEDICAID SUPPLEMENTAL PAYMENTS ARE REPORTED AS MEDICAID DIRECT OFFSETING REVENUE. CASH CONTRIBUTIONS- DURING TAX YEAR 2016 GOOD SHEPHERD MEDICAL CENTER MARSHALL ENTERED INTO THREE YEAR AFFILIATION AGREEMENTS WITH A LOCAL FEDERALLY QUALIFIED HEALTH CENTER (FQHC). THE PURPOSE OF THESE AGREEMENTS WAS TO PROVIDE ACCESSIBLE, HIGH QUALITY HEALTH CARE SERVICES, AS WELL AS UNCOMPENSATED CARE FOR PATIENTS WITH LITTLE OR NO INSURANCE, WHILE PROMOTING GENERAL PUBLIC HEALTH AND IMPROVING THE HEALTH STATUS OF CITIZENS LIVING IN MARSHALL, TEXAS. AS PART OF THESE AGREEMENTS, GSMC MARSHALL MADE GRANTS TO COVER OPERATING SHORTFALLS OF FAMILY PRACTICE AND PEDIATRIC CLINICS OF FQHC OPERATED CLINICS IN MARSHALL. CASH CONTRIBUTIONS TOTALLING $725,291 WERE MADE TO THE FQHC DURING THE CURRENT YEAR TO COVER SUCH LOSSES. DURING THE CURRENT TAX YEAR, GOOD SHEPHERD MEDICAL CENTER - LONGVIEW ENTERED INTO A THREE YEAR COMMUNITY BENEFIT GRANT RELATED TO WOMEN AND CHILDREN'S SERVICES WITH WELLNESS POINTE, A LOCAL FEDERALLY QUALIFIED HEALTH CENTER (FQHC). GRANT PAYMENTS TOTALLING $116,250 WERE MADE TO WELLNESS POINTE THIS YEAR.
FORM 990, SCHEDULE H, PART I, LINE 7, COL (F)	BAD DEBT EXPENSE BAD DEBT IN THE AMOUNT OF -$49,600,991, WAS NOT INCLUDED IN TOTAL EXPENSE USED TO COMPUTE THE PERCENTAGE REPORTED IN PART I, LINE 7 COL (F). SCHEDULE H, PART I, LINE 7 LINE 7A: RATIO OF PATIENT CARE COST TO CHARGES BASED ON SCHEDULE H, WORKSHEET 2 LINE 7B: RATIO OF PATIENT CARE COST TO CHARGES BASED ON SCHEDULE H, WORKSHEET 2 LINE 7E: ACTUAL EXPENSES LESS ANY DIRECT OFFSETTING REVENUE LINE 7F: ACTUAL EXPENSES LESS ANY DIRECT OFFSETTING REVENUE LINE 7I: ACTUAL EXPENSE OF THE CONTRIBUTIONS SCHEDULE H, PART III, SECTION A, LINE 1 BAD DEBT REPORTING IN ACCORDANCE WITH HFMA STATEMENT 15 CHRISTUS HEALTH FOLLOWS IN PRINCIPLE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. THE SYSTEM HAS ADOPTED AN UNCOMPENSATED CARE POLICY WHERE REVENUE FROM SERVICES PROVIDED TO THE UNINSURED IS RECOGNIZED AT THE TIME OF PAYMENT, RATHER THAN AT THE TIME OF SERVICE. THIS POLICY IS THE RESULT OF A LACK OF REASONABLE ASSURANCE OF COLLECTION FOR SERVICES PROVIDED TO THE UNINSURED DUE TO THE SYSTEM'S HISTORICALLY LOW COLLECTION RATE. MANAGEMENT HAS ESTIMATED THAT THE DIFFERENCE BETWEEN RECORDING REVENUE FROM THE UNINSURED ON A CASH BASIS, RATHER THAN THE ACCRUAL BASIS, IS IMMATERIAL. ACCORDINGLY, ALL ACCOUNTS RECEIVABLE FROM THE UNINSURED HAVE BEEN FULLY RESERVED IN THE ALLOWANCE FOR UNCOMPENSATED CARE. SCHEDULE H, PART III, SECTION A, LINE 2 METHODOLOGY USED IN DETERMINING BAD DEBT THE ORGANIZATION'S TOTAL BAD DEBT EXPENSE (TOTAL OF ALL HOSPITAL FACILITIES) IS IN ACCORDANCE WITH THE ORGANIZATION'S FINANCIAL STATEMENTS, WHICH IS COMPUTED AS BAD DEBT NET OF CONTRACTUAL ALLOWANCE, PAYMENTS RECEIVED AND RECOVERIES OF BAD DEBT PREVIOUSLY WRITTEN OFF. SCHEDULE H, PART III, SECTION A, LINE 3 ESTIMATE OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER ORGANIZATION'S CHARITY CARE POLICY THE FILING ORGANIZATION RECOGNIZES THAT SOME PATIENTS ARE UNABLE OR UNWILLING TO SEEK FINANCIAL ASSISTANCE DUE TO BARRIERS SUCH AS EDUCATIONAL LEVEL, LITERACY, DOCUMENTATION REQUIREMENTS, OR BEING INTIMIDATED BY THE APPLICATION PROCESS. IN ORDER TO ESTIMATE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAVE NOT SUBMITTED AN APPLICATION, THE ORGANIZATION ENGAGED PARO DECISION SUPPORT, LLC. PARO CHARITY SCORE IS DESIGNED TO IDENTIFY PATIENTS THAT LIKELY QUALIFY FOR FINANCIAL ASSISTANCE BASED ON A PREDICTIVE MODEL AND OTHER FINANCIAL AND ASSET ESTIMATES FOR THE PATIENT DERIVED FROM PUBLIC RECORD SOURCES. IN ORDER TO ASSESS THE BAD DEBT ACCOUNTS THAT WOULD LIKELY QUALIFY FOR CHARITY CARE, THE FOLLOWING CRITERIA WERE ESTABLISHED BASED ON AN ANALYSIS OF HISTORICAL DATA OF CHRISTUS HEALTH AND ITS RELATED ORGANIZATIONS: 1. PARO SCORE OF LESS THAN OR EQUAL TO 586, WHICH IS A PREDICTOR DEFINING THE LIKELY SOCIOECONOMIC CONDITIONS FOR THE PATIENT; 2. ESTIMATED FEDERAL POVERTY LEVEL OF LESS THAN OR EQUAL TO 226%, WHICH IS BASED ON ESTIMATED HOUSEHOLD SIZE AND HOUSEHOLD ESTIMATED INCOME; AND 3. THIRD PARTY DATA AVAILABLE ON PATIENT ACCOUNTS WHICH INDICATE THAT THE PATIENT IS NOT A HOMEOWNER OR A PROBABLE HOMEOWNER. FOR THE FISCAL YEAR ENDING JUNE 30, 2011, THE ORGANIZATION REPORTED THAT 30% OF BAD DEBT EXPENSES WERE ATTRIBUTABLE TO PATIENTS WHO MAY HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE BUT WERE NOT RESPONSIVE TO THE APPLICATION PROCESS EXISTING AT THAT TIME. THIS FIGURE WAS BASED ON THE PARO ANALYSIS AND ESTIMATES OF PATIENTS' FINANCIAL NEEDS THAT EXAMINED WHETHER PATIENTS WERE CHARACTERISTIC OF OTHERS WHO HISTORICALLY QUALIFIED FOR ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. THE PRESUMPTIVE CHARITY CARE ANALYSIS PERFORMED FOR THE PRIOR FISCAL YEAR DETERMINED A BENCHMARK OF BAD DEBT ACCOUNTS IN THE CHRISTUS HEALTH SYSTEM THAT LACKED THE INFORMATION TO QUALIFY FOR CHARITY CARE UNDER THE FILING ORGANIZATION'S CUSTOMARY PROCESS BUT WOULD HAVE LIKELY QUALIFIED FOR ASSISTANCE. DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2018, THE ORGANIZATION UTILIZED THE PARO SCORE TO IDENTIFY THE ACCOUNTS OF INDIVIDUAL PATIENTS THAT WERE LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE DESPITE HAVING NOT COMPLETED AN APPLICATION, AND SUCH ANALYSIS DETERMINED THAT 28.75% OF SUCH ACCOUNTS WERE LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE. THE ORGANIZATION GRANTED PRESUMPTIVE ELIGIBILITY FOR THESE ACCOUNTS AND THEY WERE RECLASSIFIED UNDER OUR FINANCIAL ASSISTANCE POLICY. THE AMOUNTS WERE NOT REPORTED AS BAD DEBT. THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 3 IS THE DIFFERENCE BETWEEN THE PRESUMPTIVE CHARITY CARE BENCHMARK ESTABLISHED IN THE FISCAL YEAR ENDING JUNE 30, 2011 AND THE AGGREGATE OF INDIVIDUAL ACCOUNTS FOR WHICH THE ORGANIZATION GRANTED PRESUMPTIVE ELIGIBILITY IN THE FISCAL YEAR ENDING SEPTEMBER 30, 2018. THUS, THE ORGANIZATION ESTIMATES THAT ONLY 3.73% OF THE BAD DEBT EXPENSES IN FISCAL YEAR ENDING SEPTEMBER 30, 2018 ARE ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY HAVE QUALIFIED FOR FINANCIAL ASSISTANCE. IT IS IMPORTANT TO NOTE THAT THE FIGURE CALCULATED FOR FISCAL YEAR ENDING JUNE 30, 2011 WAS ESTIMATED AND NOT EXACT, AND THEREFORE THE DIFFERENCE BETWEEN THE AMOUNTS QUALIFIED AS PRESUMPTIVE CHARITY CARE IN ANY FISCAL YEAR MAY VARY FROM THE BENCHMARK ESTABLISHED IN FISCAL YEAR ENDING JUNE 30, 2011. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE THE FOOTNOTE TO THE CHRISTUS HEALTH CONSOLIDATED FINANCIAL STATEMENTS SAYS, "THE PREPARATION OF THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS IN CONFORMITY WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES (US GAAP) REQUIRES MANAGEMENT OF THE SYSTEM TO MAKE ASSUMPTIONS, ESTIMATES, AND JUDGMENTS THAT AFFECT THE AMOUNTS REPORTED IN THE FINANCIAL STATEMENTS, INCLUDING THE NOTES THERETO, AND RELATED DISCLOSURES OF COMMITMENTS AND CONTINGENCIES, IF ANY. THE SYSTEM CONSIDERS CRITICAL ACCOUNTING POLICIES TO BE THOSE THAT REQUIRE MORE SIGNIFICANT JUDGMENTS AND ESTIMATES IN THE PREPARATION OF ITS FINANCIAL STATEMENTS, INCLUDING THE FOLLOWING: RECOGNITION OF NET PATIENT SERVICE REVENUES, WHICH INCLUDE CONTRACTUAL ALLOWANCES AND THE PROVISION FOR BAD DEBT; ESTIMATES FOR REIMBURSEMENT UNDER THE UPPER PAYMENT LIMIT, DISPROPORTIONATE SHARE AND MEDICAID 1115 WAIVER PROGRAMS; RESERVES FOR LOSSES AND EXPENSES RELATED TO HEALTH CARE PROFESSIONAL AND GENERAL LIABILITIES; ACCRUAL FOR CLAIMS INCURRED BUT NOT YET REPORTED RELATED TO THE SYSTEM'S HEALTH PLAN; DETERMINATION OF FAIR VALUES OF CERTAIN FINANCIAL INSTRUMENTS; DETERMINATION OF FAIR VALUE OF CERTAIN GOODWILL AND LONG-LIVED ASSETS, INCLUDING ASSETS ACQUIRED; AND RISKS AND ASSUMPTIONS FOR MEASUREMENT OF PENSION AND RETIREE MEDICAL LIABILITIES. MANAGEMENT RELIES ON HISTORICAL EXPERIENCE AND ON OTHER ASSUMPTIONS BELIEVED TO BE REASONABLE UNDER THE CIRCUMSTANCES IN MAKING ITS JUDGMENTS AND ESTIMATES. ACTUAL RESULTS COULD DIFFER MATERIALLY FROM THESE 'ESTIMATES.'"
FORM 990, SCHEDULE H, PART III, LINE 8	COSTING METHODOLOGY THE SOURCE OF INFORMATION ON LINES 5 AND 6 IS THE FISCAL PERIOD ENDED SEPTEMBER 30, 2018 MEDICARE COST REPORT. THE REVENUES WERE DERIVED FROM COST REPORT WORKSHEETS E PART A, E PART B AND E-3, PART III. COST INFORMATION WAS OBTAINED BY SUMMING OF MEDICARE PART A ALLOWABLE COSTS REPORTED ON WORKSHEET D-1, PART II (FOR BOTH INPATIENT ACUTE PPS AND INPATIENT REHAB FACILITY) AND WORKSHEET DV, COLUMNS 5.00 THROUGH 7.00 FOR MEDICARE OUTPATIENT PPS SERVICES. SINCE ALLOWABLE COSTS ARE NOT DETERMINED FOR SERVICES RENDERED TO MEDICARE PATIENTS ENROLLED IN MEDICARE ADVANTAGE (MEDICARE PART C) OR FOR PHYSICIAN SERVICES BILLED UNDER MEDICARE PART B, NEITHER THE REVENUES OR COSTS RELATED TO THESE SERVICES HAVE BEEN INCLUDED ON LINES 5 OR 6. THE COST REPORT USES FINANCIAL AND STATISTICAL DATA TO DEVELOP PER DIEMS AND COST TO CHARGE RATIOS THAT ULTIMATELY DETERMINE ALLOWABLE MEDICARE INPATIENT AND OUTPATIENT COSTS. (NOTE: EFFECTIVE AUGUST 1, 2017, THE LICENSE AND MEDICARE PROVIDER NUMBER OF GOOD SHEPHERD MEDICAL CENTER - LONGVIEW AND GOOD SHEPHERD MEDICAL CENTER - MARSHALL WERE COMBINED. THIS MERGER RESULTED IN ONE COST REPORT FOR THE COMBINED HOSPITALS.) FORM 990, SCHEDULE H, PART III, LINE 9B PROVISIONS ON COLLECTION PRACTICES THE HOSPITAL UTILIZES THE CHRISTUS REVENUE CYCLE BILLING AND COLLECTION POLICY. THIS POLICY IS DESIGNED TO COMPLY WITH IRS 501(r ) GUIDELINES AND INCLUDES THE FOLLOWING STATEMENTS: - "CHRISTUS WILL USE REASONABLE COLLECTION PROCEDURES IN A FAIR AND CONSISTENT MANNER TO COLLECT PATIENT SELF-PAY BALANCES, MAINTAINING CONFIDENTIALITY AND PATIENT DIGNITY. FINANCIAL ASSISTANCE WILL BE OFFERED TO THOSE PATIENTS WHOSE INCOME AND ASSETS WILL NOT ALLOW FULL PAYMENT OF SERVICES WITHIN A REASONABLE TIME FRAME. - PATIENTS ENROLLED IN A CHRISTUS PAYMENT PLAN WHO ARE MAKING THE MONTHLY SCHEDULED PAYMENTS WILL NOT BE ASSIGNED TO COLLECTIONS UNLESS THE PAYMENT PLAN BECOMES DELINQUENT. - CHRISTUS DOES NOT CURRENTLY ENGAGE IN EXTRAORDINARY COLLECTION ACTIONS (ECAs). UNDER NO CIRCUMSTANCE WILL CHRISTUS ENGAGE IN AN ECA BEFORE 120 DAYS FROM THE DATE OF THE FIRST POST-DISCHARGE BILLING STATEMENT."
FORM 990, SCHEDULE H, PART VI, LINE 2	NEED ASSESSMENT GOOD SHEPHERD MEDICAL CENTER ENGAGED BKD, LLP TO CONDUCT A FORMAL CHNA. BKD, LLP IS ONE OF THE LARGEST CPA AND ADVISORY FIRMS IN THE UNITED STATES, WITH APPROXIMATELY 2,000 PARTNERS AND EMPLOYEES IN 34 OFFICES. BKD SERVES MORE THAN 900 HOSPITALS AND HEALTH CARE SYSTEMS ACROSS THE COUNTRY. THE CHNA WAS CONDUCTED DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2016. BASED ON CURRENT LITERATURE AND OTHER GUIDANCE FROM THE TREASURY AND THE IRS, THE FOLLOWING STEPS WERE CONDUCTED AS PART OF GOOD SHEPHERDS CHNA: - AN EVALUATION OF THE IMPACT OF ACTIONS TAKEN TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE TAX YEAR 2013 CHNA WAS COMPLETED AND AN IMPLEMENTATION STRATEGY SCORECARD WAS PREPARED TO UNDERSTAND THE EFFECTIVENESS OF GOOD SHEPHERDS CURRENT STRATEGIES AND PROGRAMS. - THE "COMMUNITY" SERVED BY GOOD SHEPHERD WAS DEFINED BY UTILIZING INPATIENT DATA REGARDING PATIENT ORIGIN. THIS PROCESS IS FURTHER DESCRIBED IN COMMUNITY SERVED BY THE HOSPITAL. - POPULATION DEMOGRAPHICS AND SOCIOECONOMIC CHARACTERISTICS OF THE COMMUNITY WERE GATHERED AND REPORTED UTILIZING VARIOUS THIRD PARTIES (SEE REFERENCES IN APPENDICES). THE HEALTH STATUS OF THE COMMUNITY WAS THEN REVIEWED. INFORMATION ON THE LEADING CAUSES OF DEATH AND MORBIDITY INFORMATION WAS ANALYZED IN CONJUNCTION WITH HEALTH OUTCOMES AND FACTORS REPORTED FOR THE COMMUNITY BY COUNTYHEALTHRANKINGS.ORG. HEALTH FACTORS WITH SIGNIFICANT OPPORTUNITY FOR IMPROVEMENT WERE NOTED. - COMMUNITY INPUT WAS PROVIDED THROUGH KEY STAKEHOLDER SURVEYS. RESULTS AND FINDINGS ARE DESCRIBED IN THE KEY STAKEHOLDER SURVEY RESULTS SECTION OF THIS REPORT. - INFORMATION GATHERED IN THE ABOVE STEPS WAS ANALYZED AND REVIEWED TO IDENTIFY HEALTH ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS AND MINORITY GROUPS AND THE COMMUNITY AS A WHOLE. HEALTH NEEDS WERE RANKED UTILIZING A WEIGHTING METHOD THAT WEIGHS 1) THE SIZE OF THE PROBLEM, 2) THE SERIOUSNESS OF THE PROBLEM, 3) THE IMPACT OF THE ISSUES ON VULNERABLE POPULATIONS, 4) THE PREVALENCE OF COMMON THEMES AND 5) HOW IMPORTANT THE ISSUE IS TO THE COMMUNITY. - AN INVENTORY OF HEALTH CARE FACILITIES AND OTHER COMMUNITY RESOURCES POTENTIALLY AVAILABLE TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE CHNA WAS PREPARED AND COLLABORATIVE EFFORTS WERE IDENTIFIED. HEALTH NEEDS WERE THEN PRIORITIZED TAKING INTO ACCOUNT THE PERCEIVED DEGREE OF INFLUENCE GOOD SHEPHERD HAS TO IMPACT THE NEED AND THE HEALTH NEEDS IMPACT ON OVERALL HEALTH FOR THE COMMUNITY. INFORMATION GAPS IDENTIFIED DURING THE PRIORITIZATION PROCESS HAVE BEEN REPORTED.
FORM 990, SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE AS PATIENTS ENTER OUR FACILITY, SIGNAGE IS POSTED IN DESIGNATED AREAS WHICH STATE OUR POLICY TO PROVIDE CHARITY CARE TO THOSE PATIENTS WHO MEET ELIGIBILITY REQUIREMENTS. BUSINESS OFFICE AND REGISTRATION STAFF DISCUSS PAYMENT OPTIONS AND FINANCIAL ASSISTANCE AVAILABLE TO PATIENTS USING VERBAL AND WRITTEN COMMUNICATION. PATIENTS ARE CONTACTED PRIOR TO SERVICES WITH AN ESTIMATED COST AND OUT OF POCKET EXPENSES. CASH PRICES AND PAYMENT OPTIONS ARE DISCUSSED AND FINANCIAL ASSISTANCE SCREENING IS AVAILABLE UPON REQUEST. CHRISTUS GOOD SHEPHERD MEDICAL CENTER EVALUATES PATIENT APPLICATIONS AND UTILIZES A SLIDING SCALE TO QUALIFY PATIENTS BASED ON GOVERNMENT POVERTY GUIDELINES. ADDITIONALLY, OUR ELIGIBILITY VENDOR SCREENS FOR GOVERNMENT AGENCY PROGRAMS AND OFFERS FINANCIAL ASSISTANCE APPLICATIONS TO THOSE WHO DO NOT QUALIFY FOR GOVERNMENT PROGRAMS. BUSINESS OFFICE AND REGISTRATION PERSONNEL ARE AVAILABLE TO ANSWER ANY FINANCIAL QUESTIONS AND ASSIST THE PUBLIC WITH THEIR FINANCIAL OBLIGATIONS.
FORM 990, SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION CHRISTUS GOOD SHEPHERD MEDICAL CENTER IS LOCATED IN THE PINEY WOOD OF EAST TEXAS AND SERVICES A RURAL COMMUNITY WHICH INCLUDES HARRISON, NORTHERN PANALO AND SOUTHERN MARION COUNTIES. THE POPULATION IN EACH OF THESE COUNTIES IS DIVERSE IN INCOME AND ETHNICITY. HARRISON COUNTY, ESTABLISHED IN 1839, IS LOCATED IN NORTHEASTERN TEXAS ALONG THE LOUISIANA BORDER AND COMPRISES 984 SQUARE MILES. MARSHALL, THE COUNTY SEAT IS LOCATED 152 MILES EAST OF DALLAS AND 39 MILES WEST OF SHREVEPORT. ACCORDING TO THE 2018 CENSUS ESTIMATES, 17.3% OF HARRISON COUNTY POPULATION LIVES IN POVERTY. 16.9% OF HARRISON COUNTY RESIDENTS ARE AGE 65 OR OLDER. THE CENSUS BUREAU REPORTS THAT ONLY 18.8% OF ADULTS HOLD A COLLEGE DEGREE OR HIGHER LEVEL OF EDUCATION. EDUCATION LEVEL IMPACTS THE TYPES OF AVAILABLE JOBS AND BENEFIT LEVELS, INCLUDING HEALTHCARE COVERAGE. IN OTHER SERVICE LOCATIONS, MARION COUNTY HAS A MEDIAN ANNUAL INCOME OF $36,938 AND 22.8% OF ITS RESIDENTS LIVE IN POVERTY. PANOLA COUNTY HAS A MEDIAN ANNUAL HOUSEHOLD INCOME OF $49,704 AND 15.0% OF ITS RESIDENTS LIVE IN POVERTY. UNEMPLOYMENT IN HARRISON, PANOLA AND MARION COUNTIES IS CURRENTLY BETWEEN 3.8% TO 4.2%. IT IS CLEAR THAT WITHIN THE AREA SERVED THERE ARE MANY OBSTACLES TO OVERCOME REGARDING HEALTH CARE COVERAGE. MANY FIND IT DIFFICULT TO AFFORD THE COST OF HEALTHCARE BOTH IN BASIC PREVENTION AND IN TREATMENT OF EXISTING CONDITIONS. (SOURCE: U.S. CENSUS BUREAU & FEDERAL RESERVE BANK OF ST. LOUISTEXAS COUNTIES: UNEMPLOYMENT RATE) GOOD SHEPHERD HOSPITAL SERVES AN 11-COUNTY REGION INCLUDING THE FOLLOWING COUNTIES: GREGG, HARRISON, MARION, MORRIS, PANOLA, RUSK, UPSHUR, CAMP, CASS, WOOD AND TITUS. CHRISTUS GOOD SHEPHERD MEDICAL CENTERS IN LONGVIEW AND MARSHALL OFFER A TRUE SYSTEM OF HEALTHCARE THAT ENCOMPASSES THE REACH OF OUR REGION. TO MEET THE EVERYDAY HEALTHCARE NEEDS OF THE RESIDENTS IN OUR REGION, GOOD SHEPHERD HEALTH SYSTEM OPERATES FAMILY HEALTH CENTERS IN THE COMMUNITIES OF LONGVIEW, GLADEWATER, HENDERSON AND KILGORE. THE PROJECTED 2017 PRIMARY 6 COUNTIES POPULATIONS ARE GREGG 131,827, HARRISON 70,179, MARION 11,220, UPSHUR 43,368, RUSK 60,164 AND PANOLA 25,325 AND TOTAL 342,083. (SOURCE: HTTPS://WWW.DSHS.TEXAS.GOV/CHS/POPDAT/ST2017.SHTM.)
FORM 990, SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH THE COMMUNITY BUILDING ACTIVITIES INCLUDE OUR WELLNESS CENTER AND THE PROGRAMS WE OFFER IN AN ATTEMPT TO KEEP OUR COMMUNITY HEALTHY. THE WELLNESS CENTER IS THE HUB OF OUR PROGRAM OFFERING FITNESS AND WELLNESS PROGRAMS FOR INDIVIDUALS, FAMILIES AND BUSINESSES IN OUR COMMUNITY, INCLUDING HOSPITAL EMPLOYEES AND THEIR FAMILIES. WE ALSO OFFER A VARIETY OF WATER AEROBICS, ADULT AEROBIC CLASSES, SENIOR EXERCISE CLASSES, SPECIALTY CLASSES SUCH AS ZUMBA, CARDIAC REHAB, ETC. WE ALSO OFFER ACUTE, CHRONIC AND PREVENTATIVE EDUCATIONAL PROGRAMS TO OUR COMMUNITY. WE ARE INVOLVED IN THE SCHOOLS WITH PRENATAL CLASSES FOR PREGNANT TEENS AND ALSO WORK WITH THE SCHOOLS ON OBESITY PROGRAMS. IN ADDITION, WE PROVIDE COMMUNITY EDUCATIONAL SERVICES AND PROGRAMS, SUCH AS CPR, CERTIFIED DIABETIC EDUCATION PROGRAMS, WOULD CARE EDUCATION AND PREVENTION, SEATBELT AWARENESS, HARD HATS FOR LITTLE HEADS BICYCLE RODEO AND SHOPPING CLASSES FOR PERSONS TRYING TO MODIFY DIET FOR CARDIAC REASONS OR WEIGHT LOSS. FURTHERMORE, WE OFFER HEALTH FAIRS PROVIDE BASIC SCREENING EXAMS AT NO COST TO OUR COMMUNITY. OUR CASE MANAGEMENT AND SOCIAL SERVICES PROGRAM OFFERS THE AVAILABILITY OF EXTERNAL SOURCES AND PROGRAMS TO ASSIST PATIENTS AND THEIR FAMILIES, SUCH AS WIC AND OTHER GOVERNMENT AND PRIVATE PROGRAMS.
FORM 990, SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM GOOD SHEPHERD HEALTH SYSTEM IS PART OF CHRISTUS HEALTH, AN INTERNATIONAL, CATHOLIC, FAITH BASED, NONPROFIT HEALTH SYSTEM COMPRISED OF ALMOST 350 SERVICES AND FACILITIES INCLUDING MORE THAN 60 HOSPITALS AND LONG TERM CARE FACILITIES, 175 CLINICS AND OUTPATIENT CENTERS, AND OTHER COMMUNITY HEALTH MINISTRIES AND COMMUNITY DEVELOPMENT VENTURES. CHRISTUS SERVICES CAN BE FOUND IN: ARKANSAS, GEORGIA, IOWA, LOUISIANA, NEW MEXICO, TEXAS, IN SIX PROVINCES OF MEXICO, AND IN SANTIAGO, CHILE. A COMMON MISSION, CORE VALUES, AND VISION UNITE THE HEALTH SYSTEM. EACH REGION, INCLUDING GOOD SHEPHERD HEALTH SYSTEM, DEVELOPS FIVE-YEAR AND TEN-YEAR STRATEGIC PLANS THAT HELP SET THE YEARLY OPERATIONAL PLANS AND BUDGETS. REGIONAL STRATEGIC GOALS ARE SET IN COLLABORATION WITH CHRISTUS HEALTH AND INCLUDE METRICS THAT WILL BE USED TO MEASURE COMMUNITY BENEFIT, CLINICAL OUTCOMES, PATIENT SATISFACTION, AND ASSOCIATE ENGAGEMENT. CHRISTUS HEALTH PROVIDES UPDATED MARKET, DEMOGRAPHICS, AND HEALTH INDICATOR DATA ON AN ANNUAL BASIS. THE DATA SUPPLIED FROM CHRISTUS HEALTH ALONG WITH THE SYSTEM WIDE STRATEGIC INITIATIVES ARE CONSISTENT WITH THE COMMUNITY NEEDS ASSESSMENT OF THE REGION. GOOD SHEPHERD HEALTH SYSTEM, IN TURN, PARTNERS WITH OTHER NONPROFIT GROUPS (CHURCHES, HEALTH CARE PROVIDERS, AND GOVERNMENT AGENCIES) TO CREATE COLLABORATIONS WHERE HEALTH NEEDS CAN BE ADDRESSED AND THE GENERAL HEALTH OF INDIVIDUALS AND THE COMMUNITY IS IMPROVED. GOOD SHEPHERD HEALTH SYSTEM OPERATES HOSPITALS IN LONGVIEW AND MARSHALL. IN EACH OF THE COMMUNITIES, THE HOSPITAL OFFERS FREE SCREENINGS TO IDENTIFY EARLY DISEASE, EDUCATIONAL OFFERINGS FEATURING PHYSICIAN SPEAKERS AND CONTINOUSLY PARTICIPATES IN COMMUNITY ACTIVITIES WHERE PREVENTION AND WELLNESS INFORMATION CAN BE SHARED. EFFECTIVE FEBRUARY 1, 2017, CHRISTUS HEALTH ACQUIRED GOOD SHEPHERD HEALTH SYSTEM INC. CHRISTUS HEALTH BECAME THE SOLE CORPORATE MEMBER OF GOOD SHEPHERD HOSPITAL, INC. D/B/A GOOD SHEPHERD MEDICAL CENTER.
FORM 990, SCHEDULE H, PART VI, LINE 7	STATE FILING OF COMMUNITY BENEFIT REPORT A COMMUNITY BENEFIT REPORT IS PREPEARED FOR THE HOSPITAL EACH YEAR AND IS SUBMITTED ALONG WITH AN AHA SURVEY TO THE TEXAS DEPARTMENT OF STATE HEALTH SERVICES WITH A COPY PROVIDED TO HARRISON COUNTY AND GREGG COUNTY.

Schedule H (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
CHRISTUS Good Shepherd Medical Center

Employer identification number
75-0974351

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) EAST TEXAS BORDER HEALTH CLINIC POBOX 1326 MARSHALL,TX75671	03-0538912	501(c)(3)	545,071				HEALTHCARE SERVICES
(2) LONGVIEW WELLNESS CENTER INC 1107 E MARSHALL AVE LONGVIEW,TX75601	75-2723993	501(C)(3)	38,750				HEALTHCARE SERVICES

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

SCHEDULE I, PART I, LINE 2

PROCEDURE FOR MONITORING THE USE OF GRANT FUNDS AFTER A NEED IS DETERMINED FOR ASSISTANCE, A REQUEST FROM THE SERVICE ORGANIZATION OF GOOD SHEPHERD IS SUBMITTED, IDENTIFYING THE FUNDS NEEDED FOR THE PROGRAM AND/OR PATIENT. THE REQUEST IS REVIEWED AND APPROVED BY THE CFO BEFORE FUNDS ARE TRANSFERRED. A SERVICE LOG IS SUBMITTED TO THE CFO TO DOCUMENT HOURS INCURRED ON PROJECTS AND SUPPORT USE OF FUNDS.

Schedule I (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CHRISTUS Good Shepherd Medical Center

Employer identification number

75-0974351

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1VALERIE ALLMAN MD DIRECTOR	(i) (ii)	0 ------------- 155,386	0 ------------- 95,316	0 ------------- 1,237	0 ------------- 0	0 ------------- 9,877	0 ------------- 261,816	0 ------------- 0
2STEVE ALTMILLER FORMER GSHS PRESIDENT/CEO	(i) (ii)	0 ------------- 71,251	0 ------------- 160,000	0 ------------- 655,002	0 ------------- 2,769	0 ------------- 6,840	0 ------------- 895,862	0 ------------- 171,973
3RUSSELL J COLLIER PRESIDENT (THRU 1/18)	(i) (ii)	0 ------------- 317,149	0 ------------- 0	0 ------------- 63,007	0 ------------- 8,100	0 ------------- 1,623	0 ------------- 389,879	0 ------------- 47,920
4KEN CUNNINGHAM SECRETARY	(i) (ii)	0 ------------- 332,954	0 ------------- 340,000	0 ------------- 78,110	0 ------------- 35,522	0 ------------- 23,140	0 ------------- 809,726	0 ------------- 51,084
5TODD HANCOCK GSHS PRESIDENT/CEO	(i) (ii)	0 ------------- 402,471	0 ------------- 259,095	0 ------------- 700	0 ------------- 94,801	0 ------------- 19,778	0 ------------- 776,845	0 ------------- 0
6TRUNG NGUYEN MD MEDICAL STAFF VICE PRESIDENT	(i) (ii)	0 ------------- 153,511	0 ------------- 25,208	0 ------------- 12,312	0 ------------- 0	0 ------------- 8,785	0 ------------- 199,816	0 ------------- 0
7MICHAEL CHEEK CHIEF FINANCIAL OFFICER	(i) (ii)	0 ------------- 280,236	0 ------------- 0	0 ------------- 16,151	0 ------------- 29,202	0 ------------- 21,266	0 ------------- 346,855	0 ------------- 0
8JASON ADAMS CHIEF OPERATING OFFICER	(i) (ii)	0 ------------- 418,001	0 ------------- 221,213	0 ------------- 39,059	0 ------------- 73,010	0 ------------- 24,032	0 ------------- 775,315	0 ------------- 0
9RAY DELK VP OPERATIONS	(i) (ii)	0 ------------- 23,531	0 ------------- 230,000	0 ------------- 254,968	0 ------------- 0	0 ------------- 9,348	0 ------------- 517,847	0 ------------- 40,180
10JOHN MCDONALD DO MEDICAL STAFF	(i) (ii)	0 ------------- 232,864	0 ------------- 0	0 ------------- 34,401	0 ------------- 3,822	0 ------------- 6,749	0 ------------- 277,836	0 ------------- 0
11RICKY A PAUL MD MEDICAL STAFF PRESIDENT	(i) (ii)	0 ------------- 560,736	0 ------------- 57,830	0 ------------- 5,785	0 ------------- 0	0 ------------- 22,163	0 ------------- 646,514	0 ------------- 0
12LARRY VERFURTH DO CMO(THRU 8/18)	(i) (ii)	0 ------------- 240,647	0 ------------- 345,100	0 ------------- 18,046	0 ------------- 0	0 ------------- 28,513	0 ------------- 632,306	0 ------------- 40,344
13DUSTIN MCDERMOTT CRNA	(i) (ii)	65,462 ------------- 0	264,050 ------------- 0	132,000 ------------- 0	0 ------------- 0	12,675 ------------- 0	474,187 ------------- 0	0 ------------- 0
14RICHARD L HOLLADAY CRNA	(i) (ii)	276,050 ------------- 0	0 ------------- 0	53,319 ------------- 0	0 ------------- 0	4,135 ------------- 0	333,504 ------------- 0	0 ------------- 0
15LEE A HOLLADAY CRNA	(i) (ii)	269,178 ------------- 0	0 ------------- 0	38,244 ------------- 0	0 ------------- 0	13,542 ------------- 0	320,964 ------------- 0	0 ------------- 0
16ZACKARY G LISTER CRNA	(i) (ii)	262,566 ------------- 0	0 ------------- 0	29,796 ------------- 0	470 ------------- 0	10,039 ------------- 0	302,871 ------------- 0	0 ------------- 0
17ROGER C BRYANT JR CRNA	(i) (ii)	259,186 ------------- 0	0 ------------- 0	19,819 ------------- 0	4,189 ------------- 0	7,744 ------------- 0	290,938 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

Schedule J, Part I, Line 3

EXPLANATION OF RELATED ORGANIZATION DETERMINING EXECUTIVE DIRECTOR COMPENSATION THE FILING ORGANIZATION'S PRESIDENT/CEO IS AN EMPLOYEE OF CHRISTUS HEALTH, A RELATED ORGANIZATION. AS A RESULT, COMPENSATION IS ESTABLISHED AT THE CHRISTUS HEALTH LEVEL AND THE FILING ORGANIZATION DOES NOT HAVE A ROLE IN IMPLEMENTING THE METHODS USED TO ESTABLISH COMPENSATION OR IN DETERMINING THE PRESIDENT/CEO COMPENSATION. CHRISTUS HEALTH USES AN EXECUTIVE COMPENSATION COMMITTEE TO ESTABLISH AND APPROVE THE COMPENSATION OF THE FILING ORGANIZATION'S CEO/EXECUTIVE DIRECTOR. THIS COMMITTEE USES AN INDEPENDENT COMPENSATION CONSULTANT WHO PERFORMS BI-ANNUAL COMPENSATION SURVEY. FORM 990, SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENTS THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS: STEVE ALTMILLER $325,000 RAY DELK $ 92,885

Schedule J, Part I, Line 4B

SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NON QUALIFIED RETIREMENT PLAN DESCRIBED IN 457(F): INDIVIDUALS: PAYMENT IN W-2: DEFERRED COMPENSATION: STEVE ALTMILLER $171,973 $ 2,769 KEN CUNNINGHAM $ 51,084 $35,522 JASON ADAMS NONE $73,010 MICHAEL CHEEK NONE $29,202 RUSSELL J. COLLIER $ 47,920 $ 8,100 RAY DELK $ 40,180 NONE TODD HANCOCK NONE $94,801 JOHN MCDONALD NONE $ 3,822 LARRY VERFURTH $ 40,344 NONE COMPENSATION REPORTED AS DEFERRED IN A PRIOR FORM 990 DEFERRED COMPENSATION INCLUDES EXECUTIVE DEFERRED INCOME ACCOUNT, SUPPLEMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN, AND PENSION RESTORATION PLAN. ESTIMATED PENSION BENEFITS WERE CALCULATED BASED ON THE PROVISIONS OF THE CURRENT PENSION RESTORATION PLAN AT 6% OF PENSIONABLE EARNINGS WHICH ARE OVER THE IRS LEGISLATIVE COMPENSATION LIMIT. SOME ASSOCIATES ARE GRANDFATHERED UNDER AN EARLIER LEGACY PENSION PLAN. IF A PARTICIPANT HAS PROTECTED PENSION BENEFITS UNDER SUCH LEGACY PLANS, HIS/HER PERCENTAGE IS ZERO UNDER THE SUPPLEMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN, AS THE PROTECTED BENEFIT IS ALREADY EQUAL TO OR BETTER THAN CURRENT MARKET. SUPPLEMENTAL COMPENSATION INFORMATION FORM 990, SCHEDULE J, PART II W-2 COMPENSATION MAY INCLUDE PAYMENTS RELATED TO COMPENSATION DEFERRED IN PRIOR YEARS. DEFERRED COMPENSATION MAY INCLUDE DEFERRALS OF CURRENT YEAR COMPENSATION UNDER EXECUTIVE DEFERRED INCOME ACCOUNT, SUPPLEMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN AND PENSION RESTORATION PLAN. SUPPLEMENTAL COMPENSATION INFORMATION FORM 990, SCHEDULE J, PART II, COLUMN B (II) BONUS AND INCENTIVE COMPENSATION MAY INCLUDE AMOUNTS THAT WERE DEFERRED IN A PRIOR YEAR BUT PAID OUT IN CALENDAR YEAR 2017. DEFERRED COMPENSATION FORM 990, SCHEDULE J, PART II, COLUMN C DEFERRED COMPENSATION INCLUDES EXECUTIVE DEFERRED INCOME ACCOUNT, SUPPLEMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN, EMPLOYER CONTRIBUTION TO 403(B) MATCHED SAVINGS PLAN, PENSION RESTORATION PLAN AND ESTIMATED PENSION BENEFITS UNDER CHRISTUS HEALTH CASH BALANCE PLAN. ESTIMATED PENSION BENEFITS WERE CALCULATED BASED ON THE PROVISIONS OF THE CURRENT CASH BALANCE PLAN AT 6% OF PENSIONABLE EARNINGS. SOME ASSOCIATES ARE GRANDFATHERED UNDER AN EARLIER PENSION PLAN. THESE GRANDFATHERED PARTICIPANTS, BASED ON COMPUTATION AT THE TIME OF THEIR RETIREMENT, WILL RECEIVE THE LARGER OF THE RETIREMENT BENEFIT COMPUTED UNDER THE CASH BALANCE PLAN COMPARED TO THE PREVIOUS PENSION PLAN. DUE TO THE COMPLEXITY OF CALCULATING AN ACCURATE BENEFIT COST FOR GRANDFATHERED PARTICIPANTS, THE FORM 990 REPORTS AS PENSION BENEFITS THEIR ANNUAL ESTIMATED CASH BALANCE PLAN ACCRUAL.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
CHRISTUS Good Shepherd Medical Center

Employer identification number
75-0974351

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	HARRISON COUNTY HEALTH FACILITIES DEVELOPMENT	75-2740093	415221AW0	09-22-2010	43,980,049	REFUND ESCROWS & CAPITAL PROJECTS		X		X		X
B	GREGG COUNTY HEALTH FACILITIES DEVELOPMENT	75-1865828	39753MFFO	09-05-2012	33,033,015	CAPITAL IMPROVEMENTS		X		X		X
C	GREGG COUNTY HEALTH FACILITIES DEVELOPMENT	75-1865828	39753MDT2	02-01-2015	88,000,000	REFINANCING		X		X		X
D	GREGG COUNTY HEALTH FACILITIES DEVELOPMENT	75-1865828	39753MDU9	11-08-2006	99,276,418	ADVANCE REFUNDING OF BONDS		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	2,005,000		315,000		77,682,622		1,335,000
2 Amount of bonds legally defeased ..............	0		0		0		0
3 Total proceeds of issue ..................	43,980,049		33,033,015		87,286,972		99,276,418
4 Gross proceeds in reserve funds .............	3,077,293		2,176,874		8,800,000		0
5 Capitalized interest from proceeds .............	0		0		0		0
6 Proceeds in refunding escrows ...............	31,331,629		8,338,548		804,350		96,480,044
7 Issuance costs from proceeds ...............	879,600		660,660		0		636,501
8 Credit enhancement from proceeds .............	0		0		0		2,159,873
9 Working capital expenditures from proceeds .............	0		14,045,280		0		0
10 Capital expenditures from proceeds .............	8,691,527		0		0		0
11 Other spent proceeds .............	0		0		0		0
12 Other unspent proceeds .............	0		7,811,653		0		0
13 Year of substantial completion .............	2013		2014		2015		2012
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2018, a current refunding issue)? ........
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2018, an advance refunding issue)? ........
16 Has the final allocation of proceeds been made? ..........		X		X		X	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2019

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........		X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X	X		X			X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........	X			X		X	X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2019

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X	X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
SCHEDULE K, PART I, BOND ISSUES	(A) THE ISSUER NAME: HARRISON COUNTY HEALTH FACILITIES DEVELOPMENT CORPORATION (F) DESCRIPTION OF PURPOSE: REFUND ESCROWS, CAPITAL PROJECTS AND IMPROVEMENTS SCHEDULE K, PART IV, ARBITRAGE, LINE 2C: (A) ISSUER NAME: HARRISON COUNTY HEALTH FACILITIES DEVELOPMENT CORPORATION DATE THE REBATE COMPUTATION WAS PERFORMED: 08/01/2015

Schedule K (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CHRISTUS Good Shepherd Medical Center

Employer identification number

75-0974351

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( VITAL MONITORS )	X	48	288,518	FAIR VALUE
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 51227J

Schedule M (Form 990) (2019)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE M, PART I, COLUMN (B)	THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED IN COLUMN (B).

Schedule M (Form 990) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

CHRISTUS Good Shepherd Medical Center

Employer identification number

75-0974351

Return Reference	Explanation
FORM 990, PART I, ITEM C	DOING BUSINESS AS CHRISTUS GOOD SHEPHERD MEDICAL CENTER OPERATES UNDER THE FOLLOWING NAMES: ACUITY DIAGNOSTICS CARE DIRECT CENTER FOR INNOVATIVE LEARNING CHAMPION EMS-GOOD SHEPHERD MEDICAL CENTER CHRISTUS GOOD SHEPHERD BREAST CENTER GOOD SHEPHERD FRESH EXPRESS CHRISTUS GOOD SHEPHERD HEALTHY LIVING SPA GOOD SHEPHERD INSTITUTE FOR HEALTHY LIVING GOOD SHEPHERD MEDICAL CENTER CHRISTUS GOOD SHEPHERD MEDICAL CENTER LONGVIEW CHRISTUS GOOD SHEPHERD MEDICAL CENTER MARSHALL CHRISTUS GOOD SHEPHERD SURGERY CENTER GOOD SHEPHERD NORTH PARK BREAST SCREENING GOOD SHEPHERD NORTH PARK EMERGENCY DEPARTMENT GOOD SHEPHERD OCCUPATIONAL MEDICINE GOOD SHEPHERD PERFORMANCE REHABILITATION JOINT WORKS MARSHALL LIFE CENTER MEDICAL SIMULATION CENTER OF EAST TEXAS TAYLOER MEDICAL CENTER THE NEUROLOGICAL INSTITUTE AT GOOD SHEPHERD
FORM 990, PART VI, SECTION A, LINE 1A	DELEGATION OF AUTHORITY THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION BETWEEN MEETINGS OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 2 RICHARD HOLLADAY AND LEE ALLEN HOLLADAY HAVE A FAMILY RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 6	MEMBERS OR STOCKHOLDERS THE SOLE MEMBER OF THE ORGANIZATION IS GOOD SHEPHERD HEALTH SYSTEM,INC.
FORM 990, PART VI, SECTION A, LINE 7A	GOOD SHEPHERD HEALTH SYSTEM, INC., THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION, HAS THE POWER TO APPOINT ALL MEMBERS OF THE FILING ORGANIZATION'S GOVERNING BODY.
FORM 990, PART VI, LINE 7B	DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS A NUMBER OF DECISIONS OF THE ORGANIZATION ARE SUBJECT TO APPROVAL OF THE MEMBER OF THE ORGANIZATION. THESE RESERVED POWERS ARE STATED BELOW: A. THE APPOINTMENT OF ONE MEMBER OF THE ORGANIZATIONS BOARD OF DIRECTORS, AND THE APPROVAL OF THE REMAINING DIRECTORS FOLLOWING THE NOMINATION PROCESS AND SUBJECT TO THE PROVISIONS GOVERNING STAFF DIRECTOR; B. THE REMOVAL OF A MEMBER OF THE ORGANIZATIONS BOARD AND ALSO THE APPROVAL OF REMOVAL AND APPOINTMENTS TO FILL VACANCIES ON THE BOARD AND SET THE SIZE OF THE BOARD; C. APPROVE THE ELECTION AND REMOVAL OF OFFICERS OF THE ORGANIZATION AND ESTABLISH, TERMINATE, AND/OR REVISE ALL EMPLOYMENT CONTRACTS, COMPENSATION, AND BENEFIT PACKAGES OF THE OFFICERS OF THE ORGANIZATION REGARDLESS OF WHICH ENTITY ACTUALLY PAYS SUCH COMPENSATION OR BENEFITS; D. DESIGNATE THE FISCAL YEAR; E. APPROVE THE SELECTION AND REMOVAL OF INDEPENDENT AUDITORS, OUTSIDE GENERAL LEGAL COUNSEL, AND OUTSIDE INVESTMENT ADVISORS; F. AMEND THE ARTICLES OF INCORPORATION; G. APPROVE ALL MERGERS, ACQUISITIONS, CONSOLIDATIONS, OR AFFILIATIONS WITH OTHER ENTITIES, THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, OR THE SALE, MORTGAGE, OR ENCUMBRANCE OF ANY REAL PROPERTY OWNED BY THE CORPORATION; H. APPROVE THE DISSOLUTION OR LIQUIDATION OF THE ORGANIZATION; I. APPROVE CAPITAL PLANS, STRATEGIC PLANS, AND ANNUAL OPERATING AND CAPITAL BUDGETS; J. APPROVE ANY EXCEPTION TO THE CAPITAL BUDGET FOR A SINGLE ITEM OR RELATED ITEM THAT EXCEEDS $100,000 AND/OR APPROVE ANY AGGREGATE ANNUAL EXPENDITURES THAT EXCEEDS THE BUDGET BY $50,000; K. SELECT OFFICIAL DEPOSITORIES FOR THE ORGANIZATIONS FUNDS; L. CREATE OR INVEST IN ANY SUBSIDIARY ENTITY OR ENTER INTO ANY PARTNERSHIP OR JOINT VENTURE; M. AUTHORIZE ANY LOANS, GUARANTEES, OR INCURRENCE OF DEBT; N. AUTHORIZE THE COMMENCEMENT OF ANY LITIGATION OR OTHER LEGAL PROCEEDING, OR THE SETTLEMENT, DISPOSITION, OR TERMINATION OF ANY SUCH LITIGATION OR OTHER LEGAL PROCEEDING OR OF ANY CLAIM OR THREAT OF LITIGATION OR OTHER LEGAL PROCEEDING NOT FULLY COVERED BY INSURANCE; AND O. APPROVE THE ADMISSION OF ADDITIONAL MEMBERS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11B	PROCESS TO REVIEW FORM 990 THE FORM 990 IS PREPARED AND REVIEWED BY THE ORGANIZATIONS EXTERNAL INDEPENDENT ACCOUNTANTS. THE CHRISTUS HEALTH ACCOUNTING DEPARTMENT WORKS WITH AN EXTERNAL ACCOUNTING FIRM IN PREPARATION AND REVIEW OF THE FORM 990. THE FILING ORGANIZATIONS CFO, OR OTHER DESIGNEE, REVIEWS THE FORM 990. THE FINAL FORM 990 THAT WILL BE FILED WITH THE IRS IS POSTED TO A SECURE INTERNET PORTAL FOR ALL MEMBERS OF THE BOARD OF DIRECTORS TO VIEW. REVIEW OF THE FINAL FORM 990 OCCURS PRIOR TO FILING WITH THE IRS IN THE SUMMER 2019 VIA EITHER MEETING, CONFERENCE CALL OR WEB PORTAL POLLING TOOL BY THE RESPECTIVE CHRISTUS ORGANIZATIONS BOARD, BASED ON A SET OF SUGGESTED REVIEW PROCESSES DEVELOPED BY CHRISTUS HEALTH.
FORM 990, PART VI, LINE 12C	DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST AT THE END OF EACH CALENDAR YEAR, THE CHRISTUS HEALTH CORPORATE SECRETARY DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE TO ALL OF THE ORGANIZATION'S BOARD AND COMMITTEE MEMBERS FOR COMPLETION PRIOR TO THE 1ST OF JANUARY IN THE NEXT YEAR. THE CORPORATE SECRETARY THOROUGHLY REVIEWS ALL COMPLETED AND EXECUTED CONFLICT OF INTEREST QUESTIONNAIRE FORMS TO ENSURE ACCURACY AND THAT NO POTENTIAL OR IDENTIFIED CONFLICT IS DISCLOSED OR EXISTS. THE ORGANIZATION'S BOARD OF DIRECTORS IS RESPONSIBLE FOR ENFORCEMENT OF THE CONFLICT OF INTEREST POLICY OF THE ORGANIZATION.
FORM 990, PART VI, LINE 15A	COMPENSATION DETERMINATION PROCESS THE EXECUTIVE DIRECTOR OF THE FILING ORGANIZATION IS PAID BY A RELATED ORGANIZATION; THEREFORE, THE FILING ORGANIZATION WAS NOT INVOLVED IN THE PROCESS OF DETERMINING COMPENSATION FOR THE EXECUTIVE DIRECTOR OF THE FILING ORGANIZATION. THE RELATED ORGANIZATION DETERMINES THE COMPENSATION OF THE EXECUTIVE DIRECTOR OF THE FILING ORGANIZATION BY USE OF AN INDEPENDENT AND EXTERNAL CONSULTANT. THE CONSULTANT HELPS DETERMINE PAY RATES FOR THE ASSOCIATES OF THE RELATED ORGANIZATION, TAKING INTO ACCOUNT MARKET DATA AND SHIFT DIFFERENTIAL. THE COMPENSATION RATES ARE APPROVED BY THE RELATED ORGANIZATION. BASED ON THE AFOREMENTIONED PROCEDURE, THE EXECUTIVE DIRECTOR'S COMPENSATION IS NOT REVIEWED BY A COMPENSATION COMMITTEE. THE EXECUTIVE DIRECTOR'S SALARY IS SPLIT BETWEEN THE FILING ORGANIZATION AND THE RELATED ORGANIZATION.
FORM 990, PART VI, LINE 19	AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CHRISTUS HEALTH ARE MADE AVAILABLE TO THE PUBLIC VIA THE CHRISTUS HEALTH WEBSITE. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART X THE GOOD SHEPHERD HOSPITAL, INC., ALSO DOING BUSINESS AS CHRISTUS GOOD SHEPHERD MEDICAL CENTER LONGVIEW (CGSMC - LONGVIEW), IS ONE OF TWO CAMPUSES DELIVERING QUALITY HEALTHCARE SERVICES TO THE PEOPLE OF NORTHEAST TEXAS. CHRISTUS GOOD SHEPHERD MEDICAL CENTER - MARSHALL (CGSMC MARSHALL) IS THE OTHER CAMPUS. EFFECTIVE SEPTEMBER 1, 2017 AND THROUGHOUT THE FISCAL YEAR ENDED 09/30/18, THE COMBINED CAMPUSES OPERATED UNDER A SINGLE STATE HOSPITAL LICENSE #000020 HELD BY CGSMC MARSHALL. AS A RESULT OF THE CHANGE OF STATE LICENSURE, THE ACTIVITIES FOR CGSMC LONGVIEW ARE NOW BEING REPORTED UNDER CGSMC MARSHALL'S FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN) 75-0974351 FOR TAX FILING PURPOSES. THEREFORE ALL REVENUE, EXPENSES AND BALANCE SHEET AMOUNTS INCLUDING SCHEDULE H REPORTING ARE REPORTED ON CGSMC MARSHALL'S 2017 FORM 990. THE CGSMC LONGVIEW FEDERAL EIN 75-1041154 IS STILL OPEN, BUT NO ACTIVITY WILL BE REPORTED UNDER THIS FEDERAL EIN.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS CONTRIBUTED CAPITAL $17,031,507 PURCHASE PRICE ADJUSTMENT $ 614,740 INVESTMENT IN FOUNDATION (UNRESTRICTED) $ 387,799 TEMPORARY RESTRICTED CONTRIBUTIONS $ 18,937 INVESTMENT IN FOUNDATION (RESTRICTED) ($ 1,920) K-1 INCOME ($ 57,304) TRANSFER OF ASSETS FROM THE GOOD SHEPHERD HOSPITAL, INC. ($71,322,837) ---------- TOTAL -$53,329,078
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYISICIAN FEES TOTAL FEES:25491190
FORM 990 PART IX LINE 11G	DESCRIPTION:MEDICAL SERVICES TOTAL FEES:3758582
FORM 990 PART IX LINE 11G	DESCRIPTION:MAINTENANCE SERVICES TOTAL FEES:1428198
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER TOTAL FEES:13564985

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

CHRISTUS Good Shepherd Medical Center

Employer identification number

75-0974351

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)MARSHALL HEALTH SERVICES INC 700 E MARSHALL AVE LONGVIEW,TX75601 75-2580686	HEALTHCARE	TX	501(c)(3)	3	GSMC MARSH	Yes
(2)MARSHALL HOSPITAL FOUNDATION 811 S WASHINGTON AVE MARSHALL,TX75670 75-2605699	SUPPORT	TX	501(c)(3)	7	GSMC MARSH	Yes
(3)THE GOOD SHEPHERD HOSPITAL INC 700 E MARSHALL AVE LONGVIEW,TX75601 75-1041154	HEALTHCARE	TX	501(c)(3)	3	GSHS INC	Yes
(4)GSHS ADMINISTRATIVE SERVICES ORG INC 700 E MARSHALL AVE LONGVIEW,TX75601 86-1132471	ADMIN SUPPORT	TX	501(c)(3)	12A	GSHS INC	Yes
(5)GOOD SHEPHERD MEDICAL CENTER - LINDEN I 404 N KAUFMAN STREET LINDEN,TX75563 01-0829282	HEALTHCARE	TX	501(c)(3)	3	GSHS INC	Yes
(6)GSMC - LINDEN FOUNDATION INC 404 N KAUFMAN STREET LINDEN,TX75563 20-0845127	SUPPORT	TX	501(c)(3)	12a	GSMC LINDE	Yes
(7)CHRISTUS HEALTH 919 HIDDEN RIDGE DRIVE IRVING,TX75038 76-0590551	SUPT HLTH SVC	TX	501(c)(3)	10	NA		No
(8)GOOD SHEPHERD FOUNDATION 700 E MARSHALL AVE LONGVIEW,TX75601 75-2056700	SUPPORT	TX	501(c)(3)	12A	GSMC	Yes
(9)GOOD SHEPHERD HEALTH SYSTEM INC 700 E MARSHALL AVE LONGVIEW,TX75601 75-2027157	SUPPORT GSMC	TX	501(c)(3)	12B	CH		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) GSHS CUSTOMER SERVICE BUILDING I LTD 700 E MARSHALL AVE LONGVIEW,TX75601 02-0636726	CUSTOMER SERVICE	TX	GSHS INC							No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) GSHS ENTERPRISES INC 700 E MARSHALL AVE LONGVIEW,TX75601 75-2027162	HEALTHCARE	TX	GSHS INC	C Corp				Yes
(2) GS PHYSICIAN SERVICES INC 700 E MARSHALL AVE LONGVIEW,TX75601 75-2762417	MEDICAL SERVICES	TX	GSHS ENTERPRISE	C Corp				Yes
(3) MARSHALL PHYSICIAN HOSPITAL ORGANIZATION 700 E MARSHALL AVE LONGVIEW,TX75601 75-2580689	INACTIVE	TX	GSMC MARSHALL	C Corp	0	11,630	100.000 %	Yes
(4) GSHS CUSTOMER SERVICE BUILDING LLC 700 E MARSHALL AVE LONGVIEW,TX75601 71-0896055	CUSTOMER SERVICES	DE	GSHS INC	LLC				Yes

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) CHRISTUS TRINITY MOTHER FRANCIS	L	11,377,165	ACTUAL
(2) CHRISTUS TRINITY MOTHER FRANCIS	O	574,265	ACTUAL
(3) CHRISTUS TRINITY MOTHER FRANCIS	Q	84,026	ACTUAL
(4) GOOD SHEPHERD FOUNDATION	C	61,994	ACTUAL

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation
SCHEDULE R, PART III	GSHS CUSTOMER SERVICE BUILDING I, LTD. EIN: 02-0636726 ADDRESS: 700 E. MARSHALL AVE., LONGVIEW, TX 75601

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION REGARDLESS OF RACE, SEX, CREED, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	3,100
6	Total number of volunteers (estimate if necessary) .............	6	180
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	2,390,524
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	-1,283,356

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	545,512
9	Program service revenue (Part VIII, line 2g) .........	92,474,396	323,273,533
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-590,635	182,300
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	512,003	2,829,028
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	92,395,764	326,830,373
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	4,575,830	583,821
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	28,288,798	144,002,191
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 40,618
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	63,801,879	134,907,822
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	96,666,507	279,493,834
19	Revenue less expenses. Subtract line 18 from line 12.......	-4,270,743	47,336,539
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	37,546,659	166,740,862
21	Total liabilities (Part X, line 26).............	43,190,877	178,728,093
22	Net assets or fund balances. Subtract line 21 from line 20.....	-5,644,218	-11,987,231

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 232,352,590 including grants of $ 583,821 ) (Revenue $ 323,273,533 )
	DURING TAX YEAR 2016 GOOD SHEPHERD MEDICAL CENTER MARSHALL ENTERED INTO THREE YEAR TERM AFFILIATION AGREEMENTS WITH A LOCAL FEDERALLY QUALIFIED HEALTH CENTER (FQHC). THE PURPOSE OF THESE AGREEMENTS WAS TO PROVIDE ACCESSIBLE, HIGH QUALITY HEALTH CARE SERVICES, AS WELL AS UNCOMPENSATED CARE FOR PATIENTS WITH LITTLE OR NO INSURANCE, WHILE PROMOTING GENERAL PUBLIC HEALTH AND IMPROVING THE HEALTH STATUS OF CITIZENS LIVING IN MARSHALL, TEXAS. AS PART OF THESE AGREEMENTS, GSMC MARSHALL MADE GRANTS TO COVER OPERATING SHORTFALLS OF FAMILY PRACTICE AND PEDIATRIC CLINICS OF FQHC OPERATED CLINICS IN MARSHALL. CASH CONTRIBUTIONS TOTALLING $725,291 WERE MADE TO THE FQHC DURING THE CURRENT TAX YEAR TO COVER SUCH LOSSES. (THE AFFILIATION WITH THE FQHC HELPED TO ADDRESS COMMUNITY NEED #3 "AFFORDABLE PRIMARY AND PREVENTIVE CARE OPTIONSNEED #10 "UNINSURED/LIMITED INSURANCE DUE TO LACK OF MEDICAID EXPANSION OR HIGH DEDUCTIBLE PLANS".) HELPING PREPARE FUTURE HEALTHCARE PROFESSIONALS IS A DISTINGUISHING CHARACTERISTIC OF NONPROFIT HOSPITALS AND CONSTITUES A SIGNIFICANT COMMUNITY BENEFIT. CHRISTUS GOOD SHEPHERD MEDICAL CENTER - LONGVIEW ASSISTS IN THE EDUCATION OF HEALTHCARE PROFESSIONALS BY PROVIDING RESIDENCIES FOR PHYSICIANS. WE TRAINED 35 INTERNAL MEDICINE RESIDENT FTEs DURING THE FISCAL YEAR ENDED 09/30/18. TOTAL DIRECT COST (RESIDENT STIPENDS AND BENEFITS AND OTHER CHARGES FROM THE ACADEMIC PROGRAM SPONSOR) PLUS OVERHEAD ALLOCATIONS ON THE COST REPORT TOTALED $5,342,626 WITH OFFSETTING MEDICARE PAYMENTS OF $1,749,897. EACH YEAR CHRISTUS GOOD SHEPHERD MEDICAL CENTER - MARSHALL AND CHRISTUS GOOD SHEPHERD MEDICAL CENTER - LONGVIEW ASSIST IN THE EDUCATION OF NURSES AND ALLIED HEALTHCARE PROFESSIONALS BY PROVIDING CLINICAL SETTINGS AND INTERNSHIPS FOR NURSES, PHYSICAL THERAPISTS, SPEECH THERAPISTS, RESPIRATORY THERAPISTS, EMT, AND LAB. IN FYE 09/30/18, CHRISTUS GOOD SHEPHERD HELPED TRAIN 723 STUDENTS AT A COST OF $43,795. IN FYE 09/30/18, CHRISTUS GOOD SHEPHERD HELPED TRAIN 2,584 STUDENTS AT A COST OF $277,234. DURING THE TAX YEAR, CHRISTUS GOOD SHEPHERD MEDICAL CENTER - MARSHALL PROVIDED COMMUNITY HEALTH EDUCATION TO 3,314 PERSONS AT A COST OF $10,462. DURING THE CURRENT TAX YEAR, GOOD SHEPHERD MEDICAL CENTER - LONGVIEW ENTERED INTO A THREE YEAR COMMUNITY BENEFIT GRANT RELATED TO WOMEN AND CHILDREN'S SERVICES WITH WELLNESS POINTE, A LOCAL FEDERALLY QUALIFIED HEALTH CENTER (FQHC). GRANT PAYMENTS TOTALLING $116,250 WERE MADE TO WELLNESS POINTE THIS YEAR.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses232,352,590

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,669,670	6,101,277	482,134

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	350,512
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	195,000

g	Noncash contributions included in lines 1a - 1f:$		1g	288,518

h Total. Add lines 1a-1f.......		545,512

		Business Code
2a	NET PATIENT REVENUE	621990	288,306,799	288,306,799
b	LIFE WELLNESS CENTER	713940	3,773,643	3,435,156	338,487
c	GOVERNMENT FUNDS - TRAUMA	624200	3,180,358	3,180,358
d	LAB OUTREACH REVENUE	621500	1,990,619	-4,114	1,994,733
e	PHARMACY REVENUE	446110	62,466	62,466
f	All other program service revenue.		25,959,648	25,959,648
g	Total. Add lines 2a–2f .....		323,273,533

3 Investment income (including dividends, interest, and othersimilar amounts) ......			165,364			165,364
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		1,039,080	6a
b	Less: rental expenses		14,221	6b
c	Rental income or (loss)	0	1,024,859	6c
d	Net rental income or (loss).......			1,024,859			1,024,859
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		172,340	7a
b	Less: cost or other basis and sales expenses		155,404	7b
c	Gain or (loss)		16,936	7c
d	Net gain or (loss).........			16,936			16,936
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	FOOD SERVICE INCOME		722221	855,545			855,545
b	LAUNDRY SERVICES		722515	77,876			77,876
c	PARTNERSHIP INCOME		900099	57,304		57,304
d	All other revenue ....			813,444			813,444
e	Total. Add lines 11a–11d ......			1,804,169
12	Total revenue. See instructions.....			326,830,373	320,940,313	2,390,524	2,954,024

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	583,821	583,821
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	119,684,184	97,456,418	22,205,822	21,944
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,327,121	1,080,589	246,277	255
9	Other employee benefits .......	15,349,525	12,498,396	2,848,232	2,897
10	Payroll taxes ...........	7,641,361	6,221,750	1,418,119	1,492
11	Fees for services (non-employees):
a	Management ......	1,123,989	909,870	212,843	1,276
b	Legal .........	6,481	5,248	1,226	7
c	Accounting ...........	7,292	5,903	1,381	8
d	Lobbying ...........	887		887
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	44,242,955	41,088,418	3,152,407	2,130
12	Advertising and promotion ....	1,701	1,382	319
13	Office expenses .......	34,659,635	28,231,234	6,423,758	4,643
14	Information technology ......	38,756	31,570	7,181	5
15	Royalties ..	0
16	Occupancy ...........	9,308,897	7,582,499	1,725,180	1,218
17	Travel ............	132,402	107,585	24,747	70
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	78,857	64,273	14,582	2
20	Interest ...........	10,720,823	7,348,570	3,372,253
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	12,365,004	10,062,520	2,299,011	3,473
23	Insurance ...	3,403,850	2,771,509	631,681	660
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	BAD DEBTS	-49,600,991	-49,600,991
b	MEDICAL SUPPLIES	54,821,175	54,821,175
c	EQUIPMENT RENT	9,874,441	8,048,971	1,825,336	134
d	ASO SYSTEM	388,606	315,146	73,132	328
e	All other expenses	3,333,062	2,716,734	616,252	76
25	Total functional expenses. Add lines 1 through 24e	279,493,834	232,352,590	47,100,626	40,618
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			9,079	1	10,262,811
2	Savings and temporary cash investments .........			3,924,254	2	3,769,000
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			4,429,401	4	28,513,244
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			1,627,346	8	7,189,531
9	Prepaid expenses and deferred charges ......			167,171	9	415,376
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	235,376,258
b	Less: accumulated depreciation	10b	172,541,376	17,618,606	10c	62,834,882
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			349,578	12	8,634,154
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			945,319	14	858,059
15	Other assets. See Part IV, line 11 ...........			8,475,905	15	44,263,805
16	Total assets. Add lines 1 through 15 (must equal line 33)...			37,546,659	16	166,740,862

17	Accounts payable and accrued expenses .....	3,467,640	17	17,172,177
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	31,326,919	20	123,906,282
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	8,396,318	25	37,649,634
26	Total liabilities. Add lines 17 through 25..	43,190,877	26	178,728,093

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	-5,644,218	32	-11,987,231
33	Total liabilities and net assets/fund balances ........	37,546,659	33	166,740,862