2014-07-14T16:24:47-05:00 2013-08-31 990 2012-09-01 274434451 Scott & White Hospital-College Station SCOT 2542159256 2401 S 31st Street Temple TX 76508 Jason Jennings 2542159256 2014-07-14 2012 2015-11-30 17:44:51Z Jason Jennings 2401 S 31st Street Temple TX 76508 535108 0 X www.sw.org X 2010 TX See Schedule O Acute care hospital providing the most personalized, comprehensive, high quality health care services enhanced by medical education and research to Central Texas residents throughout a 29,000-square mile service area. 11 5 0 40 0 0 0 0 0 534401 0 0 0 707 0 535108 0 8800 0 0 0 5098865 0 0 0 0 2273883 0 7381548 0 -6846440 0 2678253 0 9524695 0 -6846442 X To provide the most personalized, comprehensive and highest quality health care, enhanced by medical education and research. 0 0 6395488 8800 535108 See Schedule OScott & White provides personalized, comprehensive, high quality health care services enhanced by medical education and research through 13 acute care hospital facilities, one additional announced facility, a 215,000+ member regional health plan serving residents in a 29,000-square mile service area, and one of the nation's largest multi-specialty group practices with more than 140 clinics at over 70 clinic locations providing care in 46 medical specialties. Scott & White Healthcare ("SWHC")(EIN: 26-4532547) is parent corporation of the Scott & White Healthcare System (the "System"). The Scott & White Healthcare Foundation ("SWF")(EIN: 27-3513154), a subsidiary of SWHC, raises funds for the priority programs and services of the entire Scott & White System. The Scott & White Healthcare System had more than 14,000 employees, including over 1,200 physicians and scientists and 300+ advanced practice professionals during the fiscal year ending August 31, 2013, and served over 537,000 patients accounting for 2.5 million patient visits. Scott & White Memorial Hospital ("SWMH"), located in Temple, Texas, is the flagship hospital of the Scott & White Healthcare System and is the only Level I Trauma Center between Dallas and Austin, Texas. The McLane Children's Hospital Scott & White is the only stand-alone children's hospital between Dallas and Austin, Texas. Scott & White Hospital-College Station, a 143 bed Hospital opened in August 2013. During the first few weeks of operation, there were 319 patient observation days (excluding newborns), 95 surgical cases, 106 admissions and 444 emergency room visits for the fiscal year ending August 31, 2013. Scott & White Hospital College Station offers Neonatal Intensive Care, Neurosurgical and comprehensive cardiac services. Scott & White Hospital College Station was not required to report community benefits (as reported to the Texas Department of State Health Services and in accordance with the State of Texas Statutory methodology) because it was only open for 12 days during the fiscal year ending August 31, 2013. All hospitals in the Scott & White Healthcare System reported combined community benefits under this same methodology of $223,575,612. 6395488 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 X Jon Malone 2542159259 2401 S 31st Street Temple TX 76508 X Bob Yancy 1.00 X X 0 0 0 Wayne Fischer 1.00 X 0 0 0 Tommy Ladewig 1.00 X 0 0 0 Sharon Wilkerson 1.00 X 0 0 0 Jason D Jennings 40.00 X X 0 336851 53770 Jim Kirby MD 1.00 X 0 0 0 Thomas O'Shea MD 1.00 40.00 X 0 571473 51968 Daniel Ransom MD 1.00 40.00 X 0 247270 51872 William Rayburn MD 1.00 40.00 X 0 625334 54941 Patricia M Currie 1.00 40.00 X X 0 735763 53682 Glen R Couchman MD 1.00 40.00 X 0 741071 53113 James Carroll 1.00 40.00 X X 0 511014 46414 Dick L Dixon 1.00 40.00 X 0 641174 52540 Clayton R Kolodziejczyk 40.00 X 0 185674 24334 Cynthia Dunlap 1.00 40.00 X 0 308906 45842 Robert W Pryor MD 1.00 40.00 X 0 1202973 52070 Matthew L Chambers 1.00 40.00 X 0 536594 54371 Marc R Hallee 1.00 40.00 X 0 496688 46603 Stephen F Sullivan 1.00 40.00 X 0 272378 12785 Peter S Brumleve 0.00 40.00 X 0 199976 14740 0 7613139 669045 0 1 1 0 0 Net Patient Service Re 622110 534401 534401 534401 Gift Shop 453220 707 707 707 535108 535108 0 0 8800 8800 307211 307211 3952391 3622426 329965 839263 719587 119676 388947 330980 57967 61421 52233 9188 8065 6859 1206 963966 819770 144196 89097 75769 13328 22216 18893 3323 Medical Supplies 530187 530187 Recruitment 113183 113183 Gift Shop 45978 45978 Outreach 23071 23071 27752 27752 7381548 6395488 986060 0 0 6067 0 745224 1926962 0 2678253 121096 0 9403599 0 9524695 X -6846442 0 -6846442 0 2678253 -6846440 0 X 0 1 X 1 0 X 0 Due to Related Organization 9403599 9403599 X Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Fin 48 (ASC 740) Footnote: Scott & White evaluates its income tax positions in accordance with ASC 740, Income Taxes, regarding accounting for uncertainty in income taxes. ASC 740 prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. There are no material uncertain income tax positions as of August 31, 2013 or 2012. 1 1 1 X 1 X 375.000000000000 1 0 0 249888 249888 0.03390 249888 249888 0.03390 249888 249888 0.03390 1 184688 1 1 1 1 Scott & White Hospital-College Station

700 Scott White Drive College Station TX 77845

www.sw.org X X X Scott & White Hospital-College Station 1 0 1 1 100.000000000000 1 375.000000000000 1 X X X X X X 1 1 X X X 1 0 X X X X 1 X 0 0 4 College Station Clinic

1600 University Dr East College Station TX 77840

General and specialty clinic College Station Clinic-Arrington Road

1296 Arrington Road Suite 100 College Station TX 77845

Family and pediatric clinic Rock Prairie Clinic

800 Scott White Drive College Station TX 77845

General and specialty clinic Boonville Clinic

748 N Earl Rudder Freeway Bryan TX 77802

Family medicine clinic Part I, Line 3c: Scott & White provides free or discounted care to uninsured patients who are considered Financially Indigent. In order to qualify for financial assistance a patient must live within the 31 county service area of the Scott & White Health Care System. To determine eligibility for free or discounted care, in addition to income and residency; net assets, other financial resources, credit report, and other relevant information are considered. The Scott & White financial assistance policy also provides for exceptional circumstances in which a patient with income over 375% FPG could qualify for financial assistance if the cost exceeds two times their annual household income. Part I, Line 6a: Scott & White Hospital-College Station ("SWHCS") did not prepare a community benefit report for the fiscal year ending August 31, 2013. SWHCS was not required to file an Annual Report of Community Benefit Plan with the Texas Department of State Health Services for fiscal year ending August 31, 2013. Beginning in the fiscal year ending August 31, 2014 this report will be filed with TDSHS and made available through the organization's website at www.sw.org. Part I, Line 7: The costing method used for Schedule H is the cost to charge ratio, as calculated in Schedule H, Worksheet 2. This method was applied to the costs reported on line 7b. Part III, Line 4: Audited financial statement footnote Page 18: The presentation of the provision for bad debts as a reduction of patient service revenue is based on an entity-wide assessment of the significance of patient revenue that is recognized without assessing patients' ability to pay. As stated in the combined audited financial statements, the organization maintains allowances for uncollectible accounts for estimated losses resulting from a payers inability to make payments on accounts. The organization assesses the reasonableness of the allowance account based on the historical write-offs, cash collections, the aging of the accounts and other economic factors. Accounts are written off when collection efforts have been exhausted. Management continually monitors and adjusts its allowance associated with its receivable. Bad debt does not include amounts for patients who are known to qualify under the organizations charity care policy. The amount of bad debt attributable to patient's accounts is net of contractual allowance, payments received and recoveries of bad debt previously written off. The organization has entered zero on Schedule H, Part III, Line 3; however, based on prior experience and certain demographics and other information obtained during admission, the organization believes a portion of the bad debt expenses (estimated to range from 1-5%) would be attributable to patients that would otherwise qualify for charity care. Despite all of the effort and ways the organization educates patients about qualifying for its charity care program as demonstrated in Part VI, question 3 below, many uninsured patients either refuse or fail to complete a charity care application or provide sufficient information at the time of admission, during their stay or after being discharged to qualify for assistance under the organization's charity care policy. Part III, Line 8: Scott & White Hospital-College Station opened in August of 2013. The first Medicare Cost Report covering this period will not end until May 31, 2014. Part III, Line 9b: The Scott & White Healthcare Financial Assistance Policy has a section for coordination with collection policies. It states: "notwithstanding any other provision of any other policy or provision at S&W regarding billing and collection matters, S&W will not engage in extraordinary collection actions before it makes reasonable efforts to determine whether an individual who has an unpaid billing from S&W is eligible for financial assistance under this Policy. "Reasonable efforts" includes notification to the patient by S&W of this Policy upon admission or discharge and in written and oral communications with the patient regarding the patient's billings, including invoices, telephone calls, and such other communications as may be set forth in future guidance from the U.S. Department of the Treasury or Internal Revenue Service." Scott & White Hospital-College Station Part V, Section B, Line 1j: Scott & White Hospital-College Station ("SWHCS") did not prepare a community health needs assessment for the fiscal year ending August 31, 2013. In accordance with the IRS Proposed Regulation 106499-12 issued April 5, 2013, which states: "A hospital facility that is newly acquired or placed into service, or that becomes newly subject to the requirements of section 501(r) because the hospital organization that operates it is newly recognized as described in section 501(c)(3), must meet the requirements of section 501(r)(3) by the last day of the second taxable year beginning after the date, respectively, the hospital faciliy is acquired; licensed, registered, or similarly recognized by its state as a hospital." SWHCS received its Texas Hospital License in July of 2013.Scott & White was involved in the RHP 17 Regional Health Assessment conducted through The Center for Community Health Development. The assessment was completed in the Fall of 2013 and approved by the Board of Directors in May of 2014. Scott & White Hospital-College Station Part V, Section B, Line 12h: The Scott & White Healthcare Patient Financial Assistance Policy ("PFAP") requires patients to be a Permanent Resident of the Scott & White Provider Service Area. Permanent Resident is defined as "an individual who has established and maintained residency within a Scott & White Provider Service Area for a period of at least six (6) months immediately prior to submitting an application for financial assistance." The Scott & White Provider Service Area as defined in the PFAP "is the geographic area, defined by Texas counties and determined by Scott & White, in which a patient must be a Permanent Resident in order to be eligible to receive financial assistance under this Policy." Schedule A of the PFAP lists the 31 Texas Counties that Scott & White has defined as their service area to meet the residency requirement. Scott & White Hospital-College Station Part V, Section B, Line 14g: The organization is committed to promoting health in the community including providing or finding financial assistance programs to assist patients. Patients who may qualify for financial assistance through the organization's charity care program or other federal, state and local government programs are informed and educated about their eligibility in several ways including, but not limited to, the following: 1) posting signs and notices regarding the charity care policy in the emergency departments, admitting areas and business offices located throughout the organization, 2) annual posting regarding the organization's charity care program in the local newspapers, 3) information regarding financial assistance, including the organization's charity care policy, is posted on the organization's website, 4) notices about the organization's financial assistance policies are posted on each bill sent to patients including providing a phone number to access the customer service unit dedicated to answering patients billing questions, as well as provide information regarding financial assistance, and 5) the organization provides free financial counselors to help patients determine how to meet their financial obligations for services provided. Specifically financial counselors assist patients in applying for government assistance programs such as Medicaid or the organization's charity care program. Any patient may request to speak to a financial counselor when being treated at the organization. Uninsured patients who are admitted to the hospital will automatically receive help from a financial counselor. These services are provided in writing and through interpretation services in the primary language of the patient requesting assistance. Though the most often needed alternate language is Spanish. Scott & White Hospital-College Station Part V, Section B, Line 20d: The organization's financial assistance policy is developed to provide discounted care to those qualifying for financial assistance to where the amount charged under this policy will always be equal to or lower than the Medicare rates. However, for those qualifying as medically indigent and whose income level is over 375% of the federal poverty level shall not be billed more than 2 times their annual household income, which is generally lower than the methodology listed above and the three methods listed in Schedule H Part V, Line a-c. Part VI, Line 2: Data collection is critical to understanding and meeting community health needs. Scott & White continually monitors local health trends, reviews hospitalization inpatient and outpatient records, and takes feedback from community leaders and public health officials as to what the current needs are. S&W staff members participate regularly in exchanges with government, education, and human service organizations to learn what other issues are in the community that are perhaps underlying causes of healthcare problems. And S&W executives assist with strategic planning processes for other organizations that provide healthcare services for the medically underserved. In an effort to get regular feedback from the community, Scott & White created a new department to actively engage the patients and community in continuous dialogue to provide an opportunity for them to share what their unmet needs are when they seek medical care. We believe this platform will allow the opportunity to view shortcomings from the community perspective. Additionally a strategic plan for conducting lengthy assessments on a 3 year cyclical basis has been made for upcoming years. Data pertaining to the changing demographics, hospitalization rates for the top 15 conditions, and 100 health and quality of life indicators will be collected, monitored and reported on a regular basis on the hospital's website. The data will show how counties within the Scott & White service area stand in relation to other Texas Counties, U.S. Counties and Healthy People 2020 goals for the indicators. Also, gaps in information in the current collection of data will be identified and targeted for future exploration in the form of surveys, key informant interviews and focus groups. Part VI, Line 3: The organization is committed to promoting health in the community including providing or finding financial assistance programs to assist patients. Patients who may qualify for financial assistance through the organization's charity care program or other federal, state and local government programs are informed and educated about their eligibility in several ways including, but not limited to, the following: 1) posting signs and notices regarding the charity care policy in the emergency departments, admitting areas and business offices located throughout the organization, 2) annual posting regarding the organization's charity care program in the local newspapers, 3) information regarding financial assistance, including the organization's charity care policy, is posted on the organization's website, 4) notices about the organization's financial assistance policies are posted on each bill sent to patients including providing a phone number to access the customer service unit dedicated to answering patients billing questions, as well as provide information regarding financial assistance, and 5) the organization provides free financial counselors to help patients determine how to meet their financial obligations for services provided. Specifically financial counselors assist patients in applying for government assistance programs such as Medicaid or the organization's charity care program. Any patient may request to speak to a financial counselor when being treated at the organization. Uninsured patients who are admitted to the hospital will automatically receive help from a financial counselor. These services are provided in writing and through interpretation services in the primary language of the patient requesting assistance. Though the most often needed alternate language is Spanish. Part VI, Line 4: Scott & White Hospital-Brenham identifies Washington County as its primary community served because it is where the hospital facility is located and from where most of its patients reside.The mean age of survey respondents from Washington County was 51.1 years. Washington County has a population age similar to other counties across the Brazos Valley. Compared to Texas and the U.S., Washington County has a smaller proportion of young adults and a larger proportion of adults 65 years and older. A majority of Washington County survey respondents identified themselves as White/Caucasian (86.4%), 6.3 percent indicated Black/African American, and 6 percent indicated Hispanic/Latino. Other respondents identified themselves as Asian or Pacific Islander, Native American, and as more than one race. Because of these relatively small numbers, these last three categories were combined into a single group called "All Other Races" for the purpose of analysis (total of 1.3%). Comparing these figures to 2013 Census estimates indicates that minority groups are underrepresented in this survey sample.The median household income for Washington County residents is $39,134 and the average household income is $56,878. Slightly less than 50% of the population has not received any education beyond high school. Discussion group participants described Washington County as a laid back, conservative community that is a great, safe place to live. The generosity of community members and the beautiful natural scenery were often mentioned as attractive community features. Participants said that local residents are friendly and share a sense of community based on local history and family values. Community discussion participants also emphasized that the community is growing, and with this growth, Washington County is becoming more diverse. This growth is bringing larger populations of younger and older residents, long-term families as well as new transplants, and increased proportions of racial/ethnic minorities to the community. Residents attributed the area's stable economy to supportive local businesses and strong leadership. They also said that residents have good communication networks and are proactive in planning to meet future needs in areas such as health care, transportation, and the economy. Part VI, Line 5: All Scott & White Healthcare System facilities are operated in a manner that furthers exempt purposes. Scott & White Healthcare officers and executives plan and direct the activities of all System facilities under the direction and oversight of the Scott & White Healthcare Board of Trustees. The Scott & White Hospital-College Station ("SWHCS") Board of Directors is comprised of persons residing in the service area. As explained in response to Form 990 Part VI, Section A, Question 7b, the SWHCS Board of Directors does not consist of a majority of independent directors because SWHCS relies on the Scott & White Healthcare Board of Trustees, which is controlled by a majority of community trustees, to meet community board standards. Surplus funds are reinvested in facilities, equipment and programs to further SWHCS's exempt purposes. SWHCS is operated for the benefit of the public and no part of income inures to any private individual or serves a private interest. Surplus funds are used to improve the quality of patient care, expand facilities, advance medical training and education and fund research. Scott & White Healthcare has a Financial Assistance Policy that all hospitals in the Scott & White Healthcare System, including SWHCS, follow, which provides assistance to individuals with incomes up to 375% of the Federal Poverty Guidelines. Part VI, Line 6: Scott & White provides personalized, comprehensive, high quality health care services enhanced by medical education and research through 13 acute care hospital facilities, one additional announced facility, a 215,000+ member regional health plan serving residents in a 29,000-square mile service area, and one of the nation's largest multi-specialty group practices with more than 140 clinics at over 70 clinic locations providing care in 46 medical specialties. Scott & White Healthcare ("SWHC")(EIN: 26-4532547) is parent corporation of the Scott & White Healthcare System (the "System"). The Scott & White Healthcare Foundation ("SWF")(EIN: 27-3513154), a subsidiary of SWHC, raises funds for the priority programs and services of the entire Scott & White System. The Scott & White Healthcare System had more than 14,000 employees, including over 1,200 physicians and scientists and 300+ advanced practice professionals during the fiscal year ending August 31, 2013, and served over 537,000 patients accounting for 2.5 million patient visits. Scott & White Memorial Hospital ("SWMH"), located in Temple, Texas, is the flagship hospital of the Scott & White Healthcare System and is the only Level I Trauma Center between Dallas and Austin, Texas. The McLane Children's Hospital Scott & White is the only stand-alone children's hospital between Dallas and Austin, Texas. Scott & White Hospital-College Station, a 143 bed Hospital opened in August 2013. During the first few weeks of operation, there were 319 patient observation days (excluding newborns), 95 surgical cases, 106 admissions and 444 emergency room visits for the fiscal year ending August 31, 2013. Scott & White Hospital College Station offers Neonatal Intensive Care, Neurosurgical and comprehensive cardiac services. Scott & White Hospital College Station was not required to report community benefits (as reported to the Texas Department of State Health Services and in accordance with the State of Texas Statutory methodology) because it was only open for 12 days during the fiscal year ending August 31, 2013. The combined hospital reported community benefits of the entire Scott & White Healthcare System under this same methodology was $223,575,612. Reports Filed With States Part VI, Line 7 TX 1 American Cancer Society 2433 Ridgepoint Dr Austin TX 78754 741185665 501 (c)(3) 8000 General Support 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: As part of its mission, the organization provides grants and other assistance to related organizations and/or unrelated not-for-profit organizations which are religious, charitable, scientific, or educational in nature, within the meaning of Internal Revenue Code Section 501(c)(3), when the use will fulfill an identified community need, serve an underserved population, be in line with the mission of the organization, or provide the organization opportunities to build relationships with the community members and nonprofit organizations serving the community. For related organizations, all grants and other assistance are subject to the policies and procedures set forth by Scott & White Healthcare which ensures all funds are used in accordance with the guidelines set forth above and in accordance with the related organization's exempt purpose. Grants and other assistance provided to unrelated organizations are given as a restricted gift and the receiving organization must sign a statement indicating they will use the funds for the stated purpose. 0 0 0 0 0 0 0 1 0 Jason D Jennings 0 268657 0 56710 0 11484 0 32500 0 21270 0 390621 0 0 Thomas O'Shea MD 0 537555 0 28588 0 5330 0 32500 0 19468 0 623441 0 0 Daniel Ransom MD 0 233548 0 11439 0 2283 0 32500 0 19372 0 299142 0 0 William Rayburn MD 0 528372 0 94000 0 2962 0 32500 0 22441 0 680275 0 0 Patricia M Currie 0 540415 0 192500 0 2848 0 32500 0 21182 0 789445 0 0 Glen R Couchman MD 0 545222 0 192500 0 3349 0 32500 0 20613 0 794184 0 0 James Carroll 0 375213 0 132300 0 3501 0 32500 0 13914 0 557428 0 0 Dick L Dixon 0 431778 0 207750 0 1646 0 32500 0 20040 0 693714 0 0 Clayton R Kolodziejczyk 0 158332 0 24225 0 3117 0 8759 0 15575 0 210008 0 0 Cynthia Dunlap 0 245315 0 62750 0 841 0 32500 0 13342 0 354748 0 0 Robert W Pryor MD 0 895623 0 300000 0 7350 0 32500 0 19570 0 1255043 0 0 Matthew L Chambers 0 392598 0 140000 0 3996 0 32500 0 21871 0 590965 0 0 Marc R Hallee 0 366554 0 129750 0 384 0 32500 0 14103 0 543291 0 0 Stephen F Sullivan 0 230513 0 40833 0 1032 0 0 0 12785 0 285163 0 0 Peter S Brumleve 0 118744 0 0 0 81232 0 10219 0 4521 0 214716 0 0 Part I, Line 3 The compensation review process is performed annually. All physician compensation is reviewed including pay, production data and total compensation. The physician compensation is then benchmarked against industry standards using data from ten different industry surveys. This review is performed by an independent consultant and presented to the Scott & White Healthcare Board of Trustees Compensation Committee. Scott & White Healthcare ("SWHC")(EIN: 26-4532547) is the parent corporation of the Scott & White Healthcare System (the "System"). System Officers along with regional Chief Executive Officers and Chief Medical Officers are reviewed annually. An independent consultant compares total compensation to benchmark surveys. The Scott & White Healthcare Board of Trustees Compensation Committee reviews the compensation and comparability data annually. Part I, Line 7 Discretionary bonuses are an element of various Scott & White Healthcare System (the "System") compensation plans. The Scott & White Healthcare Board of Trustees, which is the governing body of the Scott & White Healthcare System and the Board Compensation Committee have approved plans designed to measure performance based on differing job functions. The Board of Trustees approves the bonus pools reserved for the various plans. The Board of Trustees determines and approves the bonus, if any, for the System's Chief Executive Officers and other executive level personnel. Form 990, Part V, Line 1a: Scott & White Hospital-College Station ("SWHCS") does not file Forms 1096 or 1099. All expenditures for goods and services are made by Scott & White Memorial Hospital, which has filed all required reporting forms. Form 990, Part V, Line 2a: Employees of the Scott & White Healthcare System are employed by Scott & White Memorial Hospital ("SWMH")(EIN: 74-1166904) or Scott & White Clinic ("SWC")(EIN: 74-2958277). This is done to achieve parity and consistency in compensation and benefits offered to employees and to reduce administrative costs. Consistent with this practice, employee Form W-2's are filed by Scott & White Memorial Hospital or Scott & White Clinic. For financial reporting purposes, compensation, benefits and other employee costs are assigned to the Scott & White entity for which services are rendered. Oversight of and responsibility for the activities of employees are vested in the board of directors and management of the Scott & White entity to which such employees are assigned. All required employment forms have been filed by Scott & White Memorial Hospital and Scott & White Clinic. Form 990, Part VI, Section A, line 6 Scott & White Healthcare ("SWHC")(EIN: 26-4532547), an organization exempt from tax under IRC section 501(c)(3) and a public charity under IRC section 509(a)(3) is the sole member. Form 990, Part VI, Section A, line 7a Scott & White Healthcare ("SWHC")(EIN: 26-4532547), an organization exempt from tax under IRC section 501(c)(3) and a public charity under IRC section 509(a)(3) is the sole member. Election of the Hospital Board of Directors requires the approval of the Scott & White Healthcare Board of Trustees, by majority vote. The majority of the Scott & White Healthcare Board of Trustees is comprised of individuals who are representative of the community. Form 990, Part VI, Section A, line 7b Scott & White Healthcare ("SWHC")(EIN: 26-4532547), an organization exempt from tax under IRC section 501(c)(3) and a public charity under IRC section 509(a)(3) is the sole member. Actions taken by the Hospitals Board of Directors are subject to oversight and approval of the Scott & White Healthcare Board of Trustees. The majority of the Scott & White Healthcare Board of Trustees is comprised of individuals who are representative of the community. Form 990, Part VI, Section B, line 11 The Form 990 is prepared and reviewed by Scott & White Healthcare's ("SWHC") tax department. During the return preparation process the tax department works with other functional areas including finance, accounting, treasury, legal, human resources, and corporate compliance for advice, information and assistance to prepare a complete and accurate return. A complete final copy of the return is provided to the organization's governing body prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Persons with an actual or perceived ability to influence the organization have a duty to disclose annually and otherwise promptly as potential conflicts are identified, any familial, professional or financial relationships with entities or individuals that do, or seek to do business with the organization or that compete with the organization. These individuals include the organization's officers, governing body, management, physicians with administrative services agreements and other key personnel who interact with outside organizations or businesses on behalf of the organization. Scott & White Healthcare ("SWHC")Board of Trustees Audit and Compliance Committee and the SWHC Corporate Compliance Committee reviewed all relevant disclosures submitted by these individuals to determine whether a conflict of interest exists and to determine an appropriate resolution, if necessary. Any individual with a perceived or potential conflict is prohibited from voting or participating in the decision making process regarding such transaction with that individual. Form 990, Part VI, Section B, line 15 The compensation review process is performed annually. All physician compensation is reviewed; including pay, production data, and total compensation. The physician compensation is then benchmarked against industry standards using data from ten different industry surveys. This review is performed by an independent consultant and presented to the Scott & White Healthcare Board of Trustees Compensation Committee. Scott & White Healthcare ("SWHC")(EIN: 26-4532547) is the parent corporation of the Scott & White Healthcare System (the "System"). System Officers along with regional Chief Executive Officers and Chief Medical Officers are reviewed annually. An independent consultant compares total compensation to benchmark surveys. The Scott & White Healthcare Board of Trustees Compensation Committee reviews the compensation and comparability data annually. Form 990, Part VI, Section C, line 19 The Scott & White governing documents and Conflict of Interest Policy (Tax) are available to the public upon request. This entity does not have separately audited financial statements. The audited financial statements of the Scott & White Healthcare System are available at http://www.dacbond.com and upon request. Part VI, Line 14: While not formally adopted as of the organization's tax year end, written policies and procedures have been drafted by the organization that address the procedures followed with respect to written document retention and destruction compliance. The organization anticipates these procedures will be adopted within the next fiscal year. Form 990, Part VII: Average hours per week recorded in column B for the Officers, Directors, Key Employees and Highly Compensated Employees represent total hours worked for the entire Scott & White Healthcare System. Form 5471 Disclosure Statement Related to Forms 5471, Information Return of U.S. Persons With Respect to Certain Foreign Corporations, Filed on Behalf of the Taxpayer: Under the constructive ownership rules of IRC Sections 958(a) and (b). The taxpayer is required to file Forms 5471, Information Return of U.S. Persons With Respect to Certain Foreign Corporations, as a Category 5 filer with respect to certain controlled foreign corporations (CFCs). These filing requirements are or will be satisfied through the filing of Forms 5471 for these CFCs by other U.S. taxpayers identified below who have the same filing requirement. Taxpayer Name: Scott & White Memorial Hospital Taxpayer Address: 2401 S. 31st Street Temple, TX 76508 Taxpayer Identification Number of U.S. tax return with which the Forms 5471 were or will be filed: 74-1166904 IRS Service Center where U.S. tax return was or will be filed: efile Scott & White Healthcare 2401 S 31st Street Temple TX 76508 264532547 Operational Support TX 501 (c) (3) Line 11a, I N/A 0 Scott & White Memorial Hospital 2401 S 31st Street Temple TX 76508 741166904 Hospital Services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Scott & White Clinic 2401 S 31st Street Temple TX 76508 742958277 Physician Services TX 501 (c) (3) Line 9 Scott & White Healthcare 1 Scott & White Continuing Care Hospital 2401 S 31st Street Temple TX 76508 202850920 Hospital Services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Scott & White EMS Inc 2401 S 31st Street Temple TX 76508 753242749 Emergency Transportation TX 501 (c) (3) Line 9 Scott & White Memorial Hospital 1 Hillcrest Baptist Medical Center 100 Hillcrest Medical Blvd Waco TX 76712 741161944 Hospital Services TX 501 (c) (3) Line 3 Scott & White Memorial Hospital 1 Scott & White Hospital-Brenham 2401 S 31st Street Temple TX 76508 742519752 Hospital Services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Scott & White Healthcare Foundation 2401 S 31st Street Temple TX 76508 273513154 Fundraising TX 501 (c) (3) Line 7 Scott & White Healthcare 1 Scott & White Health Plan 2401 S 31st Street Temple TX 76508 742052197 HMO/Insurance TX 501 (c) (4) Scott & White Healthcare 1 Scott & White Hospital-Taylor 2401 S 31st Street Temple TX 76508 741595711 Hospital services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Scott & White Hospital-Llano 2401 S 31st Street Temple TX 76508 273026151 Hospital Services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Scott & White Hospital-Round Rock 2401 S 31st Street Temple TX 76508 203749695 Hospital Services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Brenham Hospital Services Corporation 2401 S 31st Street Temple TX 76508 742605157 Operational Support TX 501 (c) (3) Line 11a, I Scott & White Healthcare 1 Scott & White Foundation-Brenham 2401 S 31st Street Temple TX 76508 742460815 Fundraising TX 501 (c) (3) Line 7 Scott & White Hospital-Brenham 1 Brenham Care Center 2401 S 31st Street Temple TX 76508 742663229 Healthcare TX 501 (c) (3) Line 9 Scott & White Hospital-Brenham 1 Hillcrest Family Health Center 100 Hillcrest Medical Blvd Waco TX 76712 742730350 Physician Services TX 501 (c) (3) Line 11a, I Hillcrest Baptist Medical Center 1 Hillcrest Physician Services 100 Hillcrest Medical Blvd Waco TX 76712 742967081 Physician Services TX 501 (c) (3) Line 11a, I Hillcrest Baptist Medical Center 1 Scott & White Hospital-Marble Falls 2401 S 31st Street Temple TX 76508 464007700 Hospital Services TX Applied for 501 (c) Applied for Line 3 Scott & White Healthcare 1 ESWCT LLC 10077 Grogans Mill Rd Ste 100 The Woodlands TX 77380 900899017 Investment TX N/A Scott & White Properties Holdings Inc 2401 S 31st Street Temple TX 76508 452920596 Investment TX N/A C 1 Scott & White Properties Inc 2401 S 31st Street Temple TX 76508 742497061 Hotel Services TX N/A C 1 Scott & White Assurance Ltd 23 Lime Tree Bay Grand Cayman CJ 980589956 Investment CJ N/A C 1 Hillcrest Holdings Inc 3000 Herring St Waco TX 76708 742793367 Operational Support TX N/A C 1 Atumida 2401 S 31st Street Temple TX 76508 270583030 Research TX N/A C 1 Insurance Company of Scott & White 2401 S 31st Street Temple TX 76508 743092083 Insurance TX N/A C 1 Charitable Remainder Trust #1 PO Box 6101 Temple TX 765036101 526854329 Investment TX N/A T 1 Charitable Remainder Trust #2 PO Box 6101 Temple TX 765036101 206463694 Investment TX N/A T 1 Charitable Remainder Trust #3 PO Box 6101 Temple TX 765036101 416504860 Investment TX N/A T 1 Charitable Remainder Trust #4 PO Box 6101 Temple TX 765036101 742751167 Investment TX N/A T 1 Charitable Remainder Trust #5 PO Box 6101 Temple TX 765036101 746391353 Investment TX N/A T 1 Charitable Remainder Trust #6 PO Box 6101 Temple TX 765036101 746397360 Investment TX N/A T 1 Charitable Remainder Trust #7 PO Box 6101 Temple TX 765036101 742751168 Investment TX N/A T 1 Charitable Remainder Trust #8 PO Box 6101 Temple TX 765036101 746423552 Investment TX N/A T 1 Charitable Remainder Trust #9 PO Box 6101 Temple TX 765036101 456783659 Investment TX N/A T 1 Phil and June Hivnor Charitable 2401 S 31st Street Temple TX 765080001 900850773 Investment TX N/A T 1 Nelda I Staller Charitable Remainder Unitrust No 1 2401 S 31st Street Temple TX 765080001 326224724 Investment TX N/A T 1 Scott & White Lake of the Hills Regional Medical Center 2401 S 31st Street Temple TX 765080001 451608264 Hospital Services TX N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 Scott & White Healthcare P 4676365 Cost Scott & White Clinic P 572217 Cost Scott & White Memorial Hospital P 4462066 Cost