2014-05-14T15:08:12-05:00 2013-06-30 990 2012-07-01 751777119 Baylor Regional Medical Center at Grapevine BAYL 2148204135 2001 Bryan Street No 2200 Dallas TX 752013005 Terri Foster 2148204135 2014-05-13 2012 2015-11-30 17:44:51Z Doug Lawson 1650 W College Grapevine TX 76051 490441751 0 X www.BaylorHealth.com X 1981 TX Faith based acute care hospital providing exemplary patient care to Grapevine, Texas and the surrounding communities. 5 4 2330 294 9396 0 1399121 49024285 404841219 358184733 9904493 16143708 19940 23300 416164773 423376026 1977362 9048081 0 0 135385589 127328951 0 0 0 209552787 182886123 346915738 319263155 69249035 104112871 485908253 601863172 81607845 84171637 404300408 517691535 X Founded as a Christian ministry of healing, Baylor Regional Medical Center at Grapevine exists to serve all people through exemplary health care, education, research, and community service. 0 0 278225408 9048081 358315460 See Schedule OThe organization is comprised of two separately licensed hospitals: Baylor Regional Medical Center at Grapevine (Baylor Grapevine) and Baylor Medical Center at Carrollton (Baylor Carrollton). Baylor Grapevine is a faith-based, non-profit, 276-bed acute care hospital providing exemplary patient care to Grapevine, Texas and the surrounding communities. Baylor Grapevine is an affiliate of Baylor Health Care System (BHCS), a nationally acclaimed network of acute care hospitals and related health care entities providing quality patient care, medical education, medical research and community services to the North Texas region. Baylor Grapevine provides inpatient and outpatient medical services to treat individuals with diseases, illnesses and injuries of varying complexities. Comprehensive services include all offerings typical of a quality acute care hospital with multidisciplinary interaction among physicians to help provide patients with innovative methods of prevention, diagnosis, treatment, education and support. These services include comprehensive care for all stages of illness through all stages of life. Some of these clinical services are provided despite a financial loss to Baylor Grapevine. During the fiscal year ending June 30, 2013, Baylor Grapevine admitted 19,842 inpatients resulting in a total of 50,682 days of care, delivered 2,589 babies and had 35,510 emergency department visits.Baylor Carrollton is a faith-based, non-profit, 232-bed acute care hospital providing exemplary patient care to Carrollton, Texas and the surrounding communities. Established as Trinity Medical Center in 1985, Baylor Carrollton became an affiliate of Baylor Health Care System (BHCS) in 2009 and a wholly owned hospital in 2011. Baylor Carrollton provides a broad spectrum of medical and healthcare services to the people of North Dallas. The medical staff is comprised of more than 500 physicians representing nearly 50 specialties. Baylor Carrollton is a full service hospital providing comprehensive diagnostic, surgical, and medical care for inpatients and outpatients, as well as 24 hour emergency care. The hospital's emergency department is designated as an accredited chest pain center. The hospital is accredited by The Joint Commission, the nation's oldest and largest hospital accreditation agency.Comprehensive services typical of a quality acute care hospital with multidisciplinary interaction among physicians are available, providing patients with innovative methods of prevention, diagnosis, treatment, education and support of most major diseases through all stages of life. Some of these clinical services are provided despite a financial loss to Baylor Carrollton. During the fiscal year ended June 30, 2013, Baylor Carrollton admitted 11,159 total adult and special care nursery patients resulting in a total of 25,628 days of care; 1,429 babies were delivered and there were 31,686 emergency department outpatient visits. Baylor Carrollton is also committed to assisting with the preparation of future nurses at entry and advanced levels of the profession to establish a workforce of qualified nurses. Through BHCSs relationships with fifteen North Texas schools of nursing, Baylor Carrollton maintains affiliations with schools of nursing. In the fiscal year ending June 30, 2013, the Hospital invested in training 300 nurses. Total unreimbursed cost of these programs was $169,449. Many times nursing graduates trained at Baylor Grapevine or Baylor Carrollton join the hospitals staff or remain in the North Texas area to provide top quality nursing services to the community. As part of its charitable mission, the organization is committed to providing free and/or subsidized care to both financially and medically indigent patients in the community. During the year, the organization provided community benefits (as calculated in accordance with the State of Texas Statutory methodology) of $80,066,319. The organization provided community benefits (as reported on the IRS Form 990, Schedule H) of $36,851,901 during the tax year. The Texas Annual Statement of Community Benefit Standard includes approximately $41,059,688 of unreimbursed cost of Medicare that is not included in the IRS Form 990, Schedule H. 278225408 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 308 0 1 2330 1 1 1 0 0 0 0 0 0 0 0 0 X 5 4 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 0 X Terri Foster 8173292555 1650 West College Street Grapevine TX 76051 Paul Madeley MD 1.00 40.00 X 0 758942 72210 George McClesky 1.00 7.00 X 0 0 0 Ron Carter 1.00 10.00 X 0 583 0 Roy Lamkin 1.00 10.00 X 0 587 0 J Kent Newsome 1.00 7.00 X 0 0 0 Christopher York 40.00 X 322715 0 55835 Elizabeth Houser 40.00 X 232862 0 28350 T Doug Lawson 1.00 40.00 X 41742 536572 142311 Terri Foster 40.00 X 297089 0 14366 William Boyd 1.00 40.00 X 0 1236471 220519 Steve Newton 40.00 1.00 X 0 621962 148118 Michael Sanborn 40.00 X 354280 0 62464 Barbara Vaughn 40.00 40.00 X 117371 44835 22489 Christine Cerone 40.00 40.00 X 111097 32081 25693 Kirk Starr 40.00 X 177051 0 28731 Sheila Richards 40.00 X 168047 0 25048 Kristin Rabenold 40.00 X 166254 0 21475 Sheldrick Streete 40.00 X 139098 0 31898 Preshie Wilson 0.00 40.00 X 0 259578 27802 Scott Peek 0.00 40.00 X 0 412811 105188 Karen Stubbs 40.00 X 201622 0 13801 2329228 3904422 1046298 129 1 1 0 Baylor Health Care System 2001 Bryan St Ste 2200 Dallas TX 75201 Management Services 52059086 MEDCO Construction LLC 2001 Bryan St Ste 2200 Dallas TX 75201 Construction Services 34815075 Aramark Services Inc P O Box 651009 Charlotte NC 282651009 Engineering/Food Services 6473575 Med Fusion LLC P O Box 222137 Dallas TX 75222 Lab Services 2233289 Perot Systems Corporation 2300 W Plano Pkwy Plano TX 75075 Purchased Services 1831602 49 49017930 6355 49024285 Patient Care Revenue 621990 354391372 354381976 9396 EHR Incentive 900099 1660368 1660368 Rent 531120 1182557 1182557 Cafeteria 722210 789593 789593 Education 611600 79226 79226 81617 11741 69876 358184733 5079522 130727 4948795 23300 23300 78110662 19249 66772392 293333 11338270 -274084 11064186 11064186 423376026 357446595 9396 16895750 X 9048081 9048081 1959628 1959628 101824967 100502328 1322639 3175631 3109499 66132 12938165 12774820 163345 7430560 7329378 101182 142251 142251 84547 84547 61798911 31742254 30056657 94077 18569 75508 10829169 10309826 519343 20750861 20750861 15796028 10006114 5789914 187826 169966 17860 135251 129051 6200 19239863 19239740 123 119066 119066 Medical Supplies 51318203 51318203 Recruiting 912439 912439 Taxes-Income, Prop, Fra 863711 398968 464743 Special Functions 207408 110339 97069 406512 212721 193791 319263155 278225408 41037747 0 13174 34536 3363308 847222 38766386 30808974 2182296 1842099 7995120 8089276 -104536 40136 411991330 133480235 219199297 278511095 197198356 265611746 1250000 1250000 13128356 13128356 2916496 1699732 485908253 601863172 18786754 23096862 2321286 2120014 59525764 58529630 974041 425131 81607845 84171637 X 402060767 516120155 2239641 1571380 404300408 517691535 485908253 601863172 X 104112871 9876033 -597777 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 4368 1 74966 0 0 79334 0 Part IV, Supplemental Information: Statement Regarding Legislative Activity Health care policy is critical to all Americans, and Baylor Regional Medical Center at Grapevine ("BRMCG") believes that health care providers must participate in forming health care policy by interacting with national, state and local representatives and their staff members to help them better understand the complexities and ramifications of key health care policies including, without limitation, those related to uninsured and indigent patient needs as well as the legislative and regulatory needs to assure the delivery of cost-efficient, quality health care. BRMCG has established relationships with persons and industry associations that often communicate BRMCG's positions on major health care issues. These contacts may include direct contact, telephone conversations and/or letters. Also, BRMCG may attempt to educate the local community on certain legislative initiatives that may impact BRMCG's ability to provide quality health care services to the community through direct mailings, media advertising or broadcast statements. The amount of resources (time and money) involved in these activities is insubstantial. BRMCG has not intervened in any political campaign. 3687516 3687516 306049857 70776654 235273203 102253957 62703581 39550376 278511095 Physician Guarantee Liability 298486 Environmental Liability 126645 425131 X Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The filing organization does not have separate individual audited financial statements; however, the organization is included in Baylor Health Care System's combined audited financial statements (System). The System follows the provisions of ASC 740 "Income Taxes." As of June 30, 2013 and 2012, the System had no material gross unrecognized tax benefits. 1 1 X 1 X 1 X 500.000000000000 1 1 1 0 1 1 19635220 0 19635220 0.06150 14441372 8239431 6201941 0.01940 9500 0 9500 0.00000 34086092 8239431 25846661 0.08090 1415583 6656 1408927 0.00440 610909 0 610909 0.00190 0 0 0.00000 0 0 0.00000 8987954 2550 8985404 0.02820 11014446 9206 11005240 0.03450 45100538 8248637 36851901 0.11540 1 21754533 57946527 77956621 -20010094 X 1 1 2 1 Baylor Regional Med Cntr at Grapevine

1650 W College Grapevine TX 76051

www.baylorhealth.com X X X A 2 Trinity MC LLC dba Baylor Med Cntr at

Carrollton 4343 N Josey Ln Carrollton TX 75010

www.baylorhealth.com X X X A Baylor Regional Med Cntr at Grapevine 1 X X X X X X X X 12 1 1 1 X X X X X X X X 1 0 1 1 200.000000000000 1 500.000000000000 1 X X X X X 1 1 X X X 1 0 X X X 1 X 0 0 13 Baylor Grapevine OP Radiology Ctr

2020 W Hwy 114 Suite 100 Grapevine TX 76051

Radiology Center Keller Diagnostic Imaging

601 Main St Keller TX 76248

Radiology Center Baylor Grapevine Breast Imaging

1631 Lancaster Dr Suite 130 Grapevine TX 76051

Radiology Center Baylor Diagnostic Imaging Center

4525 N Josey Lane Carrollton TX 75010

Radiology Center Baylor Grapevine Cardiac Rehab Ctr

1600 W College Suite 435 Grapevine TX 76051

Cardiac Rehabilitation Baylor Spine Center at Grapevine

1631 Lancaster Suite 230 Grapevine TX 76051

Spine Center Baylor Ctr Pain Mgmt-Highland Village

2840 Village Parkway Highland Village TX 76051

Pain Management Lewisville Radiology

751 Hebron Pkwy Suite 110 Lewisville TX 75057

Radiology Center Baylor Carrollton Senior Clinic

4323 N Josey Lane Suite 107A Carrollton TX 75010

Senior Clinic The Colony Radiology

6053 Main Street Suite 125 The Colony TX 75056

Radiology Center Flower Mound Radiology

3101 Churchill Dr Suite 110 Flower Mound TX 75022

Radiology Center Weight Loss Surgery Center

2020 W Hwy 114 Suite 180 Grapevine TX 76051

Bariatric Center Baylor Grapevine Diabetes Ctr

2020 W Hwy 114 Suite 120 Grapevine TX 75077

Diabetes Center Part I, Line 3c: and Line 3b: In addition to providing free care to financially indigent patients at 200% of the federal poverty guidelines ("FPG"), the organization provides discounted care to the medically indigent which is based on both the FPG (up to 500%) and the percentage of the patient's total bills from all providers in relation to the patient's annual income. Pursuant to the charity care policy, a patient's total balance due will not exceed 10% of total annual income if the patient qualifies as medically indigent.The organization also provides discounted care to those individuals whose amount of total bills, after all payments from third parties, exceeds 50% of the patient's annual income (regardless of the level of income) if the patient is unable to pay the remaining bill. Part I, Line 6a: The organization prepares and files an Annual Report of Community Benefit Plan with the Texas Department of State Health Services. This report is made available through the organization's website at www.baylorhealth.com. Part I, Line 7: A ratio of patient care cost to charges, as determined in Worksheet 2, was used to report the amounts in Part I, Lines 7a - 7d. For amounts reported on lines 7e - 7k, actual expenses for each community benefit activity are tracked and reported using both community benefit software and/or the organization's cost accounting system.Part I, Line 7b, Column (d): Includes payments from the State 1115 Waiver Medicaid Program for uncompensated care, which funds are to be used to expand indigent care.Part I, Line 7i, Column (c): Includes charity care payments of $8,798,036 that are made directly to or on the behalf of a local public hospital and/or other nonprofit organizations for the treatment of indigent patients of those organizations. Part I, L7 Col(f): The amount of bad debt expense included on Form 990, Part IX, line 25, but removed for Schedule H, Part I, Line 7, Column (f) totaled $0. Part III, Line 4: As stated in the combined audited financial statements, the organization maintains allowances for uncollectible accounts for estimated losses resulting from a payor's 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: The amount reported on Part III, Section B, line 7 was calculated in accordance with the Schedule H instructions utilizing the organization's allowable cost reported in the Medicare cost report based on a cost to charge ratio. However, the allowable costs in the Medicare cost report do not reflect the actual cost of providing care to patients since the Medicare cost report excludes many direct patient care costs that are essential to providing quality care to these patients. For example, certain coverage fees to physicians, cost of Medicare C and D, and other similar direct patient care expenses are specifically excluded as allowable cost in the cost reports. Using the same methodology to calculate the unreimbursed cost of providing charity care and Medicaid (using applicable Schedule H Worksheets) would result in a shortfall of $31,992,112, which is $11,982,018 higher than the shortfall reported on Part III, Section B, Line 7. The organization believes that all of the shortfall should be considered as a community benefit for the following reasons. First, the IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. IRS Revenue Ruling 69-545 provides, in part, that hospitals serving patients with governmental health benefits, including for example Medicare, is an indication that the hospital operates for the promotion of health in the community. Second, the organization provides care to Medicare patients regardless of this shortfall, i.e., loss, and thereby relieves the state and federal government of the burden of paying the full cost for the care of Medicare beneficiaries. Medicare does not provide sufficient reimbursement to cover the entire cost of providing care to these patients causing the organization to use other surplus funds to cover the shortfall. It is expected that reimbursement under the Medicare program will continue to decline and therefore may further limit access to care due to the anticipated reduction of participating Medicare providers in the community. As a result, the care for these patients will likely increase at, and rest on the shoulders of, nonprofit hospitals or county hospital districts. Third, many of the Medicare participants have low fixed incomes and therefore would qualify for charity care or other means tested government programs absent being enrolled in the Medicare program. Fourth, Texas nonprofit hospitals must provide a minimum level of community benefit in order to obtain exemption from state and local taxes. According to the current Texas Health and Safety Code, the unreimbursed cost of Medicare is considered to be a community benefit in determining these state statutory requirements as it helps relieve a governmental burden of providing this care that would otherwise be provided through the county hospital system in Texas. Part III, Line 9b: The organization's debt collection policy and procedures prohibit any collection efforts for the portion of the patient account balance that qualifies for financial assistance under the organization's charity care policy. For any remaining balances due, the same collection policy and procedures are applied equally to all patient types. Part VI, Line 2: During the fiscal year ending June 30, 2013, the Organization conducted a Community Health Needs Assessment (CHNA) to assess the health care needs of the community for each of its licensed hospital facilities and developed an implementation strategy to address the needs identified in the CHNAs. The CHNAs were conducted in accordance with state and federal guidelines including Internal Revenue Code Section 501(r) and the Texas Health and Safety Code Section 311. These CHNAs and implementation strategies have been made widely available to the public and are located on the Organizations website at the following address: www.BaylorHealth.com/Community. 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, the organization can accommodate multiple languages including American Sign Language. Part VI, Line 4: The Organization has two licensed hospitals and each hospitals community is defined and summarized below. Additional information regarding the community can also be found in each of the hospitals community health needs assessment and implementation strategy located on the organizations website at www.BaylorHealth.com/Community.Baylor Regional Medical Center at Grapevine (Baylor Grapevine) is located in Tarrant County and its total service area includes zip codes primarily from the urban/suburban areas of Tarrant, Denton and Dallas counties covering more than 783,000 residents. The average household income is $94,463 with 4.7 percent living below the federal poverty level. Additionally, 9.2 percent is uninsured and 9.0 percent of the population is enrolled in Medicaid. There are three designated medically underserved areas in the Baylor Grapevine service area. In addition to Baylor Grapevine, there are 11 other hospitals providing hospital care to the service area. Baylor Medical Center at Carrollton (Baylor Carrollton) is located in Denton County and its total service area includes zip codes primarily from the urban/suburban areas of Carrollton, Dallas, Frisco and Lewisville covering more than 592,000 residents. The average household income is $90,884 with 4.7 percent living below the federal poverty level. Additionally, 10.2 percent is uninsured and 11.3 percent of the population is enrolled in Medicaid. There are no designated medically underserved areas in the Baylor Carrollton service area. In addition to Baylor Carrollton, there are eight other hospitals providing hospital care to the service area. Part VI, Line 5: With the oversight of an independent volunteer community board and Baylor Health Care System, the organization's sole member, the organization, including both the Baylor Grapevine and Baylor Carrollton hospitals, has promoted health and benefited the community by providing exemplary health care, medical education, research and other community services. The organization's governing body is comprised of volunteer community representatives that provide leadership and governance for the organization. The members of the governing body contribute their wisdom, insights, and expertise to ensure the organization is fulfilling its mission and charitable purpose while providing efficient administrative support services and direction for the System. The members are well respected residents and/or own businesses in the organization's primary or secondary service area and understand the needs of the community. The medical staff of the organization is open to all physicians in the community who meet membership and clinical privileges requirements. Surplus funds are continuously utilized to maintain access to limited patient services or expand access points of care to patients throughout the community including, but not limited to, the following:The Organization provides financial assistance in the form of charity care to patients who are indigent and satisfy certain requirements. Additionally, the Organization is committed to treating patients who are eligible for means tested government programs such as Medicaid and other government sponsored programs including Medicare, which is provided regardless of the reimbursement shortfall, and thereby relieves the state and federal government of the burden of paying the full cost of care for these patients. Often, patients are unaware of the federal, state and local programs open to them for financial assistance, or they are unable to access them due to the cumbersome enrollment process required to receive these benefits. The Organization offers assistance in enrollment to these government programs or extends financial assistance in the form of charity care through the Organizations Financial Assistance Policy which can be located on the Baylor Health Care System website at BaylorHealth.com/FinancialAssistance.Baylor Grapevine operates an emergency department accepting all patients without the regard for their ability to pay. The emergency department provides coverage 24 hours a day, seven days a week. The expanded 23,000 square foot facility is equipped with bedside check-in and triage, and advanced scanning equipment to speed a patient's diagnosis and treatment. Baylor Grapevine's involvement goes beyond the operating room and the patient floors, and reaches out to our community by way of treatment and prevention through events focused on community health education about chronic disease and issues related to maintaining a healthy lifestyle. These events include an annual Women's Health Day, Men's Health Day, the Southlake Senior Center Health Fairs, and numerous health educational programs. At these events, staff and physicians donate their time to educate the public on various health-related preventive measures and healthy lifestyle choices. Medical education is a crucial part of the Baylor Grapevine's mission. During a nurses training, clinical skills and professional competencies are developed to provide the nurse with the ability to take on increasing responsibility for patient care. Quality teaching programs add many dimensions to Baylor Grapevine's ability to serve patients. During the year, Baylor Grapevine provided education for nursing students from across the Dallas Fort Worth Metroplex to help improve the level of medical care for the entire community. Teaching programs also aid attending teaching nurse staff in keeping their own knowledge current. Upon completion of their education programs at Baylor Grapevine, many nurses remain in North Texas, providing a continuous supply of well-trained medical professionals for the region.Baylor Carrollton is committed to promoting an environment of wellness in its community and coaches residents to intentionally adopt healthier lifestyles to reduce the number of deaths associated with chronic disease. Throughout the year Baylor Carrollton offers free preventive health services to the community such as health screenings, health fairs, immunizations and community education. These efforts are targeted to meet the community health needs identified in the community health needs assessment conducted by the hospital. Baylor Carrollton provides a broad spectrum of medical and health care services to the North Dallas community. The medical staff comprises over five hundred physicians representing more than fifty specialties. Baylor Carrollton provides comprehensive diagnostic, surgical, and medical care for inpatients and outpatients, as well as 24-hour emergency care. Baylor Carrolltons emergency department is designated as an accredited chest pain center and the Hospital is accredited by the Joint Commission, the nations oldest and largest hospital accreditation agency.Baylor Carrollton is also committed to assisting with the preparation of future nurses at entry and advanced levels of the profession to establish a workforce of qualified nurses. Through Baylor Health Care Systems relationships with fifteen North Texas schools of nursing, Baylor Carrollton maintains affiliations with schools of nursing. In the fiscal year ending June 30, 2013, the Hospital invested in training 300 nurses. Total unreimbursed cost of these programs was $169,449. Many times nursing graduates trained at Baylor Carrollton join the hospitals staff or remain in the North Texas area to provide top quality nursing services to the community. Part VI, Line 6: The organization is part of a large faith based integrated health care delivery system ("System") serving the health care needs of the twelve county Dallas-Fort Worth metroplex area. The System exists to serve all people through exemplary health care, education, research and community service. Community benefits are provided through the provision of charity care, governmental sponsored programs (such as Medicaid and Medicare), medical research, medical education, community health improvement services, donations to other nonprofit health care providers, and many other community service activities. During the year, the affiliated nonprofit hospitals reported community benefits (as reported to the Texas Department of State Health Services, and in accordance with the State of Texas Statutory methodology) in excess of $638, 100,000. The System's nonprofit hospitals provided community benefits (as reported on the IRS Form 990, Schedule H) in excess of $352,700,000 during the tax year. The Texas Annual Statement of Community Benefit Standard includes approximately $269,600,000 of unreimbursed cost of Medicare that is not included in the IRS Form 990, Schedule H. The System is comprised of separate legal entities including philanthropic foundations, a research institute, a physician network, acute care hospitals, short-stay hospitals, specialty hospitals, ambulatory surgery centers and other health care providers all which fall under the common control of Baylor Health Care System, the organization's sole member. As part of the System, certain affiliates make grants and/or contributions to other related nonprofit affiliates to help financially support and/or fund worthy community benefits activities. The System has also established a patient transfer system among the affiliated hospitals allowing patients needing a particular level of care to be transferred as needed to a related hospital that can provide that service in an efficient and effective manner. As part of the System, all hospitals and other affiliated health care providers are required to adhere to high standards for medical quality, patient safety and patient satisfaction. These standards are set forth by Baylor Health Care System, the organization's sole member, which helps ensures consistency across the System. Reports Filed With States Part VI, Line 7 TX Part V, Line 8 Facility Reporting Group A See below Facility 1 -- Baylor Regional Med Cntr at Grapevine Part V, Section B, line 3: Creating healthy communities requires a high level of mutual understanding and collaboration with community individuals and partner groups. The development of the community health needs assessment brought together information from community health leaders and providers along with local residents for the purposes of researching, prioritizing and documenting the community health needs for the geographies served by the hospital facility.As an affiliate of Baylor Health Care System (BHCS), the hospital facility conducted its community health needs assessment with the assistance and direction of BHCS and the guidance of the BHCS Community Benefit Committee. The mission and role of the BHCS Community Benefit Committee is to assist the BHCS Board of Trustees in setting direction, identifying priorities, and monitoring performance in mission and vision integration into community benefits across the BHCS hospital system. The Committee is comprised of trustees (current System and community board members) and other community representatives appointed by the BHCS board of trustees. The hospital facilitys community health needs assessment brings together information from a variety of sources. This assessment consolidates information from recent community health needs assessments conducted for the Texas Regional Healthcare Partnerships, the Dallas County Community Health Needs Assessment and the Consumer Health Report conducted by the National Research Corporation (NRC) for the hospital facility. Members from Baylor Health Care System participated in the development of these reports with other health care providers, community groups and others throughout the Dallas/Fort Worth Metroplex. These reports used a variety of methods to gather and assess the community including, but not limited to, surveys, meetings, and interviews. The hospital has also fostered continued community participation and outreach activities through membership in the Dallas Fort Worth Hospital Council. They have used data from this collaboration of health care providers, including data that served as the basis for this CHNA. This datadrawn from a variety of local, state and federal sourcesrepresents the most recent evaluation of Dallas/Fort Worth residents health status and the assets available to the community for improving health.In addition, data was drawn from the Healthy North Texas website (www.healthytexas.org), which was created under the direction of the Dallas Fort Worth Hospital Council Foundations Community Health Collaborative. The website features data regarding overall population health. It boasts more than 100 local health indicators that can be compared across other Texas regions and the nation. The information can be used to expose crucial health concerns in North Texas, including incidents of diabetes, breast cancer and suicide. The site also has a database of information detailing ways to combat these health ailments. Sponsors of the site include Blue Cross Blue Shield of Texas, Communities Foundation of Texas, HCA North Texas, JPS Health Network, Methodist Health System, Texas Health Resources, University of North Texas Health Science Center and Baylor Health Care System.More detailed information can be found in the hospital community health needs assessment and community benefit plan located at the following website: http://www.baylorhealth.com/About/Community/Assessments/Pages/Default.aspx Facility 1 -- Baylor Regional Med Cntr at Grapevine Part V, Section B, line 4: As an affiliate of Baylor Health Care System, the hospital facility conducted its community health needs assessment with other related hospital facilities and with the assistance and direction of Baylor Health Care System. These related hospital facilities included the following: Baylor University Medical Center, Baylor All Saints Medical Center, Baylor Medical Center at Garland, Baylor Regional Medical Center at Grapevine, Baylor Regional Medical Center at Plano, Baylor Medical Center at Waxahachie, Baylor Medical Center at McKinney, Baylor Medical Center at Irving, Baylor Medical Center at Carrollton, Baylor Specialty Hospital, Our Childrens House at Baylor, Baylor Heart and Vascular Hospital, The Heart Hospital Baylor Plano, Baylor Medical Center at Frisco, Baylor Medical Center at Uptown, Irving/Coppell Surgical Hospital, Baylor Orthopedic and Spine Hospital at Arlington, Baylor Surgical Hospital at Fort Worth, Baylor Medical Center at Trophy Club, North Central Surgical Center, Baylor Institute for Rehabilitation at Dallas, Baylor Institute for Rehabilitation at Frisco, Baylor Institute for Rehabilitation at Northwest Dallas, Baylor Institute for Rehabilitation at Fort Worth, and Baylor Emergency Medical Center at Aubrey. Additionally, Baylor Health Care System also participated in numerous workgroups and studies used for other community health needs assessments conducted throughout the twelve county North Texas Region. The data and results of these various community health needs assessments were used by Baylor Health Care System and its affiliated hospital facilities to conduct their own community health needs assessments. Other hospital facilities in the community including county hospitals such as Parkland Memorial Hospital, John Peter Smith Hospital and other hospitals participated in these other community health needs assessments. Facility 1 -- Baylor Regional Med Cntr at Grapevine Part V, Section B, line 11: In addition to providing free care to financially indigent patients at 200% of the federal poverty guidelines (FPG), the organization provides discounted care to the medically indigent which is based on both the FPG (up to 500%) and the percentage of the patient's total bills from all providers in relation to the patient's annual income. Pursuant to the charity care policy, a patient's total balance due will not exceed 10% of total annual income if the patient qualifies as medically indigent. The organization also provides discounted care to those individuals whose amount of total bills, after all payments from third parties, exceeds 50% of the patient's annual income (regardless of the level of income) if the patient is unable to pay the remaining bill. Facility 1 -- Baylor Regional Med Cntr at Grapevine Part V, Section B, line 12h: The hospital has adopted a financial assistance policy written in accordance with Texas Health and Safety Code Chapter 311. In general, that statute defines charity care as providing, funding or otherwise financially supporting health care services to a person classified by the hospital as financially or medically indigent; or providing funding or otherwise financially supporting health care services provided to financially indigent persons through other nonprofit or public clinics, hospitals or hospital organizations. To determine if a patient meets the definition of financially or medically indigent in the statute, the number in the household is required. Additionally, although assets and other resources are not included in the calculation to determine whether a patient is financially or medically indigent, the organization's policy reserves the right to allow the patient's assets or other resources to be considered when determining if financial assistance will be granted. Facility 1 -- Baylor Regional Med Cntr at Grapevine Part V, Section B, line 14g: Measures to publicize the policy within the community served by the hospital facility, include but are 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, the organization can accommodate multiple languages including American Sign Language. Facility 1 -- Baylor Regional Med Cntr at Grapevine Part V, Section B, line 20d: The organizations financial assistance policy is developed to provide discounted care to those qualifying for financial assistance to where the amount charged under the policy will always be equal to or lower than the average of the three largest (by volume) negotiated commercial insurance rates. However, for those qualifying as medically indigent and whose income level is from 200% to 500% of the federal poverty level shall not be billed more than 10% of their annual income which is generally lower than the methodology listed above and the three methods listed in Question Part V, Line 20ac. Facility 2 -- Trinity MC, LLC dba Baylor Med Cntr at C Part V, Section B, line 3: Creating healthy communities requires a high level of mutual understanding and collaboration with community individuals and partner groups. The development of the community health needs assessment brought together information from community health leaders and providers along with local residents for the purposes of researching, prioritizing and documenting the community health needs for the geographies served by the hospital facility.As an affiliate of Baylor Health Care System (BHCS), the hospital facility conducted its community health needs assessment with the assistance and direction of BHCS and the guidance of the BHCS Community Benefit Committee. The mission and role of the BHCS Community Benefit Committee is to assist the BHCS Board of Trustees in setting direction, identifying priorities, and monitoring performance in mission and vision integration into community benefits across the BHCS hospital system. The Committee is comprised of trustees (current System and community board members) and other community representatives appointed by the BHCS board of trustees. The hospital facilitys community health needs assessment brings together information from a variety of sources. This assessment consolidates information from recent community health needs assessments conducted for the Texas Regional Healthcare Partnerships, the Dallas County Community Health Needs Assessment and the Consumer Health Report conducted by the National Research Corporation (NRC) for the hospital facility. Members from Baylor Health Care System participated in the development of these reports with other health care providers, community groups and others throughout the Dallas/Fort Worth Metroplex. These reports used a variety of methods to gather and assess the community including, but not limited to, surveys, meetings, and interviews. The hospital has also fostered continued community participation and outreach activities through membership in the Dallas Fort Worth Hospital Council. They have used data from this collaboration of health care providers, including data that served as the basis for this CHNA. This datadrawn from a variety of local, state and federal sourcesrepresents the most recent evaluation of Dallas/Fort Worth residents health status and the assets available to the community for improving health.In addition, data was drawn from the Healthy North Texas website (www.healthytexas.org), which was created under the direction of the Dallas Fort Worth Hospital Council Foundations Community Health Collaborative. The website features data regarding overall population health. It boasts more than 100 local health indicators that can be compared across other Texas regions and the nation. The information can be used to expose crucial health concerns in North Texas, including incidents of diabetes, breast cancer and suicide. The site also has a database of information detailing ways to combat these health ailments. Sponsors of the site include Blue Cross Blue Shield of Texas, Communities Foundation of Texas, HCA North Texas, JPS Health Network, Methodist Health System, Texas Health Resources, University of North Texas Health Science Center and Baylor Health Care System.More detailed information can be found in the hospital community health needs assessment and community benefit plan located at the following website: http://www.baylorhealth.com/About/Community/Assessments/Pages/Default.aspx Facility 2 -- Trinity MC, LLC dba Baylor Med Cntr at C Part V, Section B, line 4: As an affiliate of Baylor Health Care System, the hospital facility conducted its community health needs assessment with other related hospital facilities and with the assistance and direction of Baylor Health Care System. These related hospital facilities included the following: Baylor University Medical Center, Baylor All Saints Medical Center, Baylor Medical Center at Garland, Baylor Regional Medical Center at Grapevine, Baylor Regional Medical Center at Plano, Baylor Medical Center at Waxahachie, Baylor Medical Center at McKinney, Baylor Medical Center at Irving, Baylor Medical Center at Carrollton, Baylor Specialty Hospital, Our Childrens House at Baylor, Baylor Heart and Vascular Hospital, The Heart Hospital Baylor Plano, Baylor Medical Center at Frisco, Baylor Medical Center at Uptown, Irving/Coppell Surgical Hospital, Baylor Orthopedic and Spine Hospital at Arlington, Baylor Surgical Hospital at Fort Worth, Baylor Medical Center at Trophy Club, North Central Surgical Center, Baylor Institute for Rehabilitation at Dallas, Baylor Institute for Rehabilitation at Frisco, Baylor Institute for Rehabilitation at Northwest Dallas, Baylor Institute for Rehabilitation at Fort Worth, and Baylor Emergency Medical Center at Aubrey. Additionally, Baylor Health Care System also participated in numerous workgroups and studies used for other community health needs assessments conducted throughout the twelve county North Texas Region. The data and results of these various community health needs assessments were used by Baylor Health Care System and its affiliated hospital facilities to conduct their own community health needs assessments. Other hospital facilities in the community including county hospitals such as Parkland Memorial Hospital, John Peter Smith Hospital and other hospitals participated in these other community health needs assessments. Facility 2 -- Trinity MC, LLC dba Baylor Med Cntr at C Part V, Section B, line 11: In addition to providing free care to financially indigent patients at 200% of the federal poverty guidelines (FPG), the organization provides discounted care to the medically indigent which is based on both the FPG (up to 500%) and the percentage of the patient's total bills from all providers in relation to the patient's annual income. Pursuant to the charity care policy, a patient's total balance due will not exceed 10% of total annual income if the patient qualifies as medically indigent. The organization also provides discounted care to those individuals whose amount of total bills, after all payments from third parties, exceeds 50% of the patient's annual income (regardless of the level of income) if the patient is unable to pay the remaining bill. Facility 2 -- Trinity MC, LLC dba Baylor Med Cntr at C Part V, Section B, line 12h: The hospital has adopted a financial assistance policy written in accordance with Texas Health and Safety Code Chapter 311. In general, that statute defines charity care as providing, funding or otherwise financially supporting health care services to a person classified by the hospital as financially or medically indigent; or providing funding or otherwise financially supporting health care services provided to financially indigent persons through other nonprofit or public clinics, hospitals or hospital organizations. To determine if a patient meets the definition of financially or medically indigent in the statute, the number in the household is required. Additionally, although assets and other resources are not included in the calculation to determine whether a patient is financially or medically indigent, the organization's policy reserves the right to allow the patient's assets or other resources to be considered when determining if financial assistance will be granted. Facility 2 -- Trinity MC, LLC dba Baylor Med Cntr at C Part V, Section B, line 14g: Measures to publicize the policy within the community served by the hospital facility, include but are 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, the organization can accommodate multiple languages including American Sign Language. Facility 2 -- Trinity MC, LLC dba Baylor Med Cntr at C Part V, Section B, line 20d: The organizations financial assistance policy is developed to provide discounted care to those qualifying for financial assistance to where the amount charged under the policy will always be equal to or lower than the average of the three largest (by volume) negotiated commercial insurance rates. However, for those qualifying as medically indigent and whose income level is from 200% to 500% of the federal poverty level shall not be billed more than 10% of their annual income which is generally lower than the methodology listed above and the three methods listed in Question Part V, Line 20ac. 1 Tarrant County Indigent Care Corporation 612 East Lamar Blvd Arlington TX 76011 260648532 501(c)(3) 5259466 N/A N/A Indigent Care Dallas County Indigent Care Corporation PO Box 655999 Dallas TX 75265 260610562 501(c)(3) 3665392 N/A N/A Indigent Care Baylor Health Care System Foundation 2001 Bryan Street Suite 2200 Dallas TX 75201 751606705 501(c)(3) 49450 N/A N/A General Support Grapevine Relief and Community Exchange PO Box 412 Grapevine TX 76099 752195702 501(c)(3) 7686 N/A N/A Indigent Care Healing Shepherd Clinic 1350 E Lancaster Fort Worth TX 76102 264350657 501(c)(3) 11020 N/A N/A Indigent Care Grand Prairie Wellness Center 1710 Small St Grand Prairie TX 75050 752877107 501(c)(3) 9563 N/A N/A Indigent Care Muslim Community Center of Human Services Al Sifia Clinic 10 Homeplace CT Arlington TX 76016 752580088 501(c)(3) 8168 N/A N/A Indigent Care Mission Arlington Mission Metroplex 212 W South St Arlington TX 76010 752354962 501(c)(3) 9032 N/A N/A Indigent Care Mansfield Caring Place 990 Hwy 287 106-145 Mansfield TX 76063 270537258 501(c)(3) 6246 N/A N/A Indigent Care Cornerstone Assistance Network 3500 Noble Ave Fort Worth TX 76111 752417646 501(c)(3) 5958 N/A N/A Indigent Care North Texas Area Community Health Centers Inc 2100 N Main Ste 107 Fort Worth TX 76164 542117989 501(c)(3) 14153 N/A N/A Indigent Care 11 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Monitoring Grants & Other Assistance 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 further one or more tenets of Baylor's charitable mission and one of the following criteria for use of these funds is met: (1)Fulfills a need identified by a community needs assessment conducted by Baylor Health Care System (BHCS) or a third party (such as Community Health Check Up or by the United Way) and adopted as a priority by BHCS's Community Service Advisory Council, (2) Serves an under-served community or group of people through medical mission work to improve their health status. For related organizations, all grants and other assistance are subject to the policies and procedures set forth by BHCS 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 typically monitored by personal inspection. Examples include providing assistance to entities where the filing organization's employee serves as a Board Member for the recipient organization or through attendance at community events where the filing organization employees work as volunteers or to help coordinate these events. X X X 1 1 X X X X 1 1 0 0 0 0 0 1 0 Paul Madeley MD 0 422718 0 1786 0 334438 0 54893 0 17317 0 831152 0 299220 Christopher York 237261 0 73591 0 11863 0 34444 0 21391 0 378550 0 0 0 Elizabeth Houser 184466 0 48396 0 0 0 9517 0 18833 0 261212 0 0 0 T Doug Lawson 40358 341251 0 184689 1384 10632 0 113999 1963 26349 43705 676920 0 0 Terri Foster 225496 0 62362 0 9231 0 11398 0 2968 0 311455 0 0 0 William Boyd 0 561174 0 291880 0 383417 0 194567 0 25952 0 1456990 0 360186 Steve Newton 0 411928 0 196450 0 13584 0 127303 0 20815 0 770080 0 0 Michael Sanborn 283192 0 5000 0 66088 0 40744 0 21720 0 416744 0 0 0 Barbara Vaughn 95259 44835 22112 0 0 0 4916 0 12683 4890 134970 49725 0 0 Christine Cerone 105469 24802 125 5947 5503 1332 0 1408 17708 6577 128805 40066 0 0 Kirk Starr 144676 0 32325 0 50 0 7645 0 21086 0 205782 0 0 0 Sheila Richards 95959 0 11927 0 60161 0 4993 0 20055 0 193095 0 0 0 Kristin Rabenold 144571 0 21683 0 0 0 7296 0 14179 0 187729 0 0 0 Sheldrick Streete 117529 0 21569 0 0 0 6256 0 25642 0 170996 0 0 0 Preshie Wilson 0 211968 0 47610 0 0 0 10798 0 17004 0 287380 0 0 Scott Peek 0 278246 0 123078 0 11487 0 78972 0 26216 0 517999 0 0 Karen Stubbs 8793 0 0 0 192829 0 596 0 13205 0 215423 0 0 0 Part I, Line 1a Tax indemnification and gross up payments - The organization provides tax indemnification where an authorized member of management determines there is justification to reimburse an individual for the tax impact on certain taxable, non-cash benefits provided to them. All tax indemnification payments provided are treated as taxable compensation. Two of the persons listed in the Form 990, Part VII, Section A, received this benefit during the tax year. Part I, Line 1a Travel for companions-The organization reimburses eligible employees and board members certain reasonable travel expenses associated with spousal travel where the spouse's presence is important to the event. These events may include, for example, board meetings, business meetings, and award ceremonies approved by the organization's governing body and/or President. All spousal travel reimbursements are treated as taxable compensation. One person listed in the Form 990, Part VII, Section A, received this benefit during the tax year. Part I, Line 1a Discretionary spending account-The organization provides eligible employees who travel frequently in their personal vehicle an auto expense allowance in lieu of reimbursement for business mileage under the organization's business travel and expense reimbursement policy. All auto expense allowances are treated as taxable compensation. Three of the persons listed in the Form 990, Part VII, Section A, received this benefit during the tax year. Part I, Lines 4a-b Karen Stubb's and Sheila Richard's employment with the organization terminated during the tax year and they received a severance payment of $190,343 and $60,161 respectively. In order to recruit and retain key talent, BHCS offers a supplemental non qualified retirement plan to eligible employees. The plan provides an annual benefit (based on a percentage of compensation) to the employee that is paid to the employee on a future date upon vesting in the plan. The following individual(s) participated in and/or received payments (noted in parenthesis) from BHCS' supplemental non qualified retirement plan during the tax year: Scott Peek, T. Doug Lawson, Steve Newton, Paul Madeley, M.D. ($299,220), Christopher York, Michael Sanborn and William Boyd ($253,486). Also, select certain officers, as designated by BHCS's governing body, are eligible to participate in a Long Term Incentive Plan that is designed to recognize the key senior leaders value and contribution to BHCS as well as align their compensation to the long term strategy of BHCS. Performance targets are based upon a percentage of the participants base salary and are developed by independent third party expert(s) using market competitive data within the guides of reasonableness. The plan is based on BHCS's three-year performance against its peers, determined based on peer rankings or percentile rankings in quality, patient satisfaction and financial performance. At the end of three years, awards are determined by BHCS's governing body for participants. Payouts are partially made in cash and the remainder vests over an additional two year period. The following individuals participated in and/or received payments (noted in parenthesis) from this plan during the tax year: William Boyd ($214,839), Doug Lawson ($61,919), Steve Newton ($66,902) and Scott Peek ($36,526). Part I, Line 7 The organization has adopted and implemented BHCS's, the organization's sole member, Performance Award Program to provide a market competitive total cash compensation incentive program that is designed to attract and retain key leaders and establish greater individual accountability and alignment to business performance. Payout targets are based upon a percentage of base pay and are developed by independent third party expert(s) using comparable market competitive data within the bounds of reasonableness and that are reviewed and approved by BHCS's governing body. Payout levels are based upon a combination of system, entity, and individual performance using various metrics related to quality, patient satisfaction, employee retention, and financal stewardship. BHCS's governing body may approve modifications to annual incentive awards provided under the program consistent with market comparability data. Supplemental Information Part III Supplemental Information: Governing body compensation The members of the governing body serve on a voluntary basis and receive no cash compensation from the organization for these duties as a member of the governing body. Some, but not all, members have received modest benefits incident to their service on the board and/or multiple board committees or received compensation as an employee of a related organization. These benefits include reimbursement for certain reasonable expenses paid on behalf of the member's spouse while accompanying the member on business travel on behalf of the related organization and/or a wellness physical. All such benefits are treated as taxable compensation to the extent required by law and are reported in the Form 990 where applicable. Form 990, Part VI, Section A, line 6 Members or stockholders: The organization is a Texas nonprofit membership organization in which Baylor Health Care System ("BHCS"), a tax exempt, Texas nonprofit corporation, is the sole member. Form 990, Part VI, Section A, line 7a Election of members of governing body by members, stockholders, or other persons: The sole member, BHCS, elects and removes the members of the governing body. Form 990, Part VI, Section A, line 7b Governing body decisions subject to approval: All rights and powers are reserved to the sole member, BHCS, except only those rights and powers expressly set forth in the bylaws, required by state or federal law, or to meet the requirements and standards promulgated by Joint Commission. For example, the member's reserved rights and powers include, without limitation, approval of the organization's articles of incorporation and bylaws and amendments thereto, appointment and removal of members of the organization's governing body, approval of dissolutions and mergers, and other similar decisions over the organization. Form 990, Part VI, Section B, line 11 Process used to review the Form 990: The Form 990 is prepared and reviewed by BHCS's 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. Upon completion, the Form 990 is reviewed by the organization's President, financial officer and/or other key officers. 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 Process used to monitor and enforce compliance with the organization's conflict of interest policy: Persons with the actual or perceived ability to influence the organization have the 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. The BHCS Board of Trustees Audit and Compliance Committee and the BHCS 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 Process for determining compensation: The organization, a controlled affiliate of BHCS, recognizes that those chosen to lead the organization are vital to its ongoing success and growth. Thus, it must attract, retain and engage the highest quality officers and key employees to lead the organization and help BHCS maintain its national reputation for achieving high targets for medical quality, patient safety, and patient satisfaction. A significant portion of the organization's officers' and key employees' total compensation is based on significant performance achievements. This strategy, known as the Performance Award Program, works to put a greater emphasis on the importance of the organization achieving targeted improvements in the areas of People, Quality, Patient Satisfaction and Financial Stewardship, annually. Total executive compensation is part of an integrated talent management strategy developed by the BHCS Board of Trustees and its Compensation and Governance Committee (Committee) to attract, motivate, and retain the best leadership resources for the organization. Executive compensation is determined pursuant to guidelines outlined in the intermediate sanction rules under IRC Section 4958 including taking steps to meet the rebuttable presumption standard of reasonableness under Treasury Regulation 53.4958-6, as summarized below. When making compensation decisions, the organization compares itself to similar-sized, and structured businesses including other integrated health care service systems and other similar-sized organizations, both locally and nationally. The BHCS Board of Trustees and Committee, on behalf of the organization, work directly with independent compensation expert(s) to identify reasonable and competitive market rates as well as provide an annual review of the total compensation of the organization's top management officials and key employees. The Committee is made up of members of the BHCS Board of Trustees, who are independent, community volunteers. Guided by the information provided by the independent compensation expert(s), the Committee approves and recommends to the BHCS Board of Trustees salary increases, earned incentives, and benefit offerings for the organization's President, other officers and/or key employees to be comparable to similar organizations for similar services and/or positions. Furthermore, the Committee is charged with the responsibility of reviewing annually the major elements of the executive compensation program to assure designs remain consistent with the business needs, market practices, and compensation philosophy. As part of the decision making process, the Committee will often meet in executive session to discuss and review recommendations made by the independent compensation expert(s). During the executive session no officer or key employee whose compensation is being reviewed is present during these discussions. All decisions are contemporaneously documented in the Committee minutes which are timely reviewed and approved by the Committee. Form 990, Part VI, Section C, line 19 Process for making governing documents, conflict of interest policy, & financial statements available to the public: The organization's articles of incorporation and amendments thereto are made available to the public by the filing of those documents with the Texas Secretary of State. Also, the organization is included within the combined financial statements of BHCS that are made available to the public by the posting of those documents through DAC Bond and are attached to this return. The organization's other governing documents and conflicts of interest policy are not made available to the public. Other Fees Form 990, Part IX, line 11g Intercompany Expenses : Program service expenses 4,100,509. Management and general expenses 560,007. Fundraising expenses 0. Total expenses 4,660,516. Contract Labor : Program service expenses 9,906,746. Management and general expenses 689,501. Fundraising expenses 0. Total expenses 10,596,247. Other Purchased Services : Program service expenses 9,630,713. Management and general expenses 769,665. Fundraising expenses 0. Total expenses 10,400,378. Repairs : Program service expenses 3,750,289. Management and general expenses 27,287. Fundraising expenses 0. Total expenses 3,777,576. Professional Fees : Program service expenses 2,005,108. Management and general expenses 119,861. Fundraising expenses 0. Total expenses 2,124,969. Lab Fees : Program service expenses 2,348,889. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,348,889. Corporate Overhead : Program service expenses 0. Management and general expenses 27,890,336. Fundraising expenses 0. Total expenses 27,890,336. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Change in Net Assets Held at BHCS Fdn -662,331. Volunteer Auxiliary 43,520. Transfer to/from BHCS-Liability Reserve 21,034. Supplemental Information: IRC Section 6038 Statement: Baylor Grapevine is controlled by BHCS, Employer Identification Number 75-1812652. BHCS also owns Health Care Insurance Company of Texas, Ltd. (HCIC). HCIC is a controlled foreign corporation. BHCS furnishes all information required of Baylor Grapevine by IRC Section 6038 and the regulations thereunder with respect to HCIC. Therefore, pursuant to Treasury Regulation Sec. 1.6038-2(j)(2), Baylor Grapevine is excepted from providing such information. BHCS files its Return of Organization Exempt from Income Tax in Ogden, Utah. Trinity MC LLC 2001 Bryan Street Suite 2200 Dallas TX 75201 208889358 Acute Care Hospital TX 111049407 115096136 Baylor Regional Medical Center at Grapevine Baylor Health Care System 2001 Bryan Street Suite 2200 Dallas TX 75201 751812652 Management Services TX 501(c)(3) 11, Type III N/A 0 Baylor University Medical Center 2001 Bryan Street Suite 2200 Dallas TX 75201 751837454 Acute Care Hospital TX 501(c)(3) 3 Baylor Health Care System 1 Baylor Medical Centers at Garland and McKinney 2001 Bryan Street Suite 2200 Dallas TX 75201 751037591 Acute Care Hospital TX 501(c)(3) 3 Baylor Health Care System 1 Baylor Medical Center at Irving 2001 Bryan Street Suite 2200 Dallas TX 75201 752586857 Acute Care Hospital TX 501(c)(3) 3 Baylor Health Care System 1 Baylor Medical Center at Waxahachie 2001 Bryan Street Suite 2200 Dallas TX 75201 751844139 Acute Care Hospital TX 501(c)(3) 3 Baylor Health Care System 1 Baylor Regional Medical Center at Plano 2001 Bryan Street Suite 2200 Dallas TX 75201 820551704 Acute Care Hospital TX 501(c)(3) 3 Baylor Health Care System 1 Baylor Institute for Rehabilitation at Gaston Episcopal Hospital 2001 Bryan Street Suite 2200 Dallas TX 75201 751037226 Rehabilitation Hospital TX 501(c)(3) 3 Baylor Health Care System 1 Baylor Specialty Health Centers 2001 Bryan Street Suite 2200 Dallas TX 75201 751765385 Long Term Care Hospitals TX 501(c)(3) 3 Baylor Health Care System 1 Baylor All Saints Medical Center 2001 Bryan Street Suite 2200 Dallas TX 75201 751008430 Acute Care Hospital TX 501(c)(3) 3 Baylor Health Care System 1 Baylor Health Care System Foundation 2001 Bryan Street Suite 2200 Dallas TX 75201 751606705 Fundraising TX 501(c)(3) 7 Baylor Health Care System 1 All Saints Health Foundation 2001 Bryan Street Suite 2200 Dallas TX 75201 751947007 Fundraising TX 501(c)(3) 7 Baylor All Saints Medical Center 1 HealthTexas Provider Network 2001 Bryan Street Suite 2200 Dallas TX 75201 752536818 Physician Practices TX 501(c)(3) 3 Baylor Health Care System 1 Baylor Health Services 2001 Bryan Street Suite 2200 Dallas TX 75201 751917311 Inactive TX 501(c)(3) 3 Baylor Health Care System 1 Baylor Research Institute 2001 Bryan Street Suite 2200 Dallas TX 75201 751921898 Research TX 501(c)(3) 4 Baylor Health Care System 1 Southern Sector Health Initiative 2001 Bryan Street Suite 2200 Dallas TX 75201 263087442 Diabetes Health & Wellness Center TX 501(c)(3) 11, Type I Baylor University Medical Center 1 Baylor Health Care System Employee Benefit Trust 2001 Bryan Street Suite 2200 Dallas TX 75201 751848557 VEBA TX 501(c)(9) Baylor Health Care System 1 Irving Healthcare Foundation 2001 Bryan Street Suite 2200 Dallas TX 75201 751570933 Fundraising TX 501(c)(3) 7 Baylor Medical Center at Irving 1 Baylor Medical Center at Carrollton 2001 Bryan Street Suite 2200 Dallas TX 75201 454510252 Acute Care Hospital TX 501(c)(3) 3 Baylor Health Care System 1 MEDCO Construction LLC 2001 Bryan Street Suite 2200 Dallas TX 75201 205965871 Construction TX N/A Baylor Affiliated Services LLC 2001 Bryan Street Suite 2200 Dallas TX 75201 260614730 Benefit Plans TX N/A Baylor Heart and Vascular Center LLP 2001 Bryan Street Suite 2200 Dallas TX 75201 752834135 Specialty Hospital TX N/A Texas Heart Hospital of the Southwest LLP 2001 Bryan Street Suite 2200 Dallas TX 75201 412101361 Specialty Hospital TX N/A HealthTexas Provider Network-Gastro Serv LLP 2001 Bryan St Ste 2200 Dallas TX 75201 731697736 Ambulatory Surgery Center TX N/A Texas Health Venture Group LLC 15305 Dallas Parkway Suite 1600 Addison TX 75001 752696845 Holds interests in ASCs/ Short Stay Hospitals TX N/A Dallas Surgical Partners LLC 15305 Dallas Parkway Suite 1600 Addison TX 75001 722183815 Ambulatory Surgery Center TX N/A Valley View Surgicare Partners Ltd 15305 Dallas Parkway Suite 1600 Addison TX 75001 752900902 Ambulatory Surgery Center TX N/A Denton Surgicare Partners Ltd 15305 Dallas Parkway Suite 1600 Addison TX 75001 752708579 Ambulatory Surgery Center TX N/A Bellaire 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