2013-07-12T14:50:09-05:00 2012-08-31 990 2011-09-01 203749695 Scott & White Hospital Round Rock SCOT 2542159043 2401 S 31st Street Temple TX 76508 Ernest Bovio 2542159043 2013-07-12 2011 2016-02-24 21:20:13Z Ernest Bovio 2401 S 31st Street Temple TX 76508 159310909 0 X www.sw.org X 2005 TX Scott & White provides personalized, comprehensive, high quality health care services enhanced by medical education and research. The System serves residents in a 29,000-square mile service area of Central Texas. It includes 12 acute care hospital facilities, two additional announced facilities, a regional health plan with 240,000+ members, and one of the nation's largest multi-specialty group practices with more than 178 clinics at 65 clinic locations providing care in 46 medical specialties. Scott & White Hospital Round Rock ("SWRR") is a subsidiary of Scott & White Healthcare ("SWHC")(EIN: 26-4532547), the 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 provided at cost approximately: $60 million in unreimbursed charity care. 10 4 0 175 0 0 0 57483 100888146 158730277 0 0 495244 523149 101383390 159310909 0 0 0 0 30396809 54980363 0 0 0 61401958 95305039 91798767 150285402 9584623 9025507 28830312 39218287 2781480 1537518 26048832 37680769 X Scott & White Hospital Round Rock has adopted the mission statement of the Scott & White Healthcare System: "To provide the most personalized, comprehensive and highest quality health care, enhanced by medical education and research." 0 0 136362099 158730277 Scott & White provides personalized, comprehensive, high quality health care services enhanced by medical education and research. The System serves residents in a 29,000-square mile service area of Central Texas. It includes 12 acute care hospital facilities, two additional announced facilities, a regional health plan with 240,000+ members, and one of the nation's largest multi-specialty group practices with more than 178 clinics at 65 clinic locations providing care in 46 medical specialties. Scott & White Hospital Round Rock ("SWRR") is a subsidiary of Scott & White Healthcare ("SWHC")(EIN: 26-4532547), the 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 provided at cost approximately: $60 million in unreimbursed charity care, $46 million in unreimbursed Medicaid, $4.5 million in unreimbursed indigent care, $21 million in unreimbursed subsidized services, $63 million in unreimbursed health professions education, $13 million in unreimbursed research, $1 million in other community benefits, and had a Medicare shortfall of approximately $96 million in the fiscal year ending August 31, 2012.The Scott & White Healthcare System employs over 1,000 physicians and scientists and 300+ advanced practice professionals. The System has more than 14,000 employees and in the fiscal year ending August 31, 2012, served over 537,000 patients accounting for 2.2 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 Round Rock had 17,245 patient observation days (excluding newborns), 5,146 surgical cases, 4,407 admissions and 22,729 emergency room visits during the fiscal year ending August 31, 2012. SWRR completed a 58,000 square-foot expansion in April of 2012 adding 26 hospital beds, which are a combination of ICU and general medical surgical beds, four new operating rooms (increasing to a total of nine), an endoscopy suite (resulting in a total of three suites), and eight additional Emergency Department beds to increase from 11 to 19. Scott & White Hospital Round Rock serves the community through projects such as: concussion testing local athletes through its Concussion Center, offering 25 area high school students internships through its annual three-week-long Junior Volunteer Explorer Program, and recruiting patients for a Phase III lung cancer trial aimed at preventing the disease's recurrence in previously treated patients.Scott & White System personnel strive to do more than merely meet the healthcare needs of patients. Employees go into the community to educate about living a healthier life. Targeted populations are provided information on specific needs. For example, physicians specializing in geriatric care hold regular seminars discussing subjects such as preventing injury from falls, questions patients should be asking their doctor, how to maintain a healthy lifestyle with limited mobility, and more. Health educational programs regarding prevention and treatment are offered free or at minimal cost to all community members in a variety of subject areas, such as weight loss, smoking cessation, education on coping with a diagnosis, support groups for families, child safety, heart disease education, diabetes education, sex education for teens, domestic violence prevention and many more. Staff and physicians attend health fairs in the community and provide regular community presentations about health issues for different populations. Clinics in the region offer healthy cooking classes led by a Scott & White dietician to instruct families in creating easy and cost effective healthy meals. As an integrated health care delivery system, Scott & White is able to leverage the Scott & White Health Plan to provide health education information to the community and is actively working to make that information more widely available.Scott & White uses various forms of media to promote health in the community. The System website, blogs, social media, printed flyers, and newspaper and magazine articles written by staff and physicians throughout the year provide information that community members can use to enhance personal health. A specific website has been created to instruct on wellness initiatives (wellness.sw.org). Also, Scott & White staff dedicate many hours serving on community boards and collaborative groups whose missions are to improve the overall health of the community. In addition to these efforts, the System has designated specific funds to be used to enhance healthy initiatives occurring in each community. For example, Scott & White provides substantial financial and in-kind support for multiple free clinics to assist in providing better access and more affordable healthcare to the medically underserved. Scott & White is one of sixteen major U.S. health systems to be part of the National High Value Healthcare Collaborative ("HVHC"). This partnership is designed to improve healthcare, lower costs and make best practices available to the national provider community. The Dartmouth Institute for Health Policy and Clinical Practice leads the collaborative which is studying nine prevalent condition/disease specific areas that have been shown to have wide variation nationally in rates, costs and outcomes. Additional high variation, high cost conditions that affect diverse populations will be added over time. The healthcare systems in this group are responsible for 50 million patients and are using private dollars and research and grant funds to identify ways to get the most out of every healthcare dollar. In June of 2012 the HVHC received a $26 million grant from the Center for Medicare and Medicaid Innovation ("CMMI"). CMMI projects the service improvements funded by this grant will save $64 million over three years, largely due to reduced utilization and costs that have been shown to occur when patients are engaged and empowered to make health care decisions based on their own values and preferences.Scott & White strives to better serve patients while decreasing costs to the healthcare system. One way this is accomplished is through better communication between specialists and primary care physicians creating coordinated and integrated care. Scott & White's electronic medical records (EMR) system allows specialists to review a patient's medical history and lab results and make recommendations to a primary care physician possibly eliminating an office visit. If the specialist needs to see a patient the specialist has access to all tests and lab work prior to the office visit which can prevent a second or third specialty follow-up visit. Scott & White is also using the EMR system to practice active rather than passive medicine. The new EMR system allows Scott & White to automatically remind physicians that patients are due for preventive tests such as mammograms or cholesterol checks. The system allows doctors and nurses to use e-mail to provide patients with test results or to answer questions that previously would have required an office visit.The Scott & White Healthcare System has received numerous awards and accreditations. Scott & White Memorial Hospital was ranked for the eighth time as one of the Top 100 Hospitals by Thomson Reuters. For the second consecutive year, Scott & White Memorial Hospital was named one of the nation's Best Regional Hospitals according to U.S. News & World Report. Scott & White Hospital Round Rock was named one of the nation's Top Performers on Key Quality Measures by the Joint Commission. SWRR was designated as the first hospital in the U.S. to receive the American Heart Association's Mission: Lifeline Heart Attack Receiving Center Accreditation. Additionally, SWRR has achieved status as an accredited chest pain center with PC. SWRR was one of only 10 hospitals in Texas and the only hospital in Central Texas to be awarded 'Honor Roll Site' status for the American Stroke Association's Target Stroke program. SWRR serves patients qualifying for federal Medicare and state Medicaid programs and other federal and state means tested assistance programs. Services for indigent, uninsured and underinsured patients are provided according to provisions of the Scott & White Healthcare Financial Assistance Policy, which provides financial assistance to patients up to 375% of the Federal Poverty Guidelines. 136362099 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 X 10 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 0 0 X Dick Dixon 2547244733 2401 S 31st Street Temple TX 76508 X Patricia M Currie 40.00 X X 0 480343 46740 Ernest Bovio 40.00 X X 0 306074 51551 James Mills 1.00 X 0 0 0 Ted Hejl 1.00 X 0 0 0 Stuart Whitlow 1.00 X X 0 0 0 Franklin Chang MD 40.00 X X 0 331921 46686 Tom Burdett 1.00 X 0 0 0 Dennis L Laraway 40.00 X X 0 444702 42397 Dick L Dixon 40.00 X 0 313365 48214 Kelly Harris 40.00 X 0 69126 13676 L Gill Naul MD 40.00 X 0 693061 53381 James Carroll 40.00 X 0 401331 39063 Clyde Chumbley MD 40.00 X 0 370024 83032 Cynthia Dunlap 40.00 X 0 202857 38845 Glen R Couchman MD 40.00 X 0 573830 53381 Robert W Pryor MD 40.00 X 0 866989 46463 Robin Watson MD 40.00 X 0 380382 48214 Matthew L Chambers 40.00 X 0 188235 6084 Marc R Hallee 40.00 X 0 450015 6951 Bernardine Patterson 40.00 X 0 131879 18337 Jason Cole 40.00 X 0 133048 35106 Lori Roark 40.00 X 0 126497 19156 Irene Frank 40.00 X 0 136773 20163 Thu Le 40.00 X 0 126429 12240 Alfred B Knight MD 40.00 X 0 779908 49821 Kenneth A Johnson 40.00 X 0 185580 110335 Dudley P Baker MD 40.00 X 0 408346 49007 Gail VanZyl 40.00 X 0 175791 74647 0 8276506 1013490 0 1 1 0 Aureus Healthcare 13609 California St Omaha NE 68154 Staffing 377696 P2P Staffing Corp 302 Knights Run Ave Tampa FL 33602 Staffing 322473 AMN Healthcare Inc File S6157 Los Angeles CA 900746157 Staffing 310843 Lighthouse Nursing 328 Antelope Trail Killeen TX 76542 Staffing 209663 Eagle Systems Inc PO Box 21115 Waco TX 767021115 Security 188744 9 57483 57483 Net Patient Service Re 621990 158730277 158730277 158730277 Cafeteria 722210 355959 355959 Gift Shop 453220 143329 143329 Sale/Leaseback Transac 999999 23861 23861 523149 159310909 158730277 0 523149 45259780 44535609 724171 9720583 9565050 155533 3509 3509 3275033 3223932 51101 55044 55044 663806 653185 10621 280745 280745 7703709 7580447 123262 1614202 1588374 25828 43649 43649 2701146 2701146 8168580 8168580 Patient Care Expense 30001872 30001872 Bad Debt 25389526 25389526 Overhead Shared Service 12895929 289535 12606394 Rent and Maintenance 1887794 1887794 620495 397611 222884 150285402 136362099 13923303 0 120983 50527 20987059 21525311 1571255 1655594 72048 19343702 4809638 6078967 14534064 1452791 28830312 39218287 492216 1537518 2289264 0 2781480 1537518 X 26048832 37680769 26048832 37680769 28830312 39218287 X 9025507 2606430 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2029 0 0 0 2029 0 Part IV, Supplemental Information: Part II-B, Line 1(f): Scott & White Hospital Round Rock ("SWRR") maintains membership in the Texas Hospital Association. A percentage of the dues paid to this organization is attributed to lobbying activities and is reported as grants to other organizations for lobbying purposes. 19343702 4809638 14534064 14534064 Description of Uncertain Tax Positions Under FIN 48: Part X: FIN 48 Footnote: Scott & White evaluates its income tax positions in accordance with ASC 740-10, Income Taxes - Overall, regarding accounting for uncertainty in income taxes. ASC 740-10 prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken in a tax return. There are no material uncertain tax positions as of August 31, 2012 or 2011. 1 1 X 1 X 1 X 375.000000000000 1 1 0 0 510654 510654 0.00410 5107002 2919770 2187232 0.01750 1005126 711464 293662 0.00240 6622782 3631234 2991548 0.02400 11466943 10956960 509983 0.00410 38200 38200 0.00030 11505143 10956960 548183 0.00440 18127925 14588194 3539731 0.02840 14735 14735 0.00010 14735 14735 0.00010 1 7014656 36442185 49917690 -13475505 X 1 1 1 1 Scott & White Hospital Round Rock

300 University Blvd Round Rock TX 78665

X X X Scott & White Hospital Round Rock 1 0 1 1 100.000000000000 1 375.000000000000 1 X 1 1 X X X X X 1 0 1 X 0 0 Part I, Line 6a: Scott & White Hospital Round Rock ("SWRR") did not prepare a community benefit report for the fiscal year ending August 31, 2012. SWRR is located in Williamson County Texas, and Williamson County completed a county needs assessment in January 2011. While SWRR was not actively involved in conducting the assessment, the assessment is being used to reassess the current programs and services to better serve the community. 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 lines 7a, 7b, 7c and 7g. Part I, L7 Col(f): Bad debt expense subtracted from total expenses on Part IX of the Form 990 to calculate the operating expenses used in calculating the percentage in column (f) is $25,389,526. Part III, Line 4: In the Scott & White Hospital Round Rock ("SWRR") accounting system, bad debt is recorded as the cost of forgone charges. To calculate the cost of bad debt for purposes of Schedule H, Part III, line 2, the cost to charge ratio calculated in Worksheet 2 of the Schedule H Instructions was applied. Due to patient screenings which occur prior to recording bad debt charges, bad debt expense should not contain community benefit expenditures.Audited financial statement footnote: 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. Scott & White has experienced an increase in write-off trends related to bad debt and charity across the system driven by changes in insurance plan structures shifting financial responsibility away from the health plan to individuals and general economic conditions. There have been no significant changes to the charity care policies for the year ended August 31, 2012. Part III, Line 8: Scott & White Hospital Round Rock (SWRR) is a nonprofit hospital that voluntarily participates in the Medicare program. Medicare payments received do not cover the costs incurred to provide services to Medicare patients. In reporting the community benefit portion of the American Hospital Association/Texas Hospital Association survey, the Medicare short-fall is included in community benefit reporting.Costing methodology/source: The Medicare revenue and costs are from the Medicare Cost Report which has a year end May 31, 2012. All payments to providers of services must be based on the reasonable cost of services covered under title XVIII of the Social Security Act. Reasonable cost includes all necessary and proper costs incurred in rendering the services. Reasonable cost takes into account both direct and indirect costs of providers of services, including normal standby costs. The general services or overhead cost is stepped down and allocated through statistical data to equitably allocate the expenses to the hospital service departments. Part III, Line 9b: The Scott & White Healthcare Financial Assistance Policy has as section for coordination with collection policies. It states: "not withstanding 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 Round Rock Part V, Section B, Line 13g: In addition to the methods of publication listed in question 13, Scott & White Hospital Round Rock ("SWRR") annually posts a notice in the principal newspaper of its service area. Part VI, Line 2: The Scott & White Healthcare System (the "System") subscribes to Healthy Communities Institute, which supplies continuously updated community data on 75 to 200 health and quality of life indicators. Data for each hospital in the System including Scott & White Hospital Round Rock ("SWRR") can be found on the website www.sw.org. Scott & White routinely monitors local health trends, reviews hospitalization inpatient and outpatient records, and takes feedback from community leaders and public health officials regarding the current community health needs. Scott & White staff members regularly participate in exchanges with government, education, and human service organizations to identify other issues in the community that may be underlying causes of healthcare problems. Scott & White executives assist other community health service organizations with strategic planning in the delivery of services to the medically underserved. In an effort to get regular feedback from the community, Scott & White created a new department to actively engage patients and the community in continuous dialogue to provide them an opportunity to discuss their unmet medical care needs. This platform allows the opportunity to understand the communitiy's perspective regarding helpful service improvements. A strategic plan has been implemented for conducting extensive community health needs assessments on a 3 year cyclical basis, the first of which will be completed by August 31, 2013. Data pertaining to 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 SWRR service area compare to other counties in Texas and the U.S. Healthy People 2020 goals. Also, information gaps in the current data will be identified and targeted for future exploration in the form of surveys, key informant interviews and focus groups. The process for conducting the community health needs assessment was presented to the SWRR Board of Directors and the Directors were given the opportunity to provide input and make suggestions. Part VI, Line 3: Scott & White Hospital Round Rock ("SWRR") provides patients with information regarding eligibility for financial assistance in a number of ways. Patients are notified of the Financial Assistance Policy upon admission or discharge and in written and oral communications with the patient regarding patient billing statements including phone contact information for patients seeking information regarding billings, invoices and telephone calls. Scott & White personnel attempt to screen uninsured patients for eligibility for financial assistance, as well as alternative funding sources, prior to providing services. When screening prior to services is not possible, Scott & White personnel attempt to screen uninsured patients prior to billing. Scott & White financial counselors contacting patients regarding outstanding accounts attempt to screen patients for eligibility for financial assistance and opportunities for alternative funding sources. Part VI, Line 4: The Scott & White Healthcare System provides care for patients in 35 counties in the state of Texas covering 29,000+ square miles. Eighty-five percent of the patients come from the primary service area including the counties of Bell, Brazos, Coryell, Falls, Lampasas, McLennan, Milam, and Williamson. Eight percent of patients come from the secondary service area including Blanco, Bosque, Brown, Burleson, Burnet, Comanche, Grimes, Hamilton, Hays, Hill, Hood, Johnson, Lee, Leon, Limestone, Llano, Madison, Mills, Robertson, San Saba, Somervell, Travis and Washington counties.In Scott & White's primary service area, the total population is 1,268,822 and the median household income is $46,930. Twenty-seven percent of the population is under the age of 17; 42% is between the ages of 18 and 44; 21% is between the ages of 45 and 64; and 10% of the population is over 65. The top three ethnicities in the primary service area are Caucasion Non-Hispanic with 61.08% of the population; 20.67% are Hispanic and 12% are African American.Scott & White Hospital Round Rock ("SWRR") is located in Williamson County, Texas. Between 2000 and 2012, Williamson County was the 9th fastest growing county in teh U.S. with over 81% growth. Round Rock is the largest and one of the fastest growing cities in the county. Over the past decade the city has added about 44,000 people and has experienced economic and demographic changes. A greater percent of residents have higher educational attainment, the poverty rate has increased, and the county has become more racially and ethnically diverse. 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 SWRR 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 SWRR Board of Directors does not consist of a majority of independent directors because SWRR 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 SWRR's exempt purposes. SWRR maintains an emergency room following EMTALA requirements and has an open medical staff. SWRR 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 follow, including SWRR, 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 service enhanced by medical education and research through 12 acute care hospital facilities, a regional health plan, and one of the nation's largest multi-specialty group practices. Scott & White Hospital Round Rock ("SWRR") is a subsidiary of Scott & White Healthcare ("SWHC")(EIN: 26-4532547), the 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 System includes 12 hospital sites, two additional announced facilities, more than 178 clinics at 65 clinic locations providing care in 46 medical specialties and a 240,000+ member health plan serving residents in a 29,000-square mile service area. The Scott & White Healthcare System provided at cost approximately: $60 million in unreimbursed charity care, $46 million in unreimbursed Medicaid, $4.5 million in unreimbursed indigent care, $21 million in unreimbursed subsidized services, $63 million in unreimbursed health professions education, $13 million in unreimbursed research, $1 million in other community benefits, and had a Medicare shortfall of approximately $96 million in the fiscal year ending August 31, 2012. The Scott & White Healthcare System employs over 1,000 physicians and scientists and 300+ advanced practice professionals. The System has more than 14,000 employees and in the fiscal year ending August 31, 2012 served over 537,000 unique patients accounting for 2.2 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 Round Rock had 17,245 patient observation days (excluding newborns), 5,146 surgical cases, 4,407 admissions and 22,729 emergency room visits for the fiscal year ending August 31, 2012. SWRR completed a 58,000 square-foot expansion in April of 2012 adding 26 hospital beds, which are a combination of ICU and general medical surgical beds, four new operating rooms (increasing to a total of nine), an endoscopy suite (resulting in a total of three suites), and eight additional Emergency Department beds to increase from 11 to 19. Scott & White Hospital Round Rock serves the community through projects such as: concussion testing local athletes through its Concussion Center, offering 25 area high school students internships through its annual three-week-long Junior Volunteer Explorer Program and recruiting patients for a Phase III lung cancer trial aimed at preventing the disease's recurrence in previously treated patients.Scott & White strives to do more than merely meet the healthcare needs of patients. Employees go into the community to educate about living a healthier life. Targeted populations are provided information on their specific needs. For example, physicians specializing in geriatric care hold regular seminars discussing subjects such as preventing injury from falls, questions patients should be asking their doctor, how to maintain a healthy lifestyle with limited mobility, and more. Health educational programs regarding prevention and treatment are offered free or at minimal cost to all community members in a variety of subject areas, such as weight loss, smoking cessation, education on coping with a diagnosis, support groups for families, child safety, heart disease education, diabetes education, sex education for teens, domestic violence prevention and many more. Staff and physicians attend health fairs in the community and provide regular community presentations about health issues for different populations. Clinics in the region offer healthy cooking classes led by a Scott & White dietician to instruct families in creating easy and cost effective healthy meals. As an integrated health care delivery system, Scott & White is able to leverage the Scott & White Health Plan to provide health education information to the community and is actively working to make that information more widely available. Scott & White uses various forms of media to promote health in the community. The System website, blogs, social media, printed flyers, and newspaper and magazine articles written by staff and physicians throughout the year provide information that community members can use to enhance personal health. A specific website has been created specifically to instruct on wellness initiatives (wellness.sw.org). Also, Scott & White staff dedicate many hours of service serving on community boards and collaborative groups whose missions are to improve the overall health of the community. In addition to these efforts, the hospital has designated specific funds to be used to enhance healthy initiatives occurring in each community. For example, Scott & White provides substantial financial and in-kind support for multiple free clinics to assist in providing better access and more affordable healthcare to the medically underserved. Scott & White is one of sixteen major U.S. health systems to be part of the National High Value Healthcare Collaborative ("HVHC"). This partnership is designed to improve healthcare, lower costs and move best practices out to the national provider community. The Dartmouth Institute for Health Policy and Clinical Practice leads the collaborative which is studying nine prevalent condition/disease specific areas that have been shown to have wide variation in rates, costs and outcomes nationally. Additional high variation, high cost conditions that affect diverse populations will be added over time. The healthcare systems in this group are responsible for 50 million patients and are using private dollars and research and grant funds to identify ways to get the most out of every healthcare dollar. In June of 2012 the HVHC received a $26 million grant from the Center for Medicare and Medicaid Innovation ("CMMI"). CMMI projects the project funded by this grant will save $64 million over three years, largely due to reduced utilization and costs that have been shown to occur when patients are engaged and empowered to make health care decisions based on their own values and preferences.The entire Scott & White Healthcare System serves patients qualifying for federal Medicare and state Medicaid programs and other federal and state means tested assistance programs. Services for indigent patients and uninsured and underinsured patients are provided according to provisions of the Scott & White Healthcare Financial Assistance Policy, which provides assistance to individuals with incomes up to 375% of the Federal Poverty Guidelines. Scott & White also serves private pay patients and contracts with health plans and insurance companies to provide medical services for their participants. Reports Filed With States Part VI, Line 7 TX X X X X 0 0 0 0 0 0 0 1 0 Patricia M Currie 0 479377 0 0 0 966 0 31850 0 14890 0 527083 0 0 Ernest Bovio 0 305654 0 0 0 420 0 31850 0 19701 0 357625 0 0 Franklin Chang MD 0 308924 0 19691 0 3306 0 31850 0 14836 0 378607 0 0 Dennis L Laraway 0 444256 0 446 0 0 0 31850 0 10547 0 487099 0 0 Dick L Dixon 0 311559 0 0 0 1806 0 31850 0 16364 0 361579 0 0 L Gill Naul MD 0 691255 0 0 0 1806 0 31850 0 21531 0 746442 0 0 James Carroll 0 398559 0 0 0 2772 0 31850 0 7213 0 440394 0 0 Clyde Chumbley MD 0 360262 0 0 0 9762 0 65010 0 18022 0 453056 0 0 Cynthia Dunlap 0 201891 0 0 0 966 0 26914 0 11931 0 241702 0 0 Glen R Couchman MD 0 572024 0 0 0 1806 0 31850 0 21531 0 627211 0 0 Robert W Pryor MD 0 864217 0 0 0 2772 0 31850 0 14613 0 913452 0 0 Robin Watson MD 0 364347 0 15615 0 420 0 31850 0 16364 0 428596 0 0 Matthew L Chambers 0 172585 0 10000 0 5650 0 0 0 6084 0 194319 0 0 Marc R Hallee 0 346430 0 90000 0 13585 0 0 0 6951 0 456966 0 0 Bernardine Patterson 0 131755 0 0 0 124 0 13364 0 4973 0 150216 0 0 Jason Cole 0 132670 0 0 0 378 0 18233 0 16873 0 168154 0 0 Irene Frank 0 136539 0 101 0 133 0 8409 0 11754 0 156936 0 0 Alfred B Knight MD 0 776441 0 0 0 3467 0 31850 0 17971 0 829729 0 0 Kenneth A Johnson 0 87665 0 0 0 97915 0 107579 0 2756 0 295915 0 0 Dudley P Baker MD 0 404638 0 0 0 3708 0 31850 0 17157 0 457353 0 0 Gail VanZyl 0 146865 0 0 0 28926 0 67190 0 7457 0 250438 0 0 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 Officer and other executive level personnel. Julie Couchman Family of Key Employee 35406 Employee of the Scott & White Healthcare System 0 Jarrod Pryor Family of Officer 67026 Employee of the Scott & White Healthcare System 0 John Carroll Family of Officer 85314 Employee of the Scott & White Healthcare System 0 Marjo Carroll Family of Officer 71971 Employee of the Scott & White Healthcare System 0 Brett Dixon Family of Director 14995 Employee of the Scott & White Healthcare System 0 Form 990, Part V, Line 1a: Scott & White Hospital Round Rock ("SWRR") 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 administration 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 Hospital Round Rock's ("SWRR") sole member is 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). Form 990, Part VI, Section A, line 7a Scott & White Hospital Round Rock's ("SWRR") sole member is 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). Election of the SWRR 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 Hospital Round Rock's ("SWRR") sole member is 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). Actions taken by the SWRR 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 Members of the Scott & White Hospital Round Rock ("SWRR") Board of Directors were each provided a copy of Form 990 prior to filing with the IRS. A meeting was held to allow the Directors to ask questions and provide feedback with respect to the information presented in the Form 990. Form 990, Part VI, Section B, line 12c Annually, a written questionnaire is provided to all persons identified as being subject to the Scott & White Healthcare System Conflict of Interest Policy (Tax), requesting responses to questions designed to identify potential conflicts. Responses are monitored and reviewed by System personnel and follow-ups are initiated as required. The Conflict of Interest Policy (Tax) is reviewed before each board meeting or board committee meeting. Board members or persons having business with the Board are asked to identify conflicts which may arise with respect to business conducted by the Board or committee during the meeting. Form 990, Part VI, Section B, line 15a 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 Scott & White Hospital Round Rock ("SWRR"). Compensation for the Scott and White Healthcare System (the "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 Hospital Round Rock ("SWRR") governing documents and Conflict of Interest Policy (Tax) are available to the public upon request. SWRR 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. 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Reorganization adjustment 2,606,430. Total to Form 990, Part XI, Line 5: 2,606,430. 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 Properties Opportunities LLC 2401 S 31st Street Temple TX 76508 452920812 Investment TX Scott & White Properties Holdings Inc Scott & White Properties Management LLC 2401 S 31st Street Temple TX 76508 452920980 Investment TX Scott & White Properties Opportunities LLC 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 Healthplan 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-College Station 2401 S 31st Street Temple TX 76508 274434451 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 11c, III-FI Hillcrest Baptist Medical Center 1 Hillcrest Physician Services 100 Hillcrest Medical Blvd Waco TX 76712 742967081 Physician Services TX 501 (c) (3) Line 11c, III-FI Hillcrest Baptist Medical Center 1 Scott & White Lake of the Hills Regional Medical Center 2401 S 31st Street Temple TX 76508 451608264 Hospital Services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Scott & White Properties Holdings Inc 2401 S 31st Street Temple TX 76508 452920596 Investment TX N/A C Scott & White Properties Inc 2401 S 31st Street Temple TX 76508 742497061 Hotel Services TX N/A C Scott & White Assurance Ltd 23 Lime Tree Bay Grand Cayman Grand Cayman CJ 980589956 Investment Company CJ N/A C Hillcrest Holdings Inc 3000 Herring St Waco TX 76708 742793367 Operational Support TX N/A C Atumida 2401 S 31st Street Temple TX 76508 270583030 Research TX N/A C Insurance Company of Scott & White 2401 S 31st Street Temple TX 76508 743092083 Insurance TX N/A C Charitable Remainder Trust #1 PO Box 6101 Temple TX 765036101 526854329 Investment Trust TX N/A T Charitable Remainder Trust #2 PO Box 6101 Temple TX 765036101 206463694 Investment Trust TX N/A T Charitable Remainder Trust #3 PO Box 6101 Temple TX 765036101 416504860 Investment Trust TX N/A T Charitable Remainder Trust #4 PO Box 6101 Temple TX 765036101 742751167 Investment Trust TX N/A T Charitable Remainder Trust #5 PO Box 6101 Temple TX 765036101 746391353 Investment Trust TX N/A T Charitable Remainder Trust #6 PO Box 6101 Temple TX 765036101 746397360 Investment Trust TX N/A T Charitable Remainder Trust #7 PO Box 6101 Temple TX 765036101 742751168 Investment Trust TX N/A T Charitable Remainder Trust #8 PO Box 6101 Temple TX 765036101 746423552 Investment Trust TX N/A T Phil and June Hivnor Charitable 2401 S 31st Street Temple TX 765080001 900850773 Investment Trust TX N/A T Nelda I Staller Charitable Remainder Unitrust No 1 2401 S 31st Street Temple TX 765080001 326224724 Investment Trust TX N/A T 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 Scott & White Memorial Hospital O 101207207 Cost Scott & White Memorial Hospital Q 3742056 Cost