2012-11-14T09:14:05-06:00 2011-12-31 742939657 Flieller Kruger Skelton & Plyler PLLC 221 West Sixth Street Suite 1200 Austin TX 78701 990 2011-01-01 741356589 St David's Foundation STDA 5128796600 811 Barton Springs Rd No 600 Austin TX 78704 Jim Ries 5128796600 2012-11-13 1 Greg D Skelton P00104853 5124796000 2011 2016-02-24 21:20:13Z Earl Maxwell 811 Barton Springs Rd Austin TX 78704 84420606 0 X www.stdavidsfoundation.org X 1924 TX To improve health and health care for all Central Texans. 19 19 58 35 0 -46135 92537 383020 73399491 77288808 2746074 6738025 3200 10753 76241302 84420606 20346273 24374015 0 0 4315166 4845398 0 0 0 2344182 2596870 27005621 31816283 49235681 52604323 450232526 486760623 8796291 6538634 441436235 480221989 St. David's Foundation is committed to positively impacting the health of the community. It controls hospitals dedicated to serving Central Texas under the community benefit standard,and it provides grants to programs focused on improving health and healthcare in Central Texas. 0 0 25600350 24374015 The reporting organization provides grants and corresponding program services to community organizations with the purpose of improving access to health care in Central Texas. 3510492 The reporting organization provides free comprehensive dental care for low income children through Title 1 schools and for indigent adults in Central Texas who have no other access to services. This service is provided with fully equipped mobile dental clinics that are taken to the schools and safety-net agencies where the adults are located. Each clinic is staffed with full time dentists and support personnel. In 2011, the mobile clinics served 39 Title 1 elementary schools in 6 independent school districts. At these schools we screened 16,131 children for decay, 21,382 teeth were sealed and patient encounters totaled 6,533 for acute and restorative treatment. 77288808 The reporting organization controls hospitals dedicated to serving Central Texas under the community benefit standard. St. David's Healthcare Partnership includes six acute care hospitals and one rehabilitation hospital. In 2011, 61,920 patients were admitted and there were 271,826 emergency room visits. 29110842 1 1 0 1 0 0 0 0 0 1 1 1 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 1 0 0 1 22 0 1 58 1 1 1 0 0 0 0 0 0 0 0 0 X 19 19 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X Jim Ries 5128796603 811 Barton Springs Rd Suite 600 Austin TX 78704 H David Hughes 15.00 X 0 0 0 Jack T Brown 0.50 X 0 0 0 Ed Auler 0.50 X 0 0 0 Charles M Christensen 0.50 X 0 0 0 Diane Grant 0.50 X 0 0 0 Jose Guerra 0.50 X 0 0 0 Robena Jackson 5.00 X 0 0 0 Scott Thomas 0.50 X 0 0 0 Marc Winkelman 0.50 X 0 0 0 Barbara H Brightwell 0.50 X 0 0 0 Lynn Sherman 0.50 X 0 0 0 Charles Chaffin 5.00 X 0 0 0 Rev David Boyd 0.50 X 0 0 0 Jerry Turner 5.00 X 0 0 0 Bob Present 0.50 X 0 0 0 John Murray 5.00 X 0 0 0 Kathleen Angel 0.50 X 0 0 0 Ray Bonilla 5.00 X 0 0 0 Jo Anne Christian 0.50 X 0 0 0 Susie Jastrow 5.00 X 0 0 0 Mary Scott Nabers 5.00 X 0 0 0 Ray Benson 0.50 X 0 0 0 Albert Hawkins 0.50 X 0 0 0 Landy Warren 0.50 X 0 0 0 CW Hetherly 15.00 X 0 0 0 R Earl Maxwell 40.00 X 259992 0 20565 James J Ries 40.00 X 177035 0 13209 Bobbie Barker 40.00 X 206137 0 13843 Carol Clark 35.00 X 240792 0 13215 Patrice Coons 40.00 X 149148 0 12139 Monica Anderson 40.00 X 128993 0 13657 Caesar Collazo 40.00 X 127558 0 16876 Roberto Rodriguez MD 40.00 X 156359 0 15553 Ensy Atarod 40.00 X 120207 0 16689 1566221 0 135746 15 0 1 0 0 383020 383020 St. David's HealthCare 621990 77246782 77246782 Medicare Reimbursement 621990 42026 42026 77288808 6738025 6738025 10753 10753 84420606 77288808 0 6748778 24374015 24374015 925745 213742 712003 3066568 2545943 520625 95482 67425 28057 512481 399191 113290 245122 185039 60083 59774 59774 73076 73076 381822 381822 265586 233830 31756 281751 281751 127690 38915 88775 136274 93489 42785 223740 111870 111870 66233 51720 14513 83403 58476 24927 67954 33977 33977 225445 41002 184443 Supplies 288968 288968 Leased Equipment 212345 200004 12341 Employee expenses 116930 15589 101341 Repairs and Maintenance 97740 97740 -111861 59907 -171768 31816283 29110842 2705441 0 459 2443931 8233573 1578384 6507849 5926208 138903 57814 551621 186550 259133 365071 165536495 191730484 273767831 280447014 450232526 486760623 305015 726444 6969095 4613855 1522181 1198335 8796291 6538634 X 438204928 477054114 637990 618644 2593317 2549231 441436235 480221989 450232526 486760623 X 52604323 -13818569 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 290 0 1 53127 53417 0 Explanation of Lobbying Activities: Part II-B, Line 1: The Schedule K-1 from St. David's Healthcare Partnership, LP (the "Partnership") included $53,127 of lobbying expenditures, which constituted the portion of the organization's annual association dues dedicated to lobbying activities. In addition to amounts reported on the above-mentioned Schedule K-1, the reporting organization participated in direct contact with local legislators. David Huffstutler, CEO of the Partnership, spent 1 hour on lobbying activities during 2011. The amount reported on Line 1g above reflects the costs of these activities based upon hourly rates of compensation and allocable overhead for the officer involved. 2593317 -44086 2549231 2559582 33735 2593317 2500000 59582 2559582 2500000 2500000 1.00000 0 0 551621 186550 365071 365071 TIFF Absolute Return Pool II 6549220 F TIFF Multi Asset Fund 106360086 F TIFF Private Equity Partners 2007 3260630 F TIFF Private Equity Partners 2008 2561758 F TIFF Private Equity Partners 2009 834859 F TIFF Realty & Resources III 2142947 F TIFF Realty & Resources 2008 1310852 F TIFF Realty & Resources 2009 697052 F TIFF Short Term 22088642 F Vanguard Total Stock Index Fund 22301271 F Vanguard International Stock Index Fund 23623167 F 191730484 St. David's Healthcare Partnership, LP, LLP 280447014 C 280447014 Due to St. David's Community Health Foundation Holdings 1198335 1198335 Description of Intended Use of Endowment Funds: Part V, Line 4: The Executive Staff is developing recommendations to the Board of Trustees regarding the use of the earnings generated by the Key Endowment. Description of Uncertain Tax Positions Under FIN 48: Part X: The Foundation is a public, nonprofit 501(C)(3) organization exempt from federal income taxes under Section 501(C)(3) of the Internal Revenue Code, except to the extent it has unrelated business activities. As such, no provision for federal income taxes has been made in the financial statements. The Foundation's policy is to record interest and penalty expense related to income taxes as interest and other expense, respectively. At December 31, 2011 and 2010, no interest or penalties have been or are required to be accrued. The Foundation, generally, is no longer subject to income tax examination by federal authorities for years prior to December 31, 2008. THE FOUNDATION IS A PUBLIC, NONPROFIT 501(C)(3) ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 510(C)(3) OF THE INTERNAL REVENUE CODE, EXCEPT TO THE EXTENT IT HAS UNRELATED BUSINESS ACTIVITIES. AS SUCH, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN MADE IN THE FINANCIAL STATEMENTS. THE FOUNDATION'S POLICY IS TO RECORD INTEREST AND PENALTY EXPENSE RELATED TO INCOME TAXES AS INTEREST AND OTHER EXPENSE, RESPECTIVELY. AT DECEMBER 31, 2011 AND 2010, NO INTEREST OR PENALTIES HAVE BEEN OR ARE REQUIRED TO BE ACCRUED. THE FOUNDATION, GENERALLY, IS NO LONGER SUBJECT TO INCOME TAX EXAMINATION BY FEDERAL AUTHORITIES FOR YEARS PRIOR TO DECEMBER 31, 2008. 1 1 X 1 X 1 X 500.000000000000 1 1 1 0 1 1 25187282 533593 24653689 0.05370 38757456 56776640 -18019184 0.00000 0 0 0.00000 63944738 57310233 6634505 0.01450 6891435 0 6891435 0.01500 1242427 0 1242427 0.00270 0 0 0.00000 0 0 0.00000 25787580 0 25787580 0.05620 33921442 33921442 0.07390 97866180 57310233 40555947 0.08840 0 0 0.00000 0 0 0.00000 0 0 0.00000 0 0 0.00000 0 0 0.00000 0 0 0.00000 0 0 0.00000 0 0 0.00000 0 0 0.00000 0 4260301 0 131184504 127046627 4137877 X 1 1 1 St David's HealthCare Partnership LP LLP The Foundation owns a controlling interest in St. David's 0.40590 2 HealthCare Partnership, which operated six acute care hospitals in 3 Central Texas. 7 1 St David's Medical Center

919 E 32nd Street Austin TX 78705

X X X 2 St David's North Austin Medical Center

12221 N Mopac Expwy Austin TX 78758

X X X 3 St David's South Austin Medical Center

901 W Ben White Blvd Austin TX 78704

X X X 4 Heart Hospital of Austin

3801 North Lamar Blvd Austin TX 78756

X X X 5 St David's Round Rock Medical Center

2400 Round Rock Ave Round Rock TX 78681

X X X 6 St David's Rehabilitation Hospital

1005 E 32nd St Austin TX 78705

X 7 St David's Georgetown Hospital

2000 Scenic Dr Georgetown TX 78626

X X X St David's Medical Center 1 1 1 200.000000000000 1 500.000000000000 1 X X X X X X X X 1 1 X X X X X 1 0 1 X 0 0 St David's North Austin Medical Center 2 1 1 200.000000000000 1 500.000000000000 1 X X X X X X X X 1 1 X X X X X 1 0 1 X 0 0 St David's South Austin Medical Center 3 1 1 200.000000000000 1 500.000000000000 1 X X X X X X X X 1 1 X X X X X 1 0 1 X 0 0 Heart Hospital of Austin 4 1 1 200.000000000000 1 500.000000000000 1 X X X X X X X X 1 1 X X X X X 1 0 1 X 0 0 St David's Round Rock Medical Center 5 1 1 200.000000000000 1 500.000000000000 1 X X X X X X X X 1 1 X X X X X 1 0 1 X 0 0 St David's Rehabilitation Hospital 6 1 1 200.000000000000 1 500.000000000000 1 X X X X X X X X 1 1 X X X X X 1 0 0 X X 0 0 St David's Georgetown Hospital 7 1 1 200.000000000000 1 500.000000000000 1 X X X X X X X X 1 1 X X X X X 1 0 1 X 0 0 2 Bailey Square Surgery Center

1111 W 34th St 400 Austin TX 78705

Ambulatory Surgery Center South Austin Surgery Center

4207 James Casey St 203 Austin TX 78745

Ambulatory Surgery Center Part I, Line 3c: The hospitals provide 100% financial assistance(Charity Care) for eligible patients with income equal to or less 200% of the the Federal Poverty Guidelines(FPG). For eligible patients with income over 200% FPG and equal to 500% or less than FPG, discounts are provided on a sliding scale. Eligibility is determined using various sources of documentation and income verification. The accounts for individuals without any health insurance who live in low income zip codes and who fail to respond to collection efforts are removed from accounts receivable and treated as charity care. All collections efforts cease on these accounts once classified as charity care. Part I, Line 7: The hospitals utilize the cost to charge ratio from the audited financial statements. Part I, L7 Col(f): Bad debts are excluded from the calculation of total expenses. Part II: All of the hospitals are active in the community promoting health of Central Texans. The Foundation provides significant grants each year to numerous agencies and local safety net clinics. The foundation focuses its funding to six key areas that will improve the health and health care of all Central Texans. Part III, Line 4: St. David's Foundation's proportionate share of bad debt expense from its ownership interest in St. David's Healthcare Partnership, LP, LLP (the "Partnership") is reported on Schedule H, Part III, Line 2. Following is the footnote to the Partnership's audited financial statements which describes bad debt expense:"Estimated provisions for doubtful accounts are recorded to the extent it is probable that a portion or all of a particular account will not be collected. The Partnership considers a number of factors in evaluating the collectibility of accounts receivable including the age of the accounts, changes in collection patterns and other current conditions, and the composition of patient accounts by payor type." Part III, Line 8: The Foundation has used the hositals' proportionate share of the shortfall on Medicare using the Medicare Cost Reports. Part III, Line 9b: The organization writes off all charity care and does not pursue collection on those that qualify for charity care. St. David's Medical Center Part V, Section B, Line 9: The hospitals provide 100% financial assistance(Charity Care) for eligible patients with income equal to or less 200% of the the Federal Poverty Guidelines(FPG). Eligiblity is determined using various sources of documentation and income verification. The accounts for individuals without any health insurance who live in low income zip codes and who fail to respond to collection efforts are removed from accounts receivable and treated as charity care. All collections efforts cease on these accounts once classified as charity care. St. David's Medical Center Part V, Section B, Line 10: For eligible patients with income over 200% FPG and equal to 500% or less than FPG, discounts are provided on a sliding scale. Eligiblity is determined using various sources of documentation and income verification. St. David's Medical Center Part V, Section B, Line 11h: The following is a summary of the Charity Care Policy adopted by St. David's Medical Center:St. David's Medical Center actively seeks completion of an application, which facilitates collection of appropriate information, including:* Verification of family members in the household - For adult patients, patient spouse and any dependents; for minors, mother and father, and dependents of both.* Income calculation - For adults, sum of the total yearly gross income of the patient and the patient's spouse; for minors, total yearly gross income of the patient, and the patient's mother and father.* Documentation - various official income reporting documentation is sought (e.g. W-2, Wage and Tax Statement, Pay Check Remittance and others). Documentation associated with the participation in a Public Benefit Program can be provided in lieu of income documentation (proof of participation indicates the patient has been deemed financially indigent and therefore is not required to provide income information). There is also a verification process in place for patients that do not have appropriate documentation. * Charity Eligibility Classifications - For financially indigent patients, the amount owed by the patient after payment by all third-party payors must exceed ten percent of the patient's yearly income and the patient must be unable to pay the remaining bill. Acceptance by St. David's Medical Center is based on meeting one of of two criteria. Yearly income must be greater than 200%, but less than or equal to 500% of the Federal Poverty Guidelines. St. David's North Austin Medical Center Part V, Section B, Line 11h: The following is a summary of the Charity Care Policy adopted by St. David's North Austin Medical Center:St. David's North Austin Medical Center actively seeks completion of an application, which facilitates collection of appropriate information, including:* Verification of family members in the household - For adult patients, patient spouse and any dependents; for minors, mother and father, and dependents of both.* Income calculation - For adults, sum of the total yearly gross income of the patient and the patient's spouse; for minors, total yearly gross income of the patient, and the patient's mother and father.* Documentation - various official income reporting documentation is sought (e.g. W-2, Wage and Tax Statement, Pay Check Remittance and others). Documentation associated with the participation in a Public Benefit Program can be provided in lieu of income documentation (proof of participation indicates the patient has been deemed financially indigent and therefore is not required to provide income information). There is also a verification process in place for patients that do not have appropriate documentation. * Charity Eligibility Classifications - For financially indigent patients, the amount owed by the patient after payment by all third-party payors must exceed ten percent of the patient's yearly income and the patient must be unable to pay the remaining bill. Acceptance by St. David's North Austin Medical Center is based on meeting either of two criteria. Yearly income must be greater than 200%, but less than or equal to 500% of the Federal Poverty Guidelines. St. David's South Austin Medical Center Part V, Section B, Line 11h: The following is a summary of the Charity Care Policy adopted by St. David's South Austin Medical Center:St. David's South Austin Medical Center actively seeks completion of an application, which facilitates collection of appropriate information, including:* Verification of family members in the household - For adult patients, patient spouse and any dependents; for minors, mother and father, and dependents of both.* Income calculation - For adults, sum of the total yearly gross income of the patient and the patient's spouse; for minors, total yearly gross income of the patient, and the patient's mother and father.* Documentation - various official income reporting documentation is sought (e.g. W-2, Wage and Tax Statement, Pay Check Remittance and others). Documentation associated with the participation in a Public Benefit Program can be provided in lieu of income documentation (proof of participation indicates the patient has been deemed financially indigent and therefore is not required to provide income information). There is also a verification process in place for patients that do not have appropriate documentation. * Charity Eligibility Classifications - For financially indigent patients, the amount owed by the patient after payment by all third-party payors must exceed ten percent of the patient's yearly income and the patient must be unable to pay the remaining bill. Acceptance by St. David's South Austin Medical Center is based on meeting either of two criteria. Yearly income must be greater than 200%, but less than or equal to 500% of the Federal Poverty Guidelines. Heart Hospital of Austin Part V, Section B, Line 11h: The following is a summary of the Charity Care Policy adopted by the Heart Hospital of Austin:Heart Hospital of Austin actively seeks completion of an application, which facilitates collection of appropriate information, including:* Verification of family members in the household - For adult patients, patient spouse and any dependents; for minors, mother and father, and dependents of both.* Income calculation - For adults, sum of the total yearly gross income of the patient and the patient's spouse; for minors, total yearly gross income of the patient, and the patient's mother and father.* Documentation - various official income reporting documentation is sought (e.g. W-2, Wage and Tax Statement, Pay Check Remittance and others). Documentation associated with the participation in a Public Benefit Program can be provided in lieu of income documentation (proof of participation indicates the patient has been deemed financially indigent and therefore is not required to provide income information). There is also a verification process in place for patients that do not have appropriate documentation. * Charity Eligibility Classifications - For financially indigent patients, the amount owed by the patient after payment by all third-party payors must exceed ten percent of the patient's yearly income and the patient must be unable to pay the remaining bill. Acceptance by Heart Hospital of Austin is based on meeting either of two criteria. Yearly income must be greater than 200%, but less than or equal to 500% of the Federal Poverty Guidelines. St. David's Round Rock Medical Center Part V, Section B, Line 11h: The following is a summary of the Charity Care Policy adopted by St. David's Round Rock Medical Center:St. David's Round Rock Medical Center actively seeks completion of an application, which facilitates collection of appropriate information, including:* Verification of family members in the household - For adult patients, patient spouse and any dependents; for minors, mother and father, and dependents of both.* Income calculation - For adults, sum of the total yearly gross income of the patient and the patient's spouse; for minors, total yearly gross income of the patient, and the patient's mother and father.* Documentation - various official income reporting documentation is sought (e.g. W-2, Wage and Tax Statement, Pay Check Remittance and others). Documentation associated with the participation in a Public Benefit Program can be provided in lieu of income documentation (proof of participation indicates the patient has been deemed financially indigent and therefore is not required to provide income information). There is also a verification process in place for patients that do not have appropriate documentation. * Charity Eligibility Classifications - For financially indigent patients, the amount owed by the patient after payment by all third-party payors must exceed ten percent of the patient's yearly income and the patient must be unable to pay the remaining bill. Acceptance by St. David's Round Rock Medical Center is based on meeting either of two criteria. Yearly income must be greater than 200%, but less than or equal to 500% of the Federal Poverty Guidelines. St. David's Rehabilitation Hospital Part V, Section B, Line 11h: The following is a summary of the Charity Care Policy adopted by St. David's Rehabilitation Hospital:St. David's Rehabilitation Hospital actively seeks completion of an application, which facilitates collection of appropriate information, including:* Verification of family members in the household - For adult patients, patient spouse and any dependents; for minors, mother and father, and dependents of both.* Income calculation - For adults, sum of the total yearly gross income of the patient and the patient's spouse; for minors, total yearly gross income of the patient, and the patient's mother and father.* Documentation - various official income reporting documentation is sought (e.g. W-2, Wage and Tax Statement, Pay Check Remittance and others). Documentation associated with the participation in a Public Benefit Program can be provided in lieu of income documentation (proof of participation indicates the patient has been deemed financially indigent and therefore is not required to provide income information). There is also a verification process in place for patients that do not have appropriate documentation. * Charity Eligibility Classifications - For financially indigent patients, the amount owed by the patient after payment by all third-party payors must exceed ten percent of the patient's yearly income and the patient must be unable to pay the remaining bill. Acceptance by St. David's Rehabilitation Hospital is based on meeting either of two criteria. Yearly income must be greater than 200%, but less than or equal to 500% of the Federal Poverty Guidelines. St. David's Georgetown Hospital Part V, Section B, Line 11h: The following is a summary of the Charity Care Policy adopted by St. David's Georgetown Hospital:St. David's Georgetown Hospital actively seeks completion of an application, which facilitates collection of appropriate information, including:* Verification of family members in the household - For adult patients, patient spouse and any dependents; for minors, mother and father, and dependents of both.* Income calculation - For adults, sum of the total yearly gross income of the patient and the patient's spouse; for minors, total yearly gross income of the patient, and the patient's mother and father.* Documentation - various official income reporting documentation is sought (e.g. W-2, Wage and Tax Statement, Pay Check Remittance and others). Documentation associated with the participation in a Public Benefit Program can be provided in lieu of income documentation (proof of participation indicates the patient has been deemed financially indigent and therefore is not required to provide income information). There is also a verification process in place for patients that do not have appropriate documentation. * Charity Eligibility Classifications - For financially indigent patients, the amount owed by the patient after payment by all third-party payors must exceed ten percent of the patient's yearly income and the patient must be unable to pay the remaining bill. Acceptance by St. David's Georgetown Hospital is based on meeting either of two criteria. Yearly income must be greater than 200%, but less than or equal to 500% of the Federal Poverty Guidelines. St. David's Rehabilitation Hospital Part V, Section B, Line 18c: St. David's Rehabilitation Hospital does not have an emergency room facility. St. David's Medical Center Part V, Section B, Line 19d: The hospital utilized a sliding fee scale for patients between 200% and 500% of Federal Poverty Guidelines that is lower than the average of the three lowest negotiated commercial insurance rates. St. David's North Austin Medical Center Part V, Section B, Line 19d: The hospital utilized a sliding fee scale for patients between 200% and 500% of Federal Poverty Guidelines that is lower than the average of the three lowest negotiated commercial insurance rates. St. David's South Austin Medical Center Part V, Section B, Line 19d: The hospital utilized a sliding fee scale for patients between 200% and 500% of Federal Poverty Guidelines that is lower than the average of the three lowest negotiated commercial insurance rates. Heart Hospital of Austin Part V, Section B, Line 19d: The hospital utilized a sliding fee scale for patients between 200% and 500% of Federal Poverty Guidelines that is lower than the average of the three lowest negotiated commercial insurance rates. St. David's Round Rock Medical Center Part V, Section B, Line 19d: The hospital utilized a sliding fee scale for patients between 200% and 500% of Federal Poverty Guidelines that is lower than the average of the three lowest negotiated commercial insurance rates. St. David's Rehabilitation Hospital Part V, Section B, Line 19d: The hospital utilized a sliding fee scale for patients between 200% and 500% of Federal Poverty Guidelines that is lower than the average of the three lowest negotiated commercial insurance rates. St. David's Georgetown Hospital Part V, Section B, Line 19d: The hospital utilized a sliding fee scale for patients between 200% and 500% of Federal Poverty Guidelines that is lower than the average of the three lowest negotiated commercial insurance rates. Part VI, Line 2: The Partnership Strategic Planning Process continually assesses and addresses the needs of the community. The Foundation recently participated in a capacity study for the surrounding service area to assess the overall community needs. The Foundation's Grants Program addresses the needs of the service area. Part VI, Line 3: Each hospital posts a summary of its charity care policy in admission areas, emergency rooms, and other areas where eligible patients are likely to be present. The hospitals' Condition of Admission consent informs the patients that they may be eligible for financial assistance or charity care and they may request information about these programs. A summary of the financial assistance program is provided to the patient during the intake and discharge processes. Patients are informed of availability of various government benefits, such as Medicaid, and receive assistance with the qualification for such programs, where applicable. Part VI, Line 4: The hospitals are located in Travis and Williamson counties. The patients are predominately from Travis, Williamson and Hays counties. The Foundation's grant program recipients closely align with patient demographics served at the hospitals. Part VI, Line 5: The hospitals operate as exempt hospitals; they have open emergency rooms and medical staff. The Foundation invests its share of earnings from the hospitals into programs in Central Texas that increase access to healthcare. Part VI, Line 6: The Foundation is a general partner in St. David's Healthcare, a hospital system that meets the Community Benefit Standard in delivering hospital care to Central Texas. In addition, the Foundation has assessed the unmet healthcare needs of Central Texas and uses the earnings from the hospitals to meet those needs in many ways. The Foundation makes grants to charities in Central Texas meeting the healthcare needs of the indigent. The Foundation also makes grants to educational institutions to support medical education. The Foundation's subsidiaries give needs based scholarships to students pursuing healthcare careers. In addition, through a subsidiary, the Foundation provides free dental care to the children in more than 50 low income schools and to the adult patients of safety net clinics in Central Texas. Reports Filed With States Part VI, Line 7 TX 1 Childrens Optimal Health 1345 Philomena St Ste 350 Austin TX 78723 262559516 501(c)(3) 47800 Health Access Grant Any Baby Can 1121 E 7th St Austin TX 78702 742684335 501(c)(3) 285000 Health Access Grant YMCA of Austin 1402 Cesar Chavez austin TX 78702 741193464 501(c)(3) 285764 Health access grant Lone Star Circle of Care 1500 W University Ave Georgetown TX 78628 743001674 501(c)(3) 3802187 Health Access Grant Easter Seals of Central Texas 1611 Headway Cir Austin TX 78754 750808811 501(c)(3) 60000 Health Access Grant Combined Community Action 165 West Ave Giddings TX 78942 741548511 501(c)(3) 30000 Health Access Grant Indigent Care Collaborative 2101 IH 35 S 500 Austin TX 78741 311624871 501(c)(3) 250000 Health Access Grant Family Eldercare 2210 Hancock Dr Austin TX 78756 742286387 501(c)(3) 175000 Health Access Grant Texas Scottish Rite Hospial 2222 welborn st dallas TX 75219 750818178 501(c)(3) 25000 Health access grant People's Community Clinic 2909 N IH 35 Austin TX 78722 237087608 501(c)(3) 3433981 Health Access Grant Communities in Schools 3000 S IH 35 Austin TX 78704 742369020 501(c)(3) 465944 Health Access Grant Waterloo Counseling Center 3000 S IH 35 Austin TX 78704 742291792 501(c)(3) 166225 Health Access Grant Austin Travis County mhmr 3001 S 1st St 2A Austin TX 78704 741547909 501(c)(3) 320000 Health access grant Boys and Girls Club of the Capital Area 303 W Johanna St Austin TX 78704 746087356 501(c)(3) 120335 Health Access Grant Meals on Wheels and More 3227 E 5th St Austin TX 78702 237202594 501(c)(3) 200000 Health Access Grant LifeWorks 3700 S 1st St Austin TX 78704 742137189 501(c)(3) 513719 Health Access Grant Cancer Connection 3710 Cedar St Box 11 Austin TX 78731 731699037 501(c)(3) 50937 Health Access Grant Austin Group for the Elderly 3710 Cedar St Box 2 Austin TX 78705 742431028 501(c)(3) 311830 Health Access Grant Interagency Support Council of Eastern Williamson County 400 Porter St Taylor TX 76574 841636308 501(c)(3) 186475 Health Access Grant Hospice Austin 4107 Spicewood Springs Rd Austin TX 78759 742200596 501(c)(3) 202000 Health Access Grant Volunteer Healthcare Clinic 4215 Medical Parkway Austin TX 78756 746082464 501(c)(3) 67250 Health Access Grant Manos de Cristo 4911 Harmon Ave Austin TX 78751 742511974 501(c)(3) 330000 Health Access Grant El Buen Samaritano 7000 Woodhue Austin TX 78745 742488682 501(c)(3) 940038 Health Access Grant New Connections Westlake Hills Pres Church 7127 Bee Caves Rd Austin TX 78746 236393377 501(c)(3) 47672 Health Access Grant Greenlights for NonProfit Success 7703 N Lamar Austin TX 78752 742992877 501(c)(3) 42500 Health Access Grant Austin Child Guidance Center 810 W 45th St Austin TX 78751 741166783 501(c)(3) 262105 Health Access Grant Capital Area Food Bank 8201 S Congress Austin TX 78746 742217350 501(c)(3) 60000 Health Access Grant Austin Recovery 8402 Cross Park Dr Austin TX 78754 741609108 501(c)(3) 349500 Health Access Grant Texas Health Institute 8501 n mopac ste 300 austin TX 78759 742237789 501(c)(3) 20000 Health access grant Wonders and Worries 923 Westbank Dr Austin TX 78746 743012982 501(c)(3) 20000 Health Access Grant Capital Idea PO Box 1784 austin TX 78767 742893041 501(c)(3) 400000 Health access grant Marathon Kids PO Box 5501 Austin TX 78763 061722171 501(c)(3) 209130 Health access grant YMCA of Greater Williamson County PO Box 819 round Rock TX 78680 742206558 501(c)(3) 52112 Health access grant The Care Communities PO Box 16529 Austin TX 78761 742845698 501(c)(3) 66183 Health Access Grant SafePlace PO Box 19454 Austin TX 78760 741977853 501(c)(3) 868223 Health Access Grant SIMS Foundation PO Box 2152 Austin TX 78768 742766013 501(c)(3) 120000 Health Access Grant Hays-Caldwell Women's Center PO Box 234 San Marcos TX 78667 742020505 501(c)(3) 124042 Health Access Grant Breast Cancer Resource Center PO Box 300040 Austin TX 78703 742743333 501(c)(3) 202688 Health Access Grant Health Alliance for Austin Musicians PO Box 301496 Austin TX 78703 741934031 501(c)(3) 130000 Health Access Grant Round Rock Serving Center PO Box 5006 Round Rock TX 78683 742454410 501(c)(3) 130000 Health Access Grant Family Crisis Center PO Box 736 Bastrop TX 78602 742304542 501(c)(3) 45000 Health Access Grant Williamson-Burnet County Opportunities PO Box 740 Georgetown TX 78627 746075213 501(c)(3) 37500 Health Access Grant Faith in Action Caregivers PO Box 743 Georgetown TX 78627 203414707 501(c)(3) 125000 Health Access Grant University of Texas at Austin School of Nursing PO Box 7726 Austin TX 78713 746000203 501(c)(3) 4191459 Health Access Grant Texas Ramp Project PO Box 832065 Richardson TX 78083 331139484 501(c)(3) 55000 Health Access Grant Center for Child Protection 8509 FM 969 Bldg C Austin TX 78724 742562585 501(c)(3) 75000 Health Access Grant Williamson County Crisis Center 1011 Gattis School Rd Ste106 Round Rock TX 78664 742277114 501(c)(3) 37500 Health Access Grant YWCA of Greater Austin 2015 S I35 110 Austin TX 78741 746053497 501(c)(3) 18376 Health Access Grant Austin Speach Labs 7800 Shoal Creek Blvd Ste 240S Austin TX 78757 262137242 501(c)(3) 41500 Health Access Grant Aids Services of Austin 7215 Cameron Rd Austin TX 78752 742440845 501(c)(3) 229000 Health Access Grant AISD 111 W 6th St Ste D 350 Austin TX 78703 501(c)(3) 300000 Health Access Grant Austin Travis County Integral Care PO Box 3548 Austin TX 78764 741547909 501(c)(3) 320000 Health Access Grant Austin Community College Foundation 5930 Middle Fiskville Rd Austin TX 78752 742639966 501(c)(3) 37074 Health Access Grant Austin District Dental Hygentist Society 4702 Hickory Hollow Austin TX 78731 742726070 501(c)(3) 15000 Health Access Grant Austin Community Foundation PO Box 5159 Austin TX 78763 741934036 501(c)(3) 9000 Health Access Grant Austin Travis County EMS 15 Waller St Austin TX 78702 746000085 501(c)(3) 186523 Health Access Grant Blood Bank Center of Central Texas 4300 North Lamar Austin TX 78756 741366292 501(c)(3) 247002 Health Access Grant Community Health Centers of Central Texas 228 St George St Gonzales TX 78629 741548089 501(c)(3) 1065086 Health Access Grant Immunization Partnership 3015 Richmond Houston TX 77098 760695612 501(c)(3) 79000 Health Access Grant Planned Parenthood 201 East Ben White Austin TX 78704 371515621 501(c)(3) 180750 Health Access Grant Ronald McDonald House 1315 Barbara Jordon Austin TX 78723 742277664 501(c)(3) 150000 Health Access Grant Samaritan Health Ministries PO Box 133 Cedar Park TX 78630 742570190 501(c)(3) 80000 Health Access Grant Green Doors 1503 S IH 35 Austin TX 78743 742582369 501(c)(3) 50000 Health Access Grant Sustainable Food Center 1106 Clayton Lane Austin TX 78723 742441468 501(c)(3) 795000 Health Access Grant Ut Health PO Box 203382 Houston TX 77216 741767613 501(c)(3) 50141 Health Access Grant Capital City Village PO Box 300792 austin TX 78703 270539952 501(c)(3) 55000 Health Access Grant Capital Area Counseling 2824 Real St austin TX 78722 740146929 501(c)(3) 89250 Health Access Grant Connections Individual and Family Services PO Box 311268 New Braunfels TX 78131 742179169 501(c)(3) 52630 Health Access Grant Hand to Hold 11021 Deep Brook Austin TX 78726 273802900 501(c)(3) 25000 Health Access Grant Samaritan Center 2425A Burnet Austin TX 78756 741832864 501(c)(3) 196000 Health Access Grant iACT 701 Tillery St Austin TX 78728 742845698 501(c)(3) 10000 Health Access Grant Capital Area Dental Foundation 4201 Bee Caves Austin TX 78746 260776533 501(c)(3) 25000 Health Access Grant PE3 2414 Exposition Austin TX 78703 300529636 501(c)(3) 60000 Health Access Grant 73 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The Foundation monitors the use of grant funds through the following procedures: - Grantees submit quarterly reports to Program Officers 30 days after the close of each calendar quarter. Review of quarterly report information includes analysis of a) metric data for goal and outcome measures; b) demographic data; c) significant program activities, accomplishments and/or changes; and d) results of client satisfaction surveys. - Grantees submit year-end reports to Program Officers after the close of fourth quarter. Review of year-end reports includes analysis of aggregate data from quarterly reports and documentation of financial statements. - Program officers distribute summary reports to senior management and board members for analysis. - Program Officers attend grantees' board meetings at least one time per year. - Staff and board members review agency grant proposals in connection with site visits. - Staff conduct periodic site visits throughout funding year. X 0 1 X X X X X 0 0 0 0 0 0 0 0 0 R Earl Maxwell 259992 0 0 0 0 0 7350 0 13215 0 280557 0 0 0 James J Ries 177035 0 0 0 0 0 5457 0 7752 0 190244 0 0 0 Bobbie Barker 206137 0 0 0 0 0 6238 0 7605 0 219980 0 0 0 Carol Clark 240792 0 0 0 0 0 0 0 13215 0 254007 0 0 0 Patrice Coons 149148 0 0 0 0 0 4478 0 7661 0 161287 0 0 0 Roberto Rodriguez MD 156359 0 0 0 0 0 2442 0 13111 0 171912 0 0 0 Part I, Line 1a The reporting organization pays for certain officers' membership at the UT Club for the convenience of the organization to use the club for business meetings. Bobbie Barker was a member of the club during 2011, and dues totaled $852 for that year. CW Hetherly Past Chair Family relationship with St. David's Healthcare Partnership, LP, LLP 169136 C.W. Hetherly's son, Michael Hetherly, is the Director - Provider Sponsored Networks, CWT Division at St. David's Healthcare Partnership, LP, LLP, an entity related by ownership to the reporting organization, or one of its affiliates. The reported amount of the transaction includes Mr. Hetherly's salary & benefits. 0 Form 990, Part VI, Section A, line 2 Charles Christensen (Trustee), Diane Grant (Trustee) and Carol Clark (General Counsel) are limited partner investors in a real estate partnership in which C.W. Hetherly (Past Chair) is the general partner. The limited partnership units were offered in a private placement to qualified investors; all investors, a larger pool than these three investors, paid the same price per unit. Form 990, Part VI, Section A, line 2 David Hughes (Chairman) was an attorney with a private law firm that has clients among the Trustees. Mr. Hughes and his firm did not provide legal services to the reporting organization. Form 990, Part VI, Section B, line 11 The reporting organization's Tax and Audit Committee reviews a draft of the Form 990 in detail prior to it being finalized. The organization's Board then reviews a draft of the Form 990 in summary prior to finalization. A final version of Form 990 is sent to the Trustees for review prior to filing. Form 990, Part VI, Section B, line 12c The reporting organization annually verifies compliance with the conflicts of interest policy. The individuals covered by this policy include the officers, trustees, directors, board of governors representatives. The persons covered by this policy are required to annually disclose or update the Chairman of the Board of Trustees on a form provided by the organization their interests that could give rise to conflicts of interest. For each interest disclosed to the Chairman of the Board of Trustees of the foundation, the Chairman will determine whether to: (a) take no action; (b) assure full disclosure to the Board of Trustees of the Foundation and other individuals covered by this policy; (c) ask the person to recuse from participation in related discussions or decisions within the organization; or (d) ask the person to resign from his or her position in the Organization or, if the person refuses to resign, become subject to possible removal in accordance with the Organization's removal procedures. The organization's CEO will monitor proposed or ongoing transactions for conflicts of interest and disclose them to the Chairman of the Board of Trustees in order to deal with potential or actual conflicts. Form 990, Part VI, Section B, line 15 To establish the compensation of the organization's top management official, other officers, and key employees, the foundation hires an outside consultant to conduct an intermediate sanction review. Without participation of the officer, director or other top management official under consideration, the Executive Committee reviews and approves the consultant's report. This process was last undertaken for the following officers, directors, key employees as follows: Earl Maxwell, Chief Executive Officer, December 7, 2011 Jim Ries, Chief Financial Officer, December 7, 2011 Bobbie Barker, VP of Grants & Community Programs, December 7, 2011 Patrice Coons, Clinical Director, Dental Programs, December 7, 2011 Roberto Rodriguez, M.D., December 7, 2011 Caesar Collazo, Dentist, December 7, 2011 Kara Diemer, Dentist, December 7, 2011 Shailee Gupta, Dentist, December 7, 2011 Monica Anderson, Dentist, December 7, 2011 Ensy Atarod, Dentist, December 7, 2011 Falumi Patel,Dentist, December 7, 2011 Form 990, Part VI, Section C, line 19 The reporting organization's governing documents, conflict of interest policy and financial statements are available to the public upon request. Please contact Jim Ries at 512-879-6603. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -13,818,569. Form 990, Part XII, Line 2b: The reporting organization's financials statements were audited by an independent accountant as part of consolidated financial statements. The consolidated financial statements included St. David's Foundation, St. David's Community Health Foundation Holdings, St. David's Foundation Community Fund, St. David's Community Health Foundation Initiatives, St. David's Foundation Impact Fund, LP, and St. David's Foundation Impact Fund, GP, LLC. Form 990, Part VI, Section A, Line 1a: The Board of Trustees of the reporting organization (the "Foundation") established an Executive Committee (the "Committee") to assist the Board in fulfilling its oversight responsibility for the operations of the organization and its affiliates. The Committee has the power to conduct the business of the Foundation during the period between meetings of the Board, in accordance with the policies and expressed wishes of the Board and established protocol. The Committee is authorized to secure such resources as it reasonably needs to fulfill its responsibilities, including outside consultants, as appropriate. The Chief Executive Officer of the Foundation, or an appointed representative, serves as the Committee's staff liaison. The Committee also consists of two elected governing Board officers: Chair and Secretary, and the chairs of other governing Board sub-committees. All Committee members are governing board members, must be independent of management, and receive no compensation from the Foundation. The Board of Trustees has adopted a set of Central Governance Principles to provide a specific framework for the decision-making and governance activities of the Committee. Officer Compensation of Related Organizations: St. David's Foundation (the "Foundation") owns a general partner interest in St. David's Healthcare Partnership, LP, LLP (the "Partnership"). The amounts below represent the Partnership's portion of compensation paid in 2011. Jon Foster, CEO 1/1/11-2/17/11 Salary $413,911 Employee Benefits $ 12,470 David Wilson, CFO Salary $377,216 Employee Benefits $ 19,607 C. David Huffstulter CEO 3/1/11-12/31/11 Salary $314,161 Employee Benefits $ 47,857 St. David's Foundation 2011 Community Benefit Report: Impact. Community. Health. With those three words as a guide, St. David's is dedicated to making a positive impact on the health of our community. St. David's Foundation includes controlling interests in six acute care hospitals and one rehabilitation hospital dedicated to serving Central Texas under the community benefit standard and a grant program focused on improving health and health care in Central Texas. IMPACT. St. David's HealthCare Partnership capital investment in the Community $850,000,000 Since inception in 1996, the St. David's hospitals have reinvested more than $750 million in spent or committed funds in capital improvements to the hospitals and other medical facilities. The Central Texas area is one of the fastest growing areas of the country, and the St. David's HealthCare Partnership is committed to offering Central Texas the highest level of health care by expanding and upgrading facilities, recruiting the best doctors and nurses, and offering advanced medical services and technology. St. David's Hospitals Scope of Service St. David's touches thousands of Central Texans each year. In 2011, that included: * Patients admitted 61,920 * Emergency room visits 271,826 COMMUNITY. Contributions for community benefits: $26,000,000 The Foundation invests its share of the earnings from St. David's HealthCare into programs in Central Texas that increase access to quality health care. The Foundation identifies areas of need, outlines goals for each area with an overall objective to make grants that will have a significant impact. The focus areas and goals include: Healthy Aging - Supporting programs that help maintain aging in place for older adults. $1.7 million in 2011 Healthy Futures - Providing funds for educational opportunities in health care research and health careers. $4.3 million in 2011 Healthy Living - Promoting health and wellness through healthy diet and exercise. $2.1 million in 2011 Healthy Minds - Supporting behavioral health programs in schools, health clinics and community non-profits. $5.1 million in 2011 $11.2 million in 2011 Healthy Smiles - Offering free dental services to underserved children in six school districts and families at safety net clinics. $3.5 million in 2011 With so many issues affecting the health and well-being of Central Texans, the Foundation's mission is to overcome these challenges so everyone has an opportunity to receive the best health care possible. We believe that by taking the initiative to understand these direct problems, we can wisely fund programs that are innovative and surpass the expectations of the people we serve. Covering more than five counties in Central Texas, in 2011 the Foundation helped more than 57 agencies. * St. David's Foundation Grants $27,307,235 * St. David's Foundation Grants Administration $1,023,019 St. David's Healthcare Partnership also provides community health improvement services and community benefit operations. The Foundation share was $7 million in 2011. With one of the largest fleets of mobile dental clinics in the country, St. David's Dental Program offers free dental care to children at Title I elementary schools in Central Texas, as well as to adults referred by area clinics and the Health Alliance for Austin Musicians (HAAM). Each of the six vans is equipped with two dental exam rooms, digital x-rays, and computer workstations. The vans are staffed by licensed dentists, hygienists, and dental assistants. In 2011, St. David's Dental Program treated 6,533 students free of charge at 39 schools throughout Central Texas. The schools eligible for the program have a Title I designation and more than half of the student population participates in free lunch programs. St. David's Dental Program employs two oral health educators who travel to schools to teach children about good dental health care and nutrition. HEALTH. St. David's Foundation Charity Care $25 million The health care system, St. David's HealthCare, is a partnership between St. David's Foundation (a general partner with a controlling governance interest) and HCA, and operates as an exempt hospital. The St. David's hospitals provide a substantial amount of charity care to the elderly, indigent, and economically disadvantaged in Central Texas. All patients are admitted to emergency rooms regardless of their ability to pay. If further acute inpatient care is required, patients from the emergency department are admitted to the hospital, also without regard to their ability to pay. The amount represents St. David's Foundation's proportionate share of the Partnership's charity care and charity care provided by the dental program. Health Professionals Education $1 million St David's Community Health Foundation Holdings 811 Barton Springs Rd Suite 600 Austin TX 78704 742206098 Holds endowment funds used to assist the needy of Central Texas TX 501(c)(3) Sec 170 (b)(1)(A)(vi St David's Foundation 1 St David's Foundation Community Fund 811 Barton Springs Rd Suite 600 Austin TX 78704 742898888 Provides Scholarships to Needy Students in Central Texas TX 501(c)(3) Sec 170 (b)(1)(A)(vi St David's Foundation 1 St David's Community Health Foundation Initiatives 811 Barton Springs Rd Suite 600 Austin TX 78704 270112979 Supports St. David's Foundation Community Fund TX 501(c)(3) Sec 509(a)(3), I St David's Foundation Community Fund 1 St David's Healthcare Partnership LP LLP 98 San Jacinto Ste 1800 Austin TX 78701 742781812 Owns & operates 6 acute care hospitals in Central TX TX N/A Related 70483320 361823938 0 1 0.40590 Bailey Square Ambulatory Surgical Center Ltd 98 San Jacinto Ste 1800 Austin TX 78701 752467365 Ambulatory surgery center TX N/A South Austin Surgery Center Ltd 98 San Jacinto Ste 1800 Austin TX 78701 621775267 Ambulatory surgery center TX N/A Leadership Healthcare Holdings II LP LLP 98 San Jacinto Ste 1800 Austin TX 78701 341996283 Owns an interest in a radiology center TX N/A Leadership Healthcare Holdings LP LLP 98 San Jacinto Ste 1800 Austin TX 78701 203151012 Owns majority interests in ambulatory surgery centers TX N/A Oakwood Surgery Center Ltd 98 San Jacinto Ste 1800 Austin TX 78701 621641024 Ambulatory surgery center TX N/A North Austin Surgery Center LP 98 San Jacinto Ste 1800 Austin TX 78701 200648730 Ambulatory surgery center TX N/A St David's Foundation Impact Fund LP 811 Barton Springs Rd Ste 600 Austin TX 78704 341996279 Owns indirect interest in a radiology center; makes research grants TX N/A C St David's Foundation Impact Fund GP LLC 811 Barton Springs Rd Ste 600 Austin TX 78704 341996272 Owns indirect interest in a radiology center; makes research grants TX N/A C 1 0 0 1 0 0 0 0 0 1 0 0 1 1 0 1 0 0 St David's Foundation Community Fund J 200004 FMV St David's Foundation Community Fund A 102461 FMV St David's Foundation Impact Fund LP A 227671 FMV