2012-05-12T10:20:58-05:00 2011-06-30 990 2010-07-01 751008430 Baylor All Saints Medical Center BAYL 2148204135 2001 Bryan Street No 2200 Dallas TX 752013005 Preshie Wilson 2148204135 2012-05-11 2010 2016-02-24 21:20:13Z Steve Newton 1400 Eighth Avenue Fort Worth TX 76104 439995417 0 X www.BaylorHealth.com X 1900 TX Faith based acute care hospital providing exemplary patient care to the residents of Tarrant County and the surrounding communities for more than 100 years. 7 6 2755 179 303210 111357 45695562 4407294 404036051 419733907 -590872 3529957 12542 18678 449153283 427689836 8824330 5746797 0 0 158333486 154959718 0 0 0 240578658 258499476 407736474 419205991 41416809 8483845 320994666 311248479 174012554 138341476 146982112 172907003 X Founded as a Christian ministry of healing, Baylor All Saints Medical Center exists to serve all people through exemplary health care, education, research and community service. 0 0 380128350 5709387 417376525 See Schedule OBaylor All Saints Medical Center (Baylor All Saints) is a faith-based, non-profit, 658-bed acute care hospital providing exemplary patient care to the residents of Tarrant County and surrounding communities for more than 100 years. Originally founded as All Saints Episcopal Hospital, Baylor All Saints is comprised of two separate facilities Baylor All Saints Medical Center at Fort Worth, a comprehensive community medical center with 587 licensed beds located in the medical district of Fort Worth, and Baylor Medical Center at Southwest Fort Worth, a community medical center with 71 licensed beds located in the southwest quadrant of Fort Worth. Baylor All Saints is an affiliate of Baylor Health Care System (BHCS), a nationally acclaimed network of acute care hospitals and related health care entities providing quality patient care, medical education, medical research and other community services to the North Texas region. Baylor All Saints provides access to quality medical services including areas of excellence such as cardiology, neuroscience, transplantation, orthopedics, oncology, women's services, outpatient care, bariatrics and behavioral health. Baylor All Saints serves more than 125,000 people annually through its two full-service community medical centers which include primary care clinics, a rehabilitation and fitness center and a variety of specialty medical services. Some of these services are provided despite a financial loss to Baylor All Saints. During the fiscal year ended June 30, 2011, Baylor All Saints admitted 21,616 inpatients resulting in a total of 97,153 days of care, treated 54,881 outpatients, delivered 5,767 babies and had 59,227 emergency department visits. As part of its commitment to the community, Baylor All Saints has developed a comprehensive women's health program which includes the Paul and Judy Andrews Women's Hospital, specifically designed to offer the next generation of women's health care and includes a midwife center, and primary care for normal maternity, newborn and gynecological care. The midwife center was created to extend services from all walks of life including family planning, well-woman gynecology, prescriptions, prenatal care, labor and delivery management, pain management, social services, postpartum and counseling in all areas of women's health maintenance. As part of its charitable mission, Baylor All Saints is committed to providing free and/or subsidized care to both financially and medically indigent patients in the community. During the year, Baylor All Saints reported community benefits (as reported to the Texas Department of State Health Services and in accordance with the State of Texas Statutory methodology) of $78,954,433. Baylor All Saints provided community benefits (as reported on the IRS Form 990, Schedule H) of $12,908,211 during the tax year. The Texas Annual Statement of Community Benefit Standard includes approximately $61,000,000 of unreimbursed cost of Medicare that is not included in the IRS Form 990, Schedule H.Baylor All Saints also is committed to promoting the health and well-being of individuals and families beyond the health activities of the traditional hospital or clinic setting through its community outreach programs. These programs are targeted to positively alter the health of the community through outreach and education on such topics as adult nutrition, childhood obesity, and support groups for individuals suffering with diabetes, cardiovascular and pulmonary diseases and cancer. The unreimbursed cost of providing these programs was $407,188. Baylor All Saints also provided nursing supervision for the training of future nurses in an effort to increase the supply of health care professionals nationwide. Assisting with the preparation of future nurses at entry and advanced levels of nursing is critical to establishing a workforce of qualified nurses. Baylor All Saints strengthened and increased the number of affiliations with schools of nursing through their work with five Tarrant County schools of nursing. During the fiscal year ended June 30, 2011, Baylor All Saints invested time and resources in the training of 448 nursing students at an unreimbursed cost of $188,411. 380128350 1 1 0 1 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 317 0 1 2755 1 1 1 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 1 1 X Preshie Wilson 8179221957 1400 Eighth Avenue Fort Worth TX 76104 X Ron Carter 1.00 X 0 0 0 Roy Lamkin 1.00 X 0 315 0 Paul Madeley MD 1.00 X 0 733749 81205 George McCleskey 1.00 X 0 0 0 Timothy Owens 1.00 X 0 0 0 Walker Harman 1.00 X 0 4683 0 Mark Dyer 1.00 X 0 0 0 Trudi Stafford 40.00 X 208515 0 24131 David Klein MD 40.00 X 377830 0 59748 Steven Newton 40.00 X 585467 0 74763 Preshie Wilson 40.00 X 247558 0 24043 William Boyd 1.00 X 0 971758 220513 Janice Whitmire 40.00 X 214520 0 21822 Robert Watson MD 20.00 X 214887 0 29763 Richard Myers 40.00 X 180832 0 25087 Kurt Voss DO 27.00 X 157787 0 26900 Ingrid Kindipan 40.00 X 176745 0 21634 Rebecca Hardie 40.00 X 158319 0 24211 Sandra Aaron X 0 0 5171 Jason Whitfield X 0 305920 55956 2522460 2016425 689776 105 1 1 0 Baylor Health Care System 2001 Bryan St Ste 2200 Dallas TX 75201 Management Services 53290664 Aramark Services Inc P O Box 651009 Charlotte NC 282651009 Engineering/Food Serv 8427744 HealthTexas Provider Network 2001 Bryan St Ste 2200 Dallas TX 75201 Clinical/Admin Services 2549025 MEDCO Construction LLC 2001 Bryan St Ste 2200 Dallas TX 75201 Construction Services 1980220 Northstar Anesthesia PA 2000 E Lamar Blvd Ste 400 Arlington TX 76006 Anesthesia Services 1882590 53 4407294 4407294 Patient Care Revenue 621990 413393460 413393460 EHR Incentive 900099 2109333 2109333 Cafeteria 722210 1665438 1665438 Rent 531120 1165205 1165205 Rehab & Fitness Center 713940 371334 371334 1029137 295539 303210 430388 419733907 848161 41654 806507 18678 18678 12992311 1995066 11781448 524133 1210863 1470933 2681796 2681796 427689836 417376525 303210 5602807 5746797 5746797 2370934 2370934 250880 250880 120428917 120079696 349221 3789898 3696528 93370 19111749 18701676 410073 9007340 8896465 110875 719865 719865 205279 205279 45999 45999 75528571 44614316 30914255 3207088 1467 3205621 80614648 80227827 386821 14907043 14907043 19496494 19257022 239472 206216 171971 34245 168070 160071 7999 19372299 19372299 5653197 5476046 177151 Bad Debt 37480861 37480861 Special Functions 337973 215291 122682 Recruiting 214969 214969 Dues & Memberships 112678 64322 48356 Federal Income Tax 4970 4970 223256 118848 104408 419205991 380128350 39077641 0 10092 15136 11349 3479 35562097 31645634 597111 466431 8408202 8869408 379496 109972 391451293 192097791 214182462 199353502 28095073 26506101 2741640 2719668 31007144 41559148 320994666 311248479 19670412 18778297 2112391 632437 152229751 118930742 174012554 138341476 X 116283992 131962469 11404422 16979021 19293698 23965513 146982112 172907003 320994666 311248479 X 8483845 17441046 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 15136 1 99565 0 0 114701 0 Part IV, Supplemental Information: Statement Regarding Legislative Activity Health care policy is critical to all Americans, and Baylor All Saints Medical Center ("BASMC") believes that health care providers must participate in forming health care policy by interacting with national, state and local representatives and their staff members to help them better understand the complexities and ramifications of key health care policies including, without limitation, those related to uninsured and indigent patient needs as well as the legislative and regulatory needs to assure the delivery of cost-efficient, quality health care. BASMC has established relationships with persons and industry associations that often communicate BASMC's positions on major health care issues. These contacts may include direct contact, telephone conversations and/or letters. Also, BASMC may attempt to educate the local community on certain legislative initiatives that may impact BASMC's ability to provide quality health care services to the community through direct mailings, media advertising or broadcast statements. The amount of resources (time and money) involved in these activities is insubstantial. BASMC has not intervened in any political campaign. 10536655 10536655 235467450 88484023 146983427 145447188 103613768 41833420 199353502 BASMC Assets at ASH Foundation 40921414 Physician Guarantee Receivable 637734 41559148 Physician Guarantee Liability 637734 Note Payable to Related Organization 118293008 118930742 Description of Uncertain Tax Positions Under FIN 48: Part X: The filing organization does not have separate individual audited financial statements; however, the organization is included in Baylor Health Care System's combined audited financial statements (System). The System follows the provisions of ASC 740 "Income Taxes." As of June 30, 2011 and 2010, the System had no material gross unrecognized tax benefits. 1 1 X 1 X 1 X 500.000000000000 1 1 0 1 1 6575387 0 6575387 0.01720 44464080 44421742 42338 0.00010 2199 605 1594 0.00000 51041666 44422347 6619319 0.01730 311826 311826 0.00080 188411 188411 0.00050 0 0 0.00000 525324 0 525324 0.00140 5263331 0 5263331 0.01380 6288892 6288892 0.01650 57330558 44422347 12908211 0.03380 1 13619352 1361935 95669111 112922842 -17253731 X 1 1 2 1 BASMC at Fort Worth

1400 Eighth Avenue Fort Worth TX 76104

X X X X 2 BASMC at Southwest Fort Worth

7100 Oakmont Fort Worth TX 76132

X X X NA 1 4 Baylor All Saints Imaging Center

1701 W Rosedale Fort Worth TX 76104

Imaging Center Baylor Wound Management Program

1650 West Magnolia Suite 117 Fort Worth TX 76104

Wound Management Baylor Ctr for Pain Mgmt at Burleson

12608 S Freeway Burleson TX 76028

Pain Management Bariatric Excellence Program

5801 Oakbend Trail Suite 220 Fort Worth TX 76132

Bariatric Center Part I, Line 3c: and Line 3b: In addition to providing free care to financially indigent patients at 200% of the federal poverty guidelines ("FPG"), the organization provides discounted care to the medically indigent which is based on both the FPG (up to 500%) and the percentage of the patient's total bills from all providers in relation to the patient's annual income. Pursuant to the charity care policy, a patient's total balance due will not exceed 10% of total annual income if the patient qualifies as medically indigent. The organization also provides discounted care to those individuals whose amount of total bills, after all payments from third parties, exceeds 50% of the patient's annual income (regardless of the level of income) if the patient is unable to pay the remaining bill. Part I, Line 6a: The organization prepares and files an Annual Report of Community Benefit Plan with the Texas Department of State Health Services. This report is made available through the organization's website at www.baylorhealth.com. Part I, Line 7: A ratio of patient care cost to charges, as determined in Worksheet 2, was used to report the amounts in Part I, Lines 7a - 7d. For amounts reported on lines 7e - 7k, actual expenses for each community benefit activity are tracked and reported using both community benefit software and/or the organization's cost accounting system.Part I, Line 7b, Column (d): Includes payments from the State Medicaid Private Hospital Upper Payment Limit Program, which funds are to be used to expand indigent care.Part I, Line 7i, Column (c): Includes charity care payments of $5,167,969 that are made directly to or on the behalf of a local public hospital and/or other nonprofit organizations for the treatment of indigent patients of those organizations. Part I, L7 Col(f): The amount of bad debt expense included on Form 990, Part IX, line 25, but removed for Schedule H, Part I, Line 7, Column (f) totaled $37,480,861. Part III, Line 4: As stated in the combined audited financial statements, the organization maintains allowances for uncollectible accounts for estimated losses resulting from a payor's inability to make payments on accounts. The organization assesses the reasonableness of the allowance account based on the historical write-offs, cash collections, and the aging of the accounts. Accounts are written off when collection efforts have been exhausted. Management continually monitors and adjusts its allowance associated with its receivable. Bad debt does not include amounts for patients who are known to qualify under the organization's charity care policy. The amount of bad debt at cost was calculated using Worksheet A from Schedule H instructions. The amount of bad debt attributable to patient's accounts is net of contractual allowances, payments received and recoveries of bad debt previously written off. Based on prior experience and certain demographics and other information obtained during admission, the organization believes a portion of the bad debt expenses at cost would be attributable to patients that would otherwise qualify for charity care. Despite all of the effort and ways the organization educates patients about qualifying for its charity care program as demonstrated in Part IV, question 3 below, many uninsured patients either refuse or fail to complete a charity care application or provide sufficient information at the time of admission, during their stay or after being discharged to qualify for assistance under the organization's charity care policy. The amount reported on Part III, Line 3 was estimated by reviewing the average acceptance rate for charity care applications received at certain facilities during the year multiplied by the number of denials that were attributable to those facilities due to insufficient information. Part III, Line 8: The amount reported on Part III, Section B, line 6 was calculated in accordance with the Schedule H instructions utilizing the organization's allowable cost reported in the Medicare cost report based on a cost to charge ratio. However, the allowable costs in the Medicare cost report do not reflect the actual cost of providing care to patients since the Medicare cost report excludes many direct patient care costs that are essential to providing quality care to these patients. For example, certain coverage fees to physicians, cost of Medicare C and D, and other similar direct patient care expenses are specifically excluded as allowable cost in the cost reports. Using the same methodology to calculate the unreimbursed cost of providing charity care and Medicaid (using applicable Schedule H Worksheets) would result in a shortfall of $44,831,321, which is $27,577,590 higher than the shortfall reported on Part III, Section B, Line 7. The organization believes that all of the shortfall should be considered as a community benefit for the following reasons. First, the IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. IRS Revenue Ruling 69-545 provides, in part, that hospitals serving patients with governmental health benefits, including for example Medicare, is an indication that the hospital operates for the promotion of health in the community. Second, the organization provides care to Medicare patients regardless of this shortfall, i.e., loss, and thereby relieves the state and federal government of the burden of paying the full cost for the care of Medicare beneficiaries. Medicare does not provide sufficient reimbursement to cover the entire cost of providing care to these patients causing the organization to use other surplus funds to cover the shortfall. It is expected that reimbursement under the Medicare program will continue to decline and therefore may further limit access to care due to the anticipated reduction of participating Medicare providers in the community. As a result, the care for these patients will likely increase at, and rest on the shoulders of, nonprofit hospitals or county hospital districts. Third, many of the Medicare participants have low fixed incomes and therefore would qualify for charity care or other means tested government programs absent being enrolled in the Medicare program. Fourth, Texas nonprofit hospitals must provide a minimum level of community benefit in order to obtain exemption from state and local taxes. According to the current Texas Health and Safety Code, the unreimbursed cost of Medicare is considered to be a community benefit in determining these state statutory requirements as it helps relieve a governmental burden of providing this care that would otherwise be provided through the county hospital system in Texas. Part III, Line 9b: The organization's debt collection policy and procedures prohibit any collection efforts for the portion of the patient account balance that qualifies for financial assistance under the organization's charity care policy. Part VI, Line 2: Like many other nonprofit hospitals in the 12 county North Texas region, the organization elected to base their service area needs on a report generated by the local county hospital district. The community needs assessment titled: Our Community Health Checkup 2008 for the Dallas/Fort Worth Combined Metropolitan Statistical Area ("Checkup") was a collaborative effort of 16 member hospitals of the Dallas Fort Worth Hospital Council ("DFWHC"). The preparation (including support, research and analysis) of the report was provided by the staffs of the Strategic Planning and Population Medicine Department of the Parkland Health & Hospital System (also known as the Dallas County Hospital District), Baylor Health Care System and other health care providers. The Checkup was developed to address issues relative to health pertaining to individuals, families, and communities for use by the residents of the community and the institutions serving them. The Checkup provided a framework by which health needs could be joined with the assets or investments made by the community in its social and physical infrastructure. Overall coordination of this collaboration was under the auspices of the DFWHC. These documents can be found online at www.dfwhc.org. Part VI, Line 3: The organization is committed to promoting health in the community including providing or finding financial assistance programs to assist patients. Patients who may qualify for financial assistance through the organization's charity care program or other federal, state and local government programs are informed and educated about their eligibility in several ways including, but not limited to, the following: 1) posting signs and notices regarding the charity care policy in the emergency departments, admitting areas and business offices located throughout the organization: 2) annual posting regarding the organization's charity care program in the local newspapers: 3) information regarding financial assistance, including the organization's charity care policy, is posted on the organization's website: 4) notices about the organization's financial assistance policies are posted on each bill sent to patients including providing a phone number to access the customer service unit dedicated to answering patients billing questions, as well as provide information regarding financial assistance: and 5) the organization provides free financial counselors to help patients determine how to meet their financial obligations for services provided. Specifically financial counselors assist patients in applying for government assistance programs such as Medicaid or the organization's charity care program. Any patient may request to speak to a financial counselor when being treated at the organization. Uninsured patients who are admitted to the hospital will automatically receive help from a financial counselor. These services are provided in writing and through interpretation services in the primary language of the patient requesting assistance. Though the most often needed alternate language is Spanish, the organization can accommodate multiple languages including American Sign Language. Part VI, Line 4: The organization's primary patient serve area includes Tarrant, Parker, Johnson and Hood Counties. Secondary and tertiary services extend throughout western and north central Texas. During the FY 2011 year, approximately 35% of the total patient encounters were uninsured or Medicaid recipients.Tarrant County where the organization is located had a population of 1,715,623 in 2008 with a per capita income of $25,560. It ranked as the eighteenth largest county in the United States and the third largest county in Texas as of July 1, 2007. The ethnic makeup of the population was 54 percent White, 25.7 percent Hispanic, 13.7 percent Black and 4.1 percent Asian. Of that population, 12.2 percent fell below 100 percent of the federal poverty level, and 18.7 percent of the populations had an income level between 100 and 200 percent of the federal poverty level. 69.1 percent had an income above 200 percent of the federal poverty level. Parker County is immediately adjacent to Tarrant County and had a population of 110,075 in 2008 with a per capita income of $24,302. The County grew 24.4 percent between 2000 and 2008 with 11.2 percent of the population in 2008 over the age of 65. Parker County continues to become more ethnically diverse while the proportion of Whites was the highest in 2008 at 86.4 percent. The Hispanic population remains the fastest growing segment, moving from 7 percent in 2000 to 9 percent in 2008. All other ethnicities, including Black and Asian made up only 4 percent of the county population in 2008. According to the 2007 American Community Survey by Census Bureau. 7.8 percent of the population lived at an income level below 100 percent of the federal poverty level and 14.0 percent of the population earned an income between 100 and 200 percent of the federal poverty level in 2007. This left 78.2 percent of the county households living at an income level equal to 200 percent or above the federal poverty level. Johnson County lies to the south of Tarrant County and in 2008 had a population of 153,511 with an estimated per capita income of $21,074. Johnson County was the 24th largest county in Texas growing 21.1 percent between 2000 and 2008, with 10.4 percent of the population over the age of 65. As of 2008, the ethnic makeup in the county was 78.4 percent White, 3.1 percent Black and other ethnic groups made up the remaining percentage. According to the most recent America Community Survey by Census Bureau in 2007, 12.0 percent of Johnson County population lived at an income level below 100 percent of the federal poverty level in 2007. Additionally, 18.2 percent of the population in the county lived at an income level between 100 and 200 percent of the federal poverty level. Hood County, the smallest county in the organization's service area had a population of 41,100 in the 2000 Census, with a per capita income of $22,261. In Hood county, 17.9 percent of the population was 65 years of age or older. As of 2008, the ethnic makeup in the county was 94.8 percent White with remaining 5.2 percent of the population comprised of Blacks, American Indian, Alaska Natives, Asian or other groups. The organizations service area includes 21 hospitals in addition to itself.From information in the 2008 Checkup, the organizations primary areas of community health needs were identified as heart disease, diabetes, cancer, stroke, chronic respiratory disease, Alzheimer's disease, and low birth weight babies. Part VI, Line 6: With the oversight of an independent volunteer community board and Baylor Health Care System, the organization's sole member, the organization has promoted health and benefited the community by providing access to more than 20 specialty centers designed to treat a range of medical conditions. The organization's governing body is comprised of volunteer community representatives that provide leadership and governance for the organization. The members of the governing body contribute their wisdom, insights, and expertise to ensure the organization is fulfilling its mission and charitable purpose while providing efficient administrative support services and direction for the System. The members are well respected residents and/or own businesses in the organization's primary or secondary service area and understand the needs of the community. The medical staff of the organization is open to all physicians in the community who meet membership and clinical privilege requirements. Surplus funds are continuously utilized to maintain access to limited patient services or expand access points of care to patients throughout the community including, but not limited to, the following: The organization provides access to quality medical services including areas of excellence such as cardiology, neuroscience, transplantation, orthopaedics, oncology, women's services, outpatient care, bariatrics, and behavioral health. The organization serves more than 108,000 people annually through its two full-service community medical centers which include a rehabilitation and fitness center, and a variety of specialty medical services. Some of those services are provided despite a financial loss to the organization.The organization operates an emergency department accepting all patients without the regard for the ability to pay. The emergency room is operated 24 hours a day, seven days a week.As part of its commitment to the community, the organization has developed a comprehensive women's health program including a facility (Paul and Judy Andrews Women's Hospital) specifically designed to offer the next generation in women's health including a midwife center which provides primary care for normal maternity, newborn and gynecological care. The midwife center was created to extend services from all walks of life including family planning, well woman gynecology, prescriptions, prenatal care, labor and delivery management, pain management, social services, and post partum and counseling in all areas of women's health maintenance. The American College of Nurse-Midwives Benchmarking Program has identified the organization as a "best practice" facility for operative vaginal births. The program enables the organization to compare itself to other high volume midwife practices and obstetrics providers of similar size. Benchmarking is on part of the organizations internal quality assurance program. The organization is also committed to promoting the health and well being of individuals and families beyond the health activities of the traditional hospital or clinic setting through its community outreach programs. These programs are targeted to positively altering the health of the community through outreach and education on such topics as adult nutrition, childhood obesity, and support groups for individuals suffering with diseases such as diabetes, cardiovascular and pulmonary diseases, and cancer.Designated by the Health Resources and Services Administration as a medically underserved area, medical education is a crucial part of the organization's mission. During a nurses training, clinical skills and professional competencies are developed to provide the nurse with the ability to take on increasing responsibility for patient care. Quality teaching programs add many dimensions to the organization's ability to serve patients. During the fiscal year 2011 the organization provided education for 448 nursing students from across the Dallas Fort Worth Metroplex to improve the level of medical care for the entire community. Teaching programs also aid attending teaching nurse staff in keeping their own knowledge current. Upon completion of their education programs at the organization, many nurses remain in North Texas, providing a continuous supply of well-trained medical professionals for the region. Part VI, Line 7: The organization is part of a large faith based integrated health care delivery system ("System") serving the health care needs of the ten county Dallas-Fort Worth metroplex area. The System exists to serve all people through exemplary health care, education, research and community service. Community benefits are provided through the provision of charity care, governmental sponsored programs (such as Medicaid and Medicare), medical research, medical education, community health improvement services, donations to other nonprofit health care providers, and many other community service activities. During the year, the affiliated nonprofit hospitals reported community benefits (as reported to the Texas Department of State Health Services, and in accordance with the State of Texas Statutory methodology) in excess of $502,800,000. The System's nonprofit hospitals provided community benefits (as reported on the IRS Form 990, Schedule H) in excess of $151,000,000 during the tax year. The Texas Annual Statement of Community Benefit Standard includes approximately $302,000,000 of unreimbursed cost of Medicare that is not included in the IRS Form 990, Schedule H. The System is comprised of separate legal entities including philanthropic foundations, a research institute, a physician network, acute care hospitals, short-stay hospitals, specialty hospitals, ambulatory surgery centers and other health care providers all which fall under the common control of Baylor Health Care System, the organization's sole member. As part of the System, certain affiliates make grants and/or contributions to other related nonprofit affiliates to help financially support and/or fund worthy community benefits activities. The System has also established a patient transfer system among the affiliated hospitals allowing patients needing a particular level of care to be transferred as needed to a related hospital that can provide that service in an efficient and effective manner. As part of the System, all hospitals and other affiliated health care providers are required to adhere to high standards for medical quality, patient safety and patient satisfaction. These standards are set forth by Baylor Health Care System, the organization's sole member, which helps ensures consistency across the System. Reports Filed With States Part VI, Line 7 TX 1 Tarrant County Indigent Care Corporation 612 East Lamar Blvd Arlington TX 76011 260548532 501(c)(3) 5095062 N/A N/A Indigent Care Baylor Research Institute 3310 Live Oak Ste 201 Dallas TX 75204 751921898 501(c)(3) 525324 N/A N/A Research All Saints Health Foundation 1400 Eighth Street Fort Worth TX 75093 751947007 501(c)(3) 27600 N/A N/A General Support Grapevine Relief and Community Exchange P O Box 412 Grapevine TX 76099 752195702 501(c)(3) 9546 N/A N/A Indigent Care Healing Shepherd Clinic 1350 E Lancaster Fort Worth TX 76102 264350657 501(c)(3) 11634 N/A N/A Indigent Care Grand Prairie Wellness Center 1710 Small Street Grand Prairie TX 75050 752877107 501(c)(3) 10739 N/A N/A Indigent Care Muslim Community Center of Human Services 10 Homeplace Ct Arlington TX 76016 752580088 501(c)(3) 10142 N/A N/A Indigent Care Mission Metroplex Inc 212 W South St Arlington TX 76010 752354962 501(c)(3) 10142 N/A N/A Indigent Care Mansfield Caring Place Clinic 990 Hwy 287 N Mansfield TX 76063 270537258 501(c)(3) 7756 N/A N/A Indigent Care Cornerstone Assistance Network 3500 Noble Ave Fort Worth TX 76111 752417646 501(c)(3) 6861 N/A N/A Indigent Care North Texas Area Community Health Centers 2100 N Main Suite 107 Fort Worth TX 761648511 542117989 501(c)(3) 6087 N/A N/A Indigent Care 11 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Monitoring Grants & Other Assistance As part of its mission, the organization provides grants and other assistance to related organizations and/or unrelated not-for-profit organizations which are religious, charitable, scientific, or educational in nature, within the meaning of Internal Revenue Code Section 501(c)(3), when the use will further one or more tenets of Baylor's charitable mission and one of the following criteria for use of these funds is met: (1)Fulfills a need identified by a community needs assessment conducted by Baylor Health Care System (BHCS) or a third party (such as Community Health Check Up or by the United Way) and adopted as a priority by BHCS's Community Service Advisory Council, (2) Serves an under-served community or group of people through medical mission work to improve their health status. For related organizations, all grants and other assistance are subject to the policies and procedures set forth by BHCS which ensures all funds are used in accordance with the guidelines set forth above and in accordance with the related organization's exempt purpose. Grants and other assistance provided to unrelated organizations are typically monitored by personal inspection. Examples include providing assistance to entities where the filing organization's employee serves as a Board Member for the recipient organization or through attendance at community events where the filing organization employees work as volunteers or to help coordinate these events. X X X X 1 1 X X X X 1 1 0 0 0 0 0 1 0 Paul Madeley MD 0 503357 0 0 0 230392 0 67185 0 14020 0 814954 0 226611 Trudi Stafford 153245 0 23165 0 32105 0 7907 0 16224 0 232646 0 0 0 David Klein MD 264979 0 99494 0 13357 0 36383 0 23365 0 437578 0 0 0 Steven Newton 391814 0 137539 0 56114 0 58866 0 15897 0 660230 0 42582 0 Preshie Wilson 193335 0 53888 0 335 0 9855 0 14188 0 271601 0 0 0 William Boyd 0 538151 0 409474 0 24133 0 197632 0 22881 0 1192271 0 0 Janice Whitmire 165983 0 48152 0 385 0 4426 0 17396 0 236342 0 0 0 Robert Watson MD 214552 0 0 0 335 0 11136 0 18627 0 244650 0 0 0 Richard Myers 151092 0 29330 0 410 0 7895 0 17192 0 205919 0 0 0 Kurt Voss DO 157452 0 0 0 335 0 8284 0 18616 0 184687 0 0 0 Ingrid Kindipan 101503 0 9501 0 65741 0 5223 0 16411 0 198379 0 0 0 Rebecca Hardie 131312 0 26142 0 865 0 6912 0 17299 0 182530 0 0 0 Jason Whitfield 0 226956 0 70433 0 8531 0 35379 0 20577 0 361876 0 6721 Part I, Line 1a Tax indemnification and gross up payments - The organization provides tax indemnification where an authorized member of management determines there is justification to reimburse an individual for the tax impact on certain taxable, non-cash benefits provided to them. All tax indemnification payments provided are treated as taxable compensation. Two persons listed in the Form 990, Part VII, Section A, received this benefit during the tax year. Part I, Line 1a Discretionary spending account-The organization provides eligible employees who travel frequently in their personal vehicle an auto expense allowance in lieu of reimbursement for business mileage under the organization's business travel and expense reimbursement policy. All auto expense allowances are treated as taxable compensation. Two of the persons listed in the Form 990, Part VII, Section A, received this benefit during the tax year. Part I, Line 1a Housing allowance or residence of personal use-The organization provides temporary housing to eligible employees under the organization's moving and relocation reimbursement policy. All temporary housing provided to any employee is treated as taxable compensation. One person listed in the Form 990, Part VII, Section A, received this benefit during the tax year. Part I, Line 1a Health or Social Club Dues or Initiation Fees-the organization may reimburse eligible employees for dues for a health club and/or a social club where there is a bona fide business need for the membership. Such reimbursements are treated as taxable compensation to the extent any part of the membership is used for personal use. One person listed in the Form 990, Part VII, Section A received this benefit during the tax year. Part I, Lines 4a-b Ingrid Kindpan's employment with the organization terminated during the tax year and she received a severance payment of $63,254. In order to recruit and retain key talent, Baylor Health Care System ("BHCS") offers a supplemental non qualified retirement plan to eligible employees. The plan provides an annual benefit (based on a percentage of compensation) to the employee that is paid to the employee on a future date upon vesting in the plan. The following individual(s) participated in and/or received payments (noted in parenthesis) from BHCS' supplemental non qualified retirement plan during the tax year: Jason Whitfield ($6,721), Steve Newton ($42,582), William Boyd, Paul Madeley, M.D. ($226,611), and David Klein. Also, select certain officers, as designated by BHCS's governing body, are eligible to participate in a Long Term Incentive Plan that is designed to recognize the key senior leaders value and contribution to BHCS as well as align their compensation to the long term strategy of BHCS. Performance targets are based upon a percentage of the participant's base salary and are developed by independent third party expert(s) using market competitive data within the guides of reasonableness. The plan is based on BHCS's three-year performance against its peers, determined based on peer rankings or percentile rankings in quality, patient satisfaction and financial performance. At the end of three years, awards are determined by BHCS's governing body for participants. Payouts are partially made in cash and the remainder vests over an additional two year period. The following individual participated in and/or received payments (noted in parenthesis) from this plan during the tax year: William Boyd. Part I, Line 7 The organization has adopted and implemented BHCS's, the organization's sole member, Performance Award Program to provide a market competitive total cash compensation incentive program that is designed to attract and retain key leaders and establish greater individual accountability and alignment to business performance. Payout targets are based upon a percentage of base pay and are developed by independent third party expert(s) using comparable market competitive data within the bounds of reasonableness and that are reviewed and approved by BHCS's governing body. Payout levels are based upon a combination of system, entity, and individual performance using various metrics related to quality, patient satisfaction, employee retention, and financal stewardship. BHCS's governing body may approve modifications to annual incentive awards provided under the program consistent with market comparability data. Supplemental Information Part III Supplemental Information: Governing Body Compensation The members of the governing body serve on a voluntary basis and receive no cash compensation from the organization for these duties as a member of the governing body. Some, but not all, members have received modest benefits incident to their service on the board and/or multiple board committees or received compensation as an employee of a related organization. These benefits include reimbursement for certain reasonable expenses paid on behalf of the member's spouse while accompanying the member on business travel on behalf of the related organization and/or a wellness physical. All such benefits are treated as taxable compensation to the extent required by law and are reported in the Form 990 where applicable. Form 990, Part VI, Section A, line 6 Members or stockholders: The organization is a Texas nonprofit membership organization in which Baylor Health Care System ("BHCS"), a tax exempt, Texas nonprofit corporation, is the sole member. Form 990, Part VI, Section A, line 7a Election of members of governing body by members, stockholders, or other persons: The sole member, BHCS, elects and removes the members of the governing body. Form 990, Part VI, Section A, line 7b Governing body decisions subject to approval: All rights and powers are reserved to the sole member, BHCS, except only those rights and powers expressly set forth in the bylaws, required by state or federal law, or to meet the requirements and standards promulgated by Joint Commission. For example, the member's reserved rights and powers include, without limitation, approval of the organization's articles of incorporation and bylaws and amendments thereto, appointment and removal of members of the organization's governing body, approval of dissolutions and mergers, and other similar decisions over the organization. Form 990, Part VI, Section B, line 11 Process used to review the Form 990: The Form 990 is prepared and reviewed by BHCS's tax department. During the return preparation process the tax department works with other functional areas including finance, accounting, treasury, legal, human resources, and corporate compliance for advice, information and assistance to prepare a complete and accurate return. Upon completion, the Form 990 is reviewed by the organization's President, financial officer and/or other key officers. A complete final copy of the return is provided to the organization's governing body prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Process used to monitor and enforce compliance with the organization's conflict of interest policy: Persons with the actual or perceived ability to influence the organization have the duty to disclose annually and otherwise promptly as potential conflicts are identified, any familial, professional or financial relationships with entities or individuals that do, or seek to do business with the organization or that compete with the organization. These individuals include the organization's officers, governing body, management, physicians with administrative services agreements and other key personnel who interact with outside organizations or businesses on behalf of the organization. The BHCS Board of Trustees Audit and Compliance Committee and the BHCS Corporate Compliance Committee review all relevant disclosures submitted by these individuals to determine whether a conflict of interest exists and to determine an appropriate resolution, if necessary. The BHCS Compensation and Governance Committee also reviews all relevant disclosures by individuals serving on BHCS's governing body. Any individual with a perceived or potential conflict is prohibited from voting or participating in the decision making process regarding such transaction with that individual. Form 990, Part VI, Section B, line 15 Process for determining compensation: The organization, a controlled affiliate of BHCS, recognizes that those chosen to lead the organization are vital to its ongoing success and growth. Thus, it must attract, retain and engage the highest quality officers and key employees to lead the organization and help BHCS maintain its national reputation for achieving high targets for medical quality, patient safety, and patient satisfaction. A significant portion of the organization's officers' and key employees' total compensation is based on significant performance achievements. This strategy, known as the Performance Award Program, works to put a greater emphasis on the importance of the organization achieving targeted improvements in the areas of People, Quality, Patient Satisfaction and Financial Stewardship, annually. Total executive compensation is part of an integrated talent management strategy developed by the BHCS Board of Trustees and its Compensation and Governance Committee (Committee) to attract, motivate, and retain the best leadership resources for the organization. Executive compensation is determined pursuant to guidelines outlined in the intermediate sanction rules under IRC Section 4985 including taking steps to meet the rebuttable presumption standard of reasonableness under Treasury Regulation 53.4958-6, as summarized below. When making compensation decisions, the organization compares itself to similar-sized, and structured businesses including other integrated health care service systems and other similar-sized organizations, both locally and nationally. The BHCS Board of Trustees and Committee, on behalf of the organization, work directly with independent compensation expert(s) to identify reasonable and competitive market rates as well as provide an annual review of the total compensation of the organization's top management officials and key employees. The Committee is made up of members of the BHCS Board of Trustees, who are independent, community volunteers. Guided by the information provided by the independent compensation expert(s), the Committee approves and recommends to the BHCS Board of Trustees salary increases, earned incentives, and benefit offerings for the organization's President, other officers and/or key employees to be comparable to similar organizations for similar services and/or positions. Furthermore, the Committee is charged with the responsibility of reviewing annually the major elements of the executive compensation program to assure designs remain consistent with the business needs, market practices, and compensation philosophy. As part of the decision making process, the Committee will often meet in executive session to discuss and review recommendations made by the independent compensation expert(s). During the executive session no officer or key employee whose compensation is being reviewed is present during these discussions. All decisions are contemporaneously documented in the Committee minutes which are timely reviewed and approved by the Committee. Form 990, Part VI, Section C, line 19 Process for making governing documents, conflict of interest policy, & financial statements available to the public: The organization's articles of incorporation and amendments thereto are made available to the public by the filing of those documents with the Texas Secretary of State. Also, the organization is included within the combined financial statements of BHCS that are made available to the public by the posting of those documents through DAC Bond and are attached to this return. The organization's other governing documents and conflicts of interest policy are not made available to the public. Form 990, Part VI, Question 14: Document Retention and Destruction Policy: The organization has been following a written Document Retention and Destruction Policy since April 2003 that was approved by management at Baylor Health Care System, the organization's sole member. As a controlled affiliate of Baylor Health Care System, system wide policies are put in place to promote best governance practices and to implement consistent policies among controlled affiliates. Form 990, Part VII: Hours devoted to related organizations: The persons listed below also serve either as a voluntary member of the governing body, an employed officer, or an employee of a related organization. The average hours per week devoted to the related organizations are listed below: William Boyd (40 Hours) Walker Harman (10 Hours) Roy Lamkin (10 Hours) Paul Madeley, M.D. (40 Hours) Jason Whitfield (40 Hours) Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 4,068,407. Transfers Between Entities Under Common Control 193,241. Change in Net Assets Held at BHCS Foundation 10,251,013. FAS 87 (Pensions) Amortized 2,905,384. Volunteer Auxiliary 23,001. Total to Form 990, Part XI, Line 5: 17,441,046. Supplemental Information: IRC Section 6038 Statement: Baylor All Saints is controlled by BHCS, Employer Identification Number 75-1812652. BHCS also owns Health Care Insurance Company of Texas, Ltd. (HCIC). HCIC is a controlled foreign corporation. BHCS furnishes all information required of Baylor All Saints by IRC Section 6038 and the regulations thereunder with respect to HCIC. Therefore, pursuant to Treasury Regulation Sec. 1.6038-2(j)(2), Baylor All Saints is excepted from providing such information. BHCS files its Return of Organization Exempt from Income Tax in Ogden, Utah. 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