2012-05-12T10:20:58-05:00 2011-06-30 990 2010-07-01 751777119 Baylor Regional Medical Center at Grapevine BAYL 2148204135 2001 Bryan Street No 2200 Dallas TX 752013005 Terri Foster 2148204135 2012-05-11 2010 2016-02-24 21:20:13Z Doug Lawson 1650 W College Grapevine TX 76051 357318740 0 X www.BaylorHealth.com X 1981 TX Faith based acute care hospital providing exemplary patient care to Grapevine, Texas and the surrounding communities. 7 6 1614 323 4793 0 57310 121397 258269822 306110477 2745758 7615574 19589 18573 261092479 313866021 4705537 5879133 0 0 83230543 97968149 0 0 0 123118931 151292346 211055011 255139628 50037468 58726393 283180416 430123602 12595599 86153386 270584817 343970216 X Founded as a Christian ministry of healing, Baylor Regional Medical Center at Grapevine exists to serve all people through exemplary health care, education, research, and community service. 0 0 229325775 5870133 305389765 See Schedule OBaylor Regional Medical Center at Grapevine (Baylor Grapevine) is a faith-based, non-profit, 276-bed acute care hospital providing exemplary patient care to Grapevine, Texas and surrounding communities. Baylor Grapevine is an affiliate of Baylor Health Care System (BHCS), a nationally acclaimed network of acute care hospitals and related health care entities providing quality patient care, medical education, medical research and community services to the North Texas region. Baylor Grapevine provides inpatient and outpatient medical services to treat individuals with diseases, illnesses and injuries of varying complexities. Services include all of the comprehensive services typical of a quality acute care hospital with multidisciplinary interactions among physicians, providing patients with innovative methods of prevention, diagnosis, treatment, education and support. These services include comprehensive care for all stages of illness through all stages of life. Some of these clinical services are provided despite a financial loss to Baylor Grapevine. During the fiscal year ended June 30, 2011, Baylor Grapevine admitted 12,809 inpatients resulting in a total of 59,059 days of care, treated 48,493 outpatients, delivered 2,986 babies and had 42,131 emergency department visits.As part of its charitable mission, Baylor Grapevine is committed to providing free and/or subsidized care to both financially and medically indigent patients in the community. During the year, Baylor Grapevine reported community benefits (as reported to the Texas Department of State Health Services and in accordance with the State of Texas Statutory methodology) of $44,773,082. Baylor Grapevine provided community benefits (as reported on the IRS Form 990, Schedule H) of $16,323,624 during the tax year. The Texas Annual Statement of Community Benefit Standard includes approximately $31,000,000 of unreimbursed cost of Medicare that is not included in the IRS Form 990, Schedule H. Baylor Grapevine 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 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. The unreimbursed cost of providing these programs was $495,443.Baylor Grapevine also provided supervisory education programs 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. During the year, Baylor Grapevine invested 26,180 hours in the training of 230 undergraduate nurses. Total unreimbursed cost of providing these nursing education programs is $621,363.Effective May 1, 2011, Baylor Grapevine became the sole member of Trinity MC LLC d/b/a Baylor Medical Center at Carrollton (Baylor Carrollton). For federal income tax purposes, Baylor Carrollton is a disregard entity for federal income tax purposes and is therefore treated as a department or division of Baylor Grapevine. Prior to May 1, 2011, Baylor Grapevine had a 71% membership interest in Baylor Carrollton and was included in Baylor Grapevine's Form 990 where applicable. Baylor Carrollton was originally established as Trinity Medical Center in 1985 and became an affiliate of Baylor Grapevine in June 2009. The activities of Baylor Carrollton for the entire tax year are summarized below.Baylor Carrollton is a faith-based, non-profit, 236-bed acute care hospital providing exemplary patient care to Carrolton, Texas and surrounding communities. Baylor Carrolton provides inpatient and outpatient medical services to treat individuals with diseases, illnesses and injuries of varying complexities. Services include all of the comprehensive services typical of a quality acute care hospital with multidisciplinary interaction among physicians, providing patient with innovative methods of prevention, diagnosis, treatment, education and support. These services include comprehensive care for all stages of illness through all stages of life. Some of these clinical services are provided despite a financial loss to Baylor Carrollton. During the fiscal year ended June 30, 2011, Baylor Carrollton admitted 6,423 inpatients resulting in a total of 26,271 days of care, treated 46,811 outpatients, delivered 1,505 babies and had 27,438 emergency department visits. As part of its charitable mission, Baylor Carrollton is committed to providing free and/or subsidized care to both financially and medically indigent patients in the community. During the year, Baylor Carrollton provided community benefits of $7,879,243 (which is included in the amounts reported on Baylor Grapevine's IRS Form 990, Schedule H as referenced above). Baylor Carrollton also is committed to promoting the healthy 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, and support groups for individuals suffering with diseases such as diabetes, cardiovascular and pulmonary diseases and cancer. Baylor Medical Center at Carrollton works to increase awareness of the dangers of high cholesterol and high blood pressure, provide free or reduced cost cholesterol/lipid and blood pressure screenings, and educate the community about healthier lifestyle choices (like diet, exercise, etc.). Through these programs, Baylor Carrollton assists with early detection of potential health problems and early treatment of any identified problems to save lives. The unreimbursed cost of providing these programs during the year was $252,709. Baylor Carrollton provided supervisory education programs 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. During the year, Baylor Carrollton invested 1,164 hours in the training of 49 undergraduate nurses. Total unreimbursed cost of providing this nursing education program is $37,206. 229325775 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 201 0 1 1614 1 1 1 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 0 1 1 0 X Terri Foster 8173292555 1650 West College Street Grapevine TX 76051 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 Mark Dyer 1.00 X 0 0 0 Walker Harman 1.00 X 0 4683 0 Scott Peek 40.00 X 318238 0 54958 Terri Foster 40.00 X 243970 0 21580 T Doug Lawson 40.00 X 499344 0 71904 William Boyd 1.00 X 0 971758 220513 Christopher York 40.00 X 0 274534 48705 Elizabeth Houser 40.00 X 220344 0 23788 Spencer Turner 40.00 X 0 367585 29558 Norma Kretzschmar 40.00 X 0 228755 21980 Karen Stubbs 40.00 X 0 230734 9327 Robert Batton 47.00 X 169555 0 16147 John Tourville 40.00 X 146081 0 19253 Shidramappa Kotagi 40.00 X 170169 0 25050 David Damaske 40.00 X 161254 0 25523 Robert Levell 44.00 X 144203 0 24746 Preshie Wilson X 0 247558 24043 Sandra Aaron X 0 0 5171 2073158 3059671 718280 70 1 1 0 Baylor Health Care System 2001 Bryan St Ste 2200 Dallas TX 75201 Management Services 28840538 MEDCO Construction LLC 2001 Bryan St Ste 2200 Dallas TX 75201 Construction Services 5931110 Aramark Services Inc P O Box 651009 Charlotte NC 282651009 Engineering/Food Services 4806065 HealthTexas Provider Network 2001 Bryan St Ste 2200 Dallas TX 75201 Clinical/Admin Services 794433 HDR Architecture Inc P O Box 3480 Omaha NE 681030480 Architecture Services 786298 39 114288 7109 121397 Patient Care Revenue 621990 303807419 303804202 3217 Rent 531120 1813222 1813222 Cafeteria 722210 665312 665312 Education 611600 127894 127894 Gift Shop 453220 98381 98381 -401751 -418414 1576 15087 306110477 3100693 62861 3037832 18573 18573 47900153 67447 43435934 16785 4464219 50662 4514881 4514881 313866021 305389765 4793 8350066 5870133 5870133 9000 9000 1659402 1659402 77871143 76936135 935008 2377531 2288581 88950 10322752 10253218 69534 5737321 5604134 133187 1076598 69147 1007451 288068 288068 58021 58021 40565343 23107389 17457954 1995030 110524 1884506 47017554 46493189 524365 7258159 7258159 9586094 8392207 1193887 276391 248108 28283 119196 111820 7376 115210 105072 10138 14663782 14605397 58385 2773586 2676896 96690 Bad Debt 24369170 24369170 Special Functions 363385 312187 51198 Recruiting 325703 325703 Dues & Memberships 148751 133042 15709 Meals & Entertainment 39186 27455 11731 253119 19109 234010 255139628 229325775 25813853 0 18417 446 427841 4761227 19875668 18864486 662469 1625248 4899724 7376426 85717 109484 309873876 102943858 134448158 206930018 112489599 175285392 7702333 0 0 13128356 2570490 2042519 283180416 430123602 8823074 19934099 2560959 3319354 60387379 1211566 2512554 12595599 86153386 X 269054765 342286645 1530052 1683571 270584817 343970216 283180416 430123602 X 58726393 14659006 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 8529 1 56101 0 0 64630 0 Part IV, Supplemental Information: Statement Regarding Legislative Activity Health care policy is critical to all Americans, and Baylor Regional Medical Center at Grapevine ("BRMCG") believes that health care providers must participate in forming health care policy by interacting with national, state and local representatives and their staff members to help them better understand the complexities and ramifications of key health care policies including, without limitation, those related to uninsured and indigent patient needs as well as the legislative and regulatory needs to assure the delivery of cost-efficient, quality health care. BRMCG has established relationships with persons and industry associations that often communicate BRMCG's positions on major health care issues. These contacts may include direct contact, telephone conversations and/or letters. Also, BRMCG may attempt to educate the local community on certain legislative initiatives that may impact BRMCG's ability to provide quality health care services to the community through direct mailings, media advertising or broadcast statements. The amount of resources (time and money) involved in these activities is insubstantial. BRMCG has not intervened in any political campaign. 2751051 2751051 226733449 51726335 175007114 80389376 51217523 29171853 206930018 Physician Guarantee Liability 558067 Insurance Reserve 1838622 Environmental Liability 115865 2512554 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 1 0 1 1 9485855 0 9485855 0.03270 13242961 13694957 -451996 0.00000 52816 39904 12912 0.00000 22781632 13734861 9046771 0.03110 608802 19595 589207 0.00200 792469 136710 655759 0.00230 0 0 0.00000 0 0 0.00000 6035686 3789 6031897 0.02080 7436957 160094 7276863 0.02510 30218589 13894955 16323634 0.05620 1 11565944 1156594 54662832 72202408 -17539576 X 1 1 2 1 Baylor Regional Med Cntr at Grapevine

1650 W College Grapevine TX 76051

X X X See Part VI 2 Trinity MC LLC dba Baylor Med Cntr at

Carrollton 4343 N Josey Ln Carrollton TX 75010

X X X See Part VI NA 1 13 Baylor Grapevine OP Radiology Ctr

2020 W Hwy 114 Suite 100 Grapevine TX 76051

Radiology Center Keller Diagnostic Imaging

601 Main St Keller TX 76248

Radiology Center Baylor Grapevine Breast Imaging

1631 Lancaster Dr Suite 130 Grapevine TX 76051

Radiology Center Baylor Diagnostic Imaging Center

4525 N Josey Lane Carrollton TX 75010

Radiology Center Baylor Grapevine Cardiac Rehab Ctr

1600 W College Suite 435 Grapevine TX 76051

Cardiac Rehabilitation Flower Mound Radiology

3101 Churchill Dr Suite 110 Flower Mound TX 75022

Radiology Center The Colony Radiology

6053 Main Street Suite 125 The Colony TX 75056

Radiology Center Lewisville Radiology

751 Hebron Pkwy Suite 110 Lewisville TX 75057

Radiology Center Baylor Ctr Pain Mgmt-Highland Village

2840 Village Parkway Highland Village TX 76051

Pain Management Baylor Carrollton Senior Clinic

4323 N Josey Lane Suite 107A Carrollton TX 75010

Senior Clinic Baylor Grapevine Diabetes Ctr

2020 W Hwy 114 Suite 120 Grapevine TX 75077

Diabetes Center Baylor Spine Center at Grapevine

1631 Lancaster Suite 230 Grapevine TX 76051

Spine Center Weight Loss Surgery Center

2020 W Hwy 114 Suite 180 Grapevine TX 76051

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 $5,870,133 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, Line 7, Column (f): The tax software used to prepare and file electronically the Form 990 for the organization may not properly print the percentages in Part 1, Lines 7a-7k, column (f) if the product results in a negative percentage. 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 $24,369,170. 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 organizations 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 $33,739,224, which is $16,199,648 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 has elected to base their service area needs on a report generated by the local county hospital district. The annual Our Community Health Checkup 2008 for the Dallas/Fort Worth Combined Metropolitan Statistical Area ("Checkup") is 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 provides a framework by which health needs can be joined with the assets or investments made by the community in its social and physical infrastructure. Overall coordination of this collaboration is 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 community includes both the Baylor Grapevine and Baylor Carrollton service area as described below. Baylor Grapevine's service area consists primarily of cities located in Tarrant County serving a population of 814,241, and is divided into following three areas: Grapevine/Colleyville, Hurst/Euless/Bedford (HEB), and North Central. During the FY 2011 year, approximately 14% of the total patient encounters were uninsured or Medicaid recipients.The Grapevine/Colleyville service area includes zip codes 76034, 76051, 76092, and 76177. The Grapevine/Colleyville has a disproportionately high percentage of residents ages 45 to 64 (Baby Boomers). In 2008, the Checkup reported the Grapevine/Colleyville area as 80.3 percent White, 11.9 percent Hispanic, 3.2 percent Asian, 2.6 percent Black, and 2.0 percent Native American and other ethnicities. This area was among the most affluent in Tarrant County, with over 50 percent of households earning about $100,000 per year. Additionally, 91.2 percent of the population lived above 200 percent of the federal poverty level, as compared to 72.6 percent county wide. The HEB service area includes zip codes 76021, 76022, 76039, 76040, 76053, 76054, 76118, 76120, 76155, and 76180. The age group over 65 increased steadily since 1990. In 2008, the Checkup reported the HEB area as 67.5 percent White, 16 percent Hispanic, 7.9 percent Black, 5.2 percent Asian, and 3.4 percent Native American and other ethnicities. Though a significant portion (14.8 percent) of the households earned under $25,000 per year, it was still less than the county rate of 19.7 percent. Additionally, 82.6 percent of the population lived above 200 percent of the federal poverty level, as compared to 72.6 percent county wide.The North Central service area included zip codes 76052, 76131, 76137, 76148, 76177, and 76248. The North Central area's population grew by 74.7 percent between 2000 and 2008. The proportion of age groups 45 to 64 and 65 and above had increased. This pattern suggests the change from a rural to a suburban population. In 2008, the Checkup reported the North Central area as 74.6 percent white and 14.2 percent Hispanic. Over one-third of households in this area earned over $100,000 per year, making it the second wealthiest service area in the county. Additionally, 87.8 percent of the population lived above 200 percent of the federal poverty level, as compared to 72.6 percent county wide.Heart disease was the leading cause of death in Tarrant County with an incidence rate higher than the state average. Cancer was the second leading cause of death in Tarrant County and stroke was the third most prevalent leading cause of death in Tarrant County. The incidence rate for stroke was higher than the state-wide rate. Chronic respiratory conditions were the fourth leading cause of death in Tarrant County, also with an incidence rate that was higher than the state-wide rate. Alzheimers disease was the fifth leading cause of death in the Grapevine area as well as in Tarrant County. Diabetes was an area of particular concern because the rate of actual incidence was higher than the state-wide rate. Baylor Carrollton's primary service area includes the city of Carrollton and The Colony. The secondary area includes Farmers Branch, Lewisville, and southern Denton County. Baylor Carrollton is located in Denton County, the 9th largest county in Texas with a population of 617,098 in 2008, a 42.5% increase from 2000. In 2008, 13.6% of Denton County households still earned under $25,000 per years. However 30.0% of households in the county earned over $100.000 per year and 41.4% of households earned between $25,000 and $75,000 per year. According to Census Bureau information estimated for 2007, 7.2% of the Denton County population lived at an income level below 100% of the federal poverty level, and 12.8% of the county population lived at an income level between 100% and 200% of the federal poverty level. The County continues to grow more ethnically diverse. The ethnic makeup of the county was reported as 67.6% White, 16.8% Hispanic. The proportions of Asians and Blacks in the county population also grew. Only 5.9% of the population were 65 or older. Although the later figure seems to describe a very youthful population, the county underwent a fairly major shift in age distribution during 2000-2008, with the proportion of the population aged 45-64 growing from 19.0%-23.3% at the expense of the 15-44 age group. This clear progression of Baby Boom population is one more reminder that the burden of caring for the older, retired population will fall heavier in the future. As indentified in the Checkup referenced above in Question #2, the five primary areas of community health were identified as cardiovascular (heart disease and stroke), cancer, chronic pulmonary disease, cerebrovascular disease, and influenza and pneumonia. 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, including both the Baylor Grapevine and Baylor Carrollton hospitals, 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 privileges requirements. Surplus funds are continuously utilized to maintain access to limited patient services or expand access points of care to patients throughout the community including, but not limited to, the following:Baylor Grapevine operates an emergency department accepting all patients without the regard for their ability to pay. The emergency department provides coverage 24 hours a day, seven days a week. The expanded 23,000 square foot facility is equipped with bedside check-in and triage, and advanced scanning equipment to speed a patient's diagnosis and treatment. Baylor Grapevine's involvement goes beyond the operating room and the patient floors, and reaches out to our community by way of treatment and prevention through events focused on community health education about chronic disease and issues related to maintaining a healthy lifestyle. These events include an annual Women's Health Day, Men's Health Day, the Southlake Senior Center Health Fairs, and numerous health educational programs. At these events, staff and physicians donate their time to educate the public on various health-related preventive measures and healthy lifestyle choices. Through this commitment Baylor Grapevine served over 15,000 individuals.Medical education is a crucial part of the Baylor Grapevine's mission. During a nurses training, clinical skills and professional competencies are developed to provide the nurse with the ability to take on increasing responsibility for patient care. Quality teaching programs add many dimensions to Baylor Grapevine's ability to serve patients. During the fiscal year 2011 Baylor Grapevine provided education for 230 nursing students from across the Dallas Fort Worth Metroplex to help improve the level of medical care for the entire community. Teaching programs also aid attending teaching nurse staff in keeping their own knowledge current. Upon completion of their education programs at Baylor Grapevine, many nurses remain in North Texas, providing a continuous supply of well-trained medical professionals for the region.Baylor Carrollton is committed to promoting an environment of wellness in its community and coaches residents to intentionally adopt healthier lifestyles to reduce the number of deaths associated with chronic disease. Throughout the year Baylor Carrollton offers free preventive health services to the community such as health screenings, health fairs, immunizations and community education. These efforts are targeted to meet the community health needs identified in the Checkup and during the fiscal year over 70,000 individuals benefitted through these efforts. In fiscal year 2011, renovation of the Operating Room (OR) was accomplished to meet the needs of the fast growing population served by the organization. Included in the renovation was the purchase of new equipment, increased capacity for large orthopedic procedures, upgraded sterilization which are decreasing the time for sterilization from 16-18 hours to 28 minutes and purchase of 6 tables allowing for a patient weight capacity of 1,100 pounds. Identified as a medically underserved area, providing medical education is a crucial part of Baylor Carrollton'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. In fiscal year 2011, Baylor Carrollton provided education for 49 nursing students attracted from across the area to help improve the level of medical care for the entire community. Teaching programs also aid attending teaching nurse staff in keeping their own knowledge current. Upon completion of their education programs at 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 twelve county Dallas-Fort Worth metroplex area. The System exists to serve all people through exemplary health care, education, research and community service. Community benefits are provided through the provision of charity care, governmental sponsored programs (such as Medicaid and Medicare), medical research, medical education, community health improvement services, donations to other nonprofit health care providers, and many other community service activities. During the year, the affiliated nonprofit hospitals reported community benefits (as reported to the Texas Department of State Health Services, and in accordance with the State of Texas Statutory methodology) in excess of $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 260648532 501(c)(3) 5820375 N/A N/A Indigent Care Grapevine Relief and Community Exchange P O Box 412 Grapevine TX 76099 752195702 501(c)(3) 5692 N/A N/A Indigent Care Healing Shepherd Clinic 1350 E Lancaster Fort Worth TX 76102 264350657 501(c)(3) 6937 N/A N/A Indigent Care Grand Prairie Wellness Center 1710 Small Street Grand Prairie TX 75050 752877107 501(c)(3) 6404 N/A N/A Indigent Care Muslim Community Center of Human Services 10 Homeplace Ct Arlington TX 76016 752580088 501(c)(3) 6048 N/A N/A Indigent Care Mission Metroplex Inc 212 W South St Arlington TX 76010 752354962 501(c)(3) 6048 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) 9913 N/A N/A Indigent Care 7 0 Scholarships 3 9000 0 N/A N/A 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 1 1 X X X X 0 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 Scott Peek 208744 0 80977 0 28517 0 33711 0 21247 0 373196 0 16388 0 Terri Foster 182607 0 60548 0 815 0 9227 0 12353 0 265550 0 0 0 T Doug Lawson 317778 0 146552 0 35014 0 51671 0 20233 0 571248 0 22517 0 William Boyd 0 538151 0 409474 0 24133 0 197632 0 22881 0 1192271 0 0 Christopher York 0 198845 0 60154 0 15535 0 30711 0 17994 0 323239 0 14324 Elizabeth Houser 165571 0 52405 0 2368 0 8522 0 15266 0 244132 0 0 0 Spencer Turner 0 260179 0 95960 0 11446 0 12250 0 17308 0 397143 0 0 Norma Kretzschmar 0 178835 0 49920 0 0 0 9067 0 12913 0 250735 0 0 Karen Stubbs 0 181921 0 48183 0 630 0 9096 0 231 0 240061 0 0 Robert Batton 164405 0 0 0 5150 0 1186 0 14961 0 185702 0 0 0 John Tourville 122361 0 23720 0 0 0 0 0 19253 0 165334 0 0 0 Shidramappa Kotagi 153521 0 10091 0 6557 0 8009 0 17041 0 195219 0 0 0 David Damaske 139069 0 21850 0 335 0 7344 0 18179 0 186777 0 0 0 Robert Levell 143902 0 100 0 201 0 7060 0 17686 0 168949 0 0 0 Preshie Wilson 0 193335 0 53888 0 335 0 9855 0 14188 0 271601 0 0 Part I, Line 1a Tax indemnification and gross up payments - The organization provides tax indemnification where an authorized member of management determines there is justification to reimburse an individual for the tax impact on certain taxable, non-cash benefits provided to them. All tax indemnification payments provided are treated as taxable compensation. Three of the 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. Three of the persons listed in the Form 990, Part VII, Section A, received this benefit during the tax year. Part I, Line 4b 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: Scott Peek ($16,388), T. Doug Lawson ($22,517), Paul Madeley, M.D. ($226,611), Christopher York ($14,324) and William Boyd. Also, select certain officers, as designated by BHCS's governing body, are eligible to participate in a Long Term Incentive Plan that is designed to recognize the key senior leaders value and contribution to BHCS as well as align their compensation to the long term strategy of BHCS. Performance targets are based upon a percentage of the participants base salary and are developed by independent third party expert(s) using market competitive data within the guides of reasonableness. The plan is based on BHCS's three-year performance against its peers, determined based on peer rankings or percentile rankings in quality, patient satisfaction and financial performance. At the end of three years, awards are determined by BHCS's governing body for participants. Payouts are partially made in cash and the remainder vests over an additional two year period. The following 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 4958 including taking steps to meet the rebuttable presumption standard of reasonableness under Treasury Regulation 53.4958-6, as summarized below. When making compensation decisions, the organization compares itself to similar-sized, and structured businesses including other integrated health care service systems and other similar-sized organizations, both locally and nationally. The BHCS Board of Trustees and Committee, on behalf of the organization, work directly with independent compensation expert(s) to identify reasonable and competitive market rates as well as provide an annual review of the total compensation of the organization's top management officials and key employees. The Committee is made up of members of the BHCS Board of Trustees, who are independent, community volunteers. Guided by the information provided by the independent compensation expert(s), the Committee approves and recommends to the BHCS Board of Trustees salary increases, earned incentives, and benefit offerings for the organization's President, other officers and/or key employees to be comparable to similar organizations for similar services and/or positions. Furthermore, the Committee is charged with the responsibility of reviewing annually the major elements of the executive compensation program to assure designs remain consistent with the business needs, market practices, and compensation philosophy. As part of the decision making process, the Committee will often meet in executive session to discuss and review recommendations made by the independent compensation expert(s). During the executive session no officer or key employee whose compensation is being reviewed is present during these discussions. All decisions are contemporaneously documented in the Committee minutes which are timely reviewed and approved by the Committee. Form 990, Part VI, Section C, line 19 Process for making governing documents, conflict of interest policy, & financial statements available to the public: The organization's articles of incorporation and amendments thereto are made available to the public by the filing of those documents with the Texas Secretary of State. Also, the organization is included within the combined financial statements of BHCS that are made available to the public by the posting of those documents through DAC Bond and are attached to this return. The organization's other governing documents and conflicts of interest policy are not made available to the public. 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) Preshie Wilson (40 Hours) Christopher York transferred from a related organization during the year. He worked an average of 40 hours per week both before and after the transfer. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 14,431,965. Transfers Between Entities Under Co 60,920. Change in Net Assets Held at BHCS F 125,528. Volunteer Auxiliary 40,593. Total to Form 990, Part XI, Line 5: 14,659,006. Supplemental Information: IRC Section 6038 Statement: Baylor Grapevine is controlled by BHCS, Employer Identification Number 75-1812652. BHCS also owns Health Care Insurance Company of Texas, Ltd. (HCIC). HCIC is a controlled foreign corporation. BHCS furnishes all information required of Baylor Grapevine by IRC Section 6038 and the regulations thereunder with respect to HCIC. Therefore, pursuant to Treasury Regulation Sec. 1.6038-2(j)(2), Baylor Grapevine is excepted from providing such information. BHCS files its Return of Organization Exempt from Income Tax in Ogden, Utah. 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TX N/A Baylor Heart and Vascular Center LLP 2001 Bryan Street Suite 2200 Dallas TX 75201 752834135 Specialty Hospital TX N/A Texas Heart Hospital of the Southwest LLP 2001 Bryan Street Suite 2200 Dallas TX 75201 412101361 Specialty Hospital TX N/A HealthTexas Provider Network-Gastro Serv LLP 2001 Bryan St Ste 2200 Dallas TX 75201 731697736 Ambulatory Surgery Center TX N/A Trinity MC LLC 2001 Bryan Street Suite 2200 Dallas TX 75201 208889358 Acute Care Hospital TX BRMCG Holdings LLC Related -499448 0 1576 1 0.71000 Texas Health Venture Group LLC 15305 Dallas Parkway Suite 1600 Addison TX 75001 752696845 Holds interests in Ambulatory Surgery Centers/ Short Stay Hospitals TX N/A Dallas Surgical Partners LLC 15305 Dallas Parkway Suite 1600 Addison TX 75001 722183815 Ambulatory Surgery Center TX N/A Valley View Surgicare Partners Ltd 15305 Dallas Parkway Suite 1600 Addison TX 75001 752900902 Ambulatory Surgery Center TX N/A Denton Surgicare Partners Ltd 15305 Dallas Parkway Suite 1600 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