2015-11-13T15:18:37-06:00 2014-12-31 742939657 Flieller Kruger Skelton & Plyler PLLC 221 West Sixth Street Suite 1200 Austin TX 78701 990 2014-01-01 741356589 St David's Foundation STDA 5128796603 811 Barton Springs Rd No 600 Austin TX 78704 Jim Ries CFO 5128796603 2015-11-13 1 Paula Wendling P00536805 5124796000 2014 2016-03-07 17:11:31Z Earl Maxwell 811 Barton Springs Rd Austin TX 78704 118484356 0 X www.stdavidsfoundation.org X 1924 TX To improve health and healthcare for all Central Texans. 20 19 81 37 0 -132350 135408 119128 90390183 118043205 4198086 317714 4406 4309 94728083 118484356 39003106 72413820 0 0 5625925 6662428 0 0 0 3253674 4462102 47882705 83538350 46845378 34946006 661212306 719114031 18415547 32402301 642796759 686711730 X St. David's Foundation is committed to positively impacting the health of the community. It controls hospitals dedicated to serving Central Texas under the community benefit standard and The Affordable Care Act, and it provides grants to programs focused on improving health and healthcare in Central Texas. 0 0 72254885 71034364 The reporting organization provides grants and corresponding program services to community organizations with the purpose of improving access to health care in Central Texas. 6004564 The reporting organization provides free dental care for low income children through Title 1 schools and for indigent adults in Central Texas who have no other access to services. This service is provided with fully equipped mobile dental clinics that are taken to the schools and safety-net agencies where the adults are located. Each clinic is staffed with full time dentists and support personnel. In 2014, the mobile clinics served forty-two Title 1 elementary schools in six independent school districts. At these schools we screened 29,100 children for decay, and patient encounters totaled 16,774 for acute and restorative treatment. 118018314 The reporting organization controls hospitals dedicated to serving Central Texas under the community benefit standard and The Affordable Care Act. St. David's Healthcare Partnership includes hospitals, free-standing emergency rooms, ambulatory care centers, and urgent care centers. In 2014, 67,815 patients were admitted and there were 310,328 emergency room visits. 1379456 1379456 The reporting organization pays for discounted eye exams and eye glasses for low income Central Texans. 1379456 1379456 79638905 1 1 0 1 0 0 0 0 0 1 1 1 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 75 0 1 81 1 1 1 0 0 0 0 0 0 0 0 0 X 20 19 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X X Jim Ries 5128796603 811 Barton Springs Rd Suite 600 Austin TX 78704 Jerry Turner Board Chair 14.50 0.50 X 0 1331 0 Scott Thomas Trustee 0.50 X 0 0 0 Marc Winkelman Trustee 0.50 X 0 0 0 Karen Cole Trustee 0.50 X 0 0 0 Lynn Sherman Trustee 0.50 X 0 0 0 Charles Chaffin Trustee 5.00 X 0 0 0 Rev David Boyd Trustee 0.50 X 0 0 0 Ray Bonilla Vice-Chair 5.00 X 0 0 0 John Murray Trustee 5.00 X 0 1125 0 Kathleen Angel Trustee 0.50 X 0 0 0 Peter Pincoffs Secretary 5.00 X 0 0 0 Jo Anne Christian Trustee 0.50 X 0 0 0 Cathy Iberg Trustee 5.00 X 0 0 0 Mary Scott Nabers Trustee 5.00 X 0 0 0 H David Hughes Chair, Board of Governors 14.50 0.50 X 0 1305 0 Ray Benson Trustee 0.50 X 0 0 0 Albert Hawkins Trustee 0.50 X 0 0 0 CW Hetherly Past Chair, Board of Gover 14.50 0.50 X 0 1861 0 Shannon Ratliff II Chair, CHAC 5.00 X 0 0 0 Robena Jackson Trustee 0.50 X 0 0 0 R Earl Maxwell CEO 40.00 5.00 X 319978 1125 16423 James J Ries CFO 38.00 2.00 X 184309 0 14201 Bobbie Barker Vice President 34.00 6.00 X 212247 0 15043 Patrice Kistenmacher Clinical Director 40.00 X 157011 0 13432 Shailee Gupta Lead Dentist 40.00 X 142977 0 19337 Caesar Collazo Lead Dentist 40.00 X 134084 0 19195 Ensy Atarod Lead Dentist 40.00 X 134745 0 19051 Mamatha Pasala Dentist 40.00 X 121836 0 18734 1407187 6747 135416 8 0 1 0 Loria Associates LLC 9300 Old River Court West Montgomery TX 77356 Contractor for Medicare recoveries 350000 Carol Clark 3205 Dancy Austin TX 78722 Attorney's fees 241402 TCC Group Inc 31 West 27th Street 4th Floor New York NY 10001 Organizational assessment consultant 240060 TIFF Advisory Services 170 N Radnor Chester Road Suite 3 Radnor PA 19087 Investment management services 210268 Kristy Ozmun 327 Congress Ave Suite 200 Austin TX 78701 Marketing services and consulting 105000 5 119128 119128 St. David's HealthCare Partnershi 621990 118018314 118018314 Medicare Reimbursement 621990 24891 24891 118043205 317714 317714 4309 4309 118484356 118043205 0 322023 71034364 71034364 1379456 1379456 1017173 227290 789883 4349961 3553374 796587 205125 150540 54585 737116 614488 122628 353053 275098 77955 137681 137681 87739 87739 444631 444631 505404 291326 214078 748308 96274 652034 333874 112710 221164 119591 65830 53761 337553 166668 170885 106306 82567 23739 129963 87171 42792 545842 480501 65341 280883 120472 160411 Dental Program Supplies 453319 453319 Complex Dental Care Sub 266923 266923 Repairs and Maintenance 180534 180534 Leased Equipment 13844 13844 -230293 -230293 83538350 79638905 3899445 0 166 61 7247481 16508799 1488844 0 7290984 6610823 111844 185141 3192758 999371 2553270 2193387 368598140 397023429 273921577 296592391 661212306 719114031 955015 900044 15901204 30182854 1559328 1319403 18415547 32402301 X 640175598 684087948 0 2621161 2623782 642796759 686711730 661212306 719114031 34946006 8988965 -20000 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 1406 0 1 28309 29715 0 Part II-B, Line 1: The Schedule K-1 from St. David's Healthcare Partnership, LP (the "Partnership") included $28,309 of lobbying expenditures, which constituted the portion of the organization's annual association dues dedicated to lobbying activities. In addition to amounts reported on the above-mentioned Schedule K-1, the Partnership participated in direct contact with local legislators. David Huffstutler, CEO of the Partnership, spent 2 hours on lobbying activities during 2014. The amount reported on Line 1g above reflects the costs of these activities based upon hourly rates of compensation and allocable overhead for the officer involved. 2621161 2621 2623782 2584920 36241 2621161 2549231 35689 2584920 2593317 -44086 2549231 2559582 33735 2593317 1.00000 0 0 3192758 999371 2193387 2193387 TIFF Absolute Return Pool II 18868584 F TIFF Multi Asset Fund 103638909 F TIFF Private Equity Partners 2007 3625088 F TIFF Private Equity Partners 2008 5087524 F TIFF Private Equity Partners 2009 1722993 F TIFF Realty & Resources III 2263066 F TIFF Realty & Resources IV 483007 F TIFF Realty & Resources 2008 1408230 F TIFF Realty & Resources 2009 1057049 F TIFF Short Term Fund II 3268799 F Vanguard Total Stock Index Fund 20943399 F Vanguard International Stock Index Fund 19606181 F TIFF Keystone Fund 207770957 F TIFF Special Opportunities Fund 2052148 F TIFF Private Equity Partners 2012 2639556 F TIFF Private Equity Partners 2013 1892399 F TIFF Private Equity Partners 2014 695540 F 397023429 St. David's Healthcare Partnership, LP, LLP 296592391 C 296592391 Due to St. David's Community Health Foundation Holdings 1503945 Due to St. David's Foundation Community Fund -142054 Due to St. David's Community Health Foundation Initiatives -42488 1319403 X Part V, Line 4: The Key Endowment funds were left to the reporting organization as a bequest, and may be used for charitable purposes. Part X, Line 2: The Foundation, Holdings, Community Fund, and Initiatives are public, nonprofit 501(C)(3) organizations exempt from federal income taxes under Section 501(C)(3) of the Internal Revenue Code, except to the extent they have unrelated business activities. As such, no provision for federal income taxes has been made in the accompanying consolidated financial statements related to these four entities. The Foundation's policy is to record interest and penalty expense related to income taxes as interest and other expense, respectively. At December 31, 2014 and 2013, no interest or penalties have been or are required to be accrued. The Foundation, generally, is no longer subject to income tax examination by federal authorities for years prior to December 31, 2010. 1 1 X 1 X 1 X 500.000000000000 1 1 1 0 1 1 36149748 418609 35731139 0.06160 49610890 75960564 -26349674 0.00000 0 0 0.00000 85760638 76379173 9381465 0.06160 4931617 0 4931617 0.00850 1134381 0 1134381 0.00200 0 0 0.00000 0 0 0.00000 52106304 0 52106304 0.08980 58172302 58172302 0.10030 143932940 76379173 67553767 0.16190 0 6798742 0 143317289 131815934 11501355 X 1 1 1 St David's HealthCare Partnership LP LLP The Foundation owns a controlling interest in St. David's Healthcare 0.40590 0.00000 0.00000 2 Partnership, which operated four hospitals in Central Texas. 4 1 St David's Medical Center 919 E 32nd Street Austin TX 78705 www.stdavids.com X X X A 2 St David's North Austin Medical Center 12221 N Mopac Expwy Austin TX 78758 www.stdavids.com X X X A 3 St David's South Austin Medical Center 901 W Ben White Blvd Austin TX 78704 www.stdavids.com X X X A 4 St David's Round Rock Medical Center 2400 Round Rock Ave Round Rock TX 78681 www.stdavids.com X X X A Facility Reporting Group A 0 0 1 X X X X X X X X X 13 1 1 1 1 X www.stdavidsfoundation.org/about-us/community-health-needs-assessment X X 1 13 1 www.stdavidsfoundation.org/about-us/community-health-needs-assessment 1 0 1 X 200.000000000000 500.000000000000 X X X X X X X 1 1 X X X 1 X X X X X X X X 1 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: St. David's Medical Center, - Facility 2: St. David's North Austin Medical Center, - Facility 3: St. David's South Austin Medical Center, - Facility 4: St. David's Round Rock Medical Center Group A-Facility 1 -- St. David's Medical Center Part V, Section B, line 5: In preparation of the CHNA for Austin / Travis County, the reporting organization collaborated with Seton and Central Health. Through the collective effort, forums, focus groups, and interviews were conducted from February - March 2012 with leaders from a wide range of organizations in different sectors, community stakeholders, and residents to gauge their perceptions of the community, their health concerns, and what programming, services, or initiatives are most needed to address these concerns. Priority sectors and representative participants were identified based on: 1) a brainstorming session with members from the Core Coordinating and Steering Committees, 2) a survey completed by the Steering Committee nominating key informants, and 3) a survey completed by the Outreach and Engagement Subcommittee identifying focus group sectors and relevant community-based organizations. To this end, a total of 4 community forums, 14 focus groups, and 28 interviews with community stakeholders were conducted. Additionally, findings from 25 key informant interviews with senior leaders in multiple sectors including the business, education, and health fields previously conducted for the Central Health Connection's Leader Dialogue Series were included in the analysis. Ultimately, the qualitative research engaged over 300 individuals in discussion about the health issues they deemed critical in their community.In preparation of the CHNA for Bastrop County and for Hays County, the reporting organization collaborated with Seton and Central Health. Through the collective effort, five key informant interviews were conducted by telephone or in-person during October-November 2013 with leaders in the counties to gather feedback on priority health concerns, community challenges to addressing these concerns, current strengths of the area, and opportunities for the future. Interviews included discussions with health care, educational, social service, and governmental leaders. A semi-structured interview guide was used across interviews to ensure consistency in the topics covered. The key informant interviewees from Bastrop County included the General Manager of Capital Area Rural Transportation System, the Mayor of the City of Bastrop, the Executive Director of Bluebonnet Trails Community Services, the Crisis Services Coordinator for the Family Crisis Center, and the Executive Director of Community Services for the Bastrop Independent School District. The key informant interviewees from Hays County included the Pastor of Cypress Creek Church, the Case Manager of Scheib Center, the CEO of Central Texas Medical Center, the Practice Manager of CommuniCare Health Centers, and the Director of Student Health Services for the Hays Independent School District.In preparation of the CHNA for Williamson County, the reporting organization collaborated with Seton and Central Health. Community input and opinions were obtained through activities initiated by the WilCo Wellness Alliance. The Alliance, formed in 2009, is a health and wellness coalition that works to build healthier communities in Williamson County through policy, systems and environmental change. There is broad representation from the community: local government, community organizations, schools, healthcare, faith-based, businesses, and residents. Currently 146 organizations and 402 individuals make up the countywide WilCo Wellness Alliance. Approximately 74 individuals participate at the leadership level on the Community Health Improvement Steering Committee. The Alliance conducted community meetings and surveys, gathered healthcare data and epidemiology studies, and solicited reports created through local serving agencies. Group A-Facility 1 -- St. David's Medical Center Part V, Section B, line 6b: Central Health District Group A-Facility 1 -- St. David's Medical Center Part V, Section B, line 7d: The Community Health Needs Assessments are made available on the facility's web page, www.stdavids.com/locations/st-davids-medical-center Group A-Facility 1 -- St. David's Medical Center Part V, Section B, line 11: The St. David's Foundation embraced the new Affordable Care Act requirements to conduct community health needs assessments in the geographies of its medical facilities and create strategic implementation plans for each facility. St. David's augmented its area-based, collaborative, comprehensive community health planning efforts in Travis and Williamson Counties by leading similar assessments for Bastrop and Hays Counties and consolidating an assessment of community health needs across all communities in the medical facilities' geographies. The community health needs assessment (CHNA) process was data-led, evidence-based and reflective of key community partnerships.Several overarching themes emerged from synthesizing the quantitative and qualitative data of the CHNAs. These needs informed the priorities, goals, objectives, and strategies of the St David's Medical Center Strategic Implementation Plan.Need Areas:1. Access to Care/Health Services2. Behavioral and Mental Health3. Oral Health4. Elder Health5. Health Care Workforce Shortage6. Obesity PreventionThese major findings from the CHNAs align well with the six established priority areas of St. David's Foundation as described in the detailed Strategic Implementation Plan, attached as Exhibit H-1. All areas highlighted by the CHNAs are being addressed by the 2013-2015 Strategic Implementation Plan. This plan is meant to be reviewed annually and adjusted to accommodate revisions that merit attention. Group A-Facility 1 -- St. David's Medical Center Part V, Section B, line 13h: The following is a summary of the Charity Care Policy adopted by St. David's Medical Center:The facility provides applications to patients and provides help, if needed to fill out the application for charity care. The patient is asked to verify the income of family members. Adult patients must provide the income for spouses and any dependents. Dependent patients must provide the income for parents and other dependents.The facility seeks documentation of income from the patient including W-2 and paycheck stubs. Qualification for a public benefit program also qualifies patients for charity care. The facility works with patients who do not have documentation to find other ways to prove the patient's status.The facility determines charity eligibility for patients who have an income in excess of 200% of Federal Poverty Guidelines. For these financially indigent patients, a sliding scale discount is applied to accounts for patients whose income is between 200% and 500% of FPG. If the patient's discounted account balance, after any third-party payments, exceeds 10% of the patient's annual income, the excess is forgiven. Group A-Facility 1 -- St. David's Medical Center Part V, Section B, line 22d: The amount due will not exceed amounts generally billed to patients with insurance as determined by using the look back method described in the Internal Revenue Service Regulations. Group A-Facility 2 -- St. David's North Austin Medical Center Part V, Section B, line 5: In preparation of the CHNA for Austin / Travis County, the reporting organization collaborated with Seton and Central Health. Through the collective effort, forums, focus groups, and interviews were conducted from February - March 2012 with leaders from a wide range of organizations in different sectors, community stakeholders, and residents to gauge their perceptions of the community, their health concerns, and what programming, services, or initiatives are most needed to address these concerns. Priority sectors and representative participants were identified based on: 1) a brainstorming session with members from the Core Coordinating and Steering Committees, 2) a survey completed by the Steering Committee nominating key informants, and 3) a survey completed by the Outreach and Engagement Subcommittee identifying focus group sectors and relevant community-based organizations. To this end, a total of 4 community forums, 14 focus groups, and 28 interviews with community stakeholders were conducted. Additionally, findings from 25 key informant interviews with senior leaders in multiple sectors including the business, education, and health fields previously conducted for the Central Health Connection's Leader Dialogue Series were included in the analysis. Ultimately, the qualitative research engaged over 300 individuals in discussion about the health issues they deemed critical in their community.In preparation of the CHNA for Bastrop County and for Hays County, the reporting organization collaborated with Seton and Central Health. Through the collective effort, five key informant interviews were conducted by telephone or in-person during October-November 2013 with leaders in the counties to gather feedback on priority health concerns, community challenges to addressing these concerns, current strengths of the area, and opportunities for the future. Interviews included discussions with health care, educational, social service, and governmental leaders. A semi-structured interview guide was used across interviews to ensure consistency in the topics covered. The key informant interviewees from Bastrop County included the General Manager of Capital Area Rural Transportation System, the Mayor of the City of Bastrop, the Executive Director of Bluebonnet Trails Community Services, the Crisis Services Coordinator for the Family Crisis Center, and the Executive Director of Community Services for the Bastrop Independent School District. The key informant interviewees from Hays County included the Pastor of Cypress Creek Church, the Case Manager of Scheib Center, the CEO of Central Texas Medical Center, the Practice Manager of CommuniCare Health Centers, and the Director of Student Health Services for the Hays Independent School District.In preparation of the CHNA for Williamson County, the reporting organization collaborated with Seton and Central Health. Community input and opinions were obtained through activities initiated by the WilCo Wellness Alliance. The Alliance, formed in 2009, is a health and wellness coalition that works to build healthier communities in Williamson County through policy, systems and environmental change. There is broad representation from the community: local government, community organizations, schools, healthcare, faith-based, businesses, and residents. Currently 146 organizations and 402 individuals make up the countywide WilCo Wellness Alliance. Approximately 74 individuals participate at the leadership level on the Community Health Improvement Steering Committee. The Alliance conducted community meetings and surveys, gathered healthcare data and epidemiology studies, and solicited reports created through local serving agencies. Group A-Facility 2 -- St. David's North Austin Medical Center Part V, Section B, line 6b: Central Health District Group A-Facility 2 -- St. David's North Austin Medical Center Part V, Section B, line 7d: The Community Health Needs Assessments are made available on the facility's web page, www.stdavids.com/locations/st-davids-north-austin-medical-center. Group A-Facility 2 -- St. David's North Austin Medical Center Part V, Section B, line 11: The St. David's Foundation embraced the new Affordable Care Act requirements to conduct community health needs assessments in the geographies of its medical facilities and create strategic implementation plans for each facility. St. David's augmented its area-based, collaborative, comprehensive community health planning efforts in Travis and Williamson Counties by leading similar assessments for Bastrop and Hays Counties and consolidating an assessment of community health needs across all communities in the medical facilities' geographies. The community health needs assessment (CHNA) process was data-led, evidence-based, and reflective of key community partnerships.Several overarching themes emerged from synthesizing the quantitative and qualitative data of the CHNAs. These needs informed the priorities, goals, objectives, and strategies of the North Austin Medical Center Strategic Implementation Plan.Need Areas:1. Access to Care/Health Services2. Behavioral and Mental Health3. Oral Health4. Elder Health5. Health Care Workforce Shortage6. Obesity PreventionThese major findings from the CHNAs align well with the six established priority areas of St. David's Foundation as described in the detailed Strategic Implementation Plan, attached as Exhibit H-1. All areas highlighted by the CHNAs are being addressed by the 2013-2015 Strategic Implementation Plan. This plan is meant to be reviewed annually and adjusted to accommodate revisions that merit attention. Group A-Facility 2 -- St. David's North Austin Medical Center Part V, Section B, line 13h: The following is a summary of the Charity Care Policy adopted by St. David's North Austin Medical Center:The facility provides applications to patients and provides help, if needed to fill out the application for charity care. The patient is asked to verify the income of family members. Adult patients must provide the income for spouses and any dependents. Dependent patients must provide the income for parents and other dependents.The facility seeks documentation of income from the patient including W-2 and paycheck stubs. Qualification for a public benefit program also qualifies patients for charity care. The facility works with patients who do not have documentation to find other ways to prove the patient's status.The facility determines charity eligibility for patients who have an income in excess of 200% of Federal Poverty Guidelines. For these financially indigent patients, a sliding scale discount is applied to accounts for patients whose income is between 200% and 500% of FPG. If the patient's discounted account balance, after any third-party payments, exceeds 10% of the patient's annual income, the excess is forgiven. Group A-Facility 2 -- St. David's North Austin Medical Center Part V, Section B, line 22d: The amount due will not exceed amounts generally billed to patients with insurance as determined by using the look back method described in the Internal Revenue Service Regulations. Group A-Facility 3 -- St. David's South Austin Medical Center Part V, Section B, line 5: In preparation of the CHNA for Austin / Travis County, the reporting organization collaborated with Seton and Central Health. Through the collective effort, forums, focus groups, and interviews were conducted from February - March 2012 with leaders from a wide range of organizations in different sectors, community stakeholders, and residents to gauge their perceptions of the community, their health concerns, and what programming, services, or initiatives are most needed to address these concerns. Priority sectors and representative participants were identified based on: 1) a brainstorming session with members from the Core Coordinating and Steering Committees, 2) a survey completed by the Steering Committee nominating key informants, and 3) a survey completed by the Outreach and Engagement Subcommittee identifying focus group sectors and relevant community-based organizations. To this end, a total of 4 community forums, 14 focus groups, and 28 interviews with community stakeholders were conducted. Additionally, findings from 25 key informant interviews with senior leaders in multiple sectors including the business, education, and health fields previously conducted for the Central Health Connection's Leader Dialogue Series were included in the analysis. Ultimately, the qualitative research engaged over 300 individuals in discussion about the health issues they deemed critical in their community.In preparation of the CHNA for Bastrop County and for Hays County, the reporting organization collaborated with Seton and Central Health. Through the collective effort, five key informant interviews were conducted by telephone or in-person during October-November 2013 with leaders in the counties to gather feedback on priority health concerns, community challenges to addressing these concerns, current strengths of the area, and opportunities for the future. Interviews included discussions with health care, educational, social service, and governmental leaders. A semi-structured interview guide was used across interviews to ensure consistency in the topics covered. The key informant interviewees from Bastrop County included the General Manager of Capital Area Rural Transportation System, the Mayor of the City of Bastrop, the Executive Director of Bluebonnet Trails Community Services, the Crisis Services Coordinator for the Family Crisis Center, and the Executive Director of Community Services for the Bastrop Independent School District. The key informant interviewees from Hays County included the Pastor of Cypress Creek Church, the Case Manager of Scheib Center, the CEO of Central Texas Medical Center, the Practice Manager of CommuniCare Health Centers, and the Director of Student Health Services for the Hays Independent School District.In preparation of the CHNA for Williamson County, the reporting organization collaborated with Seton and Central Health. Community input and opinions were obtained through activities initiated by the WilCo Wellness Alliance. The Alliance, formed in 2009, is a health and wellness coalition that works to build healthier communities in Williamson County through policy, systems and environmental change. There is broad representation from the community: local government, community organizations, schools, healthcare, faith-based, businesses, and residents. Currently 146 organizations and 402 individuals make up the countywide WilCo Wellness Alliance. Approximately 74 individuals participate at the leadership level on the Community Health Improvement Steering Committee. The Alliance conducted community meetings and surveys, gathered healthcare data and epidemiology studies, and solicited reports created through local serving agencies. Group A-Facility 3 -- St. David's South Austin Medical Center Part V, Section B, line 6b: Central Health District Group A-Facility 3 -- St. David's South Austin Medical Center Part V, Section B, line 7d: The Community Health Needs Assessments are made available on the facility's web page, www.stdavids.com/locations/st-davids-south-austin-medical-center Group A-Facility 3 -- St. David's South Austin Medical Center Part V, Section B, line 11: The St. David's Foundation embraced the new Affordable Care Act requirements to conduct community health needs assessments in the geographies of its medical facilities and create strategic implementation plans for each facility. St. David's augmented its area-based, collaborative, comprehensive community health planning efforts in Travis and Williamson Counties by leading similar assessments for Bastrop and Hays Counties and consolidating an assessment of community health needs across all communities in the medical facilities' geographies. The community health needs assessment (CHNA) process was data-led, evidence-based, and reflective of key community partnerships.Several overarching themes emerged from synthesizing the quantitative and qualitative data of the CHNAs. These needs informed the priorities, goals, objectives, and strategies of the South Austin Medical Center Strategic Implementation Plan.Need Areas:1. Access to Care/Health Services2. Behavioral and Mental Health3. Oral Health4. Elder Health5. Health Care Workforce Shortage6. Obesity PreventionThese major findings from the CHNAs align well with the six established priority areas of St. David's Foundation as described in the detailed Strategic Implementation Plan, attached as Exhibit H-1. All areas highlighted by the CHNAs are being addressed by the 2013-2015 Strategic Implementation Plan. This plan is meant to be reviewed annually and adjusted to accommodate revisions that merit attention. Group A-Facility 3 -- St. David's South Austin Medical Center Part V, Section B, line 13h: The following is a summary of the Charity Care Policy adopted by St. David's South Austin Medical Center:The facility provides applications to patients and provides help, if needed to fill out the application for charity care. The patient is asked to verify the income of family members. Adult patients must provide the income for spouses and any dependents. Dependent patients must provide the income for parents and other dependents.The facility seeks documentation of income from the patient including W-2 and paycheck stubs. Qualification for a public benefit program also qualifies patients for charity care. The facility works with patients who do not have documentation to find other ways to prove the patient's status.The facility determines charity eligibility for patients who have an income in excess of 200% of Federal Poverty Guidelines. For these financially indigent patients, a sliding scale discount is applied to accounts for patients whose income is between 200% and 500% of FPG. If the patient's discounted account balance, after any third-party payments, exceeds 10% of the patient's annual income, the excess is forgiven. Group A-Facility 3 -- St. David's South Austin Medical Center Part V, Section B, line 22d: The amount due will not exceed amounts generally billed to patients with insurance as determined by using the look back method described in the Internal Revenue Service Regulations. Group A-Facility 4 -- St. David's Round Rock Medical Center Part V, Section B, line 5: In preparation of the CHNA for Austin / Travis County, the reporting organization collaborated with Seton and Central Health. Through the collective effort, forums, focus groups, and interviews were conducted from February - March 2012 with leaders from a wide range of organizations in different sectors, community stakeholders, and residents to gauge their perceptions of the community, their health concerns, and what programming, services, or initiatives are most needed to address these concerns. Priority sectors and representative participants were identified based on: 1) a brainstorming session with members from the Core Coordinating and Steering Committees, 2) a survey completed by the Steering Committee nominating key informants, and 3) a survey completed by the Outreach and Engagement Subcommittee identifying focus group sectors and relevant community-based organizations. To this end, a total of 4 community forums, 14 focus groups, and 28 interviews with community stakeholders were conducted. Additionally, findings from 25 key informant interviews with senior leaders in multiple sectors including the business, education, and health fields previously conducted for the Central Health Connection's Leader Dialogue Series were included in the analysis. Ultimately, the qualitative research engaged over 300 individuals in discussion about the health issues they deemed critical in their community.In preparation of the CHNA for Bastrop County and for Hays County, the reporting organization collaborated with Seton and Central Health. Through the collective effort, five key informant interviews were conducted by telephone or in-person during October-November 2013 with leaders in the counties to gather feedback on priority health concerns, community challenges to addressing these concerns, current strengths of the area, and opportunities for the future. Interviews included discussions with health care, educational, social service, and governmental leaders. A semi-structured interview guide was used across interviews to ensure consistency in the topics covered. The key informant interviewees from Bastrop County included the General Manager of Capital Area Rural Transportation System, the Mayor of the City of Bastrop, the Executive Director of Bluebonnet Trails Community Services, the Crisis Services Coordinator for the Family Crisis Center, and the Executive Director of Community Services for the Bastrop Independent School District. The key informant interviewees from Hays County included the Pastor of Cypress Creek Church, the Case Manager of Scheib Center, the CEO of Central Texas Medical Center, the Practice Manager of CommuniCare Health Centers, and the Director of Student Health Services for the Hays Independent School District.In preparation of the CHNA for Williamson County, the reporting organization collaborated with Seton and Central Health. Community input and opinions were obtained through activities initiated by the WilCo Wellness Alliance. The Alliance, formed in 2009, is a health and wellness coalition that works to build healthier communities in Williamson County through policy, systems and environmental change. There is broad representation from the community: local government, community organizations, schools, healthcare, faith-based, businesses, and residents. Currently 146 organizations and 402 individuals make up the countywide WilCo Wellness Alliance. Approximately 74 individuals participate at the leadership level on the Community Health Improvement Steering Committee. The Alliance conducted community meetings and surveys, gathered healthcare data and epidemiology studies, and solicited reports created through local serving agencies. Group A-Facility 4 -- St. David's Round Rock Medical Center Part V, Section B, line 6b: Central Health District Group A-Facility 4 -- St. David's Round Rock Medical Center Part V, Section B, line 7d: The Community Health Needs Assessments are made available on the facility's web page, www.stdavids.com/locations/st-davids-round-rock-medical-center Group A-Facility 4 -- St. David's Round Rock Medical Center Part V, Section B, line 11: The St. David's Foundation embraced the new Affordable Care Act requirements to conduct community health needs assessments in the geographies of its medical facilities and create strategic implementation plans for each facility. St. David's augmented its area-based, collaborative, comprehensive community health planning efforts in Travis and Williamson Counties by leading similar assessments for Bastrop County and consolidating an assessment of community health needs across all communities in the medical facilities' geographies. The community health needs assessment (CHNA) process was data-led, evidence-based, and reflective of key community partnerships.Several overarching themes emerged from synthesizing the quantitative and qualitative data of the CHNAs. These needs informed the priorities, goals, objectives, and strategies of the Round Rock Medical Center Strategic Implementation Plan.Need Areas:1. Access to Care/Health Services2. Behavioral and Mental Health3. Oral Health4. Elder Health5. Health Care Workforce Shortage6. Obesity PreventionThese major findings from the CHNAs align well with the six established priority areas of St. David's Foundation as described in the detailed Strategic Implementation Plan, attached as Exhibit H-1. All areas highlighted by the CHNAs are being addressed by the 2013-2015 Strategic Implementation Plan. This plan is meant to be reviewed annually and adjusted to accommodate revisions that merit attention. Group A-Facility 4 -- St. David's Round Rock Medical Center Part V, Section B, line 13h: The following is a summary of the Charity Care Policy adopted by St. David's Round Rock Medical Center:The facility provides applications to patients and provides help, if needed to fill out the application for charity care. The patient is asked to verify the income of family members. Adult patients must provide the income for spouses and any dependents. Dependent patients must provide the income for parents and other dependents.The facility seeks documentation of income from the patient including W-2 and paycheck stubs. Qualification for a public benefit program also qualifies patients for charity care. The facility works with patients who do not have documentation to find other ways to prove the patient's status.The facility determines charity eligibility for patients who have an income in excess of 200% of Federal Poverty Guidelines. For these financially indigent patients, a sliding scale discount is applied to accounts for patients whose income is between 200% and 500% of FPG. If the patient's discounted account balance, after any third-party payments, exceeds 10% of the patient's annual income, the excess is forgiven. Group A-Facility 4 -- St. David's Round Rock Medical Center Part V, Section B, line 22d: The amount due will not exceed amounts generally billed to patients with insurance as determined by using the look back method described in the Internal Revenue Service Regulations. Facility Reporting Group A Part V, Section B, line 16a website: www.stdavids.com/patients-visitors/charity-discount-policy Facility Reporting Group A Part V, Section B, line 16b website: www.stdavids.com/patients-visitors/charity-discount-policy Facility Reporting Group A Part V, Section B, line 16c website: www.stdavids.com/patients-visitors/charity-discount-policy 2 Bailey Square Medical Center 1111 W 34th St 400 Austin TX 78705 Ambulatory Surgery Center South Austin Surgery Center 4207 James Casey St 203 Austin TX 78745 Ambulatory Surgery Center Part I, Line 3c: In compliance with IRC Section 501(r), the hospitals provide 100% financial assistance (Charity Care) for eligible patients with income equal to or less than 200% of the Federal Poverty Guidelines (FPG). For eligible patients with income over 200% FPG and equal to 500% or less than FPG, discounts are provided on a sliding scale. Eligibility is determined using various sources of documentation and income verification. Throughout 2014, the accounts for individuals without any health insurance who live in low income zip codes and who failed to respond to collection efforts were removed from accounts receivable and treated as charity care. The reporting organization, together with the hospitals, began the process of updating its charity care policy in compliance with Section 501(r) in 2014. The new policy will take effect December 31, 2015. Part I, Line 7: The hospitals utilize the cost to charge ratio from the audited financial statements. Part I, Ln 7 Col(f): Bad debts are excluded from the calculation of total expenses. Part II, Community Building Activities: All of the hospitals are active in the community promoting health of Central Texans. The Foundation provides significant grants each year to numerous agencies and local safety net clinics. The foundation focuses its funding on six key areas that will improve the health and health care of all Central Texans. Part III, Line 4: St. David's Foundation's proportionate share of bad debt expense from its ownership interest in St. David's Healthcare Partnership, LP, LLP (the "Partnership") is reported on Schedule H, Part III, Line 2. Following is the footnote to the Partnership's audited financial statements which describes bad debt expense:"The SDHP [the Partnership] records a provision for doubtful accounts (based primarily on historical collection experience) related to uninsured accounts at the estimated net self-pay revenues the Partnership expects to collect. Adverse changes in general economic conditions, business office operations, payor mix, or trends in federal or state governmental health coverage could affect the Partnership's collection of accounts receivable, cash flows, and results of operations." Part III, Line 9b: The hospital facilities do not take any actions listed in Schedule H, Part V, Section B, Lines 18 and 19. The facilities write off all charity care and in compliance with IRC Section 501(r), do not pursue collection on patients who qualify for charity care. Part I, Line 7b: Part I, Line 7b, Column (f): In accordance with Form 990 instructions, the percent of total expense for Line 7b, Unreimbursed Medicaid, is reported as zero. The actual amount of Line 7b, Column (f) is -4.54%. Lines 7d and 7k, Column (f), would be 1.62% and 11.65%, respectively.Part III, Line 1: Hospitals controlled by the Foundation determine bad debt and charity care in accordance with GAAP and with IRC Section 501(r). Whether bad debt is determined in accordance with Statement 15 requirements is a more difficult issue. Statement 15 requires hospitals to recognize revenue only when collections are reasonably assured and for an amount that is determinable. Most hospitals, including those controlled by the Foundation, use mathematical models based on prior history to determine the percentage of patient billings that is likely to result in bad debt.For this reason, and out of an abundance of caution, the Foundation has answered "no" to whether Statement 15 is followed. Despite the best efforts of HMFA to assist hospitals in determining the difference between patients who have the capacity to pay for their care but won't pay and patients who lack the capacity to pay, the determination always involves judgment. However, the hospitals controlled by the Foundation determine charity care on the core principles set forth in Statement 15, including specific criteria for charity care, a specific time of determination, record keeping, disclosure of the charity care policy and valuation of charity care at cost. Part VI, Line 2: The Partnership Strategic Planning Process continually assesses and addresses the needs of the community. The Foundation recently participated in a capacity study for the surrounding service area to assess the overall community needs. The Foundation's Grants Program addresses the needs of the service area. Part VI, Line 3: Each hospital posts a summary of its charity care policy in admission areas, emergency rooms, and other areas where eligible patients are likely to be present. The hospitals' Condition of Admission consent informs the patients that they may be eligible for financial assistance or charity care and they may request information about these programs. A summary of the financial assistance program is provided to the patient during the intake and discharge processes. Patients are informed of availability of various government benefits, such as Medicaid, and receive assistance with the qualification for such programs, where applicable. Part VI, Line 4: The hospitals are located in Travis and Williamson counties. The patients are predominately from Travis, Williamson and Hays counties. The Foundation's grant program recipients closely align with patient demographics served at the hospitals. Part VI, Line 5: The hospitals operate as exempt hospitals; they have open emergency rooms and medical staff. The Foundation invests its share of earnings from the hospitals into programs in Central Texas that increase access to healthcare. Part VI, Line 6: The Foundation is a general partner in St. David's Healthcare, a hospital system that meets the Community Benefit Standard and the requirements of the Affordable Care Act in delivering hospital care to Central Texas. In addition, the Foundation has assessed the unmet healthcare needs of Central Texas and uses the earnings from the hospitals to meet those needs in many ways. The Foundation makes grants to charities in Central Texas meeting the healthcare needs of the indigent. The Foundation also makes grants to educational institutions to support medical education. The Foundation's subsidiaries give needs-based scholarships to students pursuing healthcare careers. In addition, the Foundation provides free dental care to the children in more than 50 low income schools and to the adult patients of safety net clinics in Central Texas, and it pays for discounted eye exams and eyeglasses for low income Central Texans. Part VI, Line 7, Reports Filed With States TX 1 Aids Services of Austin 7215 Cameron Rd Austin TX 78752 742440845 501(c)(3) 371735 Health Access Grant Any Baby Can 1121 E 7th St Austin TX 78702 742684335 501(c)(3) 644544 Health Access Grant Austin Child Guidance Center 810 W 45th St Austin TX 78751 741166783 501(c)(3) 462849 Health Access Grant Austin Group for the Elderly 3710 Cedar St Box 2 Austin TX 78705 742431028 501(c)(3) 610517 Health Access Grant Austin Recovery 8402 Cross Park Dr Austin TX 78754 741609108 501(c)(3) 494367 Health Access Grant Austin Speech Labs 7800 Shoal Creek Blvd Ste 240S Austin TX 78757 262137242 501(c)(3) 52096 Health Access Grant Austin Travis County Integral Care PO Box 3548 Austin TX 78764 741547909 501(c)(3) 8904351 Health Access Grant Boys and Girls Club of the Capital Area 303 W Johanna St Austin TX 78704 746087356 501(c)(3) 222408 Health Access Grant Breast Cancer Resource Center PO Box 300040 Austin TX 78703 742743333 501(c)(3) 316482 Health Access Grant Cancer Connection 3710 Cedar St Box 11 Austin TX 78731 731699037 501(c)(3) 50938 Health Access Grant Capital Area Food Bank 8201 S Congress Austin TX 78745 742217350 501(c)(3) 160171 Health Access Grant Capital City Village PO Box 300792 Austin TX 78703 270539952 501(c)(3) 9358 Health Access Grant Capital Idea PO Box 1784 Austin TX 78767 742893041 501(c)(3) 733880 Health Access Grant Center for Child Protection 8509 FM 969 Bldg C Austin TX 78724 742562585 501(c)(3) 159082 Health Access Grant Communities in Schools 3000 S IH 35 Austin TX 78704 742369020 501(c)(3) 387908 Health Access Grant Community Health Centers of Central Texas 228 St George St Gonzales TX 78629 741548089 501(c)(3) 749521 Health Access Grant Easter Seals of Central Texas 1611 Headway Cir Austin TX 78754 750808811 501(c)(3) 121195 Health Access Grant El Buen Samaritano 7000 Woodhue Austin TX 78745 742488682 501(c)(3) 1908220 Health Access Grant Family Crisis Center PO Box 736 Bastrop TX 78602 742304542 501(c)(3) 160603 Health Access Grant Family Eldercare 2210 Hancock Dr Austin TX 78756 742286387 501(c)(3) 344869 Health Access Grant Hays-Caldwell Women's Center PO Box 234 San Marcos TX 78667 742020505 501(c)(3) 107563 Health Access Grant Health Alliance for Austin Musicians PO Box 301496 Austin TX 78703 741934031 501(c)(3) 315983 Health Access Grant Hospice Austin 4107 Spicewood Springs Rd Austin TX 78759 742200596 501(c)(3) 250000 Health Access Grant Interagency Support Council of Eastern Williamson County 400 Porter St Taylor TX 76574 841636308 501(c)(3) 375000 Health Access Grant LifeWorks 3700 S 1st St Austin TX 78704 742137189 501(c)(3) 838744 Health Access Grant Lone Star Circle of Care 1500 W University Ave Georgetown TX 78628 743001674 501(c)(3) 5759297 Health Access Grant Manos de Cristo 4911 Harmon Ave Austin TX 78751 742511974 501(c)(3) 97161 Health Access Grant Marathon Kids PO Box 5501 Austin TX 78763 061722171 501(c)(3) 142514 Health Access Grant Meals on Wheels and More 3227 E 5th St Austin TX 78702 237202594 501(c)(3) 750817 Health Access Grant People's Community Clinic 2909 N IH 35 Austin TX 78722 237087608 501(c)(3) 14912809 Health Access Grant Planned Parenthood 201 East Ben White Austin TX 78704 371515621 501(c)(3) 416930 Health Access Grant Round Rock Serving Center PO Box 5006 Round Rock TX 78683 742454410 501(c)(3) 300000 Health Access Grant SafePlace PO Box 19454 Austin TX 78760 741977853 501(c)(3) 986378 Health Access Grant Samaritan Center 2425A Burnet Austin TX 78756 741832864 501(c)(3) 101953 Health Access Grant Samaritan Health Ministries PO Box 133 Cedar Park TX 78630 742570190 501(c)(3) 344865 Health Access Grant SIMS Foundation PO Box 2152 Austin TX 78768 742766013 501(c)(3) 172702 Health Access Grant Sustainable Food Center 1106 Clayton Lane Austin TX 78723 742441468 501(c)(3) 44362 Health Access Grant Texas Ramp Project PO Box 832065 Richardson TX 78083 331139484 501(c)(3) 177232 Health Access Grant Texas Scottish Rite Hospital 2222 Welborn St Dallas TX 75219 750818178 501(c)(3) 100000 Health Access Grant The Care Communities PO Box 16529 Austin TX 78761 742845698 501(c)(3) 219983 Health Access Grant University of Texas at Austin PO Box 7726 Austin TX 78713 746000203 State of Texas 1000607 Health Access Grant Volunteer Healthcare Clinic 4215 Medical Parkway Austin TX 78756 746082464 501(c)(3) 138670 Health Access Grant Waterloo Counseling Center 3000 S IH 35 Austin TX 78704 742291792 501(c)(3) 162272 Health Access Grant Williamson County Crisis Center 1011 Gattis School Rd Ste 106 Round Rock TX 78664 742277114 501(c)(3) 67757 Health Access Grant Williamson-Burnet County Opportunities PO Box 740 Georgetown TX 78627 746075213 501(c)(3) 200593 Health Access Grant YMCA of Austin 1402 Cesar Chavez Austin TX 78702 741193464 501(c)(3) 163368 Health Access Grant Texas Higher Education Coordinating Board 1200 E Anderson Lane Austin TX 78752 746016766 State of Texas 708904 Health Access Grant Communicare Barrio Comprehensive Family Care 3066 Commerce San Antonio TX 78220 741724391 501(c)(3) 181252 Health Access Grant Foundation Communities 3036 S First St Austin TX 78704 742563260 501(c)(3) 564710 Health Access Grant Austin Parks Foundation 507 Calles St Austin TX 78702 742648803 501(c)(3) 6528 Health Access Grant A Legacy of Giving 4315 Guadalupe Ste 300 Austin TX 78751 741934031 501(c)(3) 23489 Health Access Grant Area Agency on Aging of the Capital 6800 Burleson Rd Austin TX 78744 741689381 501(c)(3) 190185 Health Access Grant Helping the Aging Needy and Disabled 1640B 2nd St Austin TX 78702 741888198 501(c)(3) 250589 Health Access Grant Austin Children's Museum 1830 Simond Ave Austin TX 78723 742288789 501(c)(3) 250000 HEALTH ACCESS GRANT Bastrop County Emergency Food Bank 806 Fayette Street Bastrop TX 78602 742485884 501(c)(3) 35274 HEALTH ACCESS GRANT Drive a Senior PO Box 743 Georgetown TX 78627 203414707 501(c)(3) 270935 Health Access Grant Austin Community Foundation 4315 Guadalupe Ste 300 Austin TX 78751 741934031 501(c)(3) 140720 Health Access Grant Meadows Mental Health Policy Foundation 3003 Swiss Ave Dallas TX 75204 756015322 501(c)(3) 1000000 Health Access Grant Austin Children's Shelter 4800 Manor Rd Austin TX 78723 742320657 501(c)(3) 205417 Health Access Grant Austin Clubhouse PO Box 300568 Austin TX 78703 900505527 501(c)(3) 25000 Health Access Grant St David's Community Health Foundation Initiatives 811 Barton Springs Rd 600 Austin TX 78704 270112979 501(c)(3) 22000000 Fund Supporting Org Capital Requirements St David's Foundation Community Fund 811 Barton Springs Rd 600 Austin TX 78704 742898888 501(c)(3) 42870 Fund Scholarships Children's Optimal Health 1345 Philomena St Ste 350 Austin TX 78723 262559516 501(c)(3) 35000 Health Access Grant United Way of Greater Austin 2000 E MLK Jr Blvd Austin TX 78702 741193439 501(c)(3) 25000 Health Access Grant Ending Community Homelessness Coalition 98 San Jacinto 1900 Austin TX 78701 274449243 501(c)(3) 15000 Health Access Grant E3 Alliance 5930 Middle Fiskville Rd Austin TX 78752 640963235 501(c)(3) 38382 Health Access Grant 64 2 Discounted eye exams and eyeglasses for needy Central Texans. 8880 1379456 Part I, Line 2: The Foundation monitors the use of grant funds through the following procedures: - Grantees submit quarterly reports to Program Officers 30 days after the close of each calendar quarter. Review of quarterly report information includes analysis of a) metric data for goal and outcome measures; b) demographic data; c) significant program activities, accomplishments and/or changes; and d) results of client satisfaction surveys. - Grantees submit year-end reports to Program Officers after the close of fourth quarter. Review of year-end reports includes analysis of aggregate data from quarterly reports and documentation of financial statements. - Program officers distribute summary reports to senior management and board members for analysis. - Program Officers attend grantees' board meetings at least one time per year. - Staff and board members review agency grant proposals in connection with site visits. - Staff conduct periodic site visits throughout funding year. Part III The reporting organization pays for discounted eye exams and eye glasses for Central Texans. Eye-care providers submit invoices for services provided to patients who submit vouchers for care. Vouchers are provided to financially indigent individuals whose income equals 200% or less of federal poverty guidelines (FPG). The reporting organization pays provider invoices directly upon receiving the vouchers. 1 X X X X X 0 0 0 0 0 0 0 0 0 R Earl Maxwell CEO 319978 0 0 0 0 1125 7800 0 8623 0 336401 1125 0 0 James J Ries CFO 184309 0 0 0 0 0 5616 0 8585 0 198510 0 0 0 Bobbie Barker Vice President 212247 0 0 0 0 0 6420 0 8623 0 227290 0 0 0 Patrice Kistenmacher Clinical Director 157011 0 0 0 0 0 4929 0 8503 0 170443 0 0 0 Shailee Gupta Lead Dentist 142977 0 0 0 0 0 4445 0 14892 0 162314 0 0 0 Caesar Collazo Lead Dentist 134084 0 0 0 0 0 4316 0 14879 0 153279 0 0 0 Ensy Atarod Lead Dentist 134745 0 0 0 0 0 4177 0 14874 0 153796 0 0 0 CW Hetherly Past Chair Family relationship with St. David's Healthcare Partnership, LP, LLP 136337 C.W. Hetherly's son, Michael Hetherly, is the Director - Provider Sponsored Networks, CWT Division at St. David's Healthcare Partnership, LP, LLP, an entity related by ownership to the reporting organization, or one of its affiliates. The reported amount of the transaction includes Michael Hetherly's salary & benefits. 0 Form 990, Part VI, Section B, line 11 The reporting organization's Tax and Audit Committee reviews a draft of the Form 990 in detail prior to it being finalized. A final version of Form 990 is sent to the Trustees prior to filing. Form 990, Part VI, Section B, line 12c The reporting organization annually verifies compliance with the conflicts of interest policy. The individuals covered by this policy include the officers, trustees, directors, board of governors representatives. The persons covered by this policy are required to annually disclose or update the Chairman of the Board of Trustees on a form provided by the organization their interests that could give rise to conflicts of interest. For each interest disclosed to the Chairman of the Board of Trustees of the foundation, the Chairman will determine whether to: (a) take no action; (b) assure full disclosure to the Board of Trustees of the Foundation and other individuals covered by this policy; (c) ask the person to recuse from participation in related discussions or decisions within the organization; or (d) ask the person to resign from his or her position in the Organization or, if the person refuses to resign, become subject to possible removal in accordance with the Organization's removal procedures. The organization's CEO will monitor proposed or ongoing transactions for conflicts of interest and disclose them to the Chairman of the Board of Trustees in order to deal with potential or actual conflicts. Form 990, Part VI, Section B, line 15 To establish the compensation of the organization's top management official, other officers, and key employees, the foundation took its outside consultant's 2011 report and updated it with publicly available support data, including cost of living adjustments and comparable salaries for similar positions. Without participation of the officer, director or other top management official under consideration, the Compensation Committee determined and approved compensation based on the updated 2011 consultant's report. This process was undertaken for the following officers, directors, key employees for 2014 compensation as follows: Earl Maxwell, Chief Executive Officer, December 2, 2013 Jim Ries, Chief Financial Officer, December 2, 2013 Bobbie Barker, VP of Grants & Community Programs, December 2, 2013 Patrice Kistenmacher, Clinical Director, Dental Programs, December 2, 2013 Form 990, Part VI, Section C, line 19 The reporting organization's governing documents, conflict of interest policy and financial statements are available to the public upon request. Please contact Jim Ries at 512-879-6603. Form 990, Part XII, Line 2b: The reporting organization's financial statements were audited by an independent accountant as part of consolidated financial statements. The consolidated financial statements included St. David's Foundation, St. David's Community Health Foundation Holdings, St. David's Foundation Community Fund, St. David's Community Health Foundation Initiatives, St. David's Foundation Impact Fund, LP, and St. David's Foundation Impact Fund, GP, LLC. Form 990, Part VI, Section A, Line 1a: The Board of Trustees of the reporting organization (the "Foundation") established an Executive Committee (the "Committee") to assist the Board in fulfilling its oversight responsibility for the operations of the organization and its affiliates. The Committee has the power to conduct the business of the Foundation during the period between meetings of the Board, in accordance with the policies and expressed wishes of the Board and established protocol. The Committee is authorized to secure such resources as it reasonably needs to fulfill its responsibilities, including outside consultants, as appropriate. The Chief Executive Officer of the Foundation, or an appointed representative, serves as the Committee's staff liaison. The Committee also consists of three elected governing Board officers: Chair, Vice Chair and Secretary, the Past Chair of the Foundation, the Chair of the Board of Governors, and the chairs of other governing Board sub-committees. All Committee members are governing board members, must be independent of management, and receive no compensation from the Foundation. The Board of Trustees has adopted a set of Central Governance Principles to provide a specific framework for the decision-making and governance activities of the Committee. Officer Compensation of Related Organizations: St. David's Foundation (the "Foundation") owns a general partner interest in St. David's Healthcare Partnership, LP, LLP (the "Partnership"). The amounts below represent the compensation paid by the Partnership during 2014. Cynthia Sexton, CFO Salary $ 506,425 Employee Benefits $ 54,064 C. David Huffstutler, CEO Salary $1,077,129 Employee Benefits $ 92,611 St. David's Foundation 2014 Community Benefit Report: Impact. Community. Health. With those three words as a guide, St. David's is dedicated to making a positive impact on the health of our community. St. David's Foundation includes controlling interests in four hospitals dedicated to serving Central Texas under the community benefit standard and the Affordable Care Act and a grant program focused on improving health and health care in Central Texas. IMPACT. St. David's HealthCare Partnership capital investment in the Community $1,070,000,000 Since inception in 1996, the St. David's hospitals have reinvested more than $1.07 billion in spent or committed funds in capital improvements to the hospitals and other medical facilities. The Central Texas area is one of the fastest growing areas of the country, and the St. David's HealthCare Partnership is committed to offering Central Texas the highest level of health care by expanding and upgrading facilities, recruiting the best doctors and nurses, and offering advanced medical services and technology. St. David's Hospitals Scope of Service St. David's touches thousands of Central Texans each year. In 2014, that included: * Patients admitted 67,815 * Emergency room visits 310,328 COMMUNITY. The Foundation invests its share of the earnings from St. David's HealthCare into programs in Central Texas that increase access to quality health care. The Foundation identifies areas of need, outlines goals for each area with an overall objective to make grants that will have a significant impact. The focus areas and goals include: Healthy Aging - Supporting programs that help maintain aging in place for older adults. $3.5 million in 2014 Healthy Futures - Providing funds for educational opportunities in health care research and health careers. $1.8 million in 2014 Healthy Living - Promoting health and wellness through healthy diet and exercise. $2.5 million in 2014 Healthy Minds - Supporting behavioral health programs in schools, health clinics and community non-profits. $15.5 million in 2014 Healthy People - Improving access to health care for low income Central Texans. $24.6 million in 2014 Healthy Smiles - Offering free dental services to underserved children in six school districts and families at safety net clinics. $6.0 million in 2014 With so many issues affecting the health and well-being of Central Texans, the Foundation's mission is to overcome these challenges so everyone has an opportunity to receive the best health care possible. We believe that by taking the initiative to understand these direct problems, we can wisely fund programs that are innovative and surpass the expectations of the people we serve. Covering more than five counties in Central Texas, in 2014 the Foundation helped more than 60 agencies. * St. David's Foundation Grants $50,000,000 * St. David's Foundation Grants Administration $1,200,000 St. David's Healthcare Partnership also provides community health improvement services and community benefit operations. The Foundation's share was $16 million in 2014. With one of the largest fleets of mobile dental clinics in the country, St. David's Dental Program offers free dental care to children at Title I elementary schools in Central Texas, as well as to adults referred by area clinics and the Health Alliance for Austin Musicians (HAAM). Each of the nine vans is equipped with two dental exam rooms, digital x-rays, and computer workstations. The vans are staffed by licensed dentists, hygienists, and dental assistants. In 2014, St. David's Dental Program treated 10,109 students and patients free of charge at 46 schools and agencies throughout Central Texas. The schools eligible for the program have a Title I designation and more than half of the student population participates in free lunch programs. St. David's Dental Program employs an oral health educator who travels to schools to teach children about good dental health care and nutrition. HEALTH. St. David's Foundation Charity Care $36 million The health care system, St. David's HealthCare, is a partnership between St. David's Foundation (a general partner with a controlling governance interest) and HCA, and operates as an exempt hospital. The St. David's hospitals provide a substantial amount of charity care to the elderly, indigent, and economically disadvantaged in Central Texas. All patients are admitted to emergency rooms regardless of their ability to pay. If further acute inpatient care is required, patients from the emergency department are admitted to the hospital, also without regard to their ability to pay. The amount represents St. David's Foundation's proportionate share of the Partnership's charity care and charity care provided by the dental program. Health Professionals Education $750,000 St David's Community Health Foundation Holdings 811 Barton Springs Rd Suite 600 Austin TX 78704 742206098 Holds endowment funds used to assist the needy of Central Texas TX 501(c)(3) Sec 170 (b)(1)(A)(vi St David's Foundation 1 St David's Foundation Community Fund 811 Barton Springs Rd Suite 600 Austin TX 78704 742898888 Provides needs-based scholarships to students in Central Texas TX 501(c)(3) Sec 170 (b)(1)(A)(vi St David's Foundation 1 St David's Community Health Foundation Initiatives 811 Barton Springs Rd Suite 600 Austin TX 78704 270112979 Supports St. David's Foundation Community Fund TX 501(c)(3) Sec 509(a)(3), I St David's Foundation Community Fund 1 St David's Healthcare Partnership LP LLP 98 San Jacinto Ste 1800 Austin TX 78701 742781812 Owns & operates four hospitals in Central TX TX N/A Related 145798708 382759209 0 1 0.40590 Bailey Square Ambulatory Surgical Center Ltd 98 San Jacinto Ste 1800 Austin TX 78701 752467365 Ambulatory surgery center TX N/A South Austin Surgery Center Ltd 98 San Jacinto Ste 1800 Austin TX 78701 621775267 Ambulatory surgery center TX N/A Leadership Healthcare Holdings II LP LLP 98 San Jacinto Ste 1800 Austin TX 78701 341996283 Owns an interest in a radiology center TX N/A Leadership Healthcare Holdings LP LLP 98 San Jacinto Ste 1800 Austin TX 78701 203151012 Owns majority interests in ambulatory surgery centers TX N/A Oakwood Surgery Center Ltd 98 San Jacinto Ste 1800 Austin TX 78701 621641024 Ambulatory surgery center TX N/A North Austin Surgery Center LP 98 San Jacinto Ste 1800 Austin TX 78701 200648730 Ambulatory surgery center TX N/A CP Surgery Center LLC 98 San Jacinto Ste 1800 Austin TX 78701 800776412 Ambulatory surgery center TX N/A MCA-CTMC Holdings LLC 98 San Jacinto Ste 1800 Austin TX 78701 800899140 Ambulatory surgery center TX N/A St David's Foundation Impact Fund LP 811 Barton Springs Rd Ste 600 Austin TX 78704 341996279 Owns indirect interest in a radiology center; makes research grants TX N/A C 0 St David's Foundation Impact Fund GP LLC 811 Barton Springs Rd Ste 600 Austin TX 78704 341996272 Owns indirect interest in a radiology center; makes research grants TX N/A C 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 St David's Foundation Impact Fund LP A 159746 FMV St David's Foundation Community Fund A 157208 FMV St David's Community Health Foundation Initiatives B 22000000 FMV St David's Foundation Community Fund D 4003582 FMV St David's Foundation Impact Fund LP D 2749293 FMV St David's Community Health Foundation Holdings E 1503945 FMV St David's Foundation Community Fund O 129192 FMV