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          <BusinessNameLine1>Physician's Surg Hospital-Quail Creek</BusinessNameLine1>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>QUESTION 3</FormAndLineReferenceDesc>
        <ExplanationTxt>BSA FORMED A COMMUNITY NEEDS ASSESSMENT COMMITTEE MADE UP OF A GROUP OF 12 EMPLOYEES WITH VARIED EXPERTISE TO FIRST IDENTIFY COMMUNITY ORGANIZATIONS TO IDENTIFY AND COMPLETE THE COMMUNITY ASSESSMENT WHICH WOULD BE BEST POSITIONED TO IDENTIFY PREVALENT NEEDS FACING THE COMMUNITY. FOURTEEN COMMUNITY ORGANIZATIONS (INCLUDING THE CITY OF AMARILLO) WERE INTERVIEWED BY THE COMMITTEE AND COMPLETED THE ASSESSMENT. THE ORGANIZATIONS CONSULTED INCLUDE: UNITED WAY AMARILLO AREA FOUNDATION WEST TEXAS FAMILY COMMUNITY SERVICES CITY OF AMARILLO DEPARTMENT OF PUBLIC HEALTH CATHOLIC FAMILY SERVICES TYLER STREET RESOURCE CENTER HARRINGTON REGIONAL MEDICAL CENTER FAITH CITY MISSION CITY OFFICIALS HOSPITAL DISTRICT LEADERSHIP AMARILLO INDEPENDENT SCHOOL DISTRICT PANHANDLE REGIONAL PLANNING COMMISSION TEXAS TECH SCHOOL OF MEDICINE GOLDSTON CANCER REGISTRY Part V, Sec B, Line 14G The financial assistance and charity care policy is available upon request; however, patients are notified of the policy as follows: Patients who have a high deductible or are uninsured are informed of the charity care policy at the time of pre-registration, and patients are then directed to a financial counselor if they wish to pursue financial assistance. If prior arrangements for financial assistance were not made prior to admission, patients are directed to a financial counselor for screening. Patients admitted through the emergency department who indicate an inability to pay or are uninsured are screened by financial counselors to determine eligibility for financial assistance. Patients are notified of the availability of financial assistance at the time of billing. Part V, Sec B, Line 20D In keeping with the mission and philosophy of BSA Hospital ("BSA"), BSA will apply a discount of 25% on all services provided to uninsured patients, who do not qualify for a 100% discount. In addition, BSA will provide charity care services, within the resources available, to financially or medically indigent patients. These services will be discounted up to 100% depending on patient's need. For those uninsured or underinsured patients who do not qualify for charity, financial aid may be available. Financially indigent patients whose gross annual income is at or below 200% of the most recently published Federal Poverty Guidelines are eligible for a 100% discount. Patients whose gross annual income is between 200% and 400% of the Federal Poverty Guidelines are eligible for financial assistance with graduated discounts between 20% and 80%. All discounts are applied to gross charges. Medically indigent patients whose total medical bills for all sources exceed 25% of their gross annual income are eligible for financial assistance under the hospital's policy. Once it has been determined that the patient is medically indigent, BSA will adjust our current medical bills down to 25% of the patient's income. If the patient still cannot pay, we will ask the patient to bring in proof of all current outstanding medical bills for review. If the total of those bills is still 25% of their yearly earnings, BSA's bills will be adjusted down so that all of the patient's medical bills total 25% of their income. Once medical indigence has been determined and existing account balances have been adjusted accordingly future accounts will need to be considered independent of the original determination.</ExplanationTxt>
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      <FacilityNum>3</FacilityNum>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>The Don &amp; Sybil Harrington Cancer Center</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>1500 Wallace Blvd</AddressLine1>
            <City>Amarillo</City>
            <State>TX</State>
            <ZIPCode>79106</ZIPCode>
          </USAddress>
          <FacilityTxt>outpatient cancer center</FacilityTxt>
        </OthHlthCareFcltsGrp>
        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>Advanced Imaging Center</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>7010 W 9th</AddressLine1>
            <City>Amarillo</City>
            <State>TX</State>
            <ZIPCode>79106</ZIPCode>
          </USAddress>
          <FacilityTxt>diagnostic imaging center</FacilityTxt>
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        <OthHlthCareFcltsGrp>
          <BusinessName>
            <BusinessNameLine1>ADC Endoscopy Specialists</BusinessNameLine1>
          </BusinessName>
          <USAddress>
            <AddressLine1>1 Care Circle</AddressLine1>
            <City>Amarillo</City>
            <State>TX</State>
            <ZIPCode>79124</ZIPCode>
          </USAddress>
          <FacilityTxt>ambulatory surgical center</FacilityTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 3c</FormAndLineReferenceDesc>
        <ExplanationTxt>Baptist St. Anthony's Hospital uses income-based criteria for determining eligibility for free or discounted care under its financial assistance policy. Financially indigent patients whose gross annual income is 200% of the Federal Poverty Income Guidelines or less are eligible for free care while those with gross annual income between 200% and 400% of the Federal Poverty Income Guidelines are eligible for discounted care under the organization's financial assistance policy. The Hospital also uses an assets test to determine eligibility for charity care. Assets are evaluated to determine if the guarantor has any liquid assets in excess of those critical to living or not being used to support the family's support system. Part I, Line 6a N/A Part I, Line 7 THE ORGANIZATION IS ONE OF THE TWO OWNERS OF BSA HEALTH SYSTEM OF AMARILLO, LLC, A TEXAS LIMITED LIABILITY COMPANY, THAT OPERATES BSA HOSPITAL IN AMARILLO, TX. BSA HOSPITAL IS CONTRACTUALLY REQUIRED TO BE OPERATED IN ACCORDANCE WITH THE REQUIREMENTS WITH SECS. 501(C)(3) AND 501(R) OF THE CODE AND REV. RUL. 69-545. THE ORGANIZATION HAS CONTRACTUAL AUTHORITY TO REQUIRE COMPLIANCE WITH THESE REQUIREMENTS ON AN ON-GOING BASIS. The responses throughout Schedule H are with respect to the operations of BSA Hospital. All dollar figures have been adjusted to reflect HPBHF's 20% member interest in the BSA Hospital. The Hospital used a cost-to-charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges, to calculate the amounts reported in the table in Part I, line 7. Part II N/A PART III, LINE 2 COSTING METHODOLOGY FOR BAD DEBTS THE ORGANIZATION HAS USED 2012 AUDITED FINANCIAL STATEMENTS AND THE COST-TO-CHARGE RATIO METHODOLOGY PROVIDED FOR IN OPTIONAL WORKSHEET AESTIMATED BAD DEBT EXPENSE (AT COST). AT THE END OF 2013, THE ORGANIZATION ESTIMATED THE AMOUNT OF BAD DEBT EXPENSE THAT COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY. AS A RESULT, A RECLASSIFYING ENTRY WAS MADE FROM BAD DEBT EXPENSE TO RECOGNIZE THIS AMOUNT APPROPRIATELY AS CHARITY. CONSEQUENTLY, A ZERO AMOUNT IS BEING REPORTED IN PART III, SECTION A, LINE 3. Part III, Line 3 See response for Part III Line 2. Part III, Line 4 The footnote to the attached consolidated audited financial statements of Baptist Community Services and Affiliates is not directly applicable to Schedule H, as the Hospital activities maintained via a 20% LLC investment are only included in summary form. Part III, Line 8 The costing methodology is the structure built into the CMS 2552-96, transmittals 23-25. Costs are grouped from the general ledger and classified in the appropriate cost center as allowable or non-reimbursable. Then adjustments are made on w/s A8 for reductions to allowable costs due to income offsetting revenues or costs identified as non-reimbursable per CMS regulations. Additionally, costs are reclassified on W/S A6 for proper matching of costs and revenues or nature of the expense incurred. Next, the overhead costs are allocated to the direct and non-reimbursable expenses based on appropriate CMS allocation techniques and statistical bases. The total cost related to the Medicare revenue is taken from the following areas. The accommodation or routine portion of costs is taken from CMS 2552-96 D-1 line 37 for the appropriate Title XVIII provider or sub-provider. Cost for I/P ancillary service are taken from D-4 line 102, column 3. Costs for O/P ancillary services are taken from DV line 102, column 9. Subsidized care services are claimed as a community benefit for the following reason. These services exclude Medicaid and charity services already reported separately. These services are regarded as a community benefit because they are vital to the community in the case of Neonatal and Obstetrical services furnished at a negative margin by Baptist St Anthony's. Also other health services are provided to older patients with complications and complex health problems. These services are also necessary for public health and could not be fully provided by other resources available in the community if they were not providers by Baptist St Anthony's. Part III, Line 9B The following is an excerpt from the Bad Debt Policy. It refers collectors to the Charity Policy once it is identified that a patient may qualify. The charity policy/procedure is followed from there. When reviewing accounts as potential bad debt, the collection and reviewing personnel should always look for signs that the account might qualify for charity. Such signs may include prior charity, a large dollar amount owed to BSA, employment status, marital status, and any combination of these or other factors that may become evident while working the account. In cases where a patient cannot or will not provide sufficient information to fully document eligibility for Charity Care, a presumption of eligibility may be made based on statistical data and other reliable assumptions so long as those assumptions are properly documented. Presumptive Charity and/or Financial Aid will be applied after all normal collection activities have been exhausted and before accounts are sent to an external collection agency. This may include one or more of the following situations: -Collections and Payment Prediction and Charity Eligibility based on Mede Analytics -Insurance coverage is no longer in effect. -Patient cannot be located through collection attempts, is unemployed and uninsured. -Patient is unresponsive to collection attempts, is unemployed, uninsured, no credit information available. -Patient resided in a shelter or indicates they are homeless with no income or assets to validate. -Patient is not able to provide income information. -Patient is deceased and there is no estate. -Patient residence is in an area of high poverty. Once a determination of eligibility for Charity Care under Financial or Medical Indigence is made, no further collection efforts shall be pursued for the amount applied toward Charity Care. All patients approved will either be classified as financially indigent, medically indigent, or qualified for financial discount. Part VI, Line 2 Needs assessment N/A Part VI, Line 3 Patient education of eligibility for assistance BSA employs the services of Medical Advocacy Services for Healthcare, Inc. (MASH) to screen patients for assistance under federal and state programs, including Medicaid, SSI Medicaid and RSDI Medicare Disability, and Victims of Violent Crime Assistance. MASH screens all uninsured inpatients and outpatient and ER accounts over $500. Inpatients are contacted by personal visit while they are in the hospital. The MASH advocate works with the patient and/or family members to gather the required information and begin the application process. For outpatients and ER patients, MASH contacts them via telephone and/or locating letters with number of attempts varying based on the total charges on the account. In addition, BSA offers Charity Care and Financial Assistance. Patients are made aware of the assistance availability in multiple ways: -At the point of pre-registration for scheduled services when the patient indicates an inability to pay -At the point of registration for unscheduled services, -By Business Office staff post discharge -BSA employs 2 FTE who serve as Financial Counselors who work with patients in person, telephonically and by written correspondence. -BSA's patient statements indicate that Financial Assistance is available and provide a phone number to call if the patient is in need. -BSA's Financial Assistance Policy is published on the BSA website -All accounts with a patient balance that is not paid by the time the scheduled statements have been sent receive up to two automated phone calls. The automated message notifies patients at that time that financial assistance is available and gives the patient/guarantor the option of indicating that they would like for someone to contact them to discuss this option. Part VI, Line 4 Community Information The community served by Baptist St. Anthony's Hospital includes the City of Amarillo as well as the Texas Panhandle and surrounding states. Amarillo is located near the middle of the Texas Panhandle comprised of the upper 26 counties of the State of Texas. The hospital's service area extends to the bordering states of Oklahoma and New Mexico as well as Kansas and Colorado which are also within close proximity. The population of the City of Amarillo is approximately 200,000, and the scope of the Texas Panhandle increases that population to over 400,000. Approximately 11% of Amarillo's population reports income below the poverty line, with approximately 89% reporting above that line. Occupation classification reports indicate that 24% are Blue Collar, 57.9% are White Collar and 18.1% are employed in Service or Farm industries. Part VI, Line 5 Promotion of community health Other entities related to the heal</ExplanationTxt>
      </SupplementalInformationDetail>
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        <PersonNm>STEPHEN DALRYMPLE</PersonNm>
        <TitleTxt>PRESIDENT/CEO/GENERAL COUNSEL</TitleTxt>
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        <PersonNm>MARK HOTMANN</PersonNm>
        <TitleTxt>SR VICE PRESIDENT/TREASURER</TitleTxt>
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        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
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        <TotalCompensationFilingOrgAmt>0</TotalCompensationFilingOrgAmt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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        <FormAndLineReferenceDesc>Schedule J, Part I, Question 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>SEE PART II, COLUMN C, DEFERRED COMPENSATION PURSUANT TO INTERNAL REVENUE CODE SECTION 457 PLAN FOR THE BENEFIT OF STEPHEN DALRYMPLE AND MARK HOTMANN.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 11</FormAndLineReferenceDesc>
        <ExplanationTxt>RECEIVED ONE GRANT OF 20% MEMBER INTEREST OF BSA HEALTH SYSTEMS OF AMARILLO, LLC.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleM>
    <IRS990ScheduleN documentId="IRS990ScheduleN">
      <LiquidationOfAssetsTableGrp referenceDocumentId="BinaryAttach BinaryAttachN1" />
      <DispositionOfAssetsDetail>
        <AssetsDistriOrExpnssPaidDesc>all net operating assets and liabilities</AssetsDistriOrExpnssPaidDesc>
        <DistributionDt>2013-01-01</DistributionDt>
        <FairMarketValueOfAssetAmt>469925201</FairMarketValueOfAssetAmt>
        <MethodOfFMVDeterminationTxt>cost</MethodOfFMVDeterminationTxt>
        <EIN>751858993</EIN>
        <PersonNm>BaptistSt Anthony's Health System</PersonNm>
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          <AddressLine1>1600 WALLACE BLVD</AddressLine1>
          <City>amarillo</City>
          <State>TX</State>
          <ZIPCode>79106</ZIPCode>
        </USAddress>
        <IRCSectionTxt>501(c)(3)</IRCSectionTxt>
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      <DirectorOfSuccessor2Ind>false</DirectorOfSuccessor2Ind>
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    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part III, Line 2 and 3</FormAndLineReferenceDesc>
        <ExplanationTxt>Effective January 1, 2013, high Plains Baptist Health Foundation ("HPBHF"), formerly known as Baptist/St. Anthony's Hospital Corporation, transferred all of its operating assets, including its hospital and other medical facilities, to a related tax exempt organization. These operating assets were transferred by the related organization to a newly formed entity named BSA Health Systems of Amarillo, LLC, ("LLC") of which HPBHF later was assigned a 20% member ownership interest. HPBHF has contractual provisions to maintain board control of the LLC and to ensure the Hospital activities continue to be operated in the same charitable manner as it had while under direct ownership of HPBHF. Overall, the same program services are being conducted through the LLC, but HPBHF now maintains a 20% ownership interest in the services. Form 990, Part VI, Question 4B The governing documents and Articles were amended effective as of January 1, 2013 due to the sale of the organization's assets and to reflect it's new corporate member. FORM 990, PART VI, QUESTIONS 6, 7A, &amp; 7B BAPTIST COMMUNITY SERVICES IS THE SOLE CORPORATE MEMBER OF HIGH PLAINS BAPTIST HEALTH FOUNDATION ("HPBHF"). THE MEMBER APPOINTS THE DIRECTORS OF HPBHF AND THE MEMBER HAS CERTAIN AUTHORIZATION POWERS, WHICH INCLUDE THE FOLLOWING: (a) Amendment of the articles of incorporation or bylaws of the Corporation; (b) Any deviation from or amendment to the broad objectives of the Corporation; (c) Incurrence or assumption of any indebtedness; (d) Authorizing any public fund raising campaign; (e) Appointment of board members of BSA Health System of Amarillo, LLC ("BSAHS"), BSA Physician Holdings, Inc. ("BSAPH") or any of their Affiliates (collectively, the "Affiliates"); (f) Disposition of any part of the Corporation's assets having a fair market value in excess of $50,000; (g) Authorizing contributions, distributions, or other transfer of funds; (h) Dissolution of the Corporation; (i) Cessation of operations of any licensed hospital; (J) Sale, lease, mortgage or transfer of all or substantially all of the assets of the Corporation; (k) Approval of the annual strategic/operating plan, if any, the annual budget and the annual community benefit plan, if any, ofthe Corporation. (L) Approval of any changes to the governing documents of BSAHS, BSAPH or any Affiliate or entering into any contract arrangement or relationship with BSAHS, BSAPH or any Affiliate; FORM 990, PART VI, QUESTION 11B The form 990 is presented to each of the organization'S BOARD members prior to filing. FORM 990, PART VI, QUESTION 12C In connection with any actual or potential Conflict of Interest, an Interested Person must disclose the existence of his or her Financial Interest and all material facts to the Board of Trustees of High Plains Baptist Health Foundation ("the Corporation") or the Committee considering the proposed transaction or arrangement. "Interested Person" shall mean any Trustee, officer, or member of a Committee who has a Financial Interest. "Financial Interest" shall mean any of the following, whether on a direct or indirect basis: (a) an ownership or investment interest in any entity with which the Corporation has a transaction or arrangement; (b) a Compensation arrangement with the Corporation or with any entity or person with which the Corporation has a transaction or arrangement; or (c) a potential ownership or investment interest in, or Compensation arrangement with, any entity or person with which the Corporation is negotiating a transaction or arrangement; After disclosure of a Financial Interest and all material facts by the Interested Person, and after discussion of same, the Interested Person shall leave the Board or Committee meeting while the determination of a Conflict of Interest is discussed and voted upon. The remaining Board or Committee members shall decide if a Conflict of Interest exists. Each Trustee, officer, and member of a Committee shall annually sign a statement which affirms that such person (i) has received a copy of this Policy, (ii) has read and understands this Policy, (iii) has agreed to comply with this Policy, and (iv) understands that the Corporation, as a charitable organization and in order to maintain its federal tax exempt status, must engage primarily in activities which accomplish one or more of its tax exempt purposes. A voting member of any Committee whose jurisdiction includes Compensation matters and who receives Compensation, directly or indirectly, from the Corporation shall be precluded from voting on matters pertaining to that member's Compensation. Any officer, employee, or independent contractor of the Corporation who receives Compensation from the Corporation, directly or indirectly, shall be precluded from membership on any Committee whose jurisdiction includes Compensation matters. If the Board or a Committee has reasonable cause to believe that a member has failed to disclose an actual or potential Conflict of Interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose. If, after hearing the response of such member and making such further investigation as it may deem to be warranted under the circumstance$, the Board or Committee determines that the member has failed to disclose an actual or potential Conflict of Interest, it shall take such disciplinary and corrective action(s) as it deems appropriate. An Interested Person with a Conflict of Interest may make a presentation at the Board or Committee meeting, but after such presentation, the Interested Person shall leave the meeting during the discussion of, and the vote on, the proposed transaction or arrangement. The presiding officer of the Board or the Committee meeting, if determined to be appropriate by the Board or the Committee (though this is discretionary and not mandatory), may appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. After exercising such due diligence as the Board or the Committee deems required, the Board or the Committee shall determine whether the Corporation can obtain a more advantageous transaction or arrangement with reasonable efforts from a person or entity that would not give rise to a Conflict of Interest. If a more advantageous transaction or arrangement is determined by the Board or the Committee to not be reasonably attainable under circumstances that would not give rise to a Conflict of Interest, then the Board or the Committee shall determine by majority vote of the disinterested participants whether (i) the transaction or arrangement is in the Corporation's best interest and benefit, (ii) the transaction or arrangement is fair and reasonable to the Corporation, and (iii) the transaction or arrangement should be entered into by the Corporation. FORM 990, PART VI, QUESTIONS 15B HIGH PLAINS BAPTIST HEALTH FOUNDATION OFFICERS AND KEY EMPLOYEE COMPENSATION IS DIRECTED BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF BCS, THE CORPORATION CONTRACTS WITH SULLIVAN, COTTER, AND ASSOCIATES OF MINNEAPOLIS, MINNESOTA TO REVIEW THE DUTIES AND COMPENSATION. SULLIVAN COTTER CONFIRMS THAT COMPENSATION IS REASONABLE. SULLIVAN COTTER COMMUNICATES DIRECTLY WITH THE COMPENSATION COMMITTEE ON MATTERS OF EXECUTIVE COMPENSATION. THE MOST RECENT REVIEW WAS COMPLETED IN 2013. FORM 990, PART VI, QUESTION 19 OUR 990'S ARE AVAILABLE ON GUIDESTAR AND UPON REQUEST. GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, QUESTION 9 (469,925,201) TRANSFER NET ASSETS TO BSA HEALTH SYSTEM (4,926,451) BSA Health System of Amarillo, LLC INCOME PER K-1 IN EXCESS OF BOOKS 66,905,621 STEP UP IN BASIS OF BSA Health System of Amarillo, LLC INVESTMENT ------------- (407,946,031) TOTAL</ExplanationTxt>
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