2013-11-11T13:35:38-06:00 2012-12-31 990 2012-01-01 742519752 Scott & White Hospital Brenham SCOT 2542159043 2401 S 31st Street Temple TX 76508 Jason Jennings 2542159043 2013-10-29 2012 2016-02-24 21:20:13Z Jason Jennings 2401 S 31st Street Temple TX 76508 55172132 0 X www.sw.org X 1989 TX Scott & White provides personalized, comprehensive, high quality health care services enhanced by medical education and research through 12 acute care hospital sites, two additional announced facilities, a 240,000+ member regional health plan serving residents in a 29,000-square mile service area, and one of the nation's largest multi-specialty group practices with more than 178 clinics at 65 clinic locations providing care in 46 medical specialties. Scott & White Hospital Brenham ("SWHB") is a subsidiary of Scott & White Healthcare ("SWHC")(EIN: 26-4532547), the parent corporation of the Scott & White Healthcare System (the "System"). The Scott & White Healthcare Foundation ("SWF")(EIN: 27-3513154), a subsidiary of SWHC, raises funds for the priority programs and services of the entire Scott & White System. The Scott & White Healthcare System provided at cost approximately: $60 million in unreimbursed charity care and $50.5 million in unreimbursed Medicaid and indigent care. 11 6 0 76 0 0 623356 0 35855808 34342136 956875 1001272 98357 95797 37534396 35439205 22453 0 0 0 15998977 15742110 0 0 0 17790475 16628363 33811905 32370473 3722491 3068732 51552178 28311406 40530507 19173907 11021671 9137499 X Scott & White Hospital Brenham ("SWHB") has adopted the mission statement of the Scott & White Healthcare System: "To provide the most personalized, comprehensive, and highest quality health care, enhanced by medical education and research." 0 0 30159304 34342136 Scott & White provides personalized, comprehensive, high quality health care services enhanced by medical education and research through 12 acute care hospital facilities, two additional announced facilities, a 240,000+ member regional health plan serving residents in a 29,000-square mile service area of Central Texas, and one of the nation's largest multi-specialty group practices with more than 178 clinics at 65 clinic locations providing care in 46 medical specialties. Scott & White Hospital Brenham ("SWHB") is a subsidiary of Scott & White Healthcare ("SWHC")(EIN: 26-4532547), the parent corporation of the Scott & White Healthcare System (the "System"). The Scott & White Healthcare Foundation ("SWF")(EIN: 27-3513154), a subsidiary of SWHC, raises funds for the priority programs and services of the entire Scott & White System. The Scott & White Healthcare System provided at cost approximately: $60 million in unreimbursed charity care, $46 million in unreimbursed Medicaid, $4.5 million in unreimbursed indigent care, $21 million in unreimbursed subsidized services, $63 million in unreimbursed health professions education, $13 million in unreimbursed research, $1 million in other community benefits, and had a Medicare shortfall of approximately $96 million in the fiscal year ending August 31, 2012.The Scott & White Healthcare System had more than 14,000 employees, including over 1,000 physicians and scientists and 300+ advanced practice professionals during the fiscal year ending August 31, 2012, and served over 537,000 patients accounting for 2.2 million patient visits. Scott & White Memorial Hospital ("SWMH"), located in Temple, Texas, is the flagship hospital of the Scott & White Healthcare System and is the only Level I Trauma Center between Dallas and Austin, Texas. The McLane Children's Hospital Scott & White is the only stand-alone children's hospital between Dallas and Austin, Texas. Scott & White Hospital Brenham had 15,642 patient observation days (excluding newborns), 1,699 surgical cases, 1,733 admissions and 15,881 emergency room visits for the fiscal year ending December 31, 2012. Scott & White Hospital Brenham serves the community through projects such as: health fairs and health screenings, weekly diabetic support groups meetings, children and adult immunizations and screenings, adult fitness classes and various senior adult lectures, health screenings, and classes. Additionally, SWHB maintains a working partnership with Faith Mission and Washington County called the Washington County Health Coalition to help staff and operate the Washington County Community Clinic; which provides care for the medically underserved, underinsured and uninsured people in the community.Scott & White System personnel strive to do more than merely meet the healthcare needs of patients. Employees go into the community to educate about living a healthier life. Targeted populations are provided information on specific needs. For example, physicians specializing in geriatric care hold regular seminars discussing subjects such as preventing injury from falls; questions patients should be asking their doctor, how to maintain a healthy lifestyle with limited mobility, and more. Health educational programs regarding prevention and treatment are offered free or at minimal cost to all community members in a variety of subject areas, such as weight loss, smoking cessation, education on coping with a diagnosis, support groups for families, child safety, heart disease education, diabetes education, sex education for teens, domestic violence prevention and many more. Staff and physicians attend health fairs in the community and provide regular community presentations about health issues for different populations. Clinics in the region offer healthy cooking classes led by a Scott & White dietician to instruct families in creating easy and cost effective healthy meals. As an integrated health care delivery system, Scott & White is able to leverage the Scott & White Health Plan to provide health education information to the community and is actively working to make that information more widely available.Scott & White uses various forms of media to promote health in the community. The System website, blogs, social media, printed flyers, and newspaper and magazine articles written by staff and physicians throughout the year provide information that community members can use to enhance personal health. A specific website has been created to instruct on wellness initiatives (wellness.sw.org). Also, Scott & White staff dedicate many hours serving on community boards and collaborative groups whose missions are to improve the overall health of the community. In addition to these efforts, the System has designated specific funds to be used to enhance healthy initiatives occurring in each community. For example, Scott & White provides substantial financial and in-kind support for multiple free clinics to assist in providing better access and more affordable healthcare to the medically underserved. Scott & White is one of sixteen major U.S. health systems to be part of the National High Value Healthcare Collaborative ("HVHC"). This partnership is designed to improve healthcare, lower costs and make best practices available to the national provider community. The Dartmouth Institute for Health Policy and Clinical Practice leads the collaborative which is studying nine prevalent condition/disease specific areas that have been shown to have wide variation nationally in rates, costs and outcomes. Additional high variation, high cost conditions that affect diverse populations will be added over time. The healthcare systems in this group are responsible for 50 million patients and are using private dollars and research and grant funds to identify ways to get the most out of every healthcare dollar. In June of 2012 the HVHC received a $26 million grant from the Center for Medicare and Medicaid Innovation ("CMMI"). CMMI projects the service improvements funded by this grant will save $64 million over three years, largely due to reduced utilization and costs that have been shown to occur when patients are engaged and empowered to make health care decisions based on their own values and preferences.Scott & White strives to better serve patients while decreasing costs to the healthcare system. One way this is accomplished is through better communication between specialists and primary care physicians creating coordinated and integrated care. Scott & White's electronic medical records (EMR) system allows specialists to review a patient's medical history and lab results and make recommendations to a primary care physician possibly eliminating an office visit. If the specialist needs to see a patient the specialist has access to all tests and lab work prior to the office visit which can prevent a second or third specialty follow-up visit. Scott & White is also using the EMR system to practice active rather than passive medicine. The new EMR system allows Scott & White to automatically remind physicians that patients are due for preventive tests such as mammograms or cholesterol checks. The system allows doctors and nurses to use e-mail to provide patients with test results or to answer questions that previously would have required an office visit.The Scott & White Healthcare System has received numerous awards and accreditations. Scott & White Memorial Hospital was ranked for the eighth time as one of the Top 100 Hospitals by Thomson Reuters. For the second consecutive year, SWMH was named one of the nation's Best Regional Hospitals according to U.S. News & World Report.SWHB serves patients qualifying for federal Medicare and state Medicaid programs and other federal and state means tested assistance programs. Services for indigent, uninsured and underinsured patients are provided according to provisions of the Scott & White Healthcare Financial Assistance Policy, which provides financial assistance to patients up to 375% of the Federal Poverty Guidelines. Scott & White also serves private pay patients and contracts with health plans and insurance companies to provide medical services for their participants. 30159304 1 0 0 1 0 0 0 0 0 1 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 X 11 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 X Dick Dixon 2547244733 2401 S 31st Street Temple TX 76508 X Tommy Ladewig 1.00 X X 0 0 0 Gregg Appel 1.00 X X 0 0 0 Patricia M Currie 1.00 40.00 X X 0 735763 53682 Robert Wright PhD 1.00 X 0 0 0 Charles R Moser 1.00 X 0 0 0 Robert L Haydon MD 1.00 40.00 X 0 206018 29282 Shirley Herring 1.00 X 0 0 0 Atwood Kenjura 1.00 X 0 0 0 R Hal Moorman JD 1.00 X 0 0 0 William L Rayburn MD 1.00 40.00 X 0 625334 54941 Dick Dixon 1.00 40.00 X 0 641174 52540 Jason D Jennings 40.00 X 0 336851 51586 Glen RCouchman MD 1.00 40.00 X 0 741071 53113 Teresa Gabriel 40.00 X 0 153693 32470 Robert W Pryor MD 1.00 40.00 X 0 1202973 52070 Cynthia B Dunlap 1.00 40.00 X 0 308906 45842 James Carroll 1.00 40.00 X 0 511014 46414 Marc R Hallee 1.00 40.00 X 0 496688 46603 Matthew L Chambers 1.00 40.00 X 0 536594 54371 Stephen F Sullivan 1.00 40.00 X 0 272378 12785 Michael R Schlabach MD 1.00 40.00 X 0 273480 52619 Jeanette Scheel 40.00 X 0 112584 15761 Beth Teverbaugh 40.00 X 0 115696 25782 Janelle A Willis 40.00 X 0 109737 6584 Phillip W Frazier 40.00 X 0 107621 9456 Susan S Roden 1.00 40.00 X 0 112884 11285 John L Simms 40.00 X 0 460178 30199 Alfred B Knight MD 0.00 40.00 X 0 343534 51101 Peter Brumleve 0.00 40.00 X 0 199976 14740 0 8604147 803226 0 1 1 0 Hunter Pharmacy Services Inc 3420 Executive Services Inc Ste 10 Austin TX 78731 Pharmacy Management 491376 Legacy Healthcare Services LLC 3001 Spring Forest Rd Raleigh NC 27616 Therapy Services 419577 Columbus Respiratory Care 425 Spring St Columbus TX 78934 Respiratory Services 382548 Nursefinders PO Box 910738 Dallas TX 753910738 Staffing 340608 Gulf Coast Regional Blood Center PO BOx 200601 Houston TX 772160601 Donor Services 241292 20 Net Patient Care Rev 624100 34342136 34342136 34342136 420487 420487 20313712 19720526 12401 593186 -12401 580785 580785 Cafeteria 722210 84725 84725 Gift Shop 452000 11072 11072 95797 35439205 34342136 0 1097069 X 13205084 12760818 444266 2537026 2451671 85355 1919 1919 19257 19257 3693991 3386757 307234 5926 5926 283909 274357 9552 229158 221770 7388 549495 531008 18487 191234 191234 13736 13736 836852 836852 774531 774531 Bad Debt Expense 4206197 4206197 Patient Care 4114699 4114699 Overhead/Shared Service 1073191 15713 1057478 Rent/Maintenance 376419 376419 257849 188850 68999 32370473 30159304 2211169 0 94046 917129 8201964 1729567 6142272 6894234 5065 0 563494 1093998 995128 406244 266874 6587587 953484 4631506 5634103 22982057 4750596 7431532 7042397 81378 51552178 28311406 1002664 1192247 5368032 4108532 27320273 0 6839538 13873128 40530507 19173907 X 10219788 7860433 247752 700680 554131 576386 11021671 9137499 51552178 28311406 X 3068732 416946 -5369850 X 0 1 X 1 0 X 0 0 0 0 0 1 1434 0 0 0 1434 0 Explanation of Lobbying Activities: Part II-B, Line 1: Scott & White Hospital Brenham maintains membership in the Texas Hospital Association and the Texas Organization of Rural & Community Hospitals. A percentage of the dues paid to these organizations are allocated to lobbying activities and are reported on line 1f as "Grants to other organizations for lobbying purposes". 1276001 142042 59129 192004 7501 1277667 1292706 16705 1276001 1068025 224681 1292706 985882 82146 1068028 972978 211671 198767 985882 0.45000 0.55000 0 1 1 450998 450998 2943445 206242 2737203 3041807 709005 2332802 151337 38237 113100 5634103 Investment in Subsidiary 2964604 C Interest in Supporting Foundation 4077793 C 7042397 Insurance/Check Reserve 50000 Payroll/Benefit Liabilities 9281924 Capital Leases 252847 Due to Related Organization 4288357 13873128 X Description of Intended Use of Endowment Funds: Part V, Line 4: The endowment funds held by Scott & White Hospital Brenham are to be used for the purchase of equipment and/or building projects. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Part X, Line 2: Fin 48 Footnote: Scott & White evaluates it's income tax positions in accordance with Accounting Standard Codification 740-10, regarding accounting for uncertainty in income taxes (ASC 740-10). ASC 740-10 prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. There are no material unrecorded tax liabilities as of August 31, 2012 and 2011. 1 1 X 1 X 1 X 375.000000000000 1 1 0 0 492509 492509 0.01750 3213493 3504055 -290562 0.00000 64647 54510 10137 0.00040 3770649 3558565 212084 0.01790 6567761 5419200 1148561 0.04080 155277 155277 0.00550 6723038 5419200 1303838 0.04630 10493687 8977765 1515922 0.06420 1 1370800 4606093 12360310 -7754217 X 1 1 1 1 Scott & White Hospital Brenham

700 Medical Parkway Brenham TX 77833

X X X Scott & White Hospital Brenham 1 1 1 100.000000000000 1 375.000000000000 1 X X X X 1 1 X X X X X 1 0 0 X X 0 0 Part I, Line 7: The costing method used for Schedule H is the cost to charge ratio, as calculated in Schedule H, Worksheet 2. This method was applied to the costs reported on lines 7a, 7b, 7c, and 7g. Part I, L7 Col(f): Bad debt expense subtracted from total expenses on Part IX of the Form 990 to calculate the operating expenses used in calculating the percentage in column (f) is $4,206,197 Part III, Line 4: In the Scott & White Hospital Brenham ("SWHB") accounting system, bad debt is recorded as the cost of forgone charges. To calculate the cost of bad debt for purposes of Schedule H, Part III, line 2, the cost to charge ratio calculated in Worksheet 2 of the Schedule H Instructions was applied. Due to patient screenings which occur prior to recording bad debt charges, bad debt expense should not contain community benefit expenditures.Audited financial statement footnote, Page 19: The presentation of the provision for bad debts as a reduction of patient service revenue is based on an entity-wide assessment of the significance of patient revenue that is recognized without assessing patients' ability to pay. Scott & White has experienced an increase in write-off trends related to bad debt and charity across the system driven by changes in insurance plan structures shifting financial responsibility away from the health plan to individuals and general economic conditions. There have been no significant changes to the charity care policies for the year ended August 31, 2012. Part III, Line 8: Scott & White Hospital Brenham ("SWHB") is a nonprofit hospital that voluntarily participates in the Medicare program. Medicare payments received do not cover the costs incurred to provide services to Medicare patients. In reporting the community benefit portion of the American Hospital Association/Texas Hospital Association survey, the Medicare short-fall is included in community benefit reporting.Costing methodology/source: The Medicare revenue and costs are from the Medicare Cost Report which has a year-end December 31, 2012. All payments to providers of services must be based on the reasonable cost of services covered under title XVIII of the Social Security Act. Reasonable cost includes all necessary and proper costs incurred in rendering the services. Reasonable cost takes into account both direct and indirect costs of providers of services, including normal standby costs. The general services or overhead cost is stepped down and allocated through statistical data to equitably allocate the expenses to the hospital service departments. Part III, Line 9b: The Scott & White Healthcare Financial Assistance Policy has a section for coordination with collection policies. It states: "notwithstanding any other provision of any other policy or provision at S&W regarding billing and collection matters, S&W will not engage in extraordinary collection actions before it makes reasonable efforts to determine whether an individual who has an unpaid billing from S&W is eligible for financial assistance under this Policy. "Reasonable efforts "includes notification to the patient by S&W of this Policy upon admission or discharge and in written and oral communications with the patient regarding the patient's billings, including invoices, telephone calls, and such other communications as may be set forth in future guidance from the U.S. Department of the Treasury or Internal Revenue Service." Scott & White Hospital Brenham Part V, Section B, Line 14g: When an uninsured patient registers, the hospital's financial policy will be explained to the patient. At this time, Scott & White Hospital Brenham's ("SWHB") financial assistance program will be offered to the patient. If a patient believes they may qualify for the program, they will be provided with a financial assistance program application. Patients will also be notified of the financial assistance program through internal collections correspondence. Part VI, Line 2: Scott & White Hospital Brenham ("SWHB") participated in a Community Health Needs Assessment orchestrated by the Texas A&M School of Rural Public Health that was released in September of 2013. The report assesses the community's health status in relation to the rest of the Brazos Valley, counties across the state and across the nation. It also details the community's perception of current health care needs. The prioritized needs were presented at a regional health summit in the fall of 2013. SWHB implementation strategy to address the prioritized needs will be posted on the hospital website alongside the needs assessment in December 2013. Part VI, Line 3: Scott & White Hospital Brenham ("SWHB") provides patients with information regarding eligibility for financial assistance in a number of ways. Patients are notified of the Scott & White Financial Assistance Policy upon admission or discharge, and in written and oral communications with the patient regarding patient billing statements. Scott & White personnel attempt to screen uninsured patients for eligibility for financial assistance, as well as alternative funding sources, prior to providing services. When screening prior to service is not possible, Scott & White personnel attempt to screen uninsured patients prior to billing. Scott & White financial counselors contacting patients regarding outstanding accounts attempt to screen patients for eligibility for financial assistance and opportunities for alternative funding sources. Part VI, Line 4: Scott & White Hospital Brenham ("SWHB") is located in Washington County, Texas. From 2000 to 2012 the population has grown 12% to 33,872. The per capita income is $21,973 and the average household income is $56,878. Washington county is 59% Caucasion Non-Hispanic, 15% Hispanic, 17% African American and 9% other. 41% of the population is under the age of 18 or over the age of 65. There are 986 families below the poverty line and 72% of those families include children. 47% of the population over the age of 25 have some college education and 80% have graduated high school. Part VI, Line 5: All Scott & White Healthcare System (the "System") facilities are operated in a manner that furthers exempt purposes. Scott & White Healthcare officers and executives plan and direct the activities of all System facilities under the direction and oversight of the Scott & White Healthcare Board of Trustees. The Scott & White Hospital Brenham ("SWHB") Board of Directors is comprised of persons residing in the service area. SWHB maintains an emergency room following EMTALA requirements and has an open medical staff. SWHB is operated for the benefit of the public and no part of income inures to any private individual or serves a private interest. Surplus funds are used to further SWHB's exempt purpose by improving the quality of patient care, expanding facilities, advancing medical training and education and funding research. Scott & White Healthcare has a Financial Assistance Policy that all hospitals in the Scott & White Healthcare System follow, including SWHB, which provides assistance to individuals with incomes up to 375% of the Federal Poverty Guidelines ("FPG"), and free care up to 100% of the FPG. Part VI, Line 6: Scott & White provides personalized, comprehensive, high quality health care services enhanced by medical education and research through 12 acute care hospital facilities, two additional announced facilities, a 240,000+ member regional health plan serving residents in a 29,000-square mile service area of Central Texas, and one of the nation's largest multi-specialty group practices with more than 178 clinics at 65 clinic locations providing care in 46 medical specialties. Scott & White Hospital Brenham ("SWHB") is a subsidiary of Scott & White Healthcare ("SWHC")(EIN: 26-4532547), the parent corporation of the Scott & White Healthcare System (the "System"). The Scott & White Healthcare Foundation ("SWF")(EIN: 27-3513154), a subsidiary of SWHC, raises funds for the priority programs and services of the entire Scott & White System. The Scott & White Healthcare System provided at cost approximately: $60 million in unreimbursed charity care, $46 million in unreimbursed Medicaid, $4.5 million in unreimbursed indigent care, $21 million in unreimbursed subsidized services, $63 million in unreimbursed health professions education, $13 million in unreimbursed research, $1 million in other community benefits, and had a Medicare shortfall of approximately $96 million in the fiscal year ending August 31, 2012.The Scott & White Healthcare System had more than 14,000 employees, including over 1,000 physicians and scientists and 300+ advanced practice professionals during the fiscal year ending August 31, 2012, and served over 537,000 patients accounting for 2.2 million patient visits. Scott & White Memorial Hospital ("SWMH"), located in Temple, Texas, is the flagship hospital of the Scott & White Healthcare System and is the only Level I Trauma Center between Dallas and Austin, Texas. The McLane Children's Hospital Scott & White is the only stand-alone children's hospital between Dallas and Austin, Texas. Scott & White Hospital Brenham had 15,642 patient observation days (excluding newborns), 1,699 surgical cases, 1,733 admissions and 15,881 emergency room visits for the fiscal year ending December 31, 2012. Scott & White Hospital Brenham serves the community through projects such as: health fairs and health screenings, weekly diabetic support groups meetings, children and adult immunizations and screenings, adult fitness classes and various senior adult lectures, health screenings, and classes. Additionally, SWHB maintains a working partnership with Faith Mission and Washington County called the Washington County Health Coalition to help staff and operate the Washington County Community Clinic; which provides care for the medically underserved, underinsured and uninsured people in the community.Scott & White System personnel strive to do more than merely meet the healthcare needs of patients. Employees go into the community to educate about living a healthier life. Targeted populations are provided information on specific needs. For example, physicians specializing in geriatric care hold regular seminars discussing subjects such as preventing injury from falls; questions patients should be asking their doctor, how to maintain a healthy lifestyle with limited mobility, and more. Health educational programs regarding prevention and treatment are offered free or at minimal cost to all community members in a variety of subject areas, such as weight loss, smoking cessation, education on coping with a diagnosis, support groups for families, child safety, heart disease education, diabetes education, sex education for teens, domestic violence prevention and many more. Staff and physicians attend health fairs in the community and provide regular community presentations about health issues for different populations. Clinics in the region offer healthy cooking classes led by a Scott & White dietician to instruct families in creating easy and cost effective healthy meals. As an integrated health care delivery system, Scott & White is able to leverage the Scott & White Health Plan to provide health education information to the community and is actively working to make that information more widely available.Scott & White uses various forms of media to promote health in the community. The System website, blogs, social media, printed flyers, and newspaper and magazine articles written by staff and physicians throughout the year provide information that community members can use to enhance personal health. A specific website has been created to instruct on wellness initiatives (wellness.sw.org). Also, Scott & White staff dedicate many hours serving on community boards and collaborative groups whose missions are to improve the overall health of the community. In addition to these efforts, the System has designated specific funds to be used to enhance healthy initiatives occurring in each community. For example, Scott & White provides substantial financial and in-kind support for multiple free clinics to assist in providing better access and more affordable healthcare to the medically underserved. Scott & White is one of sixteen major U.S. health systems to be part of the National High Value Healthcare Collaborative ("HVHC"). This partnership is designed to improve healthcare, lower costs and make best practices available to the national provider community. The Dartmouth Institute for Health Policy and Clinical Practice leads the collaborative which is studying nine prevalent condition/disease specific areas that have been shown to have wide variation nationally in rates, costs and outcomes. Additional high variation, high cost conditions that affect diverse populations will be added over time. The healthcare systems in this group are responsible for 50 million patients and are using private dollars and research and grant funds to identify ways to get the most out of every healthcare dollar. In June of 2012 the HVHC received a $26 million grant from the Center for Medicare and Medicaid Innovation ("CMMI"). CMMI projects the service improvements funded by this grant will save $64 million over three years, largely due to reduced utilization and costs that have been shown to occur when patients are engaged and empowered to make health care decisions based on their own values and preferences.Scott & White strives to better serve patients while decreasing costs to the healthcare system. One way this is accomplished is through better communication between specialists and primary care physicians creating coordinated and integrated care. Scott & White's electronic medical records (EMR) system allows specialists to review a patient's medical history and lab results and make recommendations to a primary care physician possibly eliminating an office visit. If the specialist needs to see a patient the specialist has access to all tests and lab work prior to the office visit which can prevent a second or third specialty follow-up visit. Scott & White is also using the EMR system to practice active rather than passive medicine. The new EMR system allows Scott & White to automatically remind physicians that patients are due for preventive tests such as mammograms or cholesterol checks. The system allows doctors and nurses to use e-mail to provide patients with test results or to answer questions that previously would have required an office visit.The Scott & White Healthcare System has received numerous awards and accreditations. Scott & White Memorial Hospital was ranked for the eighth time as one of the Top 100 Hospitals by Thomson Reuters. For the second consecutive year, SWMH was named one of the nation's Best Regional Hospitals according to U.S. News & World Report.SWHB serves patients qualifying for federal Medicare and state Medicaid programs and other federal and state means tested assistance programs. Services for indigent, uninsured and underinsured patients are provided according to provisions of the Scott & White Healthcare Financial Assistance Policy, which provides financial assistance to patients up to 375% of the Federal Poverty Guidelines. Scott & White also serves private pay patients and contracts with health plans and insurance companies to provide medical services for their participants. Reports Filed With States Part VI, Line 7 TX 0 0 0 0 0 0 0 1 0 Patricia M Currie 0 540415 0 192500 0 2848 0 32500 0 21182 0 789445 0 0 Robert L Haydon MD 0 199005 0 400 0 6613 0 15369 0 13913 0 235300 0 0 William L Rayburn MD 0 528372 0 94000 0 2962 0 32500 0 22441 0 680275 0 0 Dick Dixon 0 431778 0 207750 0 1646 0 32500 0 20040 0 693714 0 0 Jason D Jennings 0 268657 0 56710 0 11484 0 32500 0 19086 0 388437 0 0 Glen RCouchman MD 0 545222 0 192500 0 3349 0 32500 0 20613 0 794184 0 0 Teresa Gabriel 0 145105 0 8069 0 519 0 20331 0 12139 0 186163 0 0 Robert W Pryor MD 0 895623 0 300000 0 7350 0 32500 0 19570 0 1255043 0 0 Cynthia B Dunlap 0 245315 0 62750 0 841 0 32500 0 13342 0 354748 0 0 James Carroll 0 375213 0 132300 0 3501 0 32500 0 13914 0 557428 0 0 Marc R Hallee 0 366554 0 129750 0 384 0 32500 0 14103 0 543291 0 0 Matthew L Chambers 0 392598 0 140000 0 3996 0 32500 0 21871 0 590965 0 0 Stephen F Sullivan 0 230513 0 40833 0 1032 0 0 0 12785 0 285163 0 0 Michael R Schlabach MD 0 249593 0 10250 0 13637 0 32500 0 20119 0 326099 0 0 John L Simms 0 153940 0 250 0 305988 0 20392 0 9807 0 490377 0 0 Alfred B Knight MD 0 242623 0 87500 0 13411 0 32500 0 18601 0 394635 0 0 Peter Brumleve 0 118744 0 0 0 81232 0 10219 0 4521 0 214716 0 0 Part I, Line 7 Discretionary bonuses are an element of various Scott & White Healthcare System (the "System") compensation plans. The Scott & White Healthcare Board of Trustees, which is the governing body of the Scott & White Healthcare System and the Board Compensation Committee have approved plans designed to measure performance based on differing job functions. The Board of Trustees approves the bonus pools reserved for the various plans. The Board of Trustees determines and approves the bonus, if any, for the System's Chief Executive Officers and other executive level personnel. A Washington County Health Facilities Development 742729552 999999999 2004-03-03 5250000 See Schedule O 0 0 0 A 5286199 105000 5181199 2005 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 Phillip Couchman Family of Key Employee 48128 Employee of related organization 0 Jarrod Pryor Family of Key Employee 100496 Employee of related organization 0 Brett Dixon Family of Director 54675 Employee of related organization 0 John Carroll Family of Key Employee 85378 Employee of related organization 0 Marjo Carroll Family of Key Employee 68933 Employee of related organization 0 Michele Hallee Family of Key Employee 34100 Employee of related organization 0 Form 990, Part V, Line 2a: Employees of the Scott & White Healthcare System are employed by Scott & White Memorial Hospital (EIN: 74-1166904) or Scott & White Clinic (EIN: 74-2958277). This is done to achieve parity and consistency in compensation and benefits offered to employees and to reduce administration costs. Consistent with this practice, employee Form W-2's are filed by Scott & White Memorial Hospital or Scott & White Clinic. For financial reporting purposes, compensation, benefits and other employee costs are assigned to the Scott & White affiliate for which services are rendered. Oversight of and responsibility for the activities of employees are vested in the board of directors and management of the Scott & White Healthcare subsidiary to which such employees are assigned. All required employment forms have been filed by Scott & White Memorial Hospital and Scott & White Clinic. Form 990, Part VI, Section A, line 6 Scott & White Hospital Brenham's ("SWHB") sole member is Scott & White Healthcare (EIN: 26-4532547), an organization exempt from tax under IRC section 501(c)(3) and a public charity under IRC section 509(a)(3). Form 990, Part VI, Section A, line 7a Scott & White Hospital Brenham's ("SWHB") sole member is Scott & White Healthcare (EIN: 26-4532547), an organization exempt from tax under IRC section 501(c)(3) and a public charity under IRC section 509(a)(3). Election of the SWHB Board of Directors requires the approval of the Scott & White Healthcare Board of Trustees by majority vote. The majority of the Scott & White Healthcare Board of Trustees is comprised of individuals who are representative of the community. Form 990, Part VI, Section A, line 7b The Scott & White Hospital Brenham's ("SWHB") sole member is Scott & White Healthcare (EIN: 26-4532547), an organization exempt from tax under IRC section 501(c)(3) and a public charity under IRC section 509(a)(3). Actions taken by the SWHB Board of Directors are subject to oversight and approval of the Scott & White Healthcare Board of Trustees. The majority of the Scott & White Healthcare Board of Trustees is comprised of individuals who are representative of the community and not otherwise associated with Scott & White Healthcare or other affiliates in the System. Form 990, Part VI, Section B, line 11 The Scott & White Hospital Brenham ("SWHB") Board of Directors was provided access to a copy of the Form 990, and the Scott & White Healthcare Vice President of Corporate Tax and the Corporate Tax Director were made available for questions, clarification, or feedback prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Annually, a written questionnaire is provided to all persons identified as being subject to the Scott & White Healthcare System Conflict of Interest Policy (Tax), requesting responses to questions designed to identify potential conflicts. Responses are monitored and reviewed by System personnel and follow-ups are initiated as required. The Conflict of Interest Policy (Tax) is reviewed before each board meeting or board committee meeting. Board members or persons having business with the Board are asked to identify conflicts which may arise with respect to business conducted by the Board or committee during the meeting. Form 990, Part VI, Section B, line 15 The compensation review process is performed annually. All physician compensation is reviewed including pay, production data and total compensation. The physician compensation is then benchmarked against industry standards using data from ten different industry surveys. This review is performed by an independent consultant and presented to the Scott & White Healthcare Board of Trustees Compensation Committee. Scott & White Healthcare ("SWHC")(EIN: 26-4532547) is the parent corporation of Scott & White Hospital Brenham ("SWHB"). Compensation for the Scott and White Healthcare System (the "System") Officers along with regional Chief Executive Officers and Chief Medical Officers are reviewed annually. An independent consultant compares total compensation to benchmark surveys. The Scott & White Healthcare Board of Trustees Compensation Committee reviews the compensation and comparability data annually. Form 990, Part VI, Section C, line 19 The Scott & White Hospital Brenham ("SWHB") governing documents and Conflict of Interest Policy (Tax) are available to the public upon request. SWHB does not have separately audited financial statements. The audited financial statements of the Scott & White Healthcare System are available at http://www.dacbond.com and upon request. Form 990, Part VII: Average hours per week recorded in column B for the Officers, Directors, Key Employees and Highly Compensated Employees represent total hours worked for the entire Scott & White Healthcare System. Other Fees Form 990, Part IX, line 11g Contract Services: Program service expenses 3,386,757. Management and general expenses 307,234. Fundraising expenses 0. Total expenses 3,693,991. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfers to Captive Insurance Company -324,875. Subsidiary Earnings and Changes in Net Assets 226,264. Defined Benefit Plan actuary adjustment -5,245,132. Other transfers to subsidiary -26,107. Form 5471 Disclosure Statement Related to Forms 5471, Information Return of U.S. Persons With Respect to Certain Foreign Corporations, Filed on Behalf of the Taxpayer: Under the constructive ownership rules of IRC Sections 958(a) and (b). The taxpayer is required to file Forms 5471, Information Return of U.S. Persons With Respect to Certain Foreign Corporations, as a Category 5 filer with respect to certain controlled foreign corporations (CFCs). These filing requirements are or will be satisfied through the filing of Forms 5471 for these CFCs by other U.S. taxpayers identified below who have the same filing requirement. Taxpayer Name: Scott & White Memorial Hospital Taxpayer Address: 2401 S. 31st Street Temple, TX 76508 Taxpayer Identification Number of U.S. tax return with which the Forms 5471 were or will be filed: 74-1166904 IRS Service Center where U.S. tax return was or will be filed: efile Scott & White Properties Opportunities LLC 2401 S 31st Street Temple TX 76508 452920812 Investment TX Scott & White Properties Holdings Inc Scott & White Properties Management LLC 2401 S 31st Street Temple TX 76508 452920980 Investment TX Scott & White Properties Opportunities LLC Scott & White Healthcare 2401 S 31st Street Temple TX 76508 264532547 Operational Support TX 501 (c) (3) Line 11a, I N/A 0 Scott & White Memorial Hospital 2401 S 31st Street Temple TX 76508 741166904 Hospital Services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Scott & White Clinic 2401 S 31st Street Temple TX 76508 742958277 Physician Services TX 501 (c) (3) Line 9 Scott & White Healthcare 1 Scott & White Continuing Care Hospital 2401 S 31st Street Temple TX 76508 202850920 Hospital Services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Scott & White Hospital-Round Rock 2401 S 31st Street Temple TX 76508 203749695 Hospital Services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Hillcrest Baptist Medical Center 100 Hillcrest Medical Blvd Waco TX 76712 741161944 Hospital Services TX 501 (c) (3) Line 3 Scott & White Memorial Hospital 1 Scott & White EMS Inc 2401 S 31st Street Temple TX 76508 753242749 Emergency Transportation TX 501 (c) (3) Line 9 Scott & White Memorial Hospital 1 Scott & White Healthcare Foundation 2401 S 31st Street Temple TX 76508 273513154 Fundraising TX 501 (c) (3) Line 7 Scott & White Healthcare 1 Scott & White Health Plan 2401 S 31st Street Temple TX 76508 742052197 HMO/Insurance TX 501 (c) (4) Scott & White Healthcare 1 Scott & White Hospital-Taylor 2401 S 31st Street Temple TX 76508 741595711 Hospital Services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Scott & White Hospital-Llano 2401 S 31st Street Temple TX 76508 273026151 Hospital Services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Scott & White Hospital-College Station 2401 S 31st Street Temple TX 76508 274434451 Hospital Services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Brenham Hospital Services Corporation 2401 S 31st Street Temple TX 76508 742605157 Operational Support TX 501 (c) (3) Line 11a, I Scott & White Healthcare 1 Scott & White Foundation-Brenham 2401 S 31st Street Temple TX 76508 742460815 Fundraising TX 501 (c) (3) Line 7 Scott & White Hospital-Brenham 1 Brenham Care Center 2401 S 31st Street Temple TX 76508 742663229 Healthcare TX 501 (c) (3) Line 9 Scott & White Hospital-Brenham 1 Hillcrest Family Health Center 100 Hillcrest Medical Blvd Waco TX 76712 742730350 Physician Services TX 501 (c) (3) Line 11c, III-FI Hillcrest Baptist Medical Center 1 Hillcrest Physician Services 100 Hillcrest Medical Blvd Waco TX 76712 742967081 Physician Services TX 501 (c) (3) Line 11c, III-FI Hillcrest Baptist Medical Center 1 Scott & White Properties Holdings Inc 2401 S 31st Street Temple TX 76508 452920596 Investment TX N/A C 1 Scott & White Properties Inc 2401 S 31st Street Temple TX 76508 742497061 Hotel Services TX N/A C 1 Scott & White Assurance Ltd 23 Lime Tree Bay Grand Cayman Grand Cayman CJ 980589956 Investment CJ N/A C 1 Hillcrest Holdings Inc 3000 Herring St Waco TX 76708 742793367 Operational Support TX N/A C 1 Atumida Inc 2401 S 31st Street Temple TX 76508 270583030 Research TX N/A C 1 Insurance Company of Scott & White 2401 S 31st Street Temple TX 76508 743092083 Insurance TX N/A C 1 Charitable Remainder Trust #1 PO Box 6101 Temple TX 765036101 526854329 Investment Trust TX N/A T 1 Charitable Remainder Trust #2 PO Box 6101 Temple TX 765036101 206463694 Investment Trust TX N/A T 1 Charitable Remainder Trust #3 PO Box 6101 Temple TX 765036101 416504860 Investment Trust TX N/A T 1 Charitable Remainder Trust #4 PO Box 6101 Temple TX 765036101 742751167 Investment Trust TX N/A T 1 Charitable Remainder Trust #5 PO Box 6101 Temple TX 765036101 746391353 Investment Trust TX N/A T 1 Charitable Remainder Trust #6 PO Box 6101 Temple TX 765036101 746397360 Investment Trust TX N/A T 1 Charitable Remainder Trust #7 PO Box 6101 Temple TX 765036101 742751168 Investment Trust TX N/A T 1 Charitable Remainder Trust #8 PO Box 6101 Temple TX 765036101 746423552 Investment Trust TX N/A T 1 Phil and June Hivnor Charitable 2401 S 31st Street Temple TX 76508 900850773 Investment Trust TX N/A T 1 Nelda I Staller Charitable Remainder Unitrust No 1 2401 S 31st Street Temple TX 76508 326224724 Investment Trust TX N/A T 1 Scott & White Lake of the Hills Regional Medical Center 2401 S 31st Street Temple TX 76508 451608264 Hospital Services TX N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 Scott & White Clinic O 170778 Cost Scott & White Memorial Hospital P 3563823 Cost Scott & White Memorial Hospital S 1253291 Cost Scott & White Healthcare P 3731102 Cost Scott & White Healthcare R 3197188 Cost Scott & White Foundation Brenham R 70964 Cost Scott & White Foundation Brenham S 91946 Cost