2012-11-14T10:39:06-06:00 2011-12-31 990 2011-01-01 742519752 Scott & White Hospital Brenham SCOT 2542159043 2401 S 31st Street Temple TX 76508 Jason Jennings 2542159043 2012-11-01 2011 2016-02-24 21:20:13Z Jason Jennings 2401 S 31st Street Temple TX 76508 50955469 0 X www.sw.org X 1989 TX Scott & White provides personalized, comprehensive, high quality care enhanced by medical education and research through one of the nation's largest multi-specialty group practices. Scott & White Hospital Brenham (SWHB) is a subsidiary of Scott & White Healthcare (SWHC)(EIN: 26-4532547), a 501(c)(3) organization, the parent corporation of the Scott & White Healthcare System (the "System"). The Scott & White Healthcare Foundation (SWF)(EIN: 27-3513154) raises funds for the priority programs and services of the entire Scott & White System. The System includes 12 hospital sites, more than 60 clinics and a 229,000+ member health plan serving residents in a 29,000+ square mile service area spanning 35 counties. The system provided at cost approximately: $75,000,000 in unreimbursed charity care, $68,000,000 in unreimbursed Medicaid and other means tested government programs, $28,000,000 in subsidized services and incurred a Medicare shortfall of $46,000,000. 11 6 0 0 0 0 0 623356 40714942 35855808 1420440 956875 92410 98357 42227792 37534396 23710 22453 0 0 16131869 15998977 0 0 0 22232473 17790475 38388052 33811905 3839740 3722491 39688849 50948353 37778032 40530507 1910817 10417846 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 31380809 35858501 Scott & White provides personalized, comprehensive, high quality care enhanced by medical education and research through one of the nation's largest multi-specialty group practices. Scott & White Hospital Brenham (SWHB) is a subsidiary of Scott & White Healthcare (SWHC)(EIN: 26-4532547), a 501(c)(3) organization, and the parent corporation of the Scott & White Healthcare System (the "System"). The Scott & White Healthcare Foundation (SWF)(EIN: 27-3513154), a 501(c)(3) Public Charity under 170(b)(1)(A)(vi), raises funds for the priority programs and services of the entire Scott & White System. The System includes 12 hospital sites, more than 60 clinics and a 229,000+ member health plan serving residents in a 29,000+ square mile service area spanning 35 counties. The Scott & White Healthcare System employs 1,300 primary and specialty physicians, scientists and advanced practice providers. The Scott & White Healthcare System provided at cost approximately: $75,000,000 in unreimbursed charity care, $68,000,000 in unreimbursed Medicaid and other means tested government programs, $53,000,000 in unreimbursed health professions education and research, $28,000,000 in subsidized services and incurred a Medicare shortfall of $46,000,000 for the fiscal year ending August 31, 2011. Scott & White Memorial Hospital (SWMH), a subsidiary of SWHC located in Temple, Texas, is the flagship hospital of the system and has the only Level I Trauma Center between Dallas and Austin, Texas. Scott & White Hospital Brenham operates a 60-Bed acute care hospital, and it is a level III trauma center. Scott & White Hospital Brenham had 6,462 patient observation days (excluding newborns), 1,820 surgical cases, and 15,695 emergency room visits for the calendar year ending December 31, 2011. SWHB provides medical services to the citizens of Washington County and to the surrounding counties of Austin, Burleson, Colorado, Fayette, Grimes, Lee and Waller. These counties have either limited hospital services, or in some cases, no hospital services. SWHB provides medical, surgical, obstetrical and newborn services in inpatient settings, as well as outpatient diagnostic (lab, radiology and ct scan), surgical and rehabilitation services (physical therapy, occupational therapy and speech therapy). SWHB is an American Diabetes Association recognized diabetic center. In addition to diabetes education, SWHB provides free or low cost health screenings, immunizations and health fairs.The Scott & White Healthcare System is meeting the needs of its communities through programs like the 14th Annual Seniors Day in the Brenham community were 1,000 people were given free immunizations as well as free health screenings. The 15th Annual Kids Day served 800 Brenham children and their parents providing immunizations, health screenings and fire safety education. Scott & White also provides health information on prevention and early identification of chronic diseases, such as cancer, diabetes, and heart conditions for underserved and underinsured. Special events are hosted to help identify possible risk factors for disease through free heart screenings and physicals for student athletes. Scott & White holds weekly disease-specific social issues support group services for patients and families. Scott & White provides Health education and well-being programs for: smoking cessation, Worth the Wait, child abuse prevention, childbirth classes, stress management, diabetes education, weight loss programs, more than 50 health fairs and other community-wide wellness events. Scott & White provides financial support for the following free clinics that provide care to the medically underserved: Temple Community Free Clinic, Holland ISD Free Clinic, Martha's Free Clinic, Greater Killeen Free Clinic, Health For All Clinic and Prenatal Clinic, Mission Waco and Family Health Center. These clinics are located throughout the 29,000+ square mile service area of the Scott & White System.Scott & White is one of thirteen major health systems to be part of the National High Value Healthcare Collaborative (HVHC). This partnership is designed to improve healthcare, lower costs and move best practices out to the national provider community. The Dartmouth Institute for Health Policy and Clinical Practice heads the collaborative which is studying nine prevalent condition/disease specific areas that have been shown to have wide variation in rates, costs and outcomes nationally. 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 lives and are taking private dollars along with research and grant funds to find ways get the most out of every healthcare dollar. Scott & White is creating a patient centered model of care called a medical home. This is a team of people who will provide care for patients in the Department of Family Medicine. This team will provide better patient care partly through patient education. Members of the team will include the patient's doctor, the nursing staff, a nurse practitioner or physician assistant, phone clerks and the business staff among others. The increase in staff to create a medical home is not reimbursed and is a cost Scott & White bares to provide better patient centered care.Hospital to Home is an innovative patient centric discharge program started in the Scott & White hospitals. This program was set up to prepare patients for discharge from day one. Scott & White found that by putting a Clinic clerk in the hospital as a discharge advocate, this clerk could help the patient schedule follow up appointments to fit the patient's schedule before discharge. Because Scott & White is an integrated health system there was no additional cost to move the clerk from the clinic to hospital setting. Scott & White found that before Hospital to Home was started many patients had follow up appointments that did not meet their schedule, by the discharge advocate working with the patient and their family to schedule more convenient appointments, patient satisfaction has increased. Scott & White has gone from one discharge advocate to six.Scott & White is always striving to serve patients better while decreasing costs to the healthcare system. One way to do this is through better communication between specialists and primary care physicians creating coordinated and integrated care. Through Scott & White's electronic medical records (EMR) system, specialists can review a patient's medical history and lab results and make recommendations to a primary care doctor possibly without even seeing the patient first. If they need to see the patient they have access to all of the tests and blood work ahead of time which can save a second or third specialty visit to follow up. Scott & White is also working towards using the EMR system to practice active rather than passive medicine. In the next few years Scott & White will be able to use their EMR system to automatically remind doctors when their patients are due for preventive tests like mammograms or cholesterol checks. The system will allow doctors and nurses to use e-mail to give patients their test results or to answer questions that previously would have required a clinic visit.The Scott & White Healthcare System has received numerous awards and accreditations. Scott & White has been ranked one of the top 100 health systems by Thomson Reuters. SWMH was named as one of the nation's Best Regional Hospitals 2011-12 according to U.S. News & World Report. SWHC received the Consumer Choice Award from the National Research Corporation (NRC) for 2010/2011. 31380809 1 1 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 1 1 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 X 41 0 1 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 0 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 40.00 X X 0 480343 46740 Robert Wright PhD 1.00 X 0 0 0 Charles R Moser 1.00 X 0 0 0 Glen RCouchman MD 40.00 X 0 573830 53381 Robert Haydon MD 40.00 X 77651 135673 7581 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 Rayburn MD 40.00 X 0 555012 50518 John L Simms 40.00 X 0 227397 41453 Alfred B Knight MD 40.00 X 0 779908 49821 Dennis L Laraway 40.00 X 0 444702 42397 Robert W Pryor MD 40.00 X 0 866989 46463 Cynthia B Dunlap 40.00 X 0 202857 38845 Gail O Vanzyl 40.00 X 0 175791 74647 Teresa Gabriel 40.00 X 0 151489 30970 Debra Makowsky 40.00 X 0 164263 23641 Jeanette Scheel 40.00 X 0 107462 14611 Beth Teverbaugh 40.00 X 0 113102 22793 Linda Nagy 40.00 X 0 111762 21572 Ethel Oberpriller 40.00 X 0 107631 18482 Denise Norton 40.00 X 0 104705 15633 77651 5302916 599548 0 0 1 0 Shawn J Khan MD 301 Whispering Oaks Circle Brenham TX 77833 Physician Services 232248 Hunter Pharmacy Services Inc 3420 Executive Services Inc Ste 10 Austin TX 78731 Pharmacy Management 189486 Legacy Healthcare Services LLC 3001 Spring Forest Rd Raleigh NC 27616 Therapy Services 188577 William Smith PO Box 307 Columbus TX 78934 Respiratory Services 136180 Adrienne Carmack MD 633 Medical Parkway Brenham TX 77833 Physician Services 128675 5 623356 623356 Net Patient Care Rev 624100 35855808 35855808 35855808 608096 608096 13769852 13421073 348779 348779 348779 Cafeteria 722210 95664 95664 Miscellaneous 900099 2693 2693 98357 37534396 35858501 0 1052539 22453 22453 13532140 12919002 613138 2465990 2348815 117175 847 847 39900 39900 7312 7312 3980581 3684209 296372 16703 16703 439245 439245 341241 341241 619115 619115 132372 132372 1000 1000 1274222 1274222 669706 669706 Patient Care 4663776 4663776 Bad Debt Expense 4616631 4616631 Rent/Maintenance 493251 493251 Overhead/Shared Service 330506 330506 164914 67782 97132 33811905 31380809 2431096 0 2153748 94046 8201964 5827784 6142272 9329 5065 171602 563494 1457664 1093998 561858 406244 5055545 424039 3747954 4631506 22471141 22982057 818354 6827707 853471 1615944 0 39688849 50948353 1827121 1002664 5666956 5368032 20249427 27320273 10034528 6839538 37778032 40530507 X 616027 9755670 740659 108045 554131 554131 1910817 10417846 39688849 50948353 X 3722491 4784538 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1404 0 0 0 1404 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". 1292706 630530 662176 1068025 224681 1292706 985882 82146 1068028 972978 211671 198767 985882 0.83680 0.16320 0 1 1 450998 450998 2901382 117028 2784354 1551828 283464 1268364 151337 23547 127790 4631506 Investment in Subsidiary 6827707 C 6827707 Insurance/Check Reserve 50000 Payroll/Benefit Liabilities 6219999 Capital Leases 569539 6839538 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: 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, 2011 and 2010. 1 1 1 X 1 X 1 1 0 695628 695628 0.02380 3291873 2391092 900781 0.03090 71173 57495 13678 0.00050 4058674 2448587 1610087 0.05520 8202420 5721270 2481150 0.08500 8202420 5721270 2481150 0.08500 12261094 8169857 4091237 0.14020 0 4616631 5396443 7010350 -1613907 X 1 1 1 1 Scott & White Hospital Brenham

700 Medical Parkway Brenham TX 77833

X X X Scott & White Hospital Brenham 1 1 1 200.000000000000 1 200.000000000000 1 X X X X X 1 0 1 0 1 X 0 0 Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 4616631. Part III, Line 4: Bad debt is recorded as the cost of forgone charges. 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: Patient accounts receivable are stated at estimated net realizable value. Scott & White maintains allowances for uncollectible accounts for estimated losses resulting from a payor's inability to make payments on accounts. Scott & White uses a balance sheet approach to value the allowance account based on historical write-offs, payor type, and the aging of the accounts. Accounts are written off when collection efforts have been exhausted. Management continually monitors and adjusts, as necessary, allowances associated with its receivables. The majority of uncollectible accounts result from uninsured patients and patient co-pays and deductibles. Part III, Line 8: Scott & White Hospital Brenham 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: Scott & White Hospital Brenham's 2011 Cost Report as filed with Centers for Medicare & Medicaid Services (CMS) less the amount included in subsidized services Schedule H Part I Line 7g. Part III, Line 9b: The debt collection policy for the Scott & White Healthcare system identifies charity care and financial assistance as a means to reduce a patient's financial responsibility. It then refers to the charity care policy which states that patients who qualify for charity care do not pay for services and patients who receive financial assistance will not be pursued for collection. Scott & White Hospital Brenham Part V, Section B, Line 19d: The hospital provides a 20% discount on total charges for uninsured individuals covering emergency or other medically necessary care. Part VI, Line 2: Scott & White Hospital Brenham (SWHB) completed their health needs assessment in July of 2010. SWHB looked at chronic diseases in Washington County as compared with those of the state of Texas and the nation. SWHB looked at the existing programs in the community that addressed these issues and developed an action plan based on this information. Part VI, Line 3: Scott & White Hospital Brenham (SWHB) educates patients in regards to their eligibility for financial assistance in a number of ways. Patient billing statements include phone contact information for patients seeking information regarding financial assistance. Financial counselors are available to assist patients in determining eligibility, assisting with applications for assistance as well as making payment arrangements. Additionally, SWHB contracts with a third party vendor to routinely screen self-pay patients for eligibility for local, state and federal assistance programs that may be available. These services are offered at no cost to patients. Part VI, Line 4: The Scott & White Healthcare system provides care for patients in 35 counties in the state of Texas covering 29,000+ square miles. Eighty-five percent of the patients come from a primary service area including the counties of Bell, Brazos, Coryell, Falls, Lampasas, McLennan, Milam, and Williamson. Eight percent of patients come from the secondary service area including Blanco, Bosque, Brown, Burleson, Burnet, Comanche, Grimes, Hamilton, Hays, Hill, Hood, Johnson, Lee, Leon, Limestone, Llano, Madison, Mills, Robertson, San Saba, Somervell, Travis and Washington counties.In Scott & White's primary service area, the total population is 1,268,822 and the median household income is $46,930. Twenty-seven percent of the population is under the age of 17; 42% is between the ages of 18 and 44; 21% is between the ages of 45 and 64; and 10% of the population is over 65. The top three ethnicities in the primary service area are Caucasion Non-Hispanic 61.08%, 20.67% Hispanic and 12% African American.Scott & White Hospital Brenham (SWHB) is located in Washington County, Texas. From 2000 to 2012 the population has grown 13.29% to 34,410. The per capita income is $21,973 and the average household income is $55,768. 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 1,012 families below the poverty line and 68% of those families include children. 49% of the population over the age of 25 have some college education and 79% have graduated high school. Part VI, Line 5: All Scott & White Healthcare facilities are operated in a manner that furthers the organization's exempt purposes. Scott & White Healthcare officers and executives plan and direct the activities of all facilities under the direction and oversight of the Board of Trustees of Scott & White Healthcare, sole corporate member of Scott & White Hospital Brenham (SWHB). The SWHB Board of Directors is comprised of persons residing in the service area. As explained in response to Form 990 Part VI, Section A, Question 7b, the SWHB Board of Directors does not consist of a majority of independent directors because SWHB relies on the Scott & White Healthcare Board of Trustees, which is controlled by a majority of community trustees, to meet board control tests. Surplus funds are reinvested in facilities, equipment and programs to further SWHB's exempt purposes. Part VI, Line 6: Scott & White provides personalized, comprehensive, high quality care enhanced by medical education and research through one of the nation's largest multi-specialty group practices. Scott & White Hospital Brenham (SWHB), a 501(c)(3) corporation, is a subsidiary of Scott & White Healthcare (SWHC)(EIN: 26-4532547), a 501(c)(3) 509(a)(3) - Type 1 supporting organization, the parent corporation of the Scott & White Healthcare system (the "system"). The Scott & White Healthcare Foundation (SWF)(EIN: 27-3513154), a 501(c)(3) Public Charity under 170(b)(1)(A)(vi), raises funds for the priority programs and services of the entire Scott & White Healthcare system. The Scott & White Healthcare system includes 12 hospital sites, more than 60 clinics and a 229,000+ member health plan serving residents in a 29,000+ square mile service area spanning 35 counties of Central Texas. The Scott & White Healthcare system employs 1,300 primary and specialty physicians, scientists and advanced practice providers. The Scott & White Healthcare system provided at cost approximately: $75,000,000 in unreimbursed charity care, $68,000,000 in unreimbursed Medicaid and other means tested government programs, $53,000,000 in unreimbursed health professions education and research, $28,000,000 in subsidized services and incurred a Medicare shortfall of $46,000,000 for the fiscal year ending August 31, 2011. Scott & White Memorial Hospital (SWMH) located in Temple, Texas, a subsidiary of SWHC, is the flagship hospital of the system and has the only Level I Trauma Center between Dallas and Austin, Texas. The McLane Children's Hospital at Scott & White, operated under the EIN of SWMH is the only stand-alone children's hospital between Dallas and Austin, Texas.The entire Scott & White Healthcare system serves patients qualifying for federal Medicare and state Medicaid programs and other federal and state means tested assistance programs. SWHB provides services for indigent patients and uninsured and underinsured patients according to provisions of the Scott & White Charity Care Policy and Patient Financial Assistance Program. 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 1 Grants/scholarships to individual students. 13 22453 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Scholarships are awarded annually to qualified applicants for the purpose of training Nurse Professionals, Radiological Technologists, Medical Laboratory Technologists, and Medical Technologists. Applicants are judged based upon financial need, aptitude, recommendations of teachers and/or personal references, ACT and/or SAT scores, character and moral integrity, and participation in civil, church, and extracurricular activities. Applicants complete a written application and an in-person interview. The Director of Human Resources, the Vice President of Patient & Professional Services, the Director of Development, and Scholarship Committee Members determine the scholarship award winners. 1 0 0 0 0 0 0 0 0 Patricia M Currie 0 479377 0 0 0 966 0 31850 0 14890 0 527083 0 0 Glen RCouchman MD 0 572024 0 0 0 1806 0 31850 0 21531 0 627211 0 0 Robert Haydon MD 77651 129616 0 692 0 5365 0 0 0 7581 77651 143254 0 0 William Rayburn MD 0 554046 0 0 0 966 0 31850 0 18668 0 605530 0 0 John L Simms 0 222791 0 0 0 4606 0 29270 0 12183 0 268850 0 0 Alfred B Knight MD 0 776441 0 0 0 3467 0 31850 0 17971 0 829729 0 0 Dennis L Laraway 0 444256 0 0 0 446 0 31850 0 10547 0 487099 0 0 Robert W Pryor MD 0 864217 0 0 0 2772 0 31850 0 14613 0 913452 0 0 Cynthia B Dunlap 0 201891 0 0 0 966 0 26914 0 11931 0 241702 0 0 Gail O Vanzyl 0 146865 0 0 0 28926 0 67190 0 7457 0 250438 0 0 Teresa Gabriel 0 149547 0 136 0 1806 0 19753 0 11217 0 182459 0 0 Debra Makowsky 0 106126 0 0 0 58137 0 14868 0 8773 0 187904 0 0 Washington County Health Facilities Development 742729552 999999999 2004-03-03 5250000 See Schedule O 0 0 0 5286199 105000 5181199 2005 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 Robert Haydon MD Physician practice loan X 46000 5065 0 1 1 5065 John Wright Family of Director 55668 Employee of related organization 0 Julie Couchman Family of Director 30620 Employee of related organization 0 Jarrod Pryor Family of Officer 59759 Employee of related organization 0 0 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 Healthcare (SWHC)(EIN: 26-4532547), an organization exempt from tax under IRC Section 501(c)(3) and a public charity under IRC Section 509(a)(3), is the sole corporate member of Scott & White Hospital Brenham (SWHB). Form 990, Part VI, Section A, line 7a Scott & White Healthcare (SWHC)(EIN: 26-4532547), an organization exempt from tax under IRC Section 501(c)(3) and a public charity under IRC Section 509(a)(3), is the sole corporate member of Scott & White Hospital Brenham (SWHB). SWHC has the right to appoint the SWHB Board of Directors. 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 Scott & White Healthcare (SWHC)(EIN: 26-4532547), an organization exempt from tax under IRC Section 501(c)(3) and a public charity under IRC Section 509(a)(3), is the sole corporate member of Scott & White Hospital Brenham (SWHB). 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. Form 990, Part VI, Section B, line 11 Scott & White Hospital Brenham's Directors were each provided a copy of Form 990 and all schedules prior to filing with IRS. Contact information was given to allow the directors to ask questions and provide feedback with respect to the information presented in the Form 990. 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, 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 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 15a The compensation review process is performed annually. All officers are included in the annual review. The process utilizes various comparative data with respect to similar organizations. The procedures, rationale and results of the process are documented and retained. Recommended salaries are reviewed by independent compensation consultants and approved by the Compensation Committee of the Scott & White Healthcare Board of Trustees. Form 990, Part VI, Section C, line 19 Scott & White Hospital Brenham's governing documents and conflict of interest policy are available to the public upon request. Financial statements are audited on a consolidated basis for the Scott & White Healthcare system and are also available 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -1,091,938. Transfers to Captive Insurance Company -398,442. Subsidiary Earnings and Changes in Net Assets 5,257,116. Other Nonoperating Changes in Net Assets 1,017,802. Total to Form 990, Part XI, Line 5: 4,784,538. 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 0 0 N/A Scott & White Properties Management LLC 2401 S 31st Street Temple TX 76508 452920980 Investment TX 0 0 N/A 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 Healthcare 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 Lake of the Hills Regional Medical Center 2401 S 31st Street Temple TX 76508 451608264 Hospital Services TX 501 (c) (3) Line 3 Scott & White Healthcare 1 Scott & White Properties Holdings Inc 2401 S 31st Street Temple TX 76508 452920596 Investment TX N/A C Scott & White Properties Inc 2401 S 31st Street Temple TX 76508 742497061 Hotel services TX N/A C Scott & White Assurance Ltd 23 Lime Tree Bay Grand Cayman Grand Cayman CJ 980589956 Captive Insurance Company CJ N/A C Hillcrest Holdings Inc 3000 Herring St Waco TX 76708 742793367 Operational Support TX N/A C Atumida Inc 2401 S 31st Street Temple TX 76508 270583030 Research TX N/A C Insurance Company of Scott & White 2401 S 31st Street Temple TX 76508 743092083 Insurance TX N/A C Charitable Remainder Trust #1 PO Box 6101 Temple TX 765036101 526854329 Investment Trust TX N/A T Charitable Remainder Trust #2 PO Box 6101 Temple TX 765036101 206463694 Investment Trust TX N/A T Charitable Remainder Trust #3 PO Box 6101 Temple TX 765036101 416504860 Investment Trust TX N/A T Charitable Remainder Trust #4 PO Box 6101 Temple TX 765036101 742751167 Investment Trust TX N/A T Charitable Remainder Trust #5 PO Box 6101 Temple TX 765036101 746391353 Investment Trust TX N/A T Charitable Remainder Trust #6 PO Box 6101 Temple TX 765036101 746397360 Investment Trust TX N/A T Charitable Remainder Trust #7 PO Box 6101 Temple TX 765036101 742751168 Investment Trust TX N/A T Charitable Remainder Trust #8 PO Box 6101 Temple TX 765036101 746423552 Investment Trust TX N/A T 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 Brenham Care Center P 565307 Cost Brenham Care Center O 85535 Cost Brenham Care Center Q 294307 Cost Scott & White Foundation Brenham C 623356 Cost Scott & White Memorial Hospital O 16564604 Cost Scott & White Memorial Hospital R 152703 Cost