2012-08-13T16:07:31-05:00 2011-09-30 ERNST & YOUNG US LLP 1401 MCKINNEY SUITE 1200 HOUSTON TX 77010 990 2010-10-01 741100555 TEXAS CHILDREN'S HOSPITAL TEXA 8328242982 6621 FANNIN ST HOUSTON TX 77030 BENJAMIN MELSON 8328241121 2012-08-13 0 ERNST YOUNG US LLP 7137501500 2010 2016-02-24 21:20:13Z BENJAMIN MELSON 6621 FANNIN ST HOUSTON TX 77030 1140968885 0 X WWW.TEXASCHILDRENS.ORG X 1950 TX TO SUPPORT EXCELLENCE IN PATIENT CARE, EDUCATION AND RESEARCH WITH A COMMITMENT TO QUALITY SERVICE AND COST-EFFECTIVE CARE TO ENHANCE THE HEALTH & WELL-BEING OF CHILDREN LOCALLY, NATIONALLY & INTERNATIONALLY. 34 31 6983 1535 1080915 -217287 42024779 55481783 913697000 1015748435 10312700 8308750 19657814 8045244 985692293 1087584212 5344146 7870158 0 0 471272239 506999887 2535595 2092270 5836175 489547556 518100107 968699536 1035062422 16992757 52521790 3233542290 3293884041 1032861337 1022470282 2200680953 2271413759 X TO SUPPORT EXCELLENCE IN PATIENT CARE, EDUCATION AND RESEARCH WITH ACOMMITMENT TO QUALITY SERVICE AND COST-EFFECTIVE CARE TO ENHANCE THEHEALTH AND WELL-BEING OF CHILDREN LOCALLY, NATIONALLY ANDINTERNATIONALLY. 0 0 874435497 7698915 991011044 PATIENT CARE: TEXAS CHILDREN'S HOSPITAL IS AN INTERNATIONALLY RECOGNIZED FULL-CARE PEDIATRIC HOSPITAL OPERATING TWO CAMPUSES IN THE HOUSTON AREA, THE LARGEST OF WHICH IS LOCATED IN THE TEXAS MEDICAL CENTER. ONE OF THE LARGEST PEDIATRIC HOSPITALS IN THE UNITED STATES, THE HOSPITAL OPERATED 491 INPATIENT BEDS, AND MORE THAN 65 AMBULATORY SPECIALTY CLINICS, SUPPORTED BY AN AWARD-WINNING MEDICAL STAFF CONSISTING OF MORE THAN 1,680 BOARD-CERTIFIED PEDIATRIC SUBSPECIALISTS AND DENTISTS, AND A DEDICATED AND HIGHLY SKILLED NURSING AND SUPPORT STAFF OF MORE THAN 6,200. 26648369 62153 9100317 EDUCATION: THE HOSPITAL IS THE PRIMARY PEDIATRIC TEACHING FACILITY FOR BAYLOR COLLEGE OF MEDICINE, OUR LONG TERM ACADEMIC PARTNER. THE CLOSE AFFILIATION BETWEEN THE INSTITUTIONS EXTENDS THROUGHOUT TEXAS CHILDREN'S OPERATIONS, AND BAYLOR FACULTY ARE THE SERVICE CHIEFS, MEDICAL DIRECTORS AND STAFF PHYSICIANS ACROSS THE HOSPITAL'S 60+ SUBSPECIALTY CARE OFFERINGS. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2011, THE HOSPITAL INVESTED MORE THAN $26 MILLION IN THE TRAINING OF OVER 930 TRAINEES IN 79 TRAINING PROGRAMS ROTATING AT TEXAS CHILDREN'S. 46772320 109090 14556159 RESEARCH: DURING 2011, TEXAS CHILDREN'S INVESTED MORE THAN $53.5 MILLION IN OVER 1,500 CLINICAL, BASIC AND TRANSLATIONAL RESEARCH PROJECTS, EXPLORING A WIDE RANGE OF CHILDREN'S HEALTH ISSUES. IN ADDITION, THE HOSPITAL CONTINUED ITS STRATEGIC FOCUS ON THE GROWTH AND SUCCESS OF ALL TEXAS CHILDREN'S RESEARCH ENDEAVORS THROUGH ENHANCED INFRASTRUCTURE, SUCH AS THE SMALL ANIMAL IMAGING FACILITY IN THE FEIGIN CENTER WHERE INVESTIGATORS CAN ACCESS CUTTING EDGE IMAGING MODALITIES, INCLUDING MRI, PET/CT/SPECT AND BIOLUMINESCENCE/FLUORESCENCE. 947856186 1 1 0 1 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 0 0 1 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 1 901 0 1 6983 1 1 1 1 CJ 0 0 0 1 1 0 0 0 0 X 34 31 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X RACHEL SHUPE 8328242951 1919 BRAESWOOD BLVD HOUSTON TX 77030 X WILLIE J ALEXANDER 1.00 X 0 0 0 MERRELL A ATHON 1.00 X 0 0 0 THOMAS G BACON 1.00 X 0 0 0 FREDA WILKERSON BASS 1.00 X X 0 0 0 SUSAN BELL BOYKIN 1.00 X 0 0 0 LEWIS E BRAZELTON III 1.00 X 0 0 0 DONALD P DEWALCH 1.00 X 0 0 0 JAN ELLIS DUNCAN 1.00 X 2472 0 0 JENNY ELKINS 1.00 X 0 0 0 ROBERT L GERRY III 1.00 X 0 0 0 NANCY R GORDON 1.00 X 0 0 0 VICTOR E HARRIS 1.00 X 0 0 0 JOHN B HOWENSTINE 1.00 X 0 0 0 RONALD C HULME 1.00 X X 0 0 0 JODIE LEE JILES 1.00 X 0 0 0 KEVIN C KING 1.00 X X 0 0 0 ANN LENTS 1.00 X X 0 0 0 MICHAEL C LINN 1.00 X 0 0 0 BARRY H MARGOLIS 1.00 X X 0 0 0 WILLIAM N MATHIS 1.00 X 0 0 0 BEN B MCANDREW III 1.00 X 0 0 0 EDWARD S MCCULLOUGH 1.00 X 0 0 0 ROBERT E MEADOWS 1.00 X 0 0 0 DAVID L MENDEZ 1.00 X 0 0 0 ANTHONY G PETRELLO 1.00 X 0 0 0 TOWNES G PRESSLER 1.00 X 0 0 0 GARY L ROSENTHAL 1.00 X X 0 0 0 LE SIMMONS 1.00 X 0 0 0 JOEL V STAFF 1.00 X X 0 0 0 Y PING SUN 1.00 X 0 0 0 BRAD TUCKER 1.00 X X 0 0 0 PETER S WAREING 1.00 X 0 0 0 MAX P WATSON 1.00 X 0 0 0 MARK A WALLACE 40.00 X X 2439696 0 661155 BENJAMIN MELSON 40.00 X 730077 0 225836 ANN STERN 40.00 X 535575 0 181159 RANDY WRIGHT 40.00 X 1284698 0 218808 MARY JO ANDRE 20.00 X 230836 0 74043 SUSAN MACDONALD 40.00 X 414584 0 130031 SANDRA M MCELLIGOTT 40.00 X 284245 0 90194 TABITHA RICE 40.00 X 235605 0 78979 LINDA ALDRED 40.00 X 633276 0 131116 HOWARD W HARPSTER 40.00 X 350976 0 114428 WILLIAM HILTON 40.00 X 321723 0 52226 JOHN SCALES 40.00 X 498086 0 77007 KAY TITTLE 40.00 X 384783 0 131091 SUSAN M DISTEFANO 0.00 X 799135 0 14006 9145767 0 2180079 523 1 1 0 BAYLOR COLLEGE OF MEDICINE 1 BAYLOR PLAZA HOUSTON TX 77030 PHYSCN & FACULTY SVC 29400432 SB AIR INC 2505 CLARK CARR LOOP SE ALBUQUERQUE NM 87106 AVIATION SERVICES 2770017 VIRACOR HOLDING LLC USE #307812 2695 MOMENTUM PLACE CHICAGO IL 606895326 MEDICAL TESTING 2252502 STENTOR INC 385 OYSTER POINT BLVD STE 8B SOUTH SAN FRANCISCO CA 94080 MEDICAL IMAGING SERVICES 1292620 CUSA GCT LLC 950 MCCARTY RD HOUSTON TX 77029 TRANSPORTATION 1171752 77 10276959 10133398 35071426 811461 55481783 NET PATIENT SERVICE RE 621500 956311505 955514742 796763 MGMT SERVICES 811000 22595417 22311265 284152 DISPRO REVENUE 622110 21707266 21707266 PROG.SERV.REVENUE-RELA 621500 7438494 7438494 PROGRAM SUPPORT-BAYLOR 621500 5333047 5333047 2362706 2362706 1015748435 8295091 8295091 370170 71803 298367 298367 298367 50226576 50064604 148313 161972 -148313 13659 13659 223750 10276959 828126 -604376 -604376 5203432 2271827 2931605 2931605 PARKING GARAGE REVENU 812930 5419648 5419648 5419648 1087584212 1014667520 1080915 16353994 7870158 7870158 7014748 7014748 9169 9169 404485275 370973904 31260708 2250663 13118224 11801371 1242150 74703 53246836 48676233 4262481 308122 29125635 25185243 3780969 159423 1998653 1998653 326735 326735 361280 361280 2092270 2092270 167126822 164055797 2896811 174214 6467706 6206032 246830 14844 26678205 25254709 1342965 80531 22777734 18714508 4063226 32526094 32002682 493720 29692 2589063 2376490 200514 12059 2336778 2104162 219420 13196 4007326 566654 3437085 3587 89826851 83023563 6417348 385940 8205511 8205511 PHARMACEUTICAL SUPPLIES 45654254 45654254 MEDICAL/SURGICAL SUPPLI 35564875 35564875 BAD DEBT 22955030 22955030 IMPANTS AND PROSTHESIS 13017778 13017778 BLOOD PURCHASED 5271242 5271242 30408170 26220221 3951018 236931 1035062422 947856186 81370061 5836175 -790675 3911061 32115965 16002662 73973696 64604134 90965894 104544980 8385327 8149048 18816350 22051900 2090764340 629450886 1232292681 1461313454 1638949037 100931099 203283 63863058 66702040 74970957 1445470380 3233542290 3293884041 248826051 241293753 1896914 4165805 722971355 714155567 29909143 27266188 29257874 35588969 1032861337 1022470282 X 1917780057 2016281630 193263313 160292039 89637583 94840090 2200680953 2271413759 3233542290 3293884041 X 52521790 18211016 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 1 322872 0 0 1 70993 393865 0 ORGANIZATIONS DIRECT AND INDIRECT POLITICAL CAMPAIGN ACTIVITIES: PART I-A, LINE 1: LOBBYING EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: TEXAS CHILDREN'S HOSPITAL (TCH) MAINTAINS A GOVERNMENT RELATIONS DEPARTMENT THAT ADVOCATES FOR PUBLIC POLICY AT THE LOCAL, STATE, AND FEDERAL LEVEL. TCH SUPPORTS POLICIES THAT KEEP CHILDREN HEALTHY, BUILD A HIGH QUALITY PEDIATRIC HEALTHCARE SYSTEM, AND ADVOCATE FOR HEALTH COVERAGE FOR CHILDREN. IN ADDITION TO ADVOCACY, THE GOVERNMENT RELATIONS DEPARTMENT PROVIDES EDUCATION ON THE UNIQUE NEEDS OF PEDIATRIC HEALTH CARE PROVIDERS. 89637583 5050504 4108168 3956165 94840090 79706554 435229 11161933 1666133 89637583 77544127 3674137 540963 2052673 79706554 0.06000 0.94000 0.00000 0 1 1 65955577 65955577 482642756 161160478 321482278 23480824 11873501 11607323 865740673 452444790 413295883 652944510 3972117 648972393 1461313454 INVESTMENT IN TCHF 1396383473 CHICO REBATE RECEIVAB 35099088 BOND ISSUANCE COSTS 6161248 MISC RECEIVABLES 4232996 DUE FROM AFFILIATES 3593575 1445470380 INTEREST RATE SWAP 30233578 DEFERRED COMPENSATION 5355391 35588969 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TEXAS CHILDREN'S HOSPITAL ENDOWMENT FUNDS ARE PERMANENTLY RESTRICTED FUNDS IN WHICH THE PRINCIPAL IS HELD IN PERPETUITY AND INVESTED FOR GROWTH AND THE INCOME GENERATED IS CONSUMED IN THE FURTHERANCE OF TEXAS CHILDREN'S EXEMPT PURPOSE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THERE ARE NO MATERIAL UNRECORDED TAX LIABILITIES AS OF SEPTEMBER 30, 2011. CENTRAL AMERICA AND THE CARIBBEAN PROGRAM SERVICES INSURANCE 4230649 0 0 0 0 0 0 4230649 0 4230649 1 0 1 0 0 0 X 0 AL AZ AR CT FL GA IL KS KY ME MD MA MI MS NH NJ NY NC ND OH OK OR PA RI SC TN VA WA WV CA DE ID IN IA MO MT NE NV SD VT WY WI EVENING/LEGEND 9091395 9021135 70260 398046 BAD PANTS GOLF 403879 343574 60305 79667 5 1005435 912250 93185 350413 10500709 10276959 223750 828126 828126 -604376 1 1 X 1 X 1 X 1 1 0 1 1 902 11901150 583142 11318008 0.01120 82916 425102734 365503082 59599652 0.05890 15852 44372776 43152832 1219944 0.00120 99670 481376660 409239056 72137604 0.07130 61938 3876035 231101 3644934 0.00360 913 25488615 2753525 22735090 0.02250 10632 5705081 3320965 2384116 0.00240 53550083 7778395 45771688 0.04520 6775453 83178 6692275 0.00660 73483 95395267 14167164 81228103 0.08030 173153 576771927 423406220 153365707 0.15160 107655 107655 0.00010 107655 107655 0.00010 1 9847708 0 3318410 2722805 595605 X 1 1 1 NA 4 1 WEST TOWER

6621 FANNIN HOUSTON TX 77030

X X X X X X 2 CLINICAL CARE CENTER

6701 FANNIN HOUSTON TX 77030

X X X X X 3 ABERCROMBIE BUILDING

6621 FANNIN HOUSTON TX 77030

X X X X X X FAST TRACK ER-ADD'L ER UNIT OPEN 7AM-3AM, PART OF W TOWER ER 4 WEST CAMPUS

18200 KATY FREEWAY HOUSTON TX 77094

X X X X APPLIES TO ALL FACILITIES 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X X 1 1 X X X X X X 1 0 1 X 0 1 8 THE WOODLANDS HEALTH CENTER

17198 ST LUKES WAY STE 300 THE WOODLANDS TX 77384

HOSPITAL BASED OUTPATIENT/DIAGNOSTIC CLINIC FEIGIN CENTER

1102 BATES STREET HOUSTON TX 77030

MULTI-PURPOSE INCLUDING RESEARCH AND OUTPATIENT LABORATORIES CYFAIR HEALTH CENTER

11777 FM 1960 WEST HOUSTON TX 77065

HOSPITAL BASED OUTPATIENT/DIAGNOSTIC CLINIC SUGAR LAND HEALTH CENTER

15400 SOUTHWEST FREEWAY STE 200 SUGAR LAND TX 77478

HOSPITAL BASED OUTPATIENT/DIAGNOSTIC CLINIC CLEAR LAKE HEALTH CENTER

940 CLEAR LAKE CITY BLVD STE 200 HOUSTON TX 77598

HOSPITAL BASED OUTPATIENT/DIAGNOSTIC CLINIC MATERNAL FETAL MED CLINIC WOODLANDS

17198 ST LUKES WAY STE 630 THE WOODLANDS TX 77384

HOSPITAL BASED OUTPATIENT/DIAGNOSTIC CLINIC MATERNAL FETAL MED CLINIC WILLOWBROOK

13215 DOTSON RD STE 360 HOUSTON TX 77070

HOSPITAL BASED OUTPATIENT/DIAGNOSTIC CLINIC WEST HOUSTON HEALTH CENTER

14740 BARRYKNOLL STE 100 HOUSTON TX 77079

HOSPITAL BASED OUTPATIENT/DIAGNOSTIC CLINIC (CLOSED AS OF 11/30/10) PART I, LINE 3C: TEXAS CHILDREN'S HOSPITAL USES FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. TEXAS CHILDREN'S GRANTS CHARITY TO MEDICALLY AND FINANCIALLY INDIGENT PATIENTS. THE HOSPITAL DOES NOT CONSIDER ASSETS WHEN GRANTING CHARITY CARE. TEXAS CHILDREN'S CHARITY CARE APPLICATION ASKS PATIENTS/FAMILIES TO DISCLOSE ASSETS ONLY FOR PURPOSES OF CONSIDERING ELIGIBILITY FOR GOVERNMENT PROGRAMS. PART I, LINE 7: FOR PART 1, LINE 7, TEXAS CHILDREN'S HOSPITAL APPLIED THE RATIO OF PATIENT CARE COSTS TO CHARGES DERIVED FROM WORKSHEET 2 TO THE CHARGES THE HOSPITAL FORGAVE PURSUANT TO THE CHARITY CARE POLICY (LINE 7A), MEDICAID CHARGES (LINE 7B), OTHER MEANS-TESTED CHARGES (LINE 7C), AND RESEARCH PATIENT CARE CHARGES (LINE 7H). WORKSHEETS 1, 2, 3, 4, 5, 6, 7 & 8 AND THE CORRESPONDING INSTRUCTIONS HAVE BEEN USED AS THE PRIMARY BASIS FOR COMPLETING PART 1, LINE 7.FOR PART 1, LINE 7, TEXAS CHILDREN'S HOSPITAL APPLIED INDIRECT COST RATIOS FROM THE 2011 MEDICARE COST REPORT TO DIRECT PROGRAM EXPENSE TO DETERMINE TOTAL COMMUNITY BENEFIT EXPENSE RELATED TO COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS (LINE 7E), NON-GME HEALTH PROFESSIONAL EDUCATION PROGRAMS (LINE 7F), SUBSIDIZED HEALTH SERVICES (LINE 7G), AND IN-KIND CONTRIBUTIONS (LINE 7I). THE INDIRECT COST RATIOS COMPUTED FROM THE 2011 MEDICARE COST REPORT ARE BOTH COMPREHENSIVE AND A GOOD PROXY OF THE ASSOCIATED OVERHEAD COSTS.FOR PART 1, LINE 7F, TEXAS CHILDREN'S HOSPITAL INCLUDED THE DIRECT AND INDIRECT EXPENSE FROM THE 2011 MEDICARE COST REPORT FOR ACCREDITED GRADUATE MEDICAL EDUCATION (GME) PROGRAMS. THE COST ASSOCIATED WITH NON-NATIONALLY-ACCREDITED GME PROGRAMS HAS BEEN EXCLUDED FROM THE LINE 7F. PART I, LINE 7, COLUMN (F) BAD DEBT EXPENSE INCLUDED IN FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR THE PURPOSES OF CALCULATING THE PERCENTAGES IN THIS COLUMN EQUALS $22,955,030.FOR PART 1, LINE 7H, TEXAS CHILDREN'S HOSPITAL INCLUDED THE DIRECT AND INDIRECT EXPENSE FROM THE 2011 MEDICARE COST REPORT FOR RESEARCH. NO INDUSTRY-SPONSORED RESEARCH ACTIVITIES ARE INCLUDED IN LINE 7H. PART I, LINE 7G: TEXAS CHILDREN'S HOSPITAL HAS INCLUDED THREE HOSPITAL-BASED CLINICS (THE CENTER FOR CHILDHOOD OBESITY CLINIC, RENAL OUTPATIENT SERVICES AND MENTAL HEALTH SERVICES) AND THE MOBILE CLINIC OUTREACH PROGRAM AS SUBSIDIZED HEALTH SERVICES IN PART I, LINE 7G. GROSS EXPENSES OF $5,705,081 OFFSETTING REVENUE OF $3,320,965 AND NET EXPENSES OF $2,384,116 ARE INCLUDED IN THAT LINE. THESE CLINICS QUALIFY AS SUBSIDIZED HEALTH SERVICES BECAUSE THEY PROVIDE CARE AND SERVICES TO VULNERABLE, LOW INCOME POPULATIONS WHOSE COMMUNITIES LACK PRIMARY CARE SERVICES AND PROGRAMS. OBESITY CLINIC - THIS CLINIC WAS DEVELOPED TO ASSIST THE COMMUNITY AND PROVIDERS IN CARING FOR PATIENTS WITH WEIGHT MANAGEMENT CHALLENGES, SEVERE OBESITY (> 95TH PERCENTILE) AND ASSOCIATED CO-MORBIDITIES. THE CLINIC FOCUSES ON UNDERSTANDING THE PHYSICAL AND BEHAVIORAL TENDENCIES OF THE PATIENTS AND TAILORING A PROGRAM TO IMPROVE THE PATIENT'S OVERALL HEALTH. RENAL OUTPATIENT SERVICES - SERVICES STARTED IN 1980 IN RESPONSE TO COMMUNITY NEEDS FOR CHRONIC HEMODIALYSIS FOR CHILDREN. APPROXIMATELY 70 CHRONIC PATIENTS ARE SEEN ANNUALLY BY PEDIATRIC ENDOCRINOLOGISTS AND UNDERGO DIALYSIS TREATMENT AT THE HOSPITAL OR AT HOME IN ORDER TO IMPROVE THEIR HEALTH OUTCOMES WHILE MAINTAINING A CHILD'S NORMALCY OF SCHOOL AND ACTIVITIES WITH FRIENDS. THE PSYCHOLOGY SERVICE SERVES PATIENTS WITH VARYING DEGREES OF ASSESSMENT AND TREATMENT NEEDS. SERVICES INCLUDE NEUROPSYCHOLOGICAL TESTING, COGNITIVE ASSESSMENTS, DIAGNOSTIC ASSESSMENTS FOR BEHAVIORAL OR DEVELOPMENTAL CONCERNS, AND TREATMENT IN THE AREAS OF PRE-SCHOOL AND SCHOOL AGE DISRUPTIVE BEHAVIOR, ANXIETY AND MOOD DISORDERS, COMPLEX ADHD, ETC. THE SERVICE WORKS CLOSELY WITH OTHER SERVICES WITHIN TCH, BOTH INPATIENT AND OUTPATIENT, IN HELPING PATIENTS ADJUST TO AND MANAGE COMPLICATED OR SERIOUS MEDICAL DIAGNOSES. THE SERVICE SEES BETWEEN 5,500 AND 6,000 PATIENTS ANNUALLY.MOBILE CLINIC OUTREACH PROGRAM -TEXAS CHILDREN'S MOBILE CLINICS TRAVEL TO LOW-INCOME, LARGELY HISPANIC NEIGHBORHOODS TO PROVIDE FREE HEALTH CARE TO CHILDREN AGES 0 TO 18 WHO DO NOT HAVE INSURANCE. AS PART OF ITS GOAL TO BUILD A COMMUNITY OF HEALTHY CHILDREN, TEXAS CHILDREN'S OPERATES MOBILE CLINICS TO PROVIDE TRUSTED, HIGH-QUALITY MEDICAL SERVICES TO CHILDREN WHO NORMALLY MIGHT NOT HAVE THE OPPORTUNITY TO RECEIVE HEALTH CARE. PART II, LINE 3 THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITIES SERVED BY PROVIDING EDUCATIONAL OPPORTUNITIES TO LEARN MORE ABOUT SPECIFIC DISEASES OR PUBLIC HEALTH INITIATIVES, PROVIDE HEALTHCARE-RELATED SCHOLARSHIPS AND TO SUPPORT ORGANIZATIONS FOCUSED ON THE ROOT CAUSES OF HEALTH PROBLEMS (E.G., POVERTY AND HOMELESSNESS) AND VULNERABLE POPULATIONS (E.G., CHILDREN WITH SPECIAL HEALTHCARE NEEDS). PART III, LINE 4: FOOTNOTE DESCRIBING BAD DEBT ON FINANCIAL STATEMENTSUNCOLLECTIBLE AMOUNTS FROM PATIENTS WHO DO NOT MEET THE CRITERIA UNDER THE HOSPITAL CHARITY CARE POLICY ARE INCLUDED AS OPERATING EXPENSES IN THE PROVISION FOR DOUBTFUL ACCOUNTS. RECEIVABLES FOR THE RELATED REVENUE ARE RECORDED FOR THE FULL AMOUNT AND ARE OFFSET BY THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND DOUBTFUL ACCOUNTS AND APPROPRIATELY REFLECTED AT NET REALIZABLE VALUE IN THE COMBINED BALANCE SHEETS. MANAGEMENT ROUTINELY ASSESSES THESE RECORDED ALLOWANCES RELATIVE TO CHANGES IN PAYOR MIX, CASH COLLECTIONS, WRITE-OFF, RECOVERIES, AND MARKET DYNAMICS. COSTING METHODOLOGY TO DETERMINE BAD DEBT EXPENSE AT COST UTILIZES THE SAME COST TO CHARGE RATIO IDENTIFIED ON WORKSHEET 2. BAD DEBT EXPENSE IS CALCULATED AS THE CHARGES WRITTEN OFF (AT FULL ESTABLISHED RATE) MULTIPLIED BY THE COST TO CHARGE RATIO. BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER CHARITY CARE POLICY TEXAS CHILDREN'S HOSPITAL DOES NOT CONTEND THAT ANY PORTION OF PATIENT CHARGES WRITTEN-OFF TO BAD DEBT EXPENSE (AT COST) IS ATTRIBUTABLE TO THE ORGANIZATION'S CHARITY CARE POLICY OR SHOULD BE CONSIDERED A COMMUNITY BENEFIT. ALL UNCOLLECTED CHARGES ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY ARE INCLUDED IN LINE 7A (AT COST). PART III, LINE 9B: THE HOSPITAL'S DEBT COLLECTION POLICY DIRECTS HOSPITAL PERSONNEL TO REFERENCE THE PROCEDURES OUTLINED IN THE HOSPITAL'S FINANCIAL ASSISTANCE/CHARITY CARE POLICY WHEN THE PATIENTS ARE SUSPECTED TO QUALIFY FOR ASSISTANCE. WEST CAMPUS PART V, LINE 4 TEXAS CHILDREN'S HOSPITAL WEST CAMPUS WAS CREATED TO RESPOND TO THE GROWING NEED FOR EXPERT PEDIATRIC HEALTH CARE IN WEST HOUSTON, ONE OF THE CITY'S MOST RAPIDLY GROWING COMMUNITIES. AS GREATER HOUSTON'S FIRST SUBURBAN HOSPITAL DESIGNED EXCLUSIVELY FOR CHILDREN, THIS COMMUNITY HOSPITAL OFFERS THE EXPERT CARE PATIENTS AND FAMILIES HAVE COME TO TRUST FROM TEXAS CHILDREN'S HOSPITAL COUPLED WITH A LOCATION THAT'S CONVENIENT AND ACCESSIBLE FOR AREA FAMILIES. APPLIES TO ALL FACILITIES PART V, SECTION B, LINE 11H: FACTORS USED IN DETERMINING AMOUNTS CHARGED TO PATIENTS - OTHER:CITIZENSHIP, RESIDENCY SERVICE AREA, DENIALS BY ALL POTENTIAL INSURANCE FUNDING SOURCES, EMPLOYMENT STATUS, CURRENT FINANCIAL OBLIGATIONS, GOOD FAITH EFFORT, IF PREVIOUS PATIENT, THE PAYMENT HISTORY, NUMBER OF FAMILY MEMBERS LIVING IN HOUSEHOLD, PHYSICIAN, PATIENT DIAGNOSIS, HOUSEHOLD EXPENSES, REEVALUATION EVERY SIX MONTHS OR REEVALUATION DUE TO CHANGE IN CIRCUMSTANCES SUCH AS SUBSEQUENT SERVICES, FAMILY SIZE OR INCOME CHANGES, ETC., CHARITY COMMITTEE DETERMINATION, COOPERATION WITH THE APPLICATION PROCESS AND EXCEPTIONS DUE TO EXTENUATING CIRCUMSTANCES. APPLIES TO ALL FACILITIES PART V, SECTION B, LINE 13G: THE HOSPITAL ANNUALLY PLACES A NOTICE OF ITS CHARITY CARE/FINANCIAL ASSISTANCE POLICY IN THE LEGAL SECTION OF A WIDELY READ LOCAL PAPER, THE HOUSTON CHRONICLE, AS WELL AS IN THE SPANISH VERSION OF THIS PAPER, LA VOZ. APPLIES TO ALL FACILITIES PART V, SECTION B, LINE 19D: METHOD THE HOSPITAL FACILITY USED TO DETERMINE THE AMOUNTS BILLED TO INDIVIDUALS WHO DID NOT HAVE INSURANCE COVERING EMERGENCY OR MEDICALLY NECESSARY CARE - OTHER: UNINSURED PATIENTS ARE GIVEN A 40% DISCOUNT OF GROSS CHARGES. APPLIES TO ALL FACILITIES PART V, SECTION B, LINE 21: THE HOSPITAL OFFERS A 40% DISCOUNT TO ALL US RESIDENT SELF-PAY PATIENTS. THIS CAN BE OFFERED TO PATIENTS AT MULTIPLE POINTS IN THE PROCESS OF RECEIVING SERVICES AT TCH, SUCH AS AT THE TIME OF SCHEDULING, THE DATE(S) OF SERVICE OR FOLLOWING RECEIPT OF THE BILL. IN ADDITION, THE HOSPITAL ACCEPTS PAYMENT OF 60% OF THE BILL AS PAYMENT IN FULL. PART VI, LINE 2: COMMUNITY NEEDS ASSESSMENT PROCESS FY 2010-2012THE COMMUNITY BENEFITS DEPARTMENT OF TEXAS CHILDREN'S HOSPITAL TRANSITIONED TO NEW LEADERSHIP AT THE END OF FY 2010. A MORE FORMAL COMMUNITY BENEFITS DEPARTMENT STRUCTURE AND PURPOSE WAS INAUGURATED WHERE POLICIES AND PROCEDURES REGARDING THE HOSPITAL'S CHARITY CARE PRACTICES, THE IDENTIFICATION AND REPORTING OF COMMUNITY BENEFIT PROGRAMS, AND THE FORMATION OF A FORMAL STRUCTURE OF A COMMUNITY BENEFITS WORKGROUP (CBW) WERE COMPLETED. BEGINNING IN FY 2011, THE HOSPITAL CEO, OTHER SENIOR HOSPITAL LEADERS AND BOARD MEMBERS MET WITH THE COMMUNITY BENEFITS DEPARTMENT TO PROVIDE GUIDANCE AND FOCUS TO THE COMMUNITY HEALTH ISSUES AND NEEDS THE HOSPITAL SHOULD EXAMINE AND SUPPORT THROUGH ITS COMMUNITY BENEFITS WORK. THESE ISSUES INCLUDE: ACCESS TO CARE AND HEALTH COVERAGE, MEDICAL EDUCATION AND TRAINING, DISEASE PREVENTION AND MANAGEMENT OF CHRONIC HEALTH CONDITIONS, PEDIATRIC AND MATERNAL HEALTH RESEARCH, AND COMMUNITY HEALTH PARTNERSHIPS AND COLLABORATIONS. THE CBW IS CHARGED WITH DETERMINING HOW BEST TO ADDRESS THE COMMUNITY NEEDS THAT WOULD FALL UNDER THESE LARGER HEALTH ISSUE CATEGORIES. IN ITS FIRST FORMAL MEETING, THE WORKGROUP DEFINED ITS "COMMUNITY" AS LOCAL, STATE, NATIONAL, AND INTERNATIONAL. GIVEN THE COMPLEXITY OF DESIGNING AND IMPLEMENTING A COMMUNITY NEEDS ASSESSMENT (CNA) THAT ADEQUATELY CAPTURES TEXAS CHILDREN'S HOSPITAL'S DEFINITION OF "COMMUNITY' AS WELL AS THE VOLUME OF DATA ALREADY AVAILABLE, THE CBW RECOMMENDED THAT THE COMMUNITY BENEFITS DEPARTMENT CONDUCT A META-ANALYSIS OF ALL CURRENT NEEDS ASSESSMENTS PRODUCED BY OTHER HOSPITALS OR HEALTH ORGANIZATIONS, ADVOCACY ORGANIZATIONS, CHARITIES AND FOUNDATIONS, AS WELL AS NEEDS ASSESSMENTS AND RESEARCH CONDUCTED BY VARIOUS LEVELS OF GOVERNMENT (WITHIN THE PAST 5 YEARS) THAT FOCUSED ON WOMEN AND CHILDREN. THE WORKGROUP REQUESTED THAT THE DEPARTMENT EXAMINE AND AGGREGATE DATA AND ESTABLISH CHILDREN AND MATERNAL HEALTH BENCHMARKS TO ALIGN WITH THE 5 HEALTH THEMES WHERE THE HOSPITAL WILL FOCUS ITS COMMUNITY BENEFITS EFFORTS. THE DATA GATHERED ON THE HEALTH AND WELL-BEING OF CHILDREN LOCALLY, IN OUR STATE, NATIONALLY AND INTERNATIONALLY, WERE DISCUSSED AND VETTED WITH EXTERNAL SUBJECT MATTER EXPERTS. A FEW OF THESE COMMUNITY LEADERS AND PROFESSIONALS HAVE EDUCATED OUR WORKGROUP ON WHAT OUR DATA FINDINGS MEAN, AND WHAT THE HOSPITAL SHOULD OR COULD DO TO IMPROVE VARIOUS COMMUNITY HEALTH INDICATORS OVER THE NEXT THREE TO FIVE YEARS. ONCE THE SUBJECT MATTER INTERVIEWS WERE COMPLETED, THE COMMUNITY BENEFITS DEPARTMENT FURTHER REFINED THE META-ANALYSIS AND WORKED WITH THE COMMUNITY BENEFITS WORKGROUP TO ORGANIZE AND EVALUATE THE HOSPITAL'S EXISTING BENEFIT PROGRAMS AND PRIORITIES TO BETTER REFLECT THE CURRENT NEEDS IDENTIFIED THROUGH THE CNA PROCESS AND DEPARTMENT STRUCTURE. PART VI, LINE 3: THE FAMILIES OF CHILDREN WHO RECEIVE SERVICES AT TEXAS CHILDREN'S HOSPITAL ARE NOTIFIED OF THEIR RIGHTS AND RESPONSIBILITIES AND THE AVAILABILITY OF GOVERNMENT- OR HOSPITAL-SPONSORED PROGRAMS IF FINANCIAL ASSISTANCE IS NEEDED. -INFORMATION IS PROVIDED DURING INPATIENT AND OUTPATIENT REGISTRATION, AND MATERIALS ARE AVAILABLE IN ENGLISH AND SPANISH. -NOTICES OF TEXAS CHILDREN'S HOSPITAL CHARITY CARE PROGRAM ARE POSTED IN PUBLIC WAITING AND REGISTRATION AREAS, INCLUDING ADMISSIONS, EMERGENCY CENTER, OUTPATIENT CLINICS AND OTHER PROMINENT AREAS. A VARIETY OF LANGUAGE SERVICES ARE AVAILABLE UPON REQUEST. -THE HOSPITAL'S CHARITY CARE POLICY IS POSTED ON THE TEXAS CHILDREN'S HOSPITAL PUBLIC WEBSITE IN BOTH ENGLISH AND SPANISH. THE SITE DIRECTS PATIENT FAMILIES TO CONTACT ADMISSIONS COUNSELORS AND FINANCIAL COUNSELORS IN THE ADMISSIONS DEPARTMENT FOR MORE INFORMATION ABOUT AVAILABLE FINANCIAL OPTIONS AND RESOURCES. -TEXAS CHILDREN'S HOSPITAL ANNUALLY PUBLISHES A SUMMARY OF ITS CHARITY CARE POLICY IN THE MARKET'S LOCAL MAJOR NEWSPAPER. -FINANCIAL COUNSELORS ARE AVAILABLE TO DETERMINE ELIGIBILITY FOR GOVERNMENT AND/OR HOSPITAL-SPONSORED FINANCIAL ASSISTANCE. FINANCIAL COUNSELORS RECEIVE TRAINING ON ELIGIBILITY REQUIREMENTS FOR FINANCIAL ASSISTANCE AND GOVERNMENT PROGRAMS. -STATE OUTSTATIONED ELIGIBILITY WORKERS (OEW) ARE ON-SITE TO SUPPORT THE GOVERNMENT-SPONSORED ASSISTANCE PROGRAM APPLICATION PROCESS. -REFERRALS FOR CHARITY CONSIDERATION ORIGINATE WITH ADMISSIONS CENTRAL SCHEDULING, HOSPITAL SOCIAL WORKERS AND CLINICIANS, EXTERNAL PROVIDERS, AND THROUGH SELF-REFERRAL. THESE REFERRALS ARE DIRECTED TO THE APPROPRIATE DEPARTMENT'S FINANCIAL COUNSELORS WHO DISCUSS OPTIONS, INCLUDING CHARITY ASSISTANCE. -FINANCIAL COUNSELORS ALSO CONTACT PATIENTS ARRIVING VIA THE HOSPITAL EMERGENCY ROOM TO DISCUSS ELIGIBILITY FOR GOVERNMENT PROGRAMS LIKE MEDICAID, CHIP, CSHCN AND CHARITY ASSISTANCE. PART VI, LINE 4: GIVEN THE SERVICES PROVIDED TO PATIENTS FROM AROUND THE WORLD, TEXAS CHILDREN'S HOSPITAL HAS DEFINED ITS COMMUNITY AS LOCAL, NATIONAL AND INTERNATIONAL. LOCALLY, THE FOLLOWING COUNTIES ARE ITS PRIMARY AND SECONDARY SERVICE AREAS: HARRIS, BRAZORIA, CHAMBERS, FORT BEND, GALVESTON, LIBERTY, MONTGOMERY AND WALLER. IN HARRIS COUNTY ALONE, THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES AND SERVICE ADMINISTRATION HAS IDENTIFIED 24 MEDICALLY UNDERSERVED AREAS AND MEDICALLY UNDERSERVED POPULATIONS (MUA/PS). (BRAZORIA,3; CHAMBERS, 1; FORT BEND, 1: GALVESTON, 3; LIBERTY,1; MONTGOMERY, 2; AND WALKER, 1) PART VI, LINE 6: AS A LEADER IN PEDIATRICS, TEXAS CHILDREN'S HOSPITAL CONTINUES ITS MISSION TO SERVE THE COMMUNITY THROUGH PRE-EMINENT RESEARCH, EDUCATION AND PATIENT CARE. THIS ONGOING COMMITMENT ENSURES THE HEALTH AND WELL-BEING OF THE YOUNGEST AND MOST VULNERABLE MEMBERS OF THE COMMUNITY, WHETHER THEY RESIDE IN NEARBY NEIGHBORHOODS OR ON THE OTHER SIDE OF THE WORLD. IN ADDITION TO THE INFORMATION SUPPLIED IN OTHER SECTIONS OF THIS DOCUMENT, THE FOLLOWING ARE EXAMPLES OF THE HOSPITAL'S ONGOING COMMITMENT TO THE COMMUNITY IT SERVES:1)THE HOSPITAL'S BOARD OF TRUSTEES IS COMPOSED OF REPRESENTATIVES WHO RESIDE IN THE GREATER-HOUSTON COMMUNITY AND ARE NOT EMPLOYEES OF THE HOSPITAL. MANY TRUSTEES ARE BUSINESS AND CIVIC LEADERS WHO ARE ACTIVE IN OTHER LOCAL CHARITABLE ORGANIZATIONS. 2)EMPHASIZING ITS WORLD-CLASS EXPERTISE IN HIGHLY SPECIALIZED FIELDS, TEXAS CHILDREN'S OPERATES CENTERS OF EXCELLENCE IN ONCOLOGY, CARDIOLOGY AND NEONATOLOGY, ALL RANKED AMONG THE TOP FIVE ON THE U.S.NEWS & WORLD REPORT ANNUAL LIST OF LEADING CHILDREN'S HOSPITALS. IN ADDITION, U.S.NEWS RANKS TEXAS CHILDREN'S IN THE TOP 10 FOR 9 OUT OF THE 10 AREAS RANKED. THESE STRENGTHS ENABLE THE HOSPITAL TO PROVIDE MULTIDISCIPLINARY EXPERTISE TO SOME OF THE MOST COMPLEX MEDICAL CHALLENGES FACING CHILDREN TODAY.3)AS PART OF ITS RESPONSIVENESS TO THE COMMUNITY, TEXAS CHILDREN'S HOSPITAL OPERATES AND SUPPORTS SEVERAL ADVISORY COMMITTEES, COMPRISING COMMUNITY MEMBERS AND PATIENT FAMILIES. THESE GROUPS CONSULT WITH HOSPITAL REPRESENTATIVES ON A WIDE RANGE OF TOPICS DESIGNED TO INCREASE THE QUALITY OF CARE AND SERVICES PROVIDED.4)TEXAS CHILDREN'S HOSPITAL INVESTS ITS OPERATING MARGIN IN CAPITAL PROJECTS AND PROGRAMMATIC INITIATIVES FOCUSED ON IMPROVING PATIENT CARE, MEDICAL EDUCATION, AND RESEARCH 5)IN ADDITION TO FUNDING NATIONALLY-ACCREDITED GRADUATE MEDICAL EDUCATION (GME) INITIATIVES, TEXAS CHILDREN'S HOSPITAL ALSO INVESTED $1,150,700 IN OTHER GME PROGRAMS APPROVED BY THE TEXAS MEDICAL BOARD. THE HOSPITAL'S COMMITMENT TO EDUCATION AT BAYLOR COLLEGE OF MEDICINE EXEMPLIFIES THE COMMITMENT TO ADVANCING MEDICAL KNOWLEDGE.6)TEXAS CHILDREN'S SERVED AS A TRAINING CENTER FOR NURSING STUDENTS, SUPPORTING APPROXIMATELY 800 CANDIDATES IN 2011. ALTHOUGH THESE TRAINEES ARE NOT OBLIGATED TO REMAIN AT TEXAS CHILDREN'S UPON CERTIFICATION, THEY GAIN VALUABLE KNOWLEDGE FOR THEIR CAREERS IN PEDIATRICS. 7)TEXAS CHILDREN'S HOSPITAL'S 24/7 TRANSPORT SERVICE - KANGAROO CREW - COMPRISES A FIXED-WING AIRCRAFT AND GROUND AMBULANCE MEDICAL SERVICE PROVIDING COORDINATED PATIENT ASSESSMENT, INTERVENTION, AND SAFE, RAPID TRANSPORT OF CRITICALLY ILL OR INJURED PATIENTS. ALL TRANSPORT SERVICE PERSONNEL ARE SPECIALLY TRAINED IN PEDIATRIC/NEONATAL TRANSPORT MEDICINE AND SAFETY IN ACCORDANCE WITH FEDERAL AVIATION ADMINISTRATION (FAA) AND TEXAS DEPARTMENT OF STATE HEALTH SERVICES GUIDELINES.8)THE TRANSPORT SERVICE TEAM IS A MEMBER OF THE PEDIATRIC DISASTER COALITION, A PLANNING GROUP THAT CONSISTS OF SUBJECT MATTER EXPERTS FROM FREE-STANDING CHILDREN'S HOSPITALS, FACILITIES WITH DEDICATED PEDIATRIC/NEONATAL UNITS, PEDIATRIC SPECIALTY TRANSPORT ORGANIZATIONS, LOCAL AND STATE PUBLIC HEALTH AND FEDERAL PARTNERS. THE COALITION SHARES RECOMMENDATIONS AND TECHNICAL GUIDANCE WITH OTHER HEALTHCARE FACILITIES THROUGHOUT THE STATE, AS WELL AS FEDERAL AGENCIES AND OTHER NATIONAL ORGANIZATIONS: CHILD HEALTH CARE ASSOCIATION (CHCA), NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS (NACHRI), ASSOCIATION OF AIR MEDICAL SERVICES (AAMS) AND AMERICAN ACADEMY OF PEDIATRICS (AAP) SECTION ON TRANSPORT MEDICINE, AMONG OTHERS.9)IN RESPONSE TO COMMUNITY NEEDS, BOTH LOCALLY AND NATIONALLY, TEXAS CHILDREN'S CONTINUES TO EXPAND ITS HEALTH CARE SERVICES. IN 2011, THE HOSPITAL FURTHER REALIZED ITS VISION 2010 EXPANSION, WHICH INCLUDED FOUR INITIATIVES:A.THE JAN AND DAN DUNCAN NEUROLOGICAL RESEARCH INSTITUTE, THE WORLD'S FIRST COMPREHENSIVE PEDIATRIC NEUROLOGICAL RESEARCH CENTER DEVOTED TO COLLABORATIVE EFFORTS TO UNDERSTAND NEUROLOGICAL CONDITIONS LIKE AUTISM, CEREBRAL PALSY AND EPILEPSY - A CLASS OF DISORDERS THAT TOGETHER ARE EXPECTED TO EXCEED MORE THAN A HALF-TRILLION DOLLARS ANNUALLY IN HEALTHCARE COSTS. B.TEXAS CHILDREN'S HOSPITAL WEST CAMPUS OPENED IN THE SPRING OF 2011 IN WEST HOUSTON, ONE OF THE NATION'S FASTEST-GROWING SUBURBAN AREAS, TO PROVIDE THE COMMUNITY WITH NEARBY ACCESS TO A FULL-SERVICE HOSPITAL THAT INCLUDES AN EMERGENCY CENTER, OPERATING ROOMS, INTERMEDIATE AND ACUTE-CARE INPATIENT BEDS AND OUTPATIENT SERVICES. WEST CAMPUS ALLOWS PATIENTS AND FAMILIES WHO LIVE AND WORK FAR FROM HEALTH SERVICES TO HAVE IMMEDIATE ACCESS TO BOTH PREVENTIVE AND URGENT CARE. THE WEST CAMPUS COMMUNITY ADVISORY COUNCIL ALSO PROVIDES VALUABLE GUIDANCE TO TEXAS CHILDREN'S LEADERSHIP ABOUT HOW THE HOSPITAL CAN BEST SERVE THE COMMUNITY.C.TEXAS CHILDREN'S PAVILION FOR WOMEN, WHICH BEGAN OUTPATIENT SERVICES IN FALL 2011, OFFERS COMPREHENSIVE CARE FOR EXPECTANT MOTHERS AND WOMEN AT EVERY STAGE OF THEIR LIVES. AS HIGH-RISK BIRTHS IN BOTH THE REGION AND THE NATION CONTINUE TO RISE, THE CENTER WILL OFFER A FULL RANGE OF OBSTETRIC SERVICES FOR HIGH-RISK PREGNANCIES. THE PAVILION'S WOMEN'S ADVISORY COUNCIL PROVIDES INSIGHT AND COUNSEL REGARDING THE OVERALL PATIENT EXPERIENCE, AS WELL AS OTHER INITIATIVES RELATED TO MATERNAL HEALTH, IN SUPPORT OF THE OVERALL MISSION OF TEXAS CHILDREN'S HOSPITAL. D.THE FEIGIN CENTER, ALREADY A CORNERSTONE FOR TEXAS CHILDREN'S RESEARCH AND EDUCATION, HAS EXPANDED TO ACCOMMODATE RESEARCH THAT WILL RAPIDLY TRANSLATE NOVEL CELL AND GENE THERAPY PROTOCOLS DIRECTLY FROM THE LABORATORY TO THE PATIENT. E.TEXAS CHILDREN'S HOSPITAL IS COMMITTED TO LOCAL, REGIONAL AND NATIONAL ADVOCACY EFFORTS SUPPORTING ACCESS TO QUALITY HEALTH CARE FOR ALL CHILDREN. PART VI, LINE 7: TEXAS CHILDREN'S HOSPITAL IS AFFILIATED WITH TEXAS CHILDREN'S PEDIATRIC ASSOCIATES (TCPA, EIN 76-0460242) IN PROMOTING HEALTH CARE IN THE COMMUNITY SERVED. TCPA IS ONE OF THE NATION'S LARGEST PEDIATRIC PRIMARY CARE NETWORKS. COMPRISING 44 PRACTICES THROUGHOUT THE GREATER HOUSTON AREA, TCPA PEDIATRICIANS SERVE APPROXIMATELY 20 PERCENT OF HOUSTON'S CHILDREN, HELPING TREAT AND PREVENT ILLNESSES. FIVE TCPA PRACTICES, IDENTIFIED AS PROJECT MEDICAL HOME CLINICS, ARE LOCATED IN MEDICALLY UNDERSERVED NEIGHBORHOODS AND PROVIDE CONSISTENT CARE FOR LITTLE OR NO COST TO CHILDREN WHO OTHERWISE WOULD SEEK SERVICES FROM EMERGENCY ROOMS OR GO WITHOUT CARE. TEXAS CHILDREN'S HEALTH PLAN (TCHP, EIN 76-048264) IS THE LARGEST AND MOST FREQUENTLY SELECTED PROVIDER OF CHILDREN'S MEDICAID/CHIP COVERAGE IN THE REGION. TEXAS CHILDREN'S HEALTH PLAN WAS FOUNDED IN 1996 BY TEXAS CHILDREN'S HOSPITAL. IT IS THE NATION'S FIRST HEALTH MAINTENANCE ORGANIZATION (HMO) CREATED JUST FOR CHILDREN. THROUGH A SUBCONTRACTOR ROLE WITH THE HEALTH AND HUMAN SERVICES COMMISSION (HHSC), TEXAS CHILDREN'S HEALTH PLAN PROVIDES STAR/MEDICAID AND CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) TO PREGNANT WOMEN, TEENS, CHILDREN AND ADULTS IN HOUSTON AND SURROUNDING AREAS. CURRENTLY, THE HEALTH PLAN HAS OVER 280,000 MEMBERS. THE STAFF AND NETWORK OF OVER 1100 PRIMARY CARE PHYSICIANS, 13,100 SPECIALISTS AND 70 HOSPITALS ARE COMMITTED TO PROVIDING EXCELLENT SERVICE AND PATIENT CARE TO TEXAS CHILDREN'S HEALTH PLAN MEMBERS.TEXAS CHILDREN'S IS BAYLOR COLLEGE OF MEDICINE'S (BCM) PRIMARY PEDIATRIC TRAINING HOSPITAL, WITH ONE OF THE LARGEST PEDIATRIC RESIDENCY PROGRAMS IN THE COUNTRY. THE HOSPITAL'S MEDICAL STAFF CONSISTS OF MORE THAN 1,500 BOARD-CERTIFIED, PRIMARY CARE PHYSICIANS, PEDIATRIC SUBSPECIALISTS AND PEDIATRIC-SURGICAL SUBSPECIALISTS. TOGETHER, TEXAS CHILDREN'S AND BCM REPRESENT ONE OF THE MOST ACTIVE AND BEST FUNDED PEDIATRIC RESEARCH PROGRAMS IN THE COUNTRY. BCM INVESTIGATORS AT TEXAS CHILDREN'S HOSPITAL ARE CONDUCTING INNOVATIVE RESEARCH IN NEARLY EVERY PEDIATRIC SUBSPECIALTY WITH THE GOAL OF QUICKLY TRANSLATING DISCOVERIES INTO BREAKTHROUGH TREATMENTS FOR CHILDREN EVERYWHERE. COMMUNITY BENEFIT REPORT PART VI, LINE 7 TEXAS CHILDREN'S HOSPITAL FILES A COMMUNITY BENEFIT REPORT, ANNUAL STATEMENT OF COMMUNITY BENEFITS STANDARD (ASCBS), IN TEXAS. DIFFERENCES BETWEEN SCHEDULE H AND THE ANNUAL STATEMENT OF COMMUNITY BENEFITS STANDARD ARE STATED BELOW. FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2011, THE HOSPITAL REPORTED AS THE TOTAL ANNUAL CHARITY AND COMMUNITY BENEFIT IN ITS ASCBS, THE STATE OF TEXAS' COMMUNITY BENEFIT REPORTING FOR NOT-FOR-PROFIT HOSPITALS. THE RESULTING DIFFERENCE ($14,032) BETWEEN THE ASCBS REPORTING AND THE AMOUNTS RECORDED IN PART I LINE 7 ARE DUE TO VARYING REPORTING REQUIREMENTS AS OUTLINED BELOW (IN 1000'S):ASCBS INCLUDES BAD DEBT EXPENSE IN THE PATIENT CARE COST TO CHARGE RATIO. ADDITIONALLY, THE ASCBS RATIO IS CALCULATED USING 2010 FINANCIAL INFORMATION.($12,255)ASCBS INCLUDES CHARITY CARE FROM RELATED ORGANIZATIONS($3,944)ASCBS INCLUDES THE UNREIMBURSED COST OF COMMUNITY BUILDING ACTIVITIES ($108) ASCBS INCLUDES THE UNREIMBURSED COST OF MEDICARE AND CHAMPUS($4,267) ASCBS REDUCES COMMUNITY BENEFIT PROGRAM COST BY GIFT/GRANT INCOME $6,542 TOTAL VARIANCE BETWEEN PART I LINE 7 AND ASCBS($14,032) 1 AMERICAN DIABETES ASSOC ORDER DEPT 1701 BEAUREGARD STREET ALEXANDRIA VA 22311 131623888 501(C)(3) 20000 SUPPORT NON-PROFIT HEALTHCARE ORG AMERICAN HEART ASSOCIATION 10060 BUFFALO SPEEDWAY HOUSTON TX 77054 135613797 501(C)(3) 64000 SUPPORT NON-PROFIT MISSION AMERICAN LIVER FOUNDATION 39 BROADWAY STE 2700 NEW YORK NY 10006 362883000 501(C)(3) 5000 SUPPORT NON-PROFIT HEALTHCARE ORG ARROW CHILD AND LIFE MINISTRIES 2929 FM 2920 SPRING TX 77388 742622426 501(C)(3) 5000 SUPPORT NON-PROFIT PHILANTHROPIC ORG ASIA SOCIETY TEXAS CENTER 1370 SOUTHMORE BLVD HOUSTON TX 77004 030433949 501(C)(3) 5000 SUPPORT NON-PROFIT PHILANTHROPIC ORG BALLUNAR LIFTOFF FESTIVAL 1201 NASA PARKWAY HOUSTON TX 77058 760468060 501(C)(3) 7500 SUPPORT NON-PROFIT PHILANTHROPIC ORG BAYLOR COLLEGE OF MEDICINE ONE BAYLOR PLAZA HOUSTON TX 77030 741613878 501(C)(3) 50000 SUPPORT OF AFFILIATED MED SCHL BERING OMEGA COMMUNITY SERVICES PO BOX 540517 HOUSTON TX 77254 760589592 501(C)(3) 10000 SUPPORT NON-PROFIT PHILANTHROPIC ORG BAYLOR INTERNATIONAL PEDIATRIC AIDS INI ONE BAYLOR PLAZA HOUSTON TX 77030 202951275 501(C)(3) 97087 SUPPORT NON-PROFIT HEALTHCARE ORG BLUE BIRD CIRCLE 615 WEST ALABAMA HOUSTON TX 77055 741405134 501(C)(3) 21500 SUPPORT PEDIATRIC HEALTHCARE ORG BO'S PLACE 10050 BUFFALO SPEEDWAY HOUSTON TX 77054 760326979 501(C)(3) 5000 SUPPORT NON-PROFIT PHILANTHROPIC ORG BOYS SCOUTS OF AMERICA PO BOX 924528 HOUSTON TX 77292 760239833 501(C)(3) 25000 SUPPORT NON-PROFIT BOY SCOUTS ORG BRIARWOOD BROOKWOOD INC 1752 FM 1489 BROOKSHIRE TX 77423 741587672 501(C)(3) 7000 SUPPORT NON-PROFIT SCHOOL CENTER FOR HOUSTONS FUTURE INC 1200 SMITH STREET HOUSTON TX 77002 760386539 501(C)(3) 20000 SUPPORT NON-PROFIT PHILANTHROPIC ORG CHILD LIFE COUNCIL INC 11821 PARK LAWN DRIVE STE 310 ROCKVILLE MD 20852 521799846 501(C)(3) 10000 SUPPORT NON-PROFIT HEALTHCARE ORG CHILDREN AT RISK INC 2900 WESLAYAN HOUSTON TX 77027 760360533 501(C)(3) 10500 SUPPORT NON-PROFIT HEALTHCARE ORG CHILDREN'S MUSEUM OF HOUSTON 1500 BINZ HOUSTON TX 77004 742178563 501(C)(3) 25300 SUPPORT NON-PROFIT PHILANTHROPIC ORG CROHN'S AND COLITIS FOUNDATION 386 PARK AVENUE SOUTH NEW YORK NY 10016 136193105 501(C)(3) 6000 SUPPORT NON-PROFIT HEALTHCARE ORG FOOD ALLERGY & ANAPHYLAXIS NETWORK 11781 LEE JACKSON MEMORIAL HWY STE 160 FAIRFAX VA 22033 541605958 501(C)(3) 10000 SUPPORT NON-PROFIT HEALTHCARE ORG GOOD SAMARITAN FOUNDATION 3355 W ALABAMA STREET STE 1025 HOUSTON TX 77098 741235398 501(C)(3) 20000 SUPPORT NON-PROFIT PHILANTHROPIC ORG GREAT HOPE PO BOX 189 BELLAIRE TX 77401 272794670 501(C)(3) 13000 SUPPORT 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501(C)(3) 5000 SUPPORT NON-PROFIT PHILANTHROPIC ORG JUNIOR LEAGUE OF HOUSTON 1811 BRIAR OAKS LANE HOUSTON TX 77027 741185659 501(C)(3) 25270 SUPPORT NON-PROFIT PHILANTHROPIC ORG JUVENILE DIABETES RESEARCH FOUNDATION 2425 FOUNTAINVIEW SUITE 280 HOUSTON TX 77057 231907729 501(C)(3) 15000 SUPPORT NON-PROFIT HEALTHCARE ORG LIVING BANK PO BOX 6725 HOUSTON TX 77265 741607315 501(C)(3) 18500 SUPPORT NON-PROFIT HEALTHCARE ORG MARCH OF DIMES 3000 WESLAYAN SUITE 100 HOUSTON TX 77027 131846366 501(C)(3) 20000 SUPPORT NON-PROFIT PHILANTHROPIC ORG MENTAL HEALTH AMERICA OF GREATER HOUSTON 2211 NORFOLK 810 HOUSTON TX 77098 741272394 501(C)(3) 5000 SUPPORT NON-PROFIT HEALTHCARE ORG MUSCULAR DYSTROPHY ASSOCIATION 3300 EAST SUNRISE DRIVE TUCSON AZ 85718 131665552 501(C)(3) 6000 SUPPORT NON-PROFIT HEALTHCARE ORG MUSEUM OF FINE ARTS HOUSTON PO BOX 6826 HOUSTON TX 77265 741109655 501(C)(3) 7500 SUPPORT NON-PROFIT PHILANTHROPIC ORG MUSEUM OF HEALTH & MEDICAL SCIENCE 1515 HERMANN DRIVE HOUSTON TX 77004 746106357 501(C)(3) 20000 SUPPORT NON-PROFIT PHILANTHROPIC ORG NATIONAL ASSOCIATION ADVANCEMENT COLORED PEOPLE 4805 MOUNT HOPE DRIVE BALTIMORE MD 21215 131084135 501(C)(3) 6500 SUPPORT NON-PROFIT PHILANTHROPIC ORG PEDIATRIC CARDIAC INTENSIVE CARE SOCIETY CO HOBROOK MANTER 1111 DUBLIN RD COLUMBUS OH 43215 030467764 501(C)(6) 10000 SUPPORT NON-PROFIT HEALTHCARE ORG PERIWINKLE FOUNDATION 3000 RICHMOND AVE SUITE 340 HOUSTON TX 77098 760093914 501(C)(3) 5000 SUPPORT NON-PROFIT PHILANTHROPIC ORG PIN OAK CHARITY HORSE SHOW P O BOX 218688 HOUSTON TX 77218 741755067 501(C)(3) 5000 SUPPORT NON-PROFIT PHILANTHROPIC ORG RONALD MCDONALD HOUSE OF HOUSTON INC 1907 HOLCOMBE BLVD HOUSTON TX 77030 741984499 501(C)(3) 10000 SUPPORT NON-PROFIT PHILANTHROPIC ORG TEXANS FOR LAWSUIT REFORM 1701 BRUN HOUSTON TX 77019 760439129 501(C)(6) 155000 SUPPORT NON-PROFIT PHILANTHROPIC ORG TEXAS PARENT TO PARENT - VINE TO WINE 3710 CEDAR STREET BOX 12 AUSTIN TX 78705 600001527 501(C)(3) 11500 SUPPORT NON-PROFIT PHILANTHROPIC ORG TEXAS PEDIATRIC SOCIETY 401 WEST 15TH STREET STE 682 AUSTIN TX 78701 751499413 501(C)(3) 7000 SUPPORT NON-PROFIT HEALTHCARE ORG THE FOUNDATION FOR CANCER SURVIVORS 1800 AUGUSTA DR STE 400 HOUSTON TX 77057 271790421 501(C)(3) 5000 SUPPORT NON-PROFIT HEALTHCARE ORG THETA CHARITY ANTIQUES SHOW 4212 SAN FELIPE PMB 345 HOUSTON TX 77027 742051004 501(C)(3) 10000 SUPPORT NON-PROFIT PHILANTHROPIC ORG UNITED MITOCHONDRIAL DISEASE FOUNDATION 8085 SALTSBURG ROAD STE 201 PITTSBURGH PA 15239 251767180 501(C)(3) 5000 SUPPORT NON-PROFIT HEALTHCARE ORG UNITED WAY 50 WAUGH DRIVE HOUSTON TX 77007 741167964 501(C)(3) 25000 SUPPORT NON-PROFIT HEALTHCARE ORG UNIVERSITY OF ST THOMAS 3800 MONTROSE BLVD HOUSTON TX 77006 741277664 501(C)(3) 50000 SUPPORT NON-PROFIT UNIVERSITY UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER 7000 FANNIN STREET STE 1200 HOUSTON TX 77226 741761309 501(C)(3) 60000 SUPPORT NON-PROFIT MEDICAL SCHOOL VOICES FOR AMERICAS CHILDREN 1000 VERMONT AVENUE NW WASHINGTON DC 20005 341479461 501(C)(3) 7000 SUPPORT NON-PROFIT PHILANTHROPIC ORG WEST I 10 CHAMBER OF COMMERCE PO BOX 100 PATTISON TX 77466 752988467 501(C)(6) 5000 SUPPORT HOUSTON AREA WOODROW WILSON INTERNATIONAL CENTER FOR 1300 PENNSYLVANIA AVENUE NW WASHINGTON DC 20004 521067541 501(C)(3) 25000 SUPPORT NON-PROFIT PHILANTHROPIC ORG SOCIETY FOR THE ARTS IN HEALTHCARE 2437 15TH STREET NW WASHINGTON DC 20009 020479949 501(C)(3) 15000 SUPPORT NON-PROFIT PHILANTHROPIC ORG TEXAS CHILDREN'S PEDIATRIC ASSOCIATES PO BOX 300630 HOUSTON TX 77230 760460242 501(C)(3) 6118174 SUPPORT NON-PROFIT HEALTHCARE ORG 52 4 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS SCHEDULE I, PART I, LINE 2 AFTER THE SPONSORSHIP/DONATION IS MADE, WE RECEIVE AN ACKNOWLEDGMENT LETTER WITH A RECEIPT OF THE GIFT. TYPICALLY THIS LETTER TELLS US HOW THE MONEY WILL BE USED AT THEIR PARTICULAR ORGANIZATION. OTHER INFORMATION: PART IV: DESCRIPTION OF GRANT SELECTION CRITERIA SCHEDULE I TEXAS CHILDREN'S HOSPITAL REQUIRES ALL REQUESTS TO BE IN WRITING AND BE SUBMITTED TO THE OFFICE OF DEVELOPMENT FOR EVALUATION. THE DIRECTOR OF DEVELOPMENT MAKES A RECOMMENDATION FOR RECOGNITION OF EACH CONTRIBUTION TO THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF TEXAS CHILDREN'S HOSPITAL FOR FINAL APPROVAL. X X X X 1 1 0 1 1 1 1 0 0 MARK A WALLACE 938466 0 1302352 0 198878 0 632998 0 28157 0 3100851 0 1267904 0 BENJAMIN MELSON 493364 0 154350 0 82363 0 199440 0 26396 0 955913 0 63721 0 ANN STERN 399162 0 118000 0 18413 0 168328 0 12831 0 716734 0 0 0 RANDY WRIGHT 499224 0 684444 0 101030 0 202968 0 15840 0 1503506 0 686060 0 MARY JO ANDRE 186737 0 42900 0 1199 0 52845 0 21198 0 304879 0 0 0 SUSAN MACDONALD 294819 0 82250 0 37515 0 108946 0 21085 0 544615 0 36240 0 SANDRA M MCELLIGOTT 221932 0 61100 0 1213 0 77747 0 12447 0 374439 0 0 0 TABITHA RICE 191497 0 43050 0 1058 0 62542 0 16437 0 314584 0 0 0 LINDA ALDRED 270338 0 305664 0 57274 0 108961 0 22155 0 764392 0 262843 0 HOWARD W HARPSTER 284159 0 64300 0 2517 0 79097 0 35331 0 465404 0 0 0 WILLIAM HILTON 214574 0 51550 0 55599 0 39233 0 12993 0 373949 0 0 0 JOHN SCALES 317553 0 93950 0 86583 0 63063 0 13944 0 575093 0 0 0 KAY TITTLE 281711 0 81250 0 21822 0 115487 0 15604 0 515874 0 20570 0 SUSAN M DISTEFANO 37456 0 192452 0 569227 0 13406 0 600 0 813141 0 122716 0 SUPPLEMENTAL INFORMATION PART III SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 4A: SEVERANCE OR CHANGE OF CONTROL SUSAN DISTEFANO 335,410 SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B PAID/DEFERRED MARK A WALLACE 622,542/600,531 BEN MELSON 217,621/181,488 MARY JO ANDRE 42,900/32,820 SUSAN MACDONALD 118,490/83,853 SANDRA MCELLIGOTT 51,100/55,949 TABITHA RICE 43,050/45,219 ANN STERN 118,000/149,443 RANDY WRIGHT 764,509/180,727 LINDA ALDRED 345,093/83,986 HOWARD HARPSTER 64,300/61,257 WILLIAM HILTON 88,193/24,650 JOHN SCALES 159,395/44,750 KAY TITTLE 101,820/90,605 SUSAN DISTEFANO 410,570/0 457(F) THE 457(F) PLAN IS A DEFERRED COMPENSATION PLAN THAT ALLOWS ELIGIBLE EXECUTIVES, FROM THE ASSISTANT VICE PRESIDENT LEVEL TO CHIEF EXECUTIVE OFFICER, TO CONTRIBUTE MONEY ON A PRE-TAX BASIS. FUNDS MAY BE DEFERRED INTO THIS ACCOUNT FROM ANY OF FOUR SOURCES: BASE SALARY, ANNUAL INCENTIVE PLAN, LONG-TERM INCENTIVE PLAN, AND CAPITAL ACCUMULATION ACCOUNT FROM A FLEXIBLE BENEFIT ACCOUNT SURPLUS. THESE VEST AFTER THREE YEARS IN THE 457(F) WITH THE EXCEPTION OF THE CAPITAL ACCUMULATION ACCOUNT WHICH VESTS AFTER FIVE YEARS IN THE 457(F) PLAN. SEVERANCE SEVERANCE IS DETERMINED ON A CASE-BY-CASE BASIS, WITH LEGAL COUNSEL INVOLVED IN THE DECISION. CONSIDERATION IS GIVEN TO FACTORS SUCH AS LENGTH OF SERVICE AND LEVEL OF POSITION WITH THE ORGANIZATION. SCHEDULE J, PART I, LINE 5 & 6 FY 2010 EXECUTIVE ANNUAL INCENTIVE PLAN: THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES (THE "COMMITTEE") ESTABLISHES THE PERFORMANCE MEASURES FOR THE ONE-YEAR PLAN AND THE INCENTIVE AWARD OPPORTUNITY FOR EACH PARTICIPANT IN THIS PLAN. PERFORMANCE MEASURES AND GOALS ARE DEFINED FOR EACH ENTITY. THE INCENTIVE AWARDS ARE DETERMINED ON THE WEIGHTED BLEND OF ALL THE ENTITIES' PERFORMANCE. THE PERFORMANCE MEASURES INCLUDE THE FOLLOWING INDICATORS: STRATEGIC, OPERATIONAL, FINANCIAL, PATIENT SATISFACTION, CLINICAL AND SERVICE QUALITY, AND HUMAN RESOURCES. THE PERFORMANCE MEASURES ESTABLISHED BY THE COMMITTEE USE REVENUE AS A FACTOR IN DETERMINING SOME MEASURES FOR THE FINANCIAL TARGETS. THE PAYMENT OF ANNUAL INCENTIVES IS CONTINGENT ON ACHIEVING SYSTEM BUDGETED OPERATING MARGIN. HARRIS COUNTY CULTURAL EDUCATION FACILITIES FIN CO 760337885 414009DY3 2010-01-15 80078929 SEE SCHEDULE O 0 0 0 HARRIS COUNTY CULTURAL EDUCATION FACILITIES FIN CO 760337885 414009OG3 2009-06-17 198965284 BUILD HEALTH CARE FACILITIES 0 0 0 HARRIS COUNTY HEALTH FACILITIES DEVELOPMENT CO 521284201 414152RW0 2008-04-30 300000000 SEE SCHEDULE O 0 0 0 80078929 1278929 2010 1 0 1 1 199780590 3311550 3004918 193464122 2011 0 0 0 1 300053496 53496 2011 1 0 1 1 0 0 0 0 1 1 0 1 0 0 1 0.00000 0.00000 1 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 WJ ALEXANDER & ASSOCIATES BOARD MEMBER 156267 0 MUSTANG CATERPILLAR BOARD MEMBER 104699 0 AMOUNT:$156,267DESCRIPTION: WILLIAM ALEXANDER IS THE FOUNDER AND PRESIDENT OF W.J. ALEXANDER AND ASSOCIATES, PC. W.J. ALEXANDER & ASSOCIATES IS THE AGENT FOR TEXAS CHILDREN'S HOSPITAL'S LIFE, AD&D, AND DISABILITY COVERAGE OFFERED THROUGH THE EMPLOYEE HEALTH AND BENEFIT PLAN.(B)NAME: MUSTANG CATERPILLAR - BOARD MEMBER (CHAIRMAN OF THE BOARD)AMOUNT: $104,699DESCRIPTION: BRAD TUCKER HAS OWNERSHIP INTEREST IN MUSTANG CATERPILLAR, WHICH PROVIDES PARTS AND SERVICE SUPPORT TO MAINTAIN STANDBY GENERATORS FOR TEXAS CHILDREN'S HOSPITAL. X 1 340000 APPRAISAL X 12 208417 COST/SELLING PRICE X EQUIPMENT/ REAL PROPERTY 1 263044 COST/SELLING PRICE 1 0 1 0 FORM 990, PART VI, SECTION A, LINE 2 TEXAS CHILDREN'S HOSPITAL - DONALD P. DEWALCH / WILLIAM N. MATHIS - BUSINESS RELATIONSHIP - PETER S. WAREING / MERREL A. ATHON - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION B, LINE 11 PER A RESOLUTION APPROVED BY THE BOARD OF TRUSTEES, THE BOARD'S AUDIT & COMPLIANCE COMMITTEE HAS THE DELEGATED AUTHORITY TO REVIEW THE ORGANIZATION'S COMPLETED FORM 990 PRIOR TO FILING. FOLLOWING THE COMMITTEE'S REVIEW, THE COMPLETED FORM 990 IS DISTRIBUTED TO THE BOARD OF TRUSTEES PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION CONSISTENTLY MONITORS AND ENFORCES THE CONFLICT OF INTEREST POLICY THROUGH TWO SEPARATE PROCESSES, ONE THAT APPLIES TO THE BOARD MEMBERS, AND A SECOND THAT APPLIES TO OFFICERS AND KEY EMPLOYEES. 1)BOARD MEMBERS: PER THE ORGANIZATION'S BOARD-APPROVED CONFLICTS REVIEW PROCESS, RESPONSES TO THE ANNUAL CONFLICTS QUESTIONNAIRE ARE REVIEWED BY THE MEMBER'S BOARD LEADERSHIP AND PRESENTED TO THE MEMBER'S AUDIT & COMPLIANCE COMMITTEE. IF THE COMMITTEE DEEMS THERE ARE ANY SIGNIFICANT ISSUES, THE RESPONSES ARE THEN REVIEWED BY THE MEMBER BOARD'S EXECUTIVE COMMITTEE AND ANY REQUIRED ACTION (RECUSEMENT FROM BOARD DELIBERATIONS RELATED TO THE CONFLICT, ETC.) IS TAKEN IN ACCORDANCE WITH THE ORGANIZATION'S BOARD-APPROVED CODE OF CONDUCT. 2)OFFICERS / KEY EMPLOYEES: PER THE ORGANIZATION'S BOARD-APPROVED CONFLICTS REVIEW PROCESS, RESPONSES TO THE ANNUAL CONFLICTS QUESTIONNAIRE ARE REVIEWED BY THE COMPLIANCE SERVICES DEPARTMENT. IF THE DEPARTMENT DEEMS THERE ARE ANY SIGNIFICANT ISSUES, REQUIRED ACTION IS TAKEN IN ACCORDANCE WITH THE ORGANIZATION'S BOARD-APPROVED CODE OF CONDUCT AND THE BOARD IS NOTIFIED OF SUCH ACTIONS. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION INCLUDE: - REVIEW AND APPROVAL BY GOVERNING BODY AND COMPENSATION COMMITTEE, PROVIDED THAT PERSONS WITH A CONFLICT OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT AT ISSUE WERE NOT INVOLVED. - COMPARABLE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. - CONTEMPOROUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION AGREEMENT. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. SCHEDULE K, PART I, COLUMN F TAX-EXEMPT BONDS SUPPLEMENTAL INFORMATION A) ISSUER NAME: HARRIS COUNTY CULTURAL EDUCATION FACILITIES FINANCE CORPORATION ISSUER EIN: 76-0337885 DESCRIPTION OF PURPOSE: REFUND PRIOR ISSUES (1999B-2 SERIES ISSUED 07/20/99). C) ISSUER NAME: HARRIS COUNTY HEALTH FACILITIES DEVELOPMENT CORPORATION ISSUER EIN: 52-1284201 DESCRIPTION OF PURPOSE: REFUND PRIOR ISSUES (2007 SERIES ISSUED 06/27/07). FORM 990, PART VII, SECTION A, TITLES GARY L. ROSENTHAL: BOARD MEMBER, 2010 PRESIDENT, 2011 BOARD CHAIRMAN RONALD C. HULME: BOARD MEMBER, 2010 VICE PRESIDENT, 2011 PRESIDENT KEVIN C. KING: BOARD MEMBER, 2010 VICE PRESIDENT ANN LENTS: BOARD MEMBER, 2010 & 2011 VICE PRESIDENT JOEL V. STAFF: BOARD MEMBER, 2010 TREASURER & ASSISTANT SECRETARY, 2011 TREASURER & VICE PRESIDENT FREDA WILKERSON BASS: BOARD MEMBER, 2010 & 2011 SECRETARY BRAD TUCKER: BOARD MEMBER, 2010 BOARD CHAIRMAN BARRY H. MARGOLIS: BOARD MEMBER, 2011 VICE PRESIDENT KAY TITTLE'S 40 HOURS AVERAGE PER WEEK REPRESENTS HER ROLE AS TEXAS CHILDREN'S PEDIACTRIC ASSOCIATES INC PRESIDENT IN CONJUNCTION WITH HER ROLE AS SENIOR VICE PRESIDENT FOR TEXAS CHILDREN'S HOSPITAL. SUSAN MACDONALD'S 40 HOURS AVERAGE PER WEEK REPRESENTS HER ROLE AS TEXAS CHILDREN'S PHYSCIAN'S GROUP PRESIDENT IN CONJUNCTION WITH HER ROLE AS SENIOR VICE PRESIDENT FOR TEXAS CHILDREN'S HOSPITAL. SANDRA MCELLIGOTT'S 40 HOURS AVERAGE PER WEEK REPRESENTS HER ROLE AS TEXAS CHILDREN'S PHYSCIAN'S GROUP SENIOR VICE PRESIDENT IN CONJUNCTION WITH HER ROLE AS SENIOR VICE PRESIDENT FOR TEXAS CHILDREN'S HOSPITAL. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: TRANSFER FROM FOUNDATION 127,096,364. PRIOR PERIOD ADJUSTMENTS 2,405,100. ACTUARIAL GAIN/LOSS ON PENSION -18,794,332. CHANGE IN BENEFICIAL INTEREST IN FOUNDATION -87,899,903. UNREALIZED GAINS AND LOSSES 104,888. CHANGE IN SWAP VALUATION -6,400,595. CHANGE IN TECO VALUATION 2,335,576. TRANSFER TO TCPA -636,082. TOTAL TO FORM 990, PART XI, LINE 5: 18,211,016. FORM 5471 DISCLOSURE STATEMENT: 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: TEXAS CHILDREN'S HOSPITAL FOUNDATION EIN: 20-2380599 6621 FANIN ST HOUSTON, TX 77030 OTHER FEES SERVICES PART IX NON-EMPLOYEE PROFESSIONAL FEES CONSISTING OF BAYLOR AND OTHER PHYSICIAN SERVICES. TEXAS CHILDREN'S MEDICAL GROUP 6621 FANNIN STREET HOUSTON TX 77030 741100555 INACTIVE TX 0 0 N/A TEXAS CHILDREN'S WOMEN'S SPECIALISTS PO BOX 300630 HOUSTON TX 77230 261482195 HEALTH CARE TX 501 (C) (3) 11 TYPE 1 N/A 1 TCH SYSTEM INC 1919 BRAESWOOD BLVD HOUSTON TX 77030 760461578 HEALTH CARE TX 501 (C) (3) 11 TYPE 1 N/A 1 TEXAS CHILDREN'S PHYSICIAN GROUP INC 6621 FANNIN STREET HOUSTON TX 77030 260834681 HEALTH CARE TX 501 (C) (3) 9 N/A 1 TEXAS CHILDREN'S PEDIATRIC ASSOCIATES PO BOX 300630 HOUSTON TX 77230 760460242 HEALTH CARE TX 501 (C) (3) 11 TYPE 1 N/A 1 TEXAS CHILDREN'S HEALTH PLAN 2450 HOLCOMBE HOUSTON TX 77021 760486264 HEALTH CARE TX 501 (C) (3) 9 N/A 1 TEXAS CHILDREN'S HOSPITAL FOUNDATION 6621 FANNIN STREET HOUSTON TX 77030 202380599 SUPPORTING ORG TX 501 (C) (3) 11 TYPE 1 N/A 1 TCH INSURANCE COMPANY LTD 23 LIME TREE BAY AVENUE KY1-1102 GRAND CAYMAN CJ INSURANCE CJ N/A C 14689555 94249304 1.00000 CVI GVF HOLDINGS 3 LTD UGLAND HOUSE SOUTH CHURCH STREET KY1-1104 GEORGE TOWN CJ INVESTMENT CJ N/A C 1 1 0 0 0 0 0 0 1 0 1 0 1 1 1 1 1 1 TEXAS CHILDREN'S HEALTH PLAN I 682359 GENERAL LEDGER TEXAS CHILDREN'S HEALTH PLAN K 1860051 GENERAL LEDGER TEXAS CHILDREN'S HEALTH PLAN A 735754 GENERAL LEDGER TEXAS CHILDREN'S WOMEN'S SPECIALIST K 497719 GENERAL LEDGER TEXAS CHILDREN'S HEALTH PLAN K 136608 GENERAL LEDGER TEXAS CHILDREN'S PEDIATRIC ASSOCIATES K 2000000 GENERAL LEDGER TEXAS CHILDREN'S PEDIATRIC ASSOCIATES P 17575008 GENERAL LEDGER TEXAS CHILDREN'S HEALTH PLAN P 13791073 GENERAL LEDGER TEXAS CHILDREN'S HEALTH PLAN K 102093277 GENERAL LEDGER TEXAS CHILDREN'S PHYSICIAN GROUP INC P 87307105 GENERAL LEDGER TEXAS CHILDREN'S PHYSICIAN GROUP INC R 95332161 GENERAL LEDGER TCH INSURANCE COMPANY LTD O 8000000 GENERAL LEDGER TCH INSURANCE COMPANY LTD P 612302 GENERAL LEDGER TEXAS CHILDREN'S HOSPITAL FOUNDATION R 127096364 GENERAL LEDGER TCH INSURANCE COMPANY LTD P 169351 GENERAL LEDGER TCH INSURANCE COMPANY LTD O 4400000 GENERAL LEDGER TEXAS CHILDREN'S HEALTH PLAN M 319053 GENERAL LEDGER TEXAS CHILDREN'S PEDIATRIC ASSOCIATES Q 636082 GENERAL LEDGER TEXAS CHILDREN'S PEDIATRIC ASSOCIATES B 6118174 GENERAL LEDGER