4A (Expenses $ 22995926 including grants of $ 500) (Revenue $ 23486388)
See Schedule OScott & White Hospital - Llano dba Baylor Scott & White Medical Center- Llano (BSW Llano) is a faith-based, nonprofit 27-bed acute care hospital providing exemplary patient care services to the residents of Llano County and the surrounding communities since the 1950s. BSW Llano is affiliated with Baylor Scott & White Health (BSWH), a faith based nationally acclaimed network of acute care hospitals and related health care entities providing quality patient care, medical education, medical research and other community services to the residents of North and Central Texas. As the largest not-for-profit health care system in Texas and one of the largest in the United States, BSWH was born from the 2013 combination of Baylor Health Care System and Scott & White Healthcare. Today, BSWH includes 50 hospitals, over 1,000 patient care sites, approximately 7,500 active physicians, more than 49,000 employees and the Scott & White Health Plan.During the fiscal year, BSW Llano admitted 181 patients resulting in 494 patient days of care and received 4,642 emergency department visits. Additionally, BSW Llano provided community benefits (as reported to the Texas Department of State Health Services and in accordance with the State of Texas Statutory methodology) of $1,221,634 and provided community benefits (as reported on the Internal Revenue Service (IRS) Form 990, Schedule H) of $1,284,924 during the tax year. See Schedule H for more information regarding these services and how BSW Llano promotes the health of the communities.

Baylor Scott & White Medical Ctr - Llano
Part V, Section B, Line 5: One (1) focus group with a total of 13 participants, as well as six (6) key informant interviews, were conducted to take into account the input of persons representing the broad interests of the community served. The focus group and interviews solicited feedback from leaders and representatives who serve the community and have insight into community needs. Prioritization sessions were also held with hospital clinical leadership and/or other community leaders to identify significant health needs from the assessment and prioritize them.The focus group familiarized participants with the CHNA process and solicited input to understand health needs from the community's perspective. Focus groups, formatted for individual as well as small group feedback, helped identify barriers and social determinants influencing the community's health needs. Barriers and social determinants were new topics added to the 2019 community input sessions.Watson Health conducted key informant interviews for the community served by the hospital facilities. The interviews aided in gaining understanding and insight into participants concerns about the general health status of the community and the various drivers that contributed to health issues. Participation in the qualitative assessment included at least one state, local, or regional governmental public health department (or equivalent department or agency) with knowledge, information, or expertise relevant to the health needs of the community, as well as individuals or organizations who served and/or represented the interests of medically underserved, low-income and minority populations in the community. Participation from community leaders/groups, public health organizations, other healthcare organizations, and other healthcare providers (including physicians) ensured that the input received represented the broad interests of the community served.The following is a list of groups consulted: Area Agency on Aging of The Capital Area, Baylor Scott & White, Blanco County, Celestecare of Horseshoe Bay, Central Texas Catholic Charities, Central Texas Food Bank, City of Marble Falls, Community Advocate Volunteer, Community Resource Center of Texas Inc., Highland Lakes Family Crisis Center, Marble Falls Area EMS, Marble Falls Independent School District, Methodist Healthcare Ministries , NAMI Texas, Seton Highland Lakes, Texas Department of State Health Services - HSR 7, and Texas Home Health Group.

Baylor Scott & White Medical Ctr - Llano
Part V, Section B, Line 6a: Baylor Scott & White Medical Center-Marble FallsBaylor Scott & White Medical Center - Llano:Part V, Section B, Line 9: The hospital adopted its most recent Implementation Strategy before November 15, 2019, the 15th day of the fifth month after the 2018 tax year as described in IRS Regulation Section 1.501(r)-3(c)(5).

Baylor Scott & White Medical Ctr - Llano
Part V, Section B, Line 11: The hospital is committed to serving the community by adhering to its charitable mission, using its skills and capabilities, and remaining a strong organization which continues to provide a wide range of important health care services and community benefits. The hospital has teamed up with other hospital facilities and/or other health care organizations in the community to complete a joint community health needs assessment and develop a joint implementation strategy to address the health needs of the community while meeting certain federal and state requirements. These hospitals will address all significant community health needs (except the need(s) listed below) based on the anticipated impact to the community, hospital resources available, and the expertise of each respective hospital facility. Specific actions can be found in the joint implementation strategy that is made widely available on the hospital's website at www.BSWHealth.com/CommunityNeeds.The following identified needs have not been addressed in the joint community benefit implementation plan: Children in Poverty and Uninsured Disconnected Youth and Diabetes Short-Term Complications Admission: Pediatric (Risk-Adjusted-Rate).There are multiple community and state agencies whose expertise and infrastructure are better suited for meeting the needs not addressed in the Community Health Implementation Strategies. Therefore, BSWH leadership has opted to focus its resources on the listed priorities for the betterment of the community.

Baylor Scott & White Medical Ctr - Llano
Part V, Section B, Line 16j: Measures to publicize the policy within the community served by the hospital facility, include but are not limited to, the following: 1) posting signs and notices regarding the financial assistance policy in the emergency departments, admitting areas and business offices located throughout the organization: 2) annual posting regarding the organization's financial assistance program in the local newspapers: 3) information regarding financial assistance, including the organization's financial assistance policy, is posted on the organization's website: 4) notices about the organization's financial assistance policies are posted on each bill sent to patients including providing a phone number to access the customer service unit dedicated to answering patients billing questions, as well as provide information regarding financial assistance: and 5) the organization may provide free financial counselors to help inpatients determine how to meet their financial obligations for services provided. Specifically financial counselors assist patients in applying for government assistance programs such as Medicaid or the organization's financial assistance program. Any patient may request to speak to a financial counselor when being treated at the organization. Uninsured patients who are admitted to the hospital may receive help from a financial counselor. These services are also offered through interpretation services in the primary language of the patient requesting assistance. The organization has the 501(r) policies available on its website in eight languages: English, Spanish, Russian, Korean, Vietnamese, Arabic, French and Chinese. The organization can also accommodate other languages including American Sign Language as needed.

Baylor Scott & White Medical Ctr - Llano
Part V, Section B, Line 20e: A copy of the Plain Language Summary is included on the back of every billing statement.

Part I, Line 3c:
"and Line 3b: In addition to providing free care to financially indigent patients at 200% of the federal poverty guidelines (""FPG""), the organization provides discounted care to the medically indigent which is based on both the FPG (up to 500%) and the percentage of the patient's total bills from all Baylor Scott & White Health related providers in relation to the patient's annual income."

Part I, Line 6a:
The organization prepares and files an Annual Report of Community Benefit Plan with the Texas Department of State Health Services. This report is made available through the organization's website at www.BSWHealth.com/CommunityNeeds.

Part I, Line 7:
A ratio of patient care cost to charges, as determined in Worksheet 2, was used to report the amounts in Part I, Lines 7a - 7d. For amounts reported on lines 7e - 7k, actual expenses for each community benefit activity are tracked and reported using both community benefit software and/or the organization's cost accounting system.

Part I, Ln 7 Col(f):
The amount of bad debt expense included on Form 990, Part IX, line 25, but removed for Schedule H, Part I, Line 7, Column (f) totaled $0.

Part III, Line 4:
"As stated in the combined audited financial statements, ""The System maintains allowances for uncollectible accounts for estimated losses resulting from a payor's inability to make payments on accounts. The System assesses the reasonableness of the allowance account based on the historical write-offs, cash collections, the aging of the accounts and other economic factors. Accounts are written off when collection efforts have been exhausted. Management continually monitors and adjusts its allowance associated with its receivables."" Bad debt does not include amounts for patients who are known to qualify under the organization's charity care policy. The amount of bad debt attributable to patient's accounts is net of contractual allowance, payments received and recoveries of bad debt previously written off. The Organization has entered zero on Schedule H, Part III, Line 3; however, based on prior experience and certain demographics and other information obtained during admission, the organization believes a portion of the bad debt expenses (estimated to range from 1-5%) would be attributable to patients that would otherwise qualify for charity care. Despite all of the effort and ways the organization educates patients about qualifying for its charity care program as demonstrated in Part VI, question 3 below, many uninsured patients either refuse or fail to complete a charity care application or provide sufficient information at the time of admission, during their stay or after being discharged to qualify for assistance under the organization's charity care policy."

Part III, Line 8:
The amount reported on Part III, Section B, line 7 was calculated in accordance with the Schedule H instructions utilizing the organization's allowable cost reported in the Medicare cost report based on a cost to charge ratio. However, the allowable costs in the Medicare cost report do not reflect the actual cost of providing care to patients since the Medicare cost report excludes many direct patient care costs that are essential to providing quality care to these patients. For example, certain coverage fees to physicians, cost of Medicare C and D, and other similar direct patient care expenses are specifically excluded as allowable cost in the cost reports. The organization believes that all of the shortfall should be considered as a community benefit for the following reasons. First, the IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. IRS Revenue Ruling 69-545 provides, in part, that hospitals serving patients with governmental health benefits, including for example Medicare, is an indication that the hospital operates for the promotion of health in the community. Second, the organization provides care to Medicare patients regardless of this shortfall, i.e., loss, and thereby relieves the state and federal government of the burden of paying the full cost for the care of Medicare beneficiaries. Medicare does not provide sufficient reimbursement to cover the entire cost of providing care to these patients causing the organization to use other surplus funds to cover the shortfall. It is expected that reimbursement under the Medicare program will continue to decline and therefore may further limit access to care due to the anticipated reduction of participating Medicare providers in the community. As a result, the care for these patients will likely increase at, and rest on the shoulders of, nonprofit hospitals or county hospital districts. Third, many of the Medicare participants have low fixed incomes and therefore would qualify for charity care or other means tested government programs absent being enrolled in the Medicare program. Fourth, Texas nonprofit hospitals must provide a minimum level of community benefit in order to obtain exemption from state and local taxes. According to the current Texas Health and Safety Code, the unreimbursed cost of Medicare is considered to be a community benefit in determining these state statutory requirements as it helps relieve a governmental burden of providing this care that would otherwise be provided through the county hospital system in Texas.

Part III, Line 9b:
The organization's patient billing and collection policy prohibits any collection efforts for the portion of the account balance that qualifies for financial assistance under the organization's financial assistance policy. For any remaining balances due, the same policy contains the actions that may be taken in the event of nonpayment, which are applied equally to all patient types. The policy is made widely available to the public on the organization's website https://www.bswhealth.com/financialassistance.

Part VI, Line 2:
During the fiscal year ending June 30, 2019, the Organization conducted a Community Health Needs Assessment (CHNA) to assess the health care needs of the community for each of its licensed hospital facilities and developed an implementation strategy to address the needs identified in the CHNAs. The CHNAs were conducted in accordance with state and federal guidelines including Internal Revenue Code Section 501(r) and the Texas Health and Safety Code Section 311. These CHNAs and implementation strategies have been made widely available to the public and are located on the Organization's website at the following address: www.BSWHealth.com/CommunityNeeds.

Part VI, Line 7, Reports Filed With States
TX

Part VI, Line 3:
The organization is committed to promoting health in the community including providing or finding financial assistance programs to assist patients. Patients who may qualify for financial assistance through the organization's charity care program or other federal, state and local government programs are informed and educated about their eligibility in several ways including, but not limited to, the following: 1) posting signs and notices regarding the financial assistance policy in the emergency departments, admitting areas and business offices located throughout the organization: 2) annual posting regarding the organization's financial assistance program in the local newspapers: 3) information regarding financial assistance, including the organization's financial assistance policy, is posted on the organization's website: 4) notices about the organization's financial assistance policy is posted on each bill sent to patients including providing a phone number to access the customer service unit dedicated to answering patients billing questions, as well as provide information regarding financial assistance: and 5) the organization may provide free financial counselors to help inpatients determine how to meet their financial obligations for services provided. Specifically financial counselors assist patients in applying for government assistance programs such as Medicaid or the organization's financial assistance program. Any patient may request to speak to a financial counselor when being treated at the organization. Uninsured patients who are admitted to the hospital will automatically receive help from a financial counselor. These services are provided in writing and through interpretation services in the primary language of the patient requesting assistance. The organization has the 501(r) policies available on its website in eight languages: English, Spanish, Russian, Korean, Vietnamese, Arabic, French and Chinese. The organization can also accommodate other languages including American Sign Language as needed.

Part VI, Line 4:
The organization operates a hospital facility that primarily serves the geographical area of Blanco, Burnet, Llano and San Saba counties. Additional information regarding the community can be found below, and in the hospital's community health needs assessment and implementation strategy located on the organization's website at www.BSWHealth.com/CommunityNeeds/. The population is approximately 80,757 with a median household income for the ZIP codes within this community ranging from $36,716 to $82,813 for 78663. There were seven ZIP codes with median household incomes less than $50,200 twice the 2018 Federal Poverty Limit or a family of four.The population of the community served is expected to grow 5.9% by 2023, an increase by more than 4,700 people. The 5.9% projected population growth is lower than the state's 5-year projected growth rate (7.1%) and higher compared to the national projected growth rate (3.5%). The ZIP codes expected to experience the most growth in five years are 78654 Marble Falls 1,084 people and 78611 Burnet-Bertram 953 people.The community's population was fairly distributed across four age groups with 27.6% of the population ages 18-44, 26.9% in the 45-64 age group, 26.3% age 65 plus and 19.2% under age 18. The age 65 plus cohort is expected to grow the most adding 3,270 seniors by 2023 (15.4%). Meanwhile, the 45-64 cohort is expected to shrink by 3.1%. Population statistics are analyzed by race and by Hispanic ethnicity. The community was primarily white and non-Hispanic (74.9%). The Hispanic population (all races) also comprised a large population group (20.6%) and is expected to add the greatest number of people (2,447) by 2023. Other non-white, non-Hispanic races are expected to increase slightly over the next five years adding just under 1,000 people by 2023.Most of the population (40%) was insured through employer sponsored health coverage while a quarter of the population (26%) was on Medicare. The remainder of the population was fairly equally divided between Uninsured (13%), Medicaid (10%), and private market (11%). The private market are those purchasing coverage directly or through the health insurance marketplace.The community includes 12 Health Professional Shortage Areas and four (4) Medically Underserved Areas as designated by the U.S. Department of Health and Human Services Health Resources Services Administration.

Part VI, Line 5:
With the oversight of the organization's board and Baylor Scott & White Holdings, the organization's ultimate parent, the organization's hospital facilities and/or other health care facilities have promoted health and benefited the community by providing exemplary health care, medical education, research and other community services. The organization's governing body includes volunteer community representatives that provide leadership and governance for the organization. The members of the governing body contribute their wisdom, insights, and expertise to ensure the organization is fulfilling its mission and charitable purpose while providing efficient administrative support services and direction for the organization. The members are well respected residents and/or own businesses in the organization's primary or secondary service area and understand the needs of the community. The medical staff of the organization is open to all physicians in the community who meet membership and clinical privilege requirements. The organization operates an emergency department accepting all patients without the regard for the ability to pay. The emergency room is operated 24 hours a day, seven days a week.As a nonprofit organization surplus funds are continuously invested back to the community and are utilized to maintain access to limited patient care services or expand access points of care to patients throughout the community. These efforts are generally targeted to meet the community health needs identified in the community health needs assessment conducted by each of the hospital facilities. More information of these efforts can be found in the written implementation strategies that have been made widely available to the public and are located on the organization's website at the following address: www.BSWHealth.com/CommunityNeeds. Below are summaries of a few of the hospital's key patient care services or community benefit programs designed to promote the health of the community. The organization provides financial assistance in the form of charity care to patients who are indigent and satisfy certain eligibility requirements. Additionally, the organization is committed to treating patients who are eligible for means tested government programs such as Medicaid and other government sponsored programs including Medicare, which is provided regardless of the reimbursement shortfall, and thereby relieves the state and federal government of the burden of paying the full cost of care for these patients. Often, patients are unaware of the federal, state and local programs open to them for financial assistance, or they are unable to access them due to the cumbersome enrollment process required to receive these benefits. The organization offers assistance in enrollment to these government programs or extends financial assistance in the form of charity care through the organization's Financial Assistance Policy which can be located on the organization's website at www.bswhealth.com/financialassistance.The organization is also committed to promoting the health and well-being of individuals and families beyond the health activities of the traditional hospital or clinic setting through its community outreach programs. These programs are targeted to positively alter the health of the community through outreach and education on such topics as adult nutrition, childhood obesity, behavioral health and support groups for individuals suffering with chronic diseases such as diabetes, cardiovascular and pulmonary diseases, and cancer. Throughout the year the organization offers free preventive health services to the community such as health screenings, health fairs, immunizations and many other community education programs. At these events, the organization's staff and physicians educate the public on various health-related preventive measures and healthy lifestyle choices.

Part VI, Line 6:
The organization is affiliated with Baylor Scott & White Health (BSWH or the System), a faith based nationally acclaimed network of acute care hospitals and related health care entities providing quality patient care, medical education, medical research and other community services to the communities of North and Central Texas. BSWH is the largest not-for-profit health care system in the State of Texas and one of the largest in the United States as measured by total operating revenue of $10.1 Billion and total assets of $12.8 billion based on the fiscal year ended June 30, 2019. Today, BSWH includes 50 hospitals, over 1,000 patient care sites, approximately 7,500 active physicians, more than 49,000 employees and the Scott & White Health Plan. The System includes a robust spectrum of owned, operated, ventured and affiliated philanthropic foundations, a research institute, physician clinics and networks, acute care hospitals, short-stay hospitals, specialty hospitals, ambulatory surgery centers, free standing emergency medical centers, free standing imaging centers, retail pharmacies, an accountable care organization, a health plan and other health care providers all which fall under the common control of BSW Holdings. Under the guidance of an independent community board, the System follows one single mission, vision and values focusing on quality patient centered care while meeting the demands of health care reform, the changing needs of patients and extraordinary recent advances in clinical care. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation's exemplary health care organizations.Community benefits are provided through the provision of financial assistance, governmental sponsored programs (such as Medicaid and Medicare), medical research, medical education, community health improvement services, donations to other nonprofit health care providers, and many other community service activities. During the year, the affiliated nonprofit hospitals reported community benefits (as reported to the Texas Department of State Health Services, and in accordance with the State of Texas Statutory methodology) in excess of $905,031,000. The System's nonprofit hospitals provided community benefits (as reported on the IRS Form 990, Schedule H) in excess of $446,480,000 during the tax year. The Texas Annual Statement of Community Benefit Standard includes approximately $434,034,000 of unreimbursed cost of Medicare that is not included in the IRS Form 990, Schedule H. As part of the System, certain affiliates make grants and/or contributions to other related nonprofit affiliates to help financially support and/or fund worthy community benefits activities. The System has also established a patient transfer system among the affiliated hospitals allowing patients needing a particular level of care to be transferred as needed to a related hospital that can provide that service in an efficient and effective manner. As part of the System, all hospitals and other affiliated health care providers are required to adhere to high standards for medical quality, patient safety and patient satisfaction. These standards are set forth by BSW Holdings, the organization's parent, which helps ensures consistency across the System.