4A (Expenses $ 137723461 including grants of $ 3461503) (Revenue $ 163493124)
See Schedule OBaylor Medical Centers at Garland and McKinney is a faith based, nonprofit organization that owns and operates, directly or indirectly through a partnership, two separately licensed hospitals: Baylor Scott & White Medical Center - Garland (BSW Garland) and Baylor Scott & White Medical Center - McKinney (BSW McKinney). Baylor Medical Centers at Garland and McKinney 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 1,100 patient care sites, more than 7,500 active physicians, approximately 48,000 employees and the Scott & White Health Plan. During the year, BSW Garland and BSW McKinney provided community benefits (as reported to the Texas Department of State Health Services and in accordance with the State of Texas Statutory methodology) of $40,191,948 and provided community benefits (as reported on the IRS Form 990, Schedule H) of $19,203,833 during the tax year. The Texas Annual Statement of Community Benefit Standard includes approximately $25,122,569 of unreimbursed cost of Medicare that is not included in the IRS Form 990, Schedule H. BSW Garland is a faith-based, nonprofit, 113-bed acute care hospital providing exemplary patient care services and medical education to residents of Garland, Texas and the surrounding communities since 1964. BSW Garland provides inpatient and outpatient medical services to treat individuals with diseases, illnesses and injuries of varying complexities. Services include all of the comprehensive health care services typical of a quality teaching and acute care hospital with multidisciplinary interaction among physicians, providing patients with innovative methods of prevention, diagnosis, treatment, education and support. During the fiscal year, BSW Garland admitted 4,054 patients resulting in 16,398 days of care, and received 31,443 emergency department visits. BSW Garland was closed on February 28, 2018.BSW McKinney is a faith-based, nonprofit, 143-bed acute care hospital providing exemplary patient care services to the growing community of McKinney, Texas and the surrounding areas since July 2012. BSW McKinney offers services in cancer care, digestive disease, cardiovascular care, radiology, neurology, orthopedics, and women and infant care along with a 24/7 emergency department and intensive care unit. A Level III Neonatal Intensive Care Unit with private suites also provides state-of-the-art services to new mothers. The dove-shape building is meant to enhance nurse workflow and patient safety and qualifies as Leadership in Energy and Environmental Design certified for its sustainable and efficient design. During the fiscal year, BSW McKinney admitted 8,396 patients resulting in 31,279 days of care, delivered 1,832 babies and received 39,963 emergency department visits. See Schedule H for more information regarding these services and how Baylor Medical Centers at Garland and McKinney promotes the health of the communities.

4B (Expenses $ 825731 including grants of $ 0) (Revenue $ 26560)
See Schedule OMedical education is a crucial part of the BSW Garland's mission. Being one of the nation's largest private teaching organizations, BSW Garland annually trains residents and fellows in family medicine. These quality teaching programs add many dimensions to BSW Garland's ability to serve patients. Residents in the organizations' program graduate with demonstrated competence in population health management, continuous quality improvement, and the importance of patient satisfaction. Residents work with physician's assistants and are active managers of the patient-centered medical home, often assuming leadership roles in clinic and the Organization's operations. To help address the state's health care workforce shortage, the Texas A&M Health Science Center (TAMHSC) College of Medicine and BSW Garland have joined forces to establish a Clinical Training Program in Dallas for students to complete clinical rotations in surgery, internal medicine, family medicine, psychiatry, pediatrics, and obstetrics/gynecology at BSW Garland and other clinical affiliates over their last two years of residency. While residents and fellows of BSW Garland are not required to work for an affiliate of BSWH, most remain in North Texas upon completion of their program, providing a continuous supply of well-trained medical professionals for the region. During the fiscal year, BSW Garland invested approximately $800,000 in training 18 medical residents.

Part V, Section B
Facility Reporting Group A

Facility Reporting Group A consists of:
- Facility 1: Baylor Scott & White Med Ctr-McKinney, - Facility 2: Baylor Scott & White Med Ctr-Garland

Facility Reporting Group A Part V, Section B, line 5:
Focus groups with ten (10) participants, as well as eight (8) key informant interviews, were conducted September through November of 2015 in order to take into account the input of persons representing the broad interests of the community served. The focus groups and interviews were conducted to solicit feedback from leaders and representatives who serve the community and have insight into community needs. The focus group was designed to familiarize participants with the CHNA process and gain a better understanding of priority health needs from the community's perspective. Focus groups were formatted for individual as well as small group feedback and also helped identify other community organizations already addressing health needs in the community. Truven Health also conducted key informant interviews for the community served. The interviews were designed to help understand and gain insight into how participants felt about the general health status of the community and the various drivers which contributed to health issues. In order to qualitatively assess the health needs for the community, participation was solicited from at least one state, local, tribal, 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 serving and/or representing the interests of medically underserved, low-income, and minority populations in the community. In order to ensure the input received also represented the broad interests of the community served, participation was also sought from community leaders/groups, public health organizations, other healthcare organizations, and other healthcare providers (including physicians). The following is a list of groups consulted: United Way of Tarrant County, City Square, United Way of West Ellis County, United Way of Denton County, YWCA of Metropolitan Dallas, Collin County Health Care Services, Injury Prevention Center of Greater Dallas, Parkland Health and Hospital System, Metrocrest Community Clinic, Mental Health America of Greater Dallas, Bridge-Breast Network, JPS Health Network/Regional Health Partnership District 10, Tarrant County Hospital District, JPS Health Network Trinity Springs Pavilion for Psychiatric Services, Christian Community Action, AIDS Arms, Inc., Metrocare Services

Facility Reporting Group A Part V, Section B, line 6a:
Baylor University Medical Center, Baylor Scott & Wtite Institute for Rehabilitation at Northwest Dallas, Baylor Heart and Vascular Hospital, Baylor Medical Center at Uptown, Baylor Scott & White Institute for Rehabilitation - Dallas, North Central Surgical Center, Baylor Scott & White Institute for Rehabilitation - Frisco, Baylor Scott & White Medical Center - Carrollton, Baylor Scott & White Medical Center - Frisco, Baylor Scott & White Medical Center - Garland, Baylor Scott & White Medical Center - McKinney, Baylor Scott & White Medical Center - Plano, Baylor Scott & White The Heart Hospital - Denton, Baylor Scott & White The Heart Hospital - Plano, Baylor Scott & White Medical Center - Irving, Baylor Surgical Hospital at Las Colinas, Baylor Scott & White Medical Center - White Rock, Baylor Scott & White Medical Center - Centennial.Facility Reporting Group A:Part V, Section B, Line 9: The hospital adopted its most recent Implementation Strategy before November 15, 2016, the 15th day of the fifth month after the 2015 tax year as described in IRS Regulation Section 1.501(r)-3(c)(5).

Facility Reporting Group A Part V, Section B, line 11:
The hospital organization is committed to serving the community by adhering to its 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 organization's hospital facilities have teamed up with other hospital facilities in the community to complete a joint community health needs assessment and develop a joint implementation strategy to meet certain federal and state requirements. These hospitals will address significant community health needs based on their intersection with the stated mission and key clinical strengths. Below are key actions that were taken during the year to address the following needs: Access to Care for middle to lower socioeconomic status, Mental/behavioral health, and preventable admissions- uncontrolled diabetes.Medical Education/Nursing. The hospital is committed to assisting with the preparation of future nurses at entry and advanced levels of the profession to establish a workforce of qualified nurses. Through the System's relationships with many North Texas schools of nursing, the hospital maintains strong affiliations with schools of nursing. Like physicians, nursing graduates trained at the hospital are not obligated to join the staff although many remain in the North Texas area to provide top quality nursing services to many health care institutions.Chronic Disease Management - The Baylor Community Clinic (BCC) houses a carved out chronic disease management program to provide focused and dedicated education and care for low to middle socio-economic status patients with diabetes, cardiovascular diseases (CVD) (i.e. congestive heart failure) and respiratory diseases (asthma/chronic obstructive pulmonary disease) within a primary care setting. Specific staff, comprised of community health workers (CHW) and nurse care managers, address the complex clinical and prevention needs of these patients and spend time specifically on management of these diseases. The focus of this time and education with patients not only entails clinical counseling, but also includes prevention components focused on lifestyle issues and self- management. The other key advantage that patients receive as part of this program is point of care testing for diabetes (HbA1c testing and glucose testing using test strips) and asthma (Peak Flow Meter Assessments). This will help to overcome the barrier of patients' non-compliance with completing lab orders and any financial or transportation issues that arise in obtaining these important lab results.Medication Management - This project option combines project options to implement interventions that put in place teams, technology and processes to avoid medication errors and use evidenced based interventions that put in place the teams, technology and processes to avoid medication errors. The project option combines the components of both of these project options but focuses on medication management and compliance in the ambulatory setting within the patient's Baylor Clinic Primary Care Medical Home (PCMH). Based on current estimates by providers, it is anticipated that more than 50% of patients in the Baylor Clinic have five or more medications. Ensuring that these medications are 1) appropriate, 2) taken correctly, 3) managed and 4) accessible is important to improve clinical outcomes. The project will utilize a clinical pharmacist who will review patient mediations for those patients who have multiple prescriptions on a regular basis to ensure that medications are appropriate and to ensure the patient understands how and why they are taking the medications. Additionally, eligible patients who qualify for mediations and those patients who cannot afford prescriptions will receive help obtaining the medications they need through implementing a prescription assistance program. An attempt will be made to provide medications at little to no cost for patients who are 150% below the federal poverty level, have one or more chronic diseases and remain compliant with their appointments and care regimens. Through this benefit and clinical pharmacist oversight and management, adherence and compliance to medications will increase. The additional advantage to embedding this team within the PCMH is that patients will receive comprehensive care management to address all of their needs in one care venue.Primary Care Expansion - The Baylor Clinics will expand current capacity by opening patient panels to non-Baylor lower and middle income under-served patients and fully utilize the space and providers' capacity. Additional support staff will be hired to better coordinate patient care, ensure transition from the hospital to a Baylor Clinic and help to facilitate the care of the complex underserved patients. Essentially, through expanding the capacity of the current clinic, adding additional support staff and services, a patient can receive comprehensive and complete services in one primary care location. In addition to receiving primary care, this project also proposes that ancillary services such as labs, imaging (i.e.: CT scans, MRI, mammograms, ultrasound, echocardiograms, and interventional radiology) and diagnostics (i.e.: colonoscopy, stress tests, esophageal diagnostic, retinal screens) would also be provided upon physician request. This project aims to close the loop of care and increase patient compliance by co-locating/coordinating many of the essential services that the underserved population often has issues accessing and completing. Specialty Care Expansion- Patients (including Medicaid and Uninsured) who are seen at a Baylor Clinic and have an established primary care medical home (PCMH), can receive specialty care services such as outpatient procedures, specialty office visits, wound care, and facility based procedures such as cardiac catheterizations, certain surgeries (i.e.: gall bladder/hernia), excision of masses (breast, lymphoma), and cataract removal. The specialty care referral/coordination will come from the PCMH clinic per PCP's request. This project's value comes from building relationships, contracts and a network with local specialty care providers that can be easily accessible to this population. Through utilizing our electronic health record and specialty care referral coordinator, we hope engage specialists that provide procedures to also participate in the screening and educational needs of these patients. This is why we included Category 3 outcomes around Asthma improvement, Cervical and Colorectal cancer screening. We believe engaging specialists in these types of preventive services will help to integrate them into the primary care team. Sharing feedback through the electronic health record also will help to create a central repository of patient information and allow the care team to track and improve patient outcomes. Mental/Behavioral Health Clinics - This project co-locates and integrates behavioral health services into the outpatient primary care setting. The model provides a Licensed Clinical Social Worker (LCSW) for basic counseling services. The LCSW addresses behavioral health needs such as: anxiety, depression, and substance abuse issues. The screening tools used are evidence based and include: PHQ2 or 9, GAD-7 and alcohol and substance abuse screens. Additionally, the LCSW will be supported by a Community Health Worker (CHW) to help with the screening and referral processes. This staff can be triaged to clinics and community locations to provide behavioral health services. The behavioral health program requires the LCSW and CHW to work together with the primary care team to: 1) identify the patients who have behavioral health issues, 2) coordinate the patient's care and appointments to fit both the behavioral health and primary care appointment in the same visit and 3) help the primary care team to identify those patients whose behavioral health issues are impeding the management of their acute/chronic disease management models. We expect that approximately 85-90% of these patients will be Medicaid/Uninsured.Additional actions can be found in the joint implementation strategy that is made widely available on the website listed in Schedule H, Part V, Section B, Line 10a. The following identified needs have not been specifically addressed by these hospitals because the needs are being addressed by other affiliated hospitals in the joint community benefit implementation plan or because there are other community and state agencies whose expertise and infrastructure are better suited for addressing these needs: Lack of dental providers, Teen Pregnancy and Drug Abuse. Although these needs are not formally addressed in the joint implementation strategy, the hospitals have made financial contributions during the year to agencies who are dedicated to supporting the needs and accompanying issues.

Facility Reporting Group A 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.

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 http://communityneeds.bswhealth.com/

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, Line 7b, Column (d): Includes payments from the State 1115 Waiver Program for uncompensated care, which funds are to be used to expand indigent care.Part I, Line 7i, Column (c): Includes charity care payments of $3,412,039 that are made directly to or on the behalf of a local public hospital and/or other nonprofit organizations for the treatment of indigent patients of those organizations.

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. Using the same methodology to calculate the unreimbursed cost of providing charity care and Medicaid (using applicable Schedule H Worksheets) would result in a shortfall of $21,545,230, which is $13,664,069 higher than the shortfall reported on Part III, Section B, Line 7. 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, 2016, 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: http://communityneeds.bswhealth.com/.

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 multiple hospital facilities that primarily serves the geographical area of Collin, Dallas and Tarrant counties. Additional information regarding the community can also be found below, and in the hospital's community health needs assessment and implementation strategy located on the organization's website at http://communityneeds.bswhealth.com/.According to population statistics, the overall community served was representative of Texas overall but had slightly higher median income. The community served was more racially diverse with a lower percentage of seniors than both the state and the U.S. benchmark. Overall socioeconomic barriers were similar or lower than the state benchmark, however Dallas County was above state and national benchmark for poverty level.The population of this community served is expected to grow 7.4% (310,512 people) by 2020. The 7.4% population growth is expected to be slightly higher than both the state growth rate (6.7%) and the national growth rate (3.5%). The ZIP Codes expected to experience the most growth in five years: 75070 McKinney (Colling County) - 11,518 people and 75052 Grand Prairie (Dallas County) - 8,933 people. A majority (61%) of the community's population was concentrated in Dallas County. Within the county, the city of Dallas is expected to grow at a rate of 5.4% with a population increase of 66,887 people; the rest of Dallas County is growing faster at 6.6% (86,559 people). Both Collin and Denton counties will see growth approaching 10% over the next five years with a population increase of 77,000 and 79,000, respectively.The sixty-five plus cohort is expected to experience the most growth over the next five years. This is particularly true in Collin County (34% growth) and Denton County (37% growth). Overall in this community the age 65+ population will grow by 116,000 people. Growth in this age cohort will likely contribute to increased utilization of services as the population continues to age. The age group that will experience the least amount of growth in the community is the 18-44 age cohort with an expected increase of 36,975 people.Diversity in the community is projected to increase. Collin and Denton counties are expected to experience higher rates of growth in minority populations than in Dallas County. In 2015, the community, a majority of the population (60%) was white followed by black at 17%. Black and Asian/Pacific Islander populations will see significant growth over the next five years. Growth in these populations is projected to be greater than 20% in both Collin County (37,000 additional people between both races) and Denton County at (171,000 additional people between both races). Those of Hispanic ethnicity comprised 30% of the community's population, just below the overall state proportion of Hispanics but above the national proportion. The Hispanic population in this community is expected to increase 11%, or 142,000 people. Collin and Denton counties are expected to experience higher growth rate of Hispanic population. Dallas County is projected to experience 10% growth in this population.The median household income for the community served was $60,384, greater than both the state and U.S. benchmarks. Sixty-one percent (61%) of the community were commercially insured, which equates to over 2.5 million lives. Commercial covered lives are expected to grow by over 212,000 lives (6%) over the next five years. Medicare and dual eligible lives (those receiving both Medicare and Medicaid benefits) will experience the highest growth rates at 27% (90,000 lives) and 22% (12,000 lives) respectively. The number of uninsured and Medicaid lives are expected to decline slightly in all counties. Collin and Denton counties will see a greater percentage increase in Medicare, growing 33% (20,000 lives) and 37% (18,000 lives) respectively.

Part VI, Line 7, Reports Filed With States
TX

Part VI, Line 5:
With the oversight of an independent volunteer community 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 is comprised of a majority of 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. As a nonprofit organization surplus funds are continuously invested back to the community and are utilized to maintain access to limited patient 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: http://communityneeds.bswhealth.com/. 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 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 https://www.bswhealth.com/financialassistance.The organization operates an emergency department through its hospitals accepting all patients without the regard for the ability to pay. The emergency room is operated 24 hours a day, seven days a week.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. Since late 2009, the organization has been supporting Hope Clinic. Many physicians and nurses on the organizations medical staff, as well as Family Medicine residents from the organization medical education program staff this clinic. The clinic served the working poor who have no private health insurance and who are ineligible for Medicare, Medicaid or similar programs. In addition to urgent care needs and health screenings, Hope Clinic helps its clients manage chronic conditions such as diabetes, high blood pressure, COPD and heart failure. Medications for this population are made more accessible through the clinic's prescription assistance program.Medical education is a crucial part of the organization's mission. Being affiliated with one of the nation's largest private teaching organizations, the organization annually trains 19 residents, fellows and other health care professionals. These quality teaching programs add many dimensions to the organization's ability to serve patients in the community.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. Community outreach and preventative health care are important areas of focus that fuel the organization's efforts to screen and educate local residents to improve the overall health and wellness of the community its services. Prevention leads to early detection and the ability to catch disease when treatment will be most reliable and effective. These programs are targeted to positively alter the health of the community by providing education on such topics as adult nutrition, childhood obesity, and behavioral health issues and to build 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. Equipping people with quality health information encourages individuals to make appropriate life style changes to benefit their health. As part of a health system with renowned teaching facilities, the organization attracts first-rate medical specialists who help improve the level of medical care for the entire community. The organization is also committed to assisting with the preparation of future nurses at entry and advanced levels of the profession to establish a qualified workforce. During a nurses training, clinical skills and professional competencies are developed to provide the nurse with the ability to take on increasing responsibility for patient care. Quality teaching programs add many dimensions to the organization's ability to serve patients. The efforts are coordinated through strong affiliations with schools of nursing in Central and North Texas. The nurses trained at the organization's hospital facility are not obligated to join the staff although many remain in Texas to provide top quality nursing services to many health care institutions.

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 $9.5 Billion and total assets of $12.1 billion based on the fiscal year ended June 30, 2018. Today, BSWH includes 50 hospitals, over 1,100 patient care sites, more than 7,500 active physicians, approximately 48,000 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 $954,038,000. The System's nonprofit hospitals provided community benefits (as reported on the IRS Form 990, Schedule H) in excess of $532,010,000 during the tax year. The Texas Annual Statement of Community Benefit Standard includes approximately $380,665,000 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.