4A (Expenses $ 200227064 including grants of $ 77500) (Revenue $ 266997730)
See Schedule OBaylor Medical Center at Waxahachie dba Baylor Scott & White Medical Center - Waxahachie (BSW Waxahachie) is a faith-based, nonprofit, 134-bed acute care hospital providing exemplary patient care services to the residents of Ellis County and the surrounding rural communities in North Texas. BSW Waxahachie 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 has over 1,200 patient access points including 51 hospitals, 590 specialty care clinics, 254 outpatient clinics, 158 primary care clinics, 32 pharmacies, 30 ambulatory surgery centers, and more than 7,000 active physicians. The system also includes a state certified health maintenance organization, the Scott and White Health Plan and the Baylor Scott & White Quality Alliance accountable care organization both covering over 1,000,000 lives.BSW Waxahachie has proudly served the residents of Ellis County for more than 100 years. The full-service medical center has multiple specialties and a 35-bed Emergency Department. Key service line offerings include cancer care, digestive disease, emergency services, cardiovascular care, imaging, neurosciences, orthopedics, women and infant services, and women's imaging. BSW Waxahachie is a Magnet recognized facility, a designated Primary Stroke Center, accredited by the Commission on Cancer, and holds Level IV Trauma and Level II Maternity Designations.During the fiscal year, BSW Waxahachie admitted 8,644 patients resulting in 39,079 days of care; delivered 1,171 babies and received 54,026 emergency department visits. Additionally, BSW Waxahachie provided community benefits (as reported to the Texas Department of State Health Services and in accordance with the State of Texas Statutory methodology) of $37,088,784 and provided community benefits (as reported on the IRS Form 990, Schedule H) of $21,556,314 during the tax year. The Texas Annual Statement of Community Benefit Standard includes approximately $23,318,177 of unreimbursed cost of Medicare that is not included in the IRS Form 990, Schedule H. See Schedule H for more information regarding these services and how BSW Waxahachie promotes the health of the communities.

Baylor Scott&White Med Ctr at Waxahachie
Part V, Section B, Line 5: To obtain a qualitative assessment of the health community, the organization:- Assembled a focus group representing the broad interests of the community served;- Conducted interviews and surveys with key informants / leaders and representatives who serve the community and have insight into its needs; and- Held prioritization sessions with hospital clinical leadership and community leaders to review collection results and identify the most significant healthcare needs based on information gleaned from the focus groups and key informants.Focus groups helped identify barriers and social factors influencing the community's health needs. Key informant interviews gave the team even more understanding and insight about the general health status of the community and the various drivers that contributed to health issues.Multiple governmental public health department individuals were asked to contribute their knowledge, information and expertise relevant to the health needs of the community. Individuals or organizations who served and/or represented the interests of medically underserved, low-income and minority populations in the community also took part in the process. NOTE: In some cases, public health officials were unavailable due to obligations concerning the COVID-19 pandemic.On January 19, 2022, a session was conducted with key leadership members from Baylor Scott & White along with community leaders to review the qualitative and quantitative data findings of the CHNA to date, discuss at length the significant needs identified, and complete prioritization exercises to rank the community needs. Prioritizing health needs was a twostep process. The two-step process allowed participants to consider the quantitative needs and qualitative needs as defined by the indicator dataset and focus group/interview/survey participant input.In the first step, participants reviewed the top health needs for their community using associated data-driven criteria. The criteria included health indicator value(s) for the community and how the indicator compared to the state benchmark.Participants held a group discussion about which needs were most significant, using the professional experience and community knowledge of the group. A virtual voting method was invoked for individuals to provide independent opinions.This process helped the group define and identify the community's significant health needs. Participants voted individually for the needs they considered the most significant for this community. When the votes were tallied, the top identified needs emerged and were ranked based on the number of votes.The following is a list of groups consulted: Baylor Scott & White Health, Daniel's Den, Emergency Management Midlothian Police Department, Hope Clinic, Meals on Wheels, Mansfield Independent School District (MISD), Presbyterian Children's Homes & Services (PCHAS), REACH Council, St. Joseph Church, United Way, Waxahachie Independent School District, Waxahachie Care Services.

Baylor Scott&White Med Ctr at Waxahachie
Part V, Section B, Line 6a: NonePart V, Section B, Line 9: The hospital adopted its most recent Implementation Strategy before November 15, 2022, the 15th day of the fifth month after the 2021 tax year as described in IRS Regulation Section 1.501(r)-3(c)(5).

Baylor Scott&White Med Ctr at Waxahachie
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 completed a community health needs assessment and developed an implementation strategy to address the health needs of the community while meeting certain federal and state requirements. The hospital 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 the hospital facility. Specific actions can be found in the 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 community benefit implementation plan: Diabetes, Obesity/Physical Inactivity, Rate of Uninsured in General Population, Binge Drinking and Substance Abuse/Access to Treatment, Lack of Affordable Housing, and Emergency Department Use Rate in All Populations.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 Med Ctr at Waxahachie
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 Med Ctr at Waxahachie
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. 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 $22,778,262.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, 2022, 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 that includes certain zip codes spanning Ellis County. 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 194,892 with an average median household income for the ZIP codes within this community being $80,656. There were no ZIP codes with median household incomes less than $52,400 - twice the 2020 federal poverty limit for a family of four.The community served is expected to grow 8.2% by 2025, an increase of almost 16,000 people. The Projected Population growth is higher than the state's five-year projected growth rate (6.6%) and higher than the national projected growth rate (3.3%). The ZIP codes expected to experience the most growth in five years are 75154 Red Oak -3,978 additional people, 76065 Midlothian -3,792 additional people and 76165 Waxahachie -3,607 additional people.The community's population is younger with 48.2% of the population ages 18-54 and 21.5% under age 18. The age 65-plus cohort is expected to experience the fastest growth (>26%) over the next five years. Growth in the senior population will likely contribute to increased utilization of healthcare services as the population continues to age. A majority of the population (57%) was insured through employer sponsored health coverage. The remainder of the population was fairly equally divided between Medicaid, Medicare and private market (the purchasers of coverage directly or through the health insurance marketplace). The community includes 3 Health Professional Shortage Areas and 1 Medically Underserved Area as designated by the U.S. Department of Health and Human Services.

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 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 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. Ellis County is one of the fastest growing areas in North Central Texas. Keeping its commitment to meet the health needs of a growing community, the organization built a new $175.5 million replacement hospital which opened in December 2014, the organization's 100th anniversary. Providing more than thirty services and specialties, the planned growth will bring new and expanded services to Waxahachie and the surrounding communities. The new campus is the home to Baylor Charles A. Sammons Cancer Center at Waxahachie, along with expanded facilities to increase services for women. The new facility also provides additional inpatient beds, operating rooms, and emergency and intensive care unit (ICU). In addition, the organization has committed significant funding to aid the operation of the Hope Clinic, a local community health clinic serving the medically underserved population. The Hope Clinic, operates as a community need driven, primary care clinic providing diagnostic laboratory & radiologic services, preventive health services, dental services, transportation assistance, pharmaceutical services, mental health and substance abuse services, patient case management services, health education and outreach. The clinic began with the identification of access to care needs for uninsured and indigent residents of Ellis County. In March 2009, Hope Clinic became a Federally Qualified Health Service Center for the provision of primary health care services in underserved and rural communities. 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 lifestyle 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.During the year, the organization continued its focus and efforts in fighting the unexpected COVID-19 pandemic with detailed planning and preparations along with other Baylor Scott & White affiliated entities. From the beginning, teams began securing costly personal protection equipment and finding new innovative ways to adapt. The system's patient-centric focus began offering online screening for COVID-19, eVisits and drive-thru lab specimen collection sites performing over 566,400 COVID-19 tests across the system in FY22. This kept patients from crowding emergency departments, helping limit the virus' spread and preserving scarce resources needed to care for those severely impacted by the pandemic. From the start of the pandemic, the organization along with other Baylor Scott & White affiliates have invested and devoted many resources in developing and expanding its capabilities and infrastructure to care for the community during the pandemic. Baylor Scott & White facilities cared for over 20,000 COVID-19 admitted patients in FY22. As the vaccines were made available, the organization teamed up with other Baylor Scott & White affiliates to setup vaccination clinics and access points to administer over 127,000 vaccines doses to members of the North and Central Texas communities in FY22.

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 $12.7 Billion and total assets of $16.9 Billion based on the fiscal year ended June 30, 2022. Today, BSWH has over 1,200 patient access points including 51 hospitals, 590 specialty care clinics, 254 outpatient clinics, 158 primary care clinics, 32 pharmacies, 30 ambulatory surgery centers, and more than 7,000 active physicians. The System includes a robust spectrum of owned, operated, ventured and other affiliated entities including 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 Baylor Scott White 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) of $997 Million. The System's nonprofit hospitals provided community benefits (as reported on the IRS Form 990, Schedule H) of $570 Million during the tax year. The Texas Annual Statement of Community Benefit Standard includes approximately $515 Million of unreimbursed cost of Medicare as a community benefit that is not counted 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 Baylor Scott White Holdings, the organization's parent, which helps ensures consistency across the System.Technology is rapidly changing the way consumers and health care providers connect, which has enabled the development of new and innovative solutions that enhance the patient experience and support wellness and quality health care. The System is integrating these new technologies, programs and resources into the health information technology infrastructure through the Consumer Digital Experience. This initiative enhances the way consumers discover, decide and connect with the System; improves wellness and care outcomes through digitization and analytics; and enables support for specific measures for availability, geographic use and capacity needs. The Consumer Digital Experience includes video visits, mobile device apps and patient portals, putting a variety of health and wellness tools into the patient's hands. The growth strategy in this area is to create a virtual health capability where users can book an appointment, be treated on demand through a video or electronic visit, assemble their information and personalized profile, and find out where the nearest urgent walk-in clinic might be.As part of the large health system, resources can be shared across a large geographic footprint to reach large populations in a time of unprecedented need. For example, the system continued its focus and efforts in fighting the unexpected COVID-19 pandemic with detailed planning and preparations along with other Baylor Scott & White affiliated entities. From the beginning, BSWH teams began securing costly personal protection equipment and finding new innovative ways to adapt. The system's patient-centric focus began offering online screening for COVID-19, eVisits and drive-thru lab specimen collection sites performing over 566,400 COVID-19 tests across the system in FY22. This kept patients from crowding emergency departments, helping limit the virus' spread and preserving scarce resources needed to care for those severely impacted by the pandemic. From the start of the pandemic, the organization along with other Baylor Scott & White affiliates have invested and devoted many resources in developing and expanding its capabilities and infrastructure to care for the community during the pandemic. Baylor Scott & White facilities cared for over 20,000 COVID-19 admitted patients in FY22. As the vaccines were made available, the organization teamed up with other Baylor Scott & White affiliates to setup vaccination clinics and access points to administer over 127,000 vaccines doses to members of the North and Central Texas communities in FY22.