TY 2011 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Bohn D Allen MD Chair	2.00	X		0	0
(2) Billie Farrar Trustee	2.00	X		0	0
(3) Danny Joe Garmer MD Trustee	2.00	X		0	0
(4) Michael Glaspie Vice Chair	2.00	X		0	0
(5) Philip Johnson Trustee	2.00	X		0	0
(6) W Dan Dipert Trustee	2.00	X		0	0
(7) Mary Jean Moloney Secretary	2.00	X		0	0
(8) Joan L Bergstrom MD Trustee	2.00	X		101,280	0
(9) Ignacio T Nunez MD Trustee	2.00	X		125	0
(10) Brad L Wilemon Trustee	2.00	X		0	0
(11) Frederick Cravens Trustee	2.00	X		0	0
(12) Dan T Serna Trustee	2.00	X		0	0
(13) Kirk King President	40.00		X	0	91,486
(14) Bradford Davis Vice President	40.00		X	0	26,832
(15) Larry Olive Vice President	40.00		X	0	30,012
(16) Stephanie Miland Vice President	40.00		X	0	31,316
(17) Donna Lee Bertram Vice President	40.00		X	143,003	5,350

(A) Name and business address	(B) Description of services	(C) Compensation
Texas Health Resources 612 E Lamar Blvd Arlington,TX76011	Management Fee	23,500,235
AMH Cath Labs LLC 811 Wright Street Arlington,TX76012	Medical Services	2,186,586
Texas Health Single Source Staffing 524 E Lamar Blvd 300 Arlington,TX76011	Contract Labor	1,910,099
North Texas Healthcare Laundry Co-op PO Box 535849 Grand Prairie,TX75053	Laundry Services	757,787
Navigant Consulting Inc 4511 Paysphere Circle Chicago,IL60674	Consulting Fee	309,077
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 16

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	6,150	6,150
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	1,949,651		1,949,651
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	95,177,173	94,946,909	230,264
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	4,268,151	4,268,151
9	Other employee benefits .......	14,147,195	14,125,130	22,065
10	Payroll taxes ...........	6,878,985	6,824,059	54,926
11	Fees for services (non-employees):
a	Management ......	23,500,235		23,500,235
b	Legal .........
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising. See Part IV, line 17..
f	Investment management fees ......	158,112		158,112
g	Other ..........	8,112,118	5,474,337	2,637,781
12	Advertising and promotion ....	533,379	533,379
13	Office expenses .......	373,430	159,497	213,933
14	Information technology ......	1,297,503	1,297,592	-89
15	Royalties ..
16	Occupancy ...........	3,364,035	3,363,532	503
17	Travel ............	81,973	73,210	8,763
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	65,874	58,218	7,656
20	Interest ...........	4,238,072	4,238,072
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	12,581,147	12,413,096	168,051
23	Insurance ..............	-97,567	-97,567
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	Supplies	34,539,441	34,481,688	57,753
b	Patient Care Expenses	13,917,126	13,917,126
c	Repairs & Maintenance	2,940,570	2,940,570
d	Miscellaneous Expenses	2,257,157	2,237,112	20,045
e
f	All other expenses	1,508,766	1,412,328	96,438
25	Total functional expenses. Add lines 1 through 24f	231,798,676	202,672,589	29,126,087	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	-1,785,480	1	-359,597
2	Savings and temporary cash investments .......		2
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	29,024,448	4	23,877,512
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	160,253	5	163,651
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............	1,459,365	7	1,623,504
8	Inventories for sale or use ..............	4,091,476	8	3,317,651
9	Prepaid expenses and deferred charges ............	437,912	9	301,789
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	251,220,298
b	Less: accumulated depreciation. .....	10b	121,634,431	130,792,577	10c	129,585,867
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 ......	125,169	12	125,169
13	Investments—program-related. See Part IV, line 11 ..	5,696,054	13	7,251,593
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	93,494,951	15	95,720,308
16	Total assets. Add lines 1 through 15 (must equal line 34)...	263,496,725	16	261,607,447
	17	Accounts payable and accrued expenses .	25,446,523	17	24,232,436
18	Grants payable ..........		18
19	Deferred revenue ..........		19
20	Tax-exempt bond liabilities ..........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	54,284	25	52,465
26	Total liabilities. Add lines 17 through 25.....	25,500,807	26	24,284,901
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	236,183,306	27	237,322,546
28	Temporarily restricted net assets .....	1,812,612	28
29	Permanently restricted net assets .....		29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	237,995,918	33	237,322,546
34	Total liabilities and net assets/fund balances .....	263,496,725	34	261,607,447

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

Texas Health Arlington Memorial Hospital

Employer identification number

75-0972805

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

Texas Health Arlington Memorial Hospital

Employer identification number

75-0972805

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization Texas Health Arlington Memorial Hospital
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization Texas Health Arlington Memorial Hospital
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
Texas Health Arlington Memorial Hospital

Employer identification number

75-0972805

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Texas Health Arlington Memorial Hospital

Employer identification number

75-0972805

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Yes

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Yes

100

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Total. Add lines 1c through 1i ...............................

100

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
		Description of Activity Officers and/or Board Members of the corporation may, to an insubstantial degree, make comments or statements concerning legislation that may affect either the healthcare industry or the health status of the communities the Corporation serves. In pursuing this activity, Officers and/or Board Members may engage in conversations and/or write letters to various federal, state, and local officials regarding such matters. The amount of time and money involved in these activities is negligible. In no case has either the Corporation, or any person acting on behalf of the Corporation, intervened in any political campaign.

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Texas Health Arlington Memorial Hospital

Employer identification number

75-0972805

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	2,831,017		2,831,017
b	Buildings ................	167,935,182	70,040,990	97,894,192
c	Leasehold improvements ............
d	Equipment ................	80,116,149	51,593,441	28,522,708
e	Other .................	337,950		337,950
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				129,585,867

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other (A) Cross Timbers	124,369	C
(B) Arlington Surgery Mgmt	800	C







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	125,169

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Community Hospice	6,482,424	C
(2) AMH Cath Labs	769,169	C







Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	7,251,593

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) Intercompany Receivable				95,720,308








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				95,720,308

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes
Asset Retirement Obligations		52,465








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		52,465
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	227,218,029
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	231,798,676
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	-4,580,647
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8
9	Total adjustments (net). Add lines 4 through 8 .........................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	-4,580,647

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation

Schedule D (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Texas Health Arlington Memorial Hospital

Employer identification number

75-0972805

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

200% 250% 300% 350% 400% Other

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............

Did the organization prepare a community benefit report during the tax year?...........

Yes

If "Yes," did the organization make it available to the public? ...............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..	14,807,828	149,571	14,658,257	5.730 %
b Medicaid (from Worksheet 3, column a) .....	23,280,454	28,178,066	-4,897,612
c Costs of other means-tested government programs (from Worksheet 3, column b) .	13,802	1,170	12,632
dTotal Financial Assistance and Means-Tested Government Programs .....	38,102,084	28,328,807	9,773,277	3.820 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	219,911		219,911	0.090 %
f Health professions education (from Worksheet 5) ..	573,127		573,127	0.220 %
g Subsidized health services (from Worksheet 6) ..
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	9,832,826		9,832,826	3.840 %
jTotal Other Benefits ...	10,625,864		10,625,864	4.150 %
kTotal. Add lines 7d and 7j. ..	48,727,948	28,328,807	20,399,141	7.970 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing
2	Economic development
3	Community support	7,817	7,817
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building		7,817
7	Community health improvement advocacy
8	Workforce development	9,538	9,538
9	Other
10	Total	17,355	17,355

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense........

29,779,372

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

53,094,261

Enter Medicare allowable costs of care relating to payments on line 5.....

67,193,159

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-14,098,898

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?2 Name and address		Other (Describe)
1	Texas Health Arlington Memorial 800 W Randol Mill Rd Arlington,TX76011	X	X	X
2	AMH Cath Labs LLC 811 Wright St Arlington,TX76011	X	X

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?.......		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: % If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14
15	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	DDid the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?1
Name and address		Type of Facility (describe)
1	Cross Timbers Surgery Ctr 1001 Waldrop Dr Ste 705 Arlington,TX76012	ASC
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2011

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Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
1	Part 1, line 3c	Part 1, line 3c: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application.
2	Part 1, line7	Part 1, line7: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. Part I, Line 7 Costing Methodology A cost to charge ratio, as calculated using Worksheet 2 (Ratio of Patient Care Cost-to-Charges) is used in computing the amounts reported in Lines 7a - 7c. The amounts reported on Lines 7e - 7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate.
3	Part III, line 4	Part III, line 4: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. Part I, Line 7 Costing Methodology A cost to charge ratio, as calculated using Worksheet 2 (Ratio of Patient Care Cost-to-Charges) is used in computing the amounts reported in Lines 7a - 7c. The amounts reported on Lines 7e - 7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management.
4	Part III, line 8	Part III, line 8: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. Part I, Line 7 Costing Methodology A cost to charge ratio, as calculated using Worksheet 2 (Ratio of Patient Care Cost-to-Charges) is used in computing the amounts reported in Lines 7a - 7c. The amounts reported on Lines 7e - 7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges.
5	Part III, line 9b	Part III, line 9b: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. Part I, Line 7 Costing Methodology A cost to charge ratio, as calculated using Worksheet 2 (Ratio of Patient Care Cost-to-Charges) is used in computing the amounts reported in Lines 7a - 7c. The amounts reported on Lines 7e - 7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program.
6	Part VI, line 1	Part VI, line 1: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. Part I, Line 7 Costing Methodology A cost to charge ratio, as calculated using Worksheet 2 (Ratio of Patient Care Cost-to-Charges) is used in computing the amounts reported in Lines 7a - 7c. The amounts reported on Lines 7e - 7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c
7	Part V, Section B, line 11h	Part V, Section B, line 11h: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. Part I, Line 7 Costing Methodology A cost to charge ratio, as calculated using Worksheet 2 (Ratio of Patient Care Cost-to-Charges) is used in computing the amounts reported in Lines 7a - 7c. The amounts reported on Lines 7e - 7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10
8	Part V, Section B, line 13g	Part V, Section B, line 13g: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. Part I, Line 7 Costing Methodology A cost to charge ratio, as calculated using Worksheet 2 (Ratio of Patient Care Cost-to-Charges) is used in computing the amounts reported in Lines 7a - 7c. The amounts reported on Lines 7e - 7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital
9	Part VI, line 2	Part VI, line 2: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. Part I, Line 7 Costing Methodology A cost to charge ratio, as calculated using Worksheet 2 (Ratio of Patient Care Cost-to-Charges) is used in computing the amounts reported in Lines 7a - 7c. The amounts reported on Lines 7e - 7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital The organization is developing strategies to ensure that it is in full compliance with the 2013 Community Health Needs Assessment (CHNA) requirements, and has completed work on the community profile for the defined community or service area in preparation for conducting the CHNA. Special attention will be given to persons facing disproportionate unmet health related needs. The organization is in the process of identifying resources for strategic planning and community health improvement project planning. The CHNA process will result in the compilation of data, opinion, and observation about the health and well-being of the surrounding community. The goals identified for action at the end of this process will translate the organizations mission and priorities into a strategy with specific activities and projects focusing on a positive community impact that is demonstrative, sustainable and measurable. The organization's community health profile provides a snapshot of the service area using key health indicators, which facilitate comparisons locally, regionally and over time. National, state and local secondary and primary data sources are used to provide a current overview of local health needs, factors impacting disease and injury burden, socioeconomic status, access to health care, age distribution, indicators and lifestyle behaviors. This data is used to galvanize joint community health efforts to improve health, to reduce inequalities and to empower the greater community.
10	Part VI, line 3	Part VI, line 3: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. Part I, Line 7 Costing Methodology A cost to charge ratio, as calculated using Worksheet 2 (Ratio of Patient Care Cost-to-Charges) is used in computing the amounts reported in Lines 7a - 7c. The amounts reported on Lines 7e - 7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital The organization is developing strategies to ensure that it is in full compliance with the 2013 Community Health Needs Assessment (CHNA) requirements, and has completed work on the community profile for the defined community or service area in preparation for conducting the CHNA. Special attention will be given to persons facing disproportionate unmet health related needs. The organization is in the process of identifying resources for strategic planning and community health improvement project planning. The CHNA process will result in the compilation of data, opinion, and observation about the health and well-being of the surrounding community. The goals identified for action at the end of this process will translate the organizations mission and priorities into a strategy with specific activities and projects focusing on a positive community impact that is demonstrative, sustainable and measurable. The organization's community health profile provides a snapshot of the service area using key health indicators, which facilitate comparisons locally, regionally and over time. National, state and local secondary and primary data sources are used to provide a current overview of local health needs, factors impacting disease and injury burden, socioeconomic status, access to health care, age distribution, indicators and lifestyle behaviors. This data is used to galvanize joint community health efforts to improve health, to reduce inequalities and to empower the greater community. A description of both the Charity Care program and application are available on the THR website at www.TexasHealth.org in English and Spanish. Signs alerting patients of charity care assistance and related contact information are posted in various areas of the hospital including admissions & registration, the emergency room and other outpatient departments. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms forms necessary to apply for the assistance. At the same time, patients are provided with a Charity Care application and information flyer. The patient is informed that the hospital is a non-profit organization offering financial assistance to patients deemed medically or financially indigent. The financial counselors may assist the patient in completing the application and obtain available verification information. Once the patient is discharged, the counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and Charity Care have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the financial assistance program. Each bill sent for hospital services also contains contact information alerting patients that Texas Health has a charity care program.
11	Part VI, line 4	Part VI, line 4: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. Part I, Line 7 Costing Methodology A cost to charge ratio, as calculated using Worksheet 2 (Ratio of Patient Care Cost-to-Charges) is used in computing the amounts reported in Lines 7a - 7c. The amounts reported on Lines 7e - 7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital The organization is developing strategies to ensure that it is in full compliance with the 2013 Community Health Needs Assessment (CHNA) requirements, and has completed work on the community profile for the defined community or service area in preparation for conducting the CHNA. Special attention will be given to persons facing disproportionate unmet health related needs. The organization is in the process of identifying resources for strategic planning and community health improvement project planning. The CHNA process will result in the compilation of data, opinion, and observation about the health and well-being of the surrounding community. The goals identified for action at the end of this process will translate the organizations mission and priorities into a strategy with specific activities and projects focusing on a positive community impact that is demonstrative, sustainable and measurable. The organization's community health profile provides a snapshot of the service area using key health indicators, which facilitate comparisons locally, regionally and over time. National, state and local secondary and primary data sources are used to provide a current overview of local health needs, factors impacting disease and injury burden, socioeconomic status, access to health care, age distribution, indicators and lifestyle behaviors. This data is used to galvanize joint community health efforts to improve health, to reduce inequalities and to empower the greater community. A description of both the Charity Care program and application are available on the THR website at www.TexasHealth.org in English and Spanish. Signs alerting patients of charity care assistance and related contact information are posted in various areas of the hospital including admissions & registration, the emergency room and other outpatient departments. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms forms necessary to apply for the assistance. At the same time, patients are provided with a Charity Care application and information flyer. The patient is informed that the hospital is a non-profit organization offering financial assistance to patients deemed medically or financially indigent. The financial counselors may assist the patient in completing the application and obtain available verification information. Once the patient is discharged, the counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and Charity Care have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the financial assistance program. Each bill sent for hospital services also contains contact information alerting patients that Texas Health has a charity care program. See Schedule O
12	Part VI, line 5	Part VI, line 5: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. Part I, Line 7 Costing Methodology A cost to charge ratio, as calculated using Worksheet 2 (Ratio of Patient Care Cost-to-Charges) is used in computing the amounts reported in Lines 7a - 7c. The amounts reported on Lines 7e - 7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital The organization is developing strategies to ensure that it is in full compliance with the 2013 Community Health Needs Assessment (CHNA) requirements, and has completed work on the community profile for the defined community or service area in preparation for conducting the CHNA. Special attention will be given to persons facing disproportionate unmet health related needs. The organization is in the process of identifying resources for strategic planning and community health improvement project planning. The CHNA process will result in the compilation of data, opinion, and observation about the health and well-being of the surrounding community. The goals identified for action at the end of this process will translate the organizations mission and priorities into a strategy with specific activities and projects focusing on a positive community impact that is demonstrative, sustainable and measurable. The organization's community health profile provides a snapshot of the service area using key health indicators, which facilitate comparisons locally, regionally and over time. National, state and local secondary and primary data sources are used to provide a current overview of local health needs, factors impacting disease and injury burden, socioeconomic status, access to health care, age distribution, indicators and lifestyle behaviors. This data is used to galvanize joint community health efforts to improve health, to reduce inequalities and to empower the greater community. A description of both the Charity Care program and application are available on the THR website at www.TexasHealth.org in English and Spanish. Signs alerting patients of charity care assistance and related contact information are posted in various areas of the hospital including admissions & registration, the emergency room and other outpatient departments. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms forms necessary to apply for the assistance. At the same time, patients are provided with a Charity Care application and information flyer. The patient is informed that the hospital is a non-profit organization offering financial assistance to patients deemed medically or financially indigent. The financial counselors may assist the patient in completing the application and obtain available verification information. Once the patient is discharged, the counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and Charity Care have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the financial assistance program. Each bill sent for hospital services also contains contact information alerting patients that Texas Health has a charity care program. See Schedule O See Schedule O
13	Part VI, line 6	Part VI, line 6: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. Part I, Line 7 Costing Methodology A cost to charge ratio, as calculated using Worksheet 2 (Ratio of Patient Care Cost-to-Charges) is used in computing the amounts reported in Lines 7a - 7c. The amounts reported on Lines 7e - 7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital The organization is developing strategies to ensure that it is in full compliance with the 2013 Community Health Needs Assessment (CHNA) requirements, and has completed work on the community profile for the defined community or service area in preparation for conducting the CHNA. Special attention will be given to persons facing disproportionate unmet health related needs. The organization is in the process of identifying resources for strategic planning and community health improvement project planning. The CHNA process will result in the compilation of data, opinion, and observation about the health and well-being of the surrounding community. The goals identified for action at the end of this process will translate the organizations mission and priorities into a strategy with specific activities and projects focusing on a positive community impact that is demonstrative, sustainable and measurable. The organization's community health profile provides a snapshot of the service area using key health indicators, which facilitate comparisons locally, regionally and over time. National, state and local secondary and primary data sources are used to provide a current overview of local health needs, factors impacting disease and injury burden, socioeconomic status, access to health care, age distribution, indicators and lifestyle behaviors. This data is used to galvanize joint community health efforts to improve health, to reduce inequalities and to empower the greater community. A description of both the Charity Care program and application are available on the THR website at www.TexasHealth.org in English and Spanish. Signs alerting patients of charity care assistance and related contact information are posted in various areas of the hospital including admissions & registration, the emergency room and other outpatient departments. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms forms necessary to apply for the assistance. At the same time, patients are provided with a Charity Care application and information flyer. The patient is informed that the hospital is a non-profit organization offering financial assistance to patients deemed medically or financially indigent. The financial counselors may assist the patient in completing the application and obtain available verification information. Once the patient is discharged, the counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and Charity Care have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the financial assistance program. Each bill sent for hospital services also contains contact information alerting patients that Texas Health has a charity care program. See Schedule O See Schedule O See Schedule O
14	Part VI, line 7	Part VI, line 7: Patients with family income at or below 200% of applicable FPG may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. All self pay patients who don't qualify for the organization's charity program, regardless of income, are eligible for a discount of 45% off the hospital's charge for general hospital services. In addition, a 60% discount is available on charges associated with certain implantable devices. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's charity care application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a charity care application. Part I, Line 7 Costing Methodology A cost to charge ratio, as calculated using Worksheet 2 (Ratio of Patient Care Cost-to-Charges) is used in computing the amounts reported in Lines 7a - 7c. The amounts reported on Lines 7e - 7i were obtained using direct costs, as determined by a cash outlay or, in the case of reporting employee volunteer hours, by using an average national volunteer wage rate. Bad debt expense is not included as a community benefit for purposes of reporting community benefits to Texas. We treat each patient qualifying for charity care as a charity patient and no charges related to that patient are included in bad patient are included in bad debt expense. The hospital is part of a consolidated system of hospitals which operate under the name Texas Health Resources (THR). THRs annual audit is conducted on a system-wide basis with a single consolidated audit report issued for THR and its affiliates. The audited financial statements of THR, which includes the activity of the organization, contain a footnote regarding Accounts Receivable and Allowance for Doubtful Accounts, that reads as follows. Patient accounts receivable are reported net of estimated allowances for doubtful accounts and contractual adjustments in the consolidated balance sheets. The provision for bad debts is based upon a combination of the aging of receivables and managements assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience and payment trends by payor category. Patient accounts are also monitored and, if necessary, past due accounts are placed with collection agencies in accordance with guidelines established by management. The State of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care and community benefit. For the State, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost to charge ratio, with costs determined in accordance with GAAP, to billed charges. During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Charity Care Program. Part V, Section B, Line 10 See response to Part I Line 3c See response to Part I, Line 3c and Part V Sec B, Line 10 A full copy of the Charity Care Policy is provided upon request. Notice of financial assistance and a summary of the policy are communicated to the public and to patients. A summary of the policy is in each of the following. posted on the hospital's website, attached to billing invoices, posted at the emergency room and waiting rooms, posted in Admissions office, and provided, in writing, to patients on admission to the hospital The organization is developing strategies to ensure that it is in full compliance with the 2013 Community Health Needs Assessment (CHNA) requirements, and has completed work on the community profile for the defined community or service area in preparation for conducting the CHNA. Special attention will be given to persons facing disproportionate unmet health related needs. The organization is in the process of identifying resources for strategic planning and community health improvement project planning. The CHNA process will result in the compilation of data, opinion, and observation about the health and well-being of the surrounding community. The goals identified for action at the end of this process will translate the organizations mission and priorities into a strategy with specific activities and projects focusing on a positive community impact that is demonstrative, sustainable and measurable. The organization's community health profile provides a snapshot of the service area using key health indicators, which facilitate comparisons locally, regionally and over time. National, state and local secondary and primary data sources are used to provide a current overview of local health needs, factors impacting disease and injury burden, socioeconomic status, access to health care, age distribution, indicators and lifestyle behaviors. This data is used to galvanize joint community health efforts to improve health, to reduce inequalities and to empower the greater community. A description of both the Charity Care program and application are available on the THR website at www.TexasHealth.org in English and Spanish. Signs alerting patients of charity care assistance and related contact information are posted in various areas of the hospital including admissions & registration, the emergency room and other outpatient departments. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms forms necessary to apply for the assistance. At the same time, patients are provided with a Charity Care application and information flyer. The patient is informed that the hospital is a non-profit organization offering financial assistance to patients deemed medically or financially indigent. The financial counselors may assist the patient in completing the application and obtain available verification information. Once the patient is discharged, the counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and Charity Care have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the financial assistance program. Each bill sent for hospital services also contains contact information alerting patients that Texas Health has a charity care program. See Schedule O See Schedule O See Schedule O See Schedule O

Schedule H (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
Texas Health Arlington Memorial Hospital

Employer identification number
75-0972805

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2011

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
		The organization receives various requests from the community for assistance. Management reviews these requests to verify they are benefiting the community and they in agreement with the organization's mission. The grants or assistance given are generally to local organizations who have a longstanding record of benefiting the local community. Since the vast majority of the assistance given by the organization is to local organizations, management is able to monitor the use of the funds using personal inspection. Many of the events are published in the local paper. Many are community wide events where the organization's employees attend, or work as volunteers or coordinators.

Schedule I (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Texas Health Arlington Memorial Hospital

Employer identification number

75-0972805

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Yes

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) Dan T Serna	(i) (ii)
(2) Kirk King	(i) (ii)	348,974	309,074	98,446	69,000	22,486	847,980	169,982
(3) Bradford Davis	(i) (ii)	175,548	54,302	101,374	14,700	12,132	358,056
(4) Larry Olive	(i) (ii)	173,543	40,577	33,830	14,982	15,031	277,963
(5) Stephanie Miland	(i) (ii)	147,993	39,398	48,719	14,268	17,048	267,426
(6) Barclay Berdan	(i) (ii)
(7) Charles Boes	(i) (ii)
(8) Kenneth Kramer	(i) (ii)
(9) John Mitchell	(i) (ii)
(10) Kathleen Gilman	(i) (ii)
(11) Linda Wren	(i) (ii)	77,966	2,421	84,171		13,302	177,860
(12) Sabatino Bianco	(i) (ii)	163,980		25	4,122		168,127
(13) Rex Schimpf	(i) (ii)	141,587	6,601	1,775	8,918	19,070	177,951

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
		Sch J, Part I, Line 1 Gross-up payments Certain imputed income is grossed-up to include the employment taxes paid on the listed person's behalf. The grossed up amount is included in the taxable compensation of the employee. . Discretionary Spending Account Each executive at the vice president level and above receive a perk allowance which is included in the taxable compensation of the employee. . Personal Services - Financial Planning Officers can use their discretionary spending account to pay for financial planning services. The organization does not directly pay for any officer's personal services. . . Sch J, Part I, Question 3 The organization relied on Texas Health Resources (THR), a related 501(c)(3) organization, with centralized compensation professionals to use the following methods to establish the compensation of the organization's President. - THR has a compensation committee comprised of external Board members that review compensation philosophy and design. - THR Board hired independent compensation consultants - THR & the independent compensation consultants utilize published third-party compensation surveys . An independent third party compensation consultant is hired by the THR Board of Trustees (Board) to review base pay annually as compared to a peer group of employers similar in size and scope to THR. Every three years the independent compensation consultant reviews all aspects of executive compensation (base, incentives, benefits, etc.) which includes: - Review and confirmation of the executive compensation philosophy, - Market review of base and incentive pay for all positions. National, regional, and local data is reviewed when available. - Market review of benefits and perquisites, - Interview of selected officers and members of the Governance Committee of the THR Board of Trustees, and - Review of financial reports, job descriptions, organizational charts, current salaries, incentive opportunities, incentive payments, benefits, perquisites and plan documents. . The independent compensation consultant meets directly with the executive compensation & benefits sub-committee which is made up of five independent Board members and the governance committee to report the results of the total compensation study. . At the beginning of each year, the executive compensation & benefits sub-committee reviews; the governance committee reviews and recommends for approval by the Board; and the Board approves the following: - Market analysis recommendation based on the results of the outside consultant's review - Officer market/equity base salary adjustments - Prior year executive annual incentive awards - Current year executive annual incentive plan targets, key performance indicators and potential payout amounts . . Sch J, Part I, Question 4a The severance payment was paid out of the Separation Pay Plan of Texas Health Resources (THR), a related 501(c)(3) organization. THR's Separation Pay Plan provides payments to to employees whose positions were eliminated by the organization based on the employee's years of service and the level of the affected position. - Bradford Davis $23,962 - Linda Wren $83,196 . Sch J, Part I, Question 4b Participation in the plan is made available to a select group of management and highly compensated employees, as determined by the THR Board of Trustees, who are providing services to an employer in key positions of management and responsibility. - Benefits are calculated for eligible employees when base pay and incentives exceed the IRS qualified plan compensation limit. - SERP benefits vest while the participant is employed if the participant: reaches age 68, becomes disabled, dies, or reaches the following years of service: 2 years - 25%; 3 years - 50%; 4 years - 75%; and 5 or more - 100%. - For Frozen Restoration Accounts (account balances prior to 1/1/2010), the participant or beneficiary shall be taxed on his or her vested SERP benefit upon the earliest of: Remaining employed by THR to age 68; Termination of employment for disability or death; Involuntary termination of employment without reasonable cause; or Satisfying a 24 month non-compete period following his or her termination of employment. Payment is made following the before mentioned events, except in the case of involuntary separations for which the participant must wait until after 24 months to receive the previously taxed benefit. - For the Active Restoration Accounts (account balances after 12/31/2009) participants must be employed on Dec 1 to qualify for the current year's SERP amount unless separation is due to death, disability, retirement (age 65) or early retirement (age 60 or above with 15 or more years of service). SERP amounts are calculated each Dec 1; vested balances are taxed; and the net balances can begin accruing earnings. Vested balances are paid in cash lump sums within the 90-day period commencing upon the earlier of death, disability, or separation from service. - THR owns any investments purchased in connection with its obligations under the SERP Plan. If THR becomes insolvent, executives are unsecured creditors and will have no preferred claim to any assets.

Schedule J (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Texas Health Arlington Memorial Hospital

Employer identification number

75-0972805

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No
(1) Joan Bergstrom MD PA Physician Recruiting		X	162,580	163,651		No	Yes		Yes





Total ............... $				163,651

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2011

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person	(c) Amount of transaction	(d) Description of transaction	Yes	No

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

Texas Health Arlington Memorial Hospital

Employer identification number

75-0972805

Identifier	Return Reference	Explanation
		Part VI, Section A, Line 2: John Mitchell & Barclay Berdan have a business relationship. Kirk King & Shelly Miland have a business relationship. Part VI, Section B, Line 11b: A full copy of the Form 990 is provided to members of the governing board before filing. In addition, the Audit & Compliance Committee of the Texas Health Resources (THR) Board of Trustees is given the opportunity to review, comment, and ask questions regarding the Form 990s filed for THR and each of its wholly controlled affiliates. Part VI, Section B, Line 12c: Texas Health Resources (THR) has adopted a Conflict of Interest policy that applies to THR and all of its wholly owned or wholly controlled affiliates. During the first quarter of each fiscal year, a Duality and Conflict Statement Form is distributed by the THR Chief Compliance Officer to all persons who are covered by this policy. All disclosed conflicts are reviewed by the THR Chief Compliance Officer, THR General Counsel and the THR Audit & Compliance Committee. A report listing each reported Duality of Interest or Conflict of Interest is given to both the Chair of the Governing Body and the President of the Corporation with which the reporting person is affiliated. The THR Board of Trustees receives a report when the Annual Disclosure process is complete. Part VI, Section B, Line 15 a& b An independent third party compensation consultant is hired by the Texas Health Resources (THR) Board of Trustees (Board) to review base pay annually as compared to a peer group of employers similar in size and scope to THR. Every three years the independent compensation consultant reviews all aspects of executive compensation (base, incentives, benefits, etc.) which includes: - Review and confirmation of the executive compensation philosophy, - Market review of base and incentive pay for all positions. National, regional, and local data is reviewed when available. - Market review of benefits and perquisites, - Survey of officers and members of the Governance Committee of the THR Board of Trustees, and - Review of financial reports, job descriptions, organizational charts, current salaries, salary range midpoints, incentive opportunities, incentive payments, benefits, perquisites and plan documents. The independent compensation consultant meets directly with the executive compensation & benefits sub-committee which is made up of five independent Board members and the governance committee to report the results of the total compensation study. At the beginning of each year, the executive compensation & benefits sub-committee reviews; the governance committee reviews and recommends for approval by the Board; and the Board approves the following: - Market analysis recommendation based on the results of the outside consultant's review - Officer Market/equity base salary adjustments - Prior year executive annual incentive awards - Current year executive annual incentive plan targets, key performance indicators, and potential payout amounts Part VI, Section C, Line 19: The organization does not make its governing documents or conflict of interest policy available to the public. The consolidated financial statements of Texas Health Resources (THR) are made available to the public on the website www.dacbond.com. Consolidated financial statements are posted to this website quarterly and the audited financial statements are posted annually. The financial statements of the wholly controlled affiliates of THR are not posted to the website nor are they generally made available to the public in any other manner. Part VII, Section A, Officers Related Entity Hours: The following persons devoted the indicated estimated average hours per week to related organizations: Bohn Allen, MD - 2 hours Ignacio T. Nunez, MD - 1 hour Barclay Berdan - 40 hours Charles Boes - 40 hours John Mitchell - 40 hours Kenneth Kramer - 40 hours Kathleen Gilman - 40 hours Part XII, Line 2c: Texas Health Resources (THR) prepares consolidated financial statements with its related entities. The THR Board appoints an audit and compliance sub-committee that assumes responsibility for oversight of the consolidated audit for all related entities. The related entities do not have a separate audit committee, but abide by the THR committee's oversight. There has been no change during the year in the organization' oversight or selection process. Sch H, Part VI, Line 4-Community Information Texas Health Arlington Memorial Hospital (THAM) is a suburban hospital in a service area with a population of more than 618,034. The average household income in the service area is $67,913. During the year, 19% of THAMs patients were uninsured and 18.3% were Medicaid recipients. The hospital's service area has an uninsured rate of 18.9% of the population. There is one other for-profit acute care hospital and one other not-for-profit acute care hospital in THAMs service area. Sch H, Part VI, Line 5-Promotion of Community Health The board of trustees is comprised of community members including medical and business professionals. A majority of these trustees reside in THAMs service area and volunteer their time to serve on THAMs board. The hospital has an open medical staff and privileges are offered to qualified physicians in the community. The organization utilizes surplus funds to maintain access to patient services and to expand access to healthcare. The uses of these surplus funds include providing community benefit programs and expended capital improvements to the healthcare facilities of the organization. Of the $9,832,826 in contributions to community groups reported on Sch H, Part I, line 7i, $9,828,374 was contributed to or at the direction of Tarrant County Indigent Care Corporation, a charitable organization that provides various local organizations with funds to cover healthcare provided to indigent patients. Sch H, Part VI, Line 6 Healthcare System The organization is part of the THR healthcare system. THR is one of the largest faith-based, nonprofit healthcare delivery systems in the US and the largest in North TX in terms of patients served. The system of 14 hospitals includes an organization for medical research and education. The system also includes two foundations that foster philanthropic relationships which support the programs and services of the hospitals they support. The mission of the hospitals in the THR system is to improve the the health of the people in the communities we serve. THR takes its responsibility to its communities seriously and invests charitable resources to promote good health and prevent disease. Not only does THR provide health care to those who do not have the means to pay, its hospitals also conduct a variety of programs designed to improve health and prevent illness in the community. The community health strategies of THR and its affiliated healthcare organizations are driven by community health needs, are community-based and include confronting health problems at the source and emphasize health promotion, disease prevention, and early treatment of illness. Sch H, Part VI, Line 7 State Filing The organization files a Texas an Annual Statement of Community Benefit Standard. Texas has established a minimum level of charity care and community benefit that must be provided by nonprofit hospitals in order to retain their Texas tax- exempt status. The standard set by the state is met when charity care and community benefits are provided in a combined amount equal to at least five percent of the hospital's or hospital system's net patient revenue, provided that charity care and government- sponsored indigent health care are provided are at least least four percent of net patient revenue. The hospital is part of the THR system of healthcare organizations. During the year, the THR system, as a whole, reported to Texas the following charity care and community benefits amounts. $145,581,949 in patient charity care, $64,476,774 in support provided by others, $17,816,432 in unreimbursed Medicaid, $13,351,949 in other community benefits and $477,948,889 in unreimbursed Medicare

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Texas Health Arlington Memorial Hospital

Employer identification number

75-0972805

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(f) Direct controlling entity
(1) Texas Health Partners LLC 14131 Midway Rd Ste 1050 Addison,TX75001 02-0546958	Management Company	TX	Texas Health Resources

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Deuteronomy 612 E Lamar Blvd Arlington,TX76011 75-2561680	Physician Clinic - Inactive	TX	501(c)(3)	9	Texas Health Resources		No
(2) Harris Methodist Health System 612 E Lamar Blvd Arlington,TX76011 75-1823547	Supporting Organization	TX	501(c)(3)	11 Type 1	N/A		No
(3) Healty Tarrant County Collaboration PO Box 8040 Fort Worth,TX76124 43-2087946	Supporting Organization	TX	501(c)(3)	11 Type 1	N/A		No
(4) Presbyterian Healthcare Resources 612 E Lamar Blvd Arlington,TX76011 51-0190395	Supporting Organization	TX	501(c)(3)	11 Type 3	N/A		No
(5) Texas Health Arlington Memorial Hospital 800 West Randol Mill Rd Arlington,TX76012 75-0972805	Hospital	TX	501(c)(3)	3	Texas Health Resources		No
(6) Texas Health Harris Methodist Foundation 612 E Lamar Blvd Arlington,TX76011 75-2401033	Supporting Organization	TX	501(c)(3)	9	Texas Health Resources		No
(7) Texas Health Presbyterian Hospital Alliance 10864 Texas Health Trail Fort Worth,TX76244 45-1502252	Hospital	TX	501(c)(3) Pend	3	Texas Health Resources		No
(8) Texas Health Harris Methodist Hospital Azle 108 Denver Trail Azle,TX76020 75-1748586	Hospital	TX	501(c)(3)	3	Texas Health Resources		No
(9) Texas Health Harris Methodist Hospital Cleburne 201 Walls Dr Cleburne,TX76033 75-1977850	Hospital	TX	501(c)(3)	3	Texas Health Resources		No
(10) Texas Health Harris Methodist Hospital Fort Worth 1301 Pennsylvania Ave Fort Worth,TX76104 75-6001743	Hospital	TX	501(c)(3)	3	Texas Health Resources		No
(11) Texas Health Harris Methodist Hospital Hurst-Euless-Bedford 1600 Hospital Parkway Bedford,TX76022 75-1438726	Hospital	TX	501(c)(3)	3	Texas Health Resources		No
(12) Texas Health Harris Methodist Hospital Southwest Fort Worth 6100 Hospital Parkway Fort Worth,TX76132 75-2678857	Hospital	TX	501(c)(3)	3	Texas Health Resources		No
(13) Texas Health Harris Methodist Hospital Stephenville 411 Belknap Stephenville,TX76401 75-1752253	Hospital	TX	501(c)(3)	3	Texas Health Resources		No
(14) Texas Health Physicians Group 1301 Pennsylvania Ave Fort Worth,TX76104 75-2613493	Physician Clinic	TX	501(c)(3)	11 Type 1	Texas Health Resources		No
(15) Texas Health Presbyterian Foundation 612 E Lamar Blvd Arlington,TX76011 75-2022128	Supporting Organization	TX	501(c)(3)	9	Texas Health Resources		No
(16) Texas Health Presbyterian Hospital Allen 1105 Central Expressway North Allen,TX75013 75-2890358	Hospital	TX	501(c)(3)	3	Texas Health Resources		No
(17) Texas Health Presbyterian Hospital Dallas 8200 Walnut Hill Ln Dallas,TX75231 75-1047527	Hospital	TX	501(c)(3)	3	Texas Health Resources		No
(18) Texas Health Presbyterian Hospital Denton 3000 North Interstate 35 Denton,TX76201 43-2008974	Hospital	TX	501(c)(3)	3	Texas Health Resources		No
(19) Texas Health Presbyterian Hospital Kaufman 850 Ed Hall Drive Kaufman,TX75142 75-2771437	Hospital	TX	501(c)(3)	3	Texas Health Resources		No
(20) Texas Health Presbyterian Hospital Plano 6200 W Parker Rd Plano,TX75093 75-2770738	Hospital	TX	501(c)(3)	3	Texas Health Resources		No
(21) Texas Health Research Education Institute 612 E Lamar Blvd Arlington,TX76011 75-2562191	Medical Research & Education	TX	501(c)(3)	4	Texas Health Resources		No
(22) Texas Health Resources 612 E Lamar Blvd Arlington,TX76011 75-2702388	Mgmt Supporting Organization	TX	501(c)(3)	11 Type 3	N/A		No
(23) Texas Health Resources Self-Insurance Trust 612 E Lamar Blvd Arlington,TX76011 75-6335901	Insurance Trust	TX	501(c)(3)	11 Type 3	Texas Health Resources		No
(24) Texas Health Specialty Hospital Fort Worth 1301 Pennsylvania Ave 4th Flr Fort Worth,TX76104 75-1648589	Long Term Hospital	TX	501(c)(3)	3	Texas Health Resources		No
(25) WW Ward Endowment Fund Trust 612 E Lamar Blvd Arlington,TX76011 75-6196065	Supporting Organization	TX	501(c)(3)	11 Type 1	Texas Health Harris Methodist Foundation		No

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) AMH Cath Labs LLC 800 W Randol Mill Rd Arlington,TX76012 20-3003947	Healthcare Services	TX	Texas Health Arlington Memorial Hospital	related	-2,055,868	16,923,701						56.000 %
(2) Denton Surgery Center LLC 14131 Midway Rd Ste 1050 Addison,TX75001 47-0926556	Ambulatory Surgery Center	TX	N/A
(3) Flower Mound Hospital Partners LLC 14131 Midway Rd Ste 1050 Addison,TX75001 26-0684968	Hospital	TX	N/A
(4) Harris Oncology LLC 1600 Hospital Parkway Bedford,TX76022 75-2927939	Rental Real Estate	TX	N/A
(5) Health Imaging Partners LLC 8610 Explorer Dr Ste 300 Colorado Spring,CO80920 27-1385885	Outpatient Diag. Imaging Ctr	TX	N/A
(6) HEB Oncology LP 1601 Hospital Parkway Bedford,TX76022 75-2927940	Rental Real Estate	TX	N/A
(7) Physician Medical Center LLC 6200 W Parker Rd Plano,TX75093 48-1281376	Hospital	TX	N/A
(8) Presbyterian Cancer Center-Dallas LLC 6200 W Parker Rd Plano,TX75093 26-0422749	Medical Management	TX	N/A
(9) Rockwall Regional Hospital LLC 14131 Midway Rd Ste 1050 Addison,TX75001 20-2848116	Hospital	TX	N/A
(10) Sherman Grayson Health System LLC 500 Highland Ave Sherman,TX75092 27-2025497	Hospital	TX	N/A
(11) Southlake Specialty Hospital LLC 14131 Midway Rd Ste 1050 Addison,TX75001 02-0555370	Hospital	TX	N/A
(12) Texas Health MedSynergies LLC 1255 Corporate Drive Fl 3 Irving,TX75038 80-0272951	Management Consulting	TX	N/A
(13) Texas Single Source Staffing 524 E Lamar Blvd Ste 300 Arlington,TX76011 27-0324828	Manage Contract Nursing	TX	N/A
(14) Texas Institute for Surgery LLP 7715 Greenville Ave Ste 100 Dallas,TX75231 77-0628004	Hospital	TX	N/A
(15) Womens Specialty Surgery Center 1300 Post Oak Blvd Ste 600 Houston,TX77056 26-2310072	Ambulatory Surgery Center	TX	N/A
(16) USMD Hospital at Fort Worth LP 801 I-20 West Arlington,TX76107 73-1662763	Hospital	TX	N/A
(17) USMD Hospital at Arlington LP 801 I-20 West Arlington,TX76107 20-3571243	Hospital	TX	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(h) Percentage ownership
(1) AMH Health Ventures Inc 800 W Randol Mill Road Arlington,TX76012 75-2141114	Computer & Billing Services	TX	Arlington Memorial Hospital Texas Health Arlington Memorial Hospital	C-Corp	100.000 %
(2) PH Denton Physicians Inc 3000 N Interstate 35 Denton,TX76201 26-1696945	Physician Services	TX	Texas Health Presbyterian Hospital Denton	C-Corp
(3) Biomedical Advancement Center Inc 612 E Lamar Blvd Arlington,TX76011 75-2636884	Inactive	TX	Texas Health Research Education Institute	C-Corp
(4) Texas Health Resources Casualty Company c/o AON Insurance 76 St Paul 5th floor Burlington,VT05401 03-0310676	Insurance	VT	Texas Health Resources	C-Corp
(5) Charitable Remainder Trusts 5 612 E Lamar Blvd Arlington,TX76011		TX	N/A

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: A faith-based organization whose mission is to improve the health of the people in the communities it serves regardless of one's ability to pay.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	11
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	2,055
6	Total number of volunteers (estimate if necessary) ....	6	292
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	179,411
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	136,061

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,049,204	1,052,656
9	Program service revenue (Part VIII, line 2g) .........	280,259,076	205,523,955
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-87,655	-523,088
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	4,643,716	21,164,506
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	286,864,341	227,218,029
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	44,481	6,150
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	123,033,941	122,421,155
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	155,155,248	109,371,371
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	278,233,670	231,798,676
19	Revenue less expenses. Subtract line 18 from line 12.......	8,630,671	-4,580,647
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	263,496,725	261,607,447
21	Total liabilities (Part X, line 26).............	25,500,807	24,284,901
22	Net assets or fund balances. Subtract line 21 from line 20.....	237,995,918	237,322,546

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 202,672,589 including grants of $ 6,150 ) (Revenue $ 227,218,030 )
	Texas Health Arlington Memorial Hospital (THAM) is a 370 bed community hospital providing health care for residents in Arlington & its surrounding communities in North Texas. Since opening its doors in 1958, THAM has contributed to the medical and health education needs of area residents. The hopsital provides health care services such as cardiology, rehabilitation, neurosciences and urology services. THAM also offers services through its Women's & Children's Center, Health Services Center and Same-Day Surgery Center. ************************************************************************ During the year, THAM had 65,000 patient days, 13,087 discharges, 100,345 outpatient encounters, 68,348 emergency room visits and 1,684 births. ********************************************************************** THAM provides quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. The hospital provides care to persons covered by governmental programs including Medicare and Medicaid for reimbursement that does not always cover the cost of providing the care. Recognizing its mission to the community, services are provided to both financially indigent and medically indigent patients. ************************************************************************ Community benefit is provided through many reduced price services and free programs to the community. These services are essential to provide complete healthcare to the communities served. Some of these programs include: * Various health screenings were offered to the community free of charge or for a nominal charge through programs such as Fiesta Health, where adults and children were provided the screenings along with educational materials for overall health with a focus on diabetes awareness, healthy food choices and good health practices. * THAM participated in community education regarding good hand hygiene to promote awareness of proper hand washing in an effort to slow the spread of infection and disease.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 202,672,589

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Lori Jo Donovan Vice President	40.00	X		78,270	0	4,185
(19) Barclay Berdan Corporate Officer		X		0	0	119,583
(20) Charles Boes Assistant Secretary		X		0	0	82,524
(21) Kenneth Kramer Assistant Secretary		X		0	0	65,227
(22) John Mitchell Assistant Secretary		X		0	0	61,351
(23) Kathleen Gilman Assistant Secretary		X		0	0	23,471
(24) Linda Wren Manager	40.00		X	0	0	13,302
(25) Sabatino Bianco Medical Director	10.00		X	0	0	4,122
(26) Rex Schimpf Director	40.00		X	0	0	27,988
(27) Karen Brittain Nursing Supervisor	40.00		X	146,404	0	23,711
(28) Hoyt Frenzel Medical Director	20.00		X	141,465	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,660,851	2,871,214	610,460

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		980,151
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f		72,505
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			1,052,656
			Business Code
2a	Patient Serv Revenue			206,909,679	206,909,679
b	Joint Venture Revenue		561,000	-1,385,724	-1,565,135	179,411
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			205,523,955
3	Investment income (including dividends, interest
	and other similar amounts).....			72,474			72,474
4	Income from investment of tax-exempt bond proceeds..
5	Royalties............			280,246			280,246
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory		39,002
b	Less: cost or other basis and sales expenses		634,564
c	Gain or (loss)		-595,562
d	Net gain or (loss)..........			-595,562			-595,562
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	Patient Services Revenue			11,060,751			11,060,751
b	Rental Revenue			5,169,992			5,169,992
c	Electronic Health Records Stimulus Rev			2,863,393			2,863,393
d	All other revenue ....			1,790,124			1,790,124
e	Total. Add lines 11a–11d ......			20,884,260
12	Total revenue. See Instructions....			227,218,029	205,344,544	179,411	20,641,418


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			-1,785,480	1	-359,597
2	Savings and temporary cash investments .......				2
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			29,024,448	4	23,877,512
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			160,253	5	163,651
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............			1,459,365	7	1,623,504
8	Inventories for sale or use ..............			4,091,476	8	3,317,651
9	Prepaid expenses and deferred charges ............			437,912	9	301,789
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	251,220,298
b	Less: accumulated depreciation. .....	10b	121,634,431	130,792,577	10c	129,585,867
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 ......			125,169	12	125,169
13	Investments—program-related. See Part IV, line 11 ..			5,696,054	13	7,251,593
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			93,494,951	15	95,720,308
16	Total assets. Add lines 1 through 15 (must equal line 34)...			263,496,725	16	261,607,447
17	Accounts payable and accrued expenses .			25,446,523	17	24,232,436
18	Grants payable ..........				18
19	Deferred revenue ..........				19
20	Tax-exempt bond liabilities ..........				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			54,284	25	52,465
26	Total liabilities. Add lines 17 through 25.....			25,500,807	26	24,284,901
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			236,183,306	27	237,322,546
28	Temporarily restricted net assets .....			1,812,612	28
29	Permanently restricted net assets .....				29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			237,995,918	33	237,322,546
34	Total liabilities and net assets/fund balances .....			263,496,725	34	261,607,447