Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
Memorial Hermann Health System
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
909 Frostwood
Suite 2100
Room/suite
City or town, state or country, and ZIP + 4
Houston, TX77024
D Employer identification number

74-1152597
E Telephone number

G Gross receipts $ 3,349,562,421
F Name and address of principal officer:
Dan Wolterman
929 Gessner Suite 2700
Houston,TX77024
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.memorialhermann.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1910
M State of legal domicile: TX
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Memorial Hermann Health System is a not-for-profit,community-owned health care system with spiritual values, dedicated to providing high quality health services.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 27
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 19
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 20,479
6 Total number of volunteers (estimate if necessary) ............. 6 3,059
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 11,764,397
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 10,288,319 20,006,884
9 Program service revenue (Part VIII, line 2g) ......... 2,878,657,345 3,090,398,545
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -22,049,639 82,934,522
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 91,335,021 92,001,954
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 2,958,231,046 3,285,341,905
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,148,795 1,432,901
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 1,245,302,554 1,385,588,675
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 1,559,780,935 1,667,528,756
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 2,806,232,284 3,054,550,332
19 Revenue less expenses. Subtract line 18 from line 12....... 151,998,762 230,791,573
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 4,235,751,217 4,480,604,151
21 Total liabilities (Part X, line 26)............. 2,331,389,383 2,274,374,490
22 Net assets or fund balances. Subtract line 21 from line 20..... 1,904,361,834 2,206,229,661
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: MISSION AND VALUES MISSION MEMORIAL HERMANN Health SYSTEM IS A NOT-FOR-PROFIT, COMMUNITY-OWNED, HEALTH CARE SYSTEM WITH SPIRITUAL VALUES, DEDICATED TO PROVIDING HIGH QUALITY HEALTH SERVICES IN ORDER TO IMPROVE THE HEALTH OF THE PEOPLE IN SOUTHEAST TEXAS. VALUES IN COLLABORATION WITH OTHERS, WE ARE COMMITTED TO ASSESSING AND CREATING HEALTHCARE SOLUTIONS WHICH MEET THE NEEDS OF INDIVIDUALS IN OUR DIVERSE COMMUNITIES. WE ARE STEWARDS OF COMMUNITY RESOURCES AND ARE COMMITTED TO BEING MEDICALLY, SOCIALLY, FINANCIALLY, LEGALLY, AND ENVIRONMENTALLY RESPONSIBLE. WE ARE DEVOTED TO PROVIDING SUPERIOR QUALITY AND COST-EFFICIENT, INNOVATIVE, AND COMPASSIONATE CARE. WE COLLABORATE WITH OUR PATIENTS, FAMILIES, PHYSICIANS, EMPLOYEES, VOLUNTEERS, VENDORS, AND COMMUNITIES TO ACHIEVE OUR MISSION. WE SUPPORT TEACHING PROGRAMS THAT DEVELOP THE HEALTH CARE PROFESSIONALS OF TOMORROW. WE SUPPORT BIOMEDICAL RESEARCH AND IMPLEMENTATION OF INNOVATIVE TECHNOLOGY TO EXPAND OUR KNOWLEDGE AND LEARN HOW TO PROVIDE
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 2,600,655,673 including grants of $ 1,432,901 ) (Revenue $ 3,178,875,993 )
MEMORIAL HERMANN IS A NON-PROFIT COMMUNITY-OWNED, HEALTHCARE SYSTEM WITH SPIRITUAL VALUES, DEDICATED TO PROVIDING HIGH QUALITY HEALTHCARE SERVICES TO OUR COMMUNITIES. ANNUAL DELIVERIES: 23,939 ANNUAL INPATIENT ADMISSIONS: 140,090 ANNUAL INPATIENT DAYS 1,433,574 ANNUAL EMERGENCY VISITS: 476,909 ANNUAL OUTPATIENT SURGERIES 82,156 ANNUAL DIAGNOSTIC AND THERAPY 1,041,110.
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 expensesMediumBullet2,600,655,673
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................ Click to see list of attachments
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
1,071
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
20,479
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
27
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
19
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletANTHONY FRANK909 FROSTWOOD SUITE 2100HoustonTX77024 (713) 338-4643
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Alexander Charlotte B MD........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(2) Balasura Viren J MD........................................................................
Director/Med Staff Pres - WDL
 1.0
.......................0.0 		X           0 0 0
(3) Bennett R Gerald........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(4) Blackshear A T Jr........................................................................
Member and Director
 1.0
.......................0.0 		X           0 0 0
(5) Cali Joseph R MD........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(6) Cannon Deborah M........................................................................
Member,Director,Chairman 2012
 1.0
.......................0.0 		X           0 0 0
(7) Colasurado Giuseppe N MD........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(8) Cormier Rufus P........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(9) Croyle Robert G........................................................................
Member,Director,Chairman 2013
 1.0
.......................0.0 		X           0 0 0
(10) Dara Anil A MD........................................................................
Director Med Staff Pres - NE
 1.0
.......................0.0 		X           0 0 0
(11) Davis Joe R........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(12) Diaz-Gonzalez Irma........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(13) Easter William H III........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(14) Edmonds James T........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(15) Elliott Don H........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(16) Ewing J Randolph........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(17) Farris George R........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Few Jason B........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(19) Galtney William F Jr........................................................................
Member and Director
 1.0
.......................0.0 		X           0 0 0
(20) Garrison Robert E II........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(21) Genty Carmen L........................................................................
Director Aux Representative
 1.0
.......................0.0 		X           0 0 0
(22) Giglio J Kevin MD........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(23) Gogola Jon R MD........................................................................
Director Med Staff Pres - MC
 1.0
.......................0.0 		X           0 0 0
(24) Graham David J........................................................................
Member and Director
 1.0
.......................0.0 		X           0 0 0
(25) Hearnsberger Roy G........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(26) Holmes Ned S........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(27) Jackson Grover G........................................................................
Member and Director
 1.0
.......................0.0 		X           0 0 0
(28) James Argentina M........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(29) Kim Jin MD........................................................................
Director Med Staff Pres - SL
 1.0
.......................0.0 		X           0 0 0
(30) King Brent R MD........................................................................
Director Med Staff Pres - TMC
 1.0
.......................0.0 		X           0 0 0
(31) Manning Ramon........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(32) Martin Raymond A MD........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(33) McBride Ralph D........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(34) McCord Frederick R........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(35) McLean Scott J........................................................................
Member and Director
 1.0
.......................0.0 		X           0 0 0
(36) McClelland Scott B........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(37) Mir Gasper III........................................................................
Member and Director
 1.0
.......................0.0 		X           0 0 0
(38) Montague James R........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(39) Morey Daryl R........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(40) Noor Sohail I MD........................................................................
Director Med Staff Press - KT
 1.0
.......................0.0 		X           0 0 0
(41) Penland William E Jr........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(42) Perrin Melinda H........................................................................
Member and Director
 1.0
.......................0.0 		X           0 0 0
(43) Peterkin George A III MD........................................................................
Director Med Staff Pres - SW
 1.0
.......................0.0 		X           0 0 0
(44) Postl James J........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(45) Pouns Stephen H........................................................................
Member and Director
 1.0
.......................0.0 		X           0 0 0
(46) Raspino Louis A........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(47) Royer James R........................................................................
Member and Director
 1.0
.......................0.0 		X           0 0 0
(48) Simon Caralisa M........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(49) Sloan Robert B Jr........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(50) Strake George W III........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(51) Strake Stephen D........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(52) Torres Ana M MD........................................................................
Director Med Staff Pres - NW
 1.0
.......................0.0 		X           0 0 0
(53) Vaduganathan Periyanan MD........................................................................
Director Med Staff Pres - SE
 1.0
.......................0.0 		X           0 0 0
(54) Villarreal Massey........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(55) Williams Willoughby C Jr........................................................................
Member and Director
 1.0
.......................0.0 		X           0 0 0
(56) Woo Donald M........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(57) Ytterberg Alan V........................................................................
Director
 1.0
.......................0.0 		X           0 0 0
(58) Wolterman Daniel J........................................................................
Director and President & CEO
 50.0
.......................1.0 		X   X       3,399,400 0 1,839,882
(59) Duco Bernard A Jr........................................................................
Chief Legal Officer & Secr.
 50.0
.......................0.0 		    X       1,144,673 0 118,423
(60) Laraway Dennis L........................................................................
CFO & Treasurer
 50.0
.......................0.0 		    X       1,337,764 0 81,212
(61) McVeigh Dennis P........................................................................
CAO & Asst Treas.
 50.0
.......................0.0 		    X       554,834 0 78,273
(62) Reimer P Renee........................................................................
Chief Risk Officer & Asst Secr
 50.0
.......................0.0 		    X       481,299 0 57,797
(63) Shabot M Michael MD........................................................................
Chief Medical Officer
 50.0
.......................0.0 		    X       1,029,317 0 132,181
(64) Stokes Charles D........................................................................
Chief Operating Officer
 50.0
.......................0.0 		    X       1,364,931 0 267,855
(65) Alexander Keith........................................................................
CEO Memorial City Campus
 50.0
.......................0.0 		      X     730,991 0 110,593
(66) Brace Rodney........................................................................
Chief Regional Operations Offi
 50.0
.......................0.0 		      X     964,386 0 162,552
(67) Bradshaw David........................................................................
Chief Information Planning & M
 50.0
.......................0.0 		      X     958,235 0 132,708
(68) Brownawell H Jeffrey........................................................................
Chief Revenue Officer
 50.0
.......................0.0 		      X     1,099,272 0 116,003
(69) Cordola Craig........................................................................
CEO TMC, MH TMC Campus
 50.0
.......................0.0 		      X     879,540 0 108,715
(70) Garman Jim........................................................................
Chief Human Resource Officer
 50.0
.......................0.0 		      X     729,184 0 57,876
(71) Gaston George H........................................................................
CEO Southeast Campus
 50.0
.......................0.0 		      X     708,215 0 102,226
(72) Heins Marshall B........................................................................
Chief Facility Services Office
 50.0
.......................0.0 		      X     888,270 0 128,392
(73) Metzger Pat........................................................................
System Executive, Care Managem
 50.0
.......................0.0 		      X     394,671 0 65,843
(74) Paret Carol........................................................................
Chief Community Officer
 50.0
.......................0.0 		      X     461,536 0 85,635
(75) Trevino Illeana V........................................................................
CEO Foundation
 0.0
.......................50.0 		      X     0 529,597 73,970
(76) Aulbaugh Carrol E........................................................................
Former Officer - Chief Financi
 0.0
.......................0.0 		        X   1,231,273 0 5,171
(77) Barbe Scott........................................................................
CEO Katy
 50.0
.......................0.0 		        X   658,689 0 98,441
(78) Sanders G Steven........................................................................
CEO Woodlands
 50.0
.......................0.0 		        X   840,210 0 139,708
(79) Smith Louis G Jr........................................................................
CEO Northeast
 50.0
.......................0.0 		        X   617,775 0 83,154
(80) FLANAGANTHOMAS J........................................................................
Former High 5 - COO TMC
 50.0
.......................0.0 		        X   534,620 0 73,250
(81) Cross Mary A MD........................................................................
Former Member
 0.0
.......................0.0 		          X 0 157,114 19,700
(82) Asprec Erin S........................................................................
Former Key EE - CEO Southeast
 50.0
.......................0.0 		          X 597,843 0 71,718
(83) Brown James B........................................................................
Former Key EE- CEO OPID/ASC, M
 50.0
.......................0.0 		          X 519,417 0 69,182
(84) Distefano Susan........................................................................
Former Key EE - CEO Children's
 50.0
.......................0.0 		          X 540,329 0 53,356
(85) Josehart Carl E........................................................................
Former Key EE- TIRR MH CEO
 50.0
.......................0.0 		          X 480,187 0 63,694
(86) Kerr Gary........................................................................
Former Key EE - CEO Northwest,
 50.0
.......................0.0 		          X 594,248 0 77,960
(87) Lloyd Christopher........................................................................
Former Key EE -CEO, MHMD
 50.0
.......................0.0 		          X 0 474,541 60,099
(88) McCracken Ayse........................................................................
Former Key EE - CEO, MHMG
 50.0
.......................0.0 		          X 497,787 0 40,878
(89) Beckstett Douglas G........................................................................
Former Chief Human Resources O
 50.0
.......................0.0 		          X 805,097 0 8,962
(90) PARKSWILLIAM B........................................................................
Former High 5 - Chief Medical
 50.0
.......................0.0 		          X 405,160 0 65,962
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 25,449,153 1,161,252 4,651,371
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet1,464
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
J E Dunn Construction, 3500 south Gessner Suite 200HOUSTONTX77063 Construction 8,404,052
Cerner DHT, 2800 Rockcreek ParkwayKANSAS CITYMO64117 Professional Service 11,830,546
Universal Hospital Services, PO Box 86 SDS 12-0940MINNEAPOLISMN55486 Equipment Rental 63,041,028
Sodexo, 1669 Phoenix ParkwayCOLLEGE PARKGA30349 Food Service 15,721,791
Crothall Healthcare, 13028 Collection Center DrCHICAGOIL60693 Housekeeping 38,072,718
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet127
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 14,339,888
e Government grants (contributions)1e 5,666,996
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 20,006,884
Program Service Revenue Business Code
2a PATIENT SERVICE REVENUE 900099 3,090,398,545 3,090,398,545    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 3,090,398,545
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 81,113,656     81,113,656
4 Income from investment of tax-exempt bond proceeds..MediumBullet 1,820,866     1,820,866
5 Royalties...........MediumBullet 740,366     740,366
(i) Real (ii) Personal
6a Gross rents 47,086,884  
b Less: rental expenses 60,933,376  
c Rental income or (loss) -13,846,492 0
d Net rental income or (loss).......MediumBullet -13,846,492     -13,846,492
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet 0      
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..MediumBullet 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...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a 8,153,375
b Less: cost of goods sold ..b 3,287,140
c Net income or (loss) from sales of inventory..MediumBullet 4,866,235     4,866,235
Miscellaneous Revenue Business Code
11a LAUNDRY SERVICES 812300 7,800,111   7,800,111  
b MANAGEMENT FEES 621500 3,067,977 1,137,220 1,930,757  
c SECURITY SERVICE 541900 1,871,192   1,871,192  
d All other revenue .... 87,502,565 87,340,228 162,337  
e Total. Add lines 11a–11d ...... MediumBullet 100,241,845
12 Total revenue. See Instructions......MediumBullet 3,285,341,905 3,178,875,993 11,764,397 74,694,631
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
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 1,432,901 1,432,901
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 20,356,330 10,386,010 9,970,320  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 1,129,438,039 968,623,619 160,814,420  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 57,217,464 46,445,176 10,772,288  
9 Other employee benefits ....... 92,459,889 76,665,555 15,794,334  
10 Payroll taxes ........... 86,116,953 70,623,986 15,492,967  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 4,442,124 317,633 4,124,491  
c Accounting ........... 0      
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 0      
12 Advertising and promotion .... 12,786,613 7,295,570 5,491,043  
13 Office expenses ....... 523,372,901 516,518,844 6,854,057  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 86,648,231 75,128,485 11,519,746  
17 Travel ............ 3,701,627 2,461,780 1,239,847  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 2,176,297 1,470,719 705,578  
20 Interest ........... 69,855,675 41,171,414 28,684,261  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 192,543,224 161,603,090 30,940,134  
23 Insurance .............. 9,458,256 6,067,436 3,390,820  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a PROFESSIONAL & CONTRACT FEES 527,023,519 489,998,651 37,024,868  
b EQUIPMENT RENTAL & MAINTENANCE 127,122,823 109,573,036 17,549,787  
c MISCELLANEOUS & OTHER EXPENSE 97,473,723 4,707,697 92,766,026  
d PHYSICIAN INTERGRATION 7,253,267 7,253,267    
e All other expenses 3,670,476 2,910,804 759,672  
25 Total functional expenses. Add lines 1 through 24e 3,054,550,332 2,600,655,673 453,894,659 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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 308,767,542 1 410,872,671
2 Savings and temporary cash investments ......... 39,217,160 2 24,011,070
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 446,696,279 4 565,733,981
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 20,888,565 8 24,481,563
9 Prepaid expenses and deferred charges .......... 34,635,078 9 25,390,709
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 4,462,603,594
b Less: accumulated depreciation ..... 10b 2,346,126,764 2,112,000,700 10c 2,116,476,830
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... 1,083,787,000 12 1,134,200,000
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 189,758,893 15 179,437,327
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 4,235,751,217 16 4,480,604,151
Liabilities 17 Accounts payable and accrued expenses ......... 362,984,132 17 389,826,129
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 1,012,255,608 20 1,039,065,497
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
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.................... 956,149,643 25 845,482,864
26 Total liabilities. Add lines 17 through 25......... 2,331,389,383 26 2,274,374,490
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 1,891,644,449 27 2,193,681,643
28 Temporarily restricted net assets ........... 12,717,385 28 12,548,018
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet 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 ........... 1,904,361,834 33 2,206,229,661
34 Total liabilities and net assets/fund balances ........ 4,235,751,217 34 4,480,604,151
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
3,285,341,905
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
3,054,550,332
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
230,791,573
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
1,904,361,834
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
71,076,254
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
2,206,229,661
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
Yes
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Memorial Hermann Health System
 
Employer identification number

74-1152597
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
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.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of 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)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (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 monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
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
14
14
 
15
15
 
16a
b
17a
b
18
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
Memorial Hermann Health System
 
Employer identification number

74-1152597
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......................... 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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
Memorial Hermann Health System
  		Employer identification number

74-1152597
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


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
Memorial Hermann Health System
  		Employer identification number

74-1152597
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
Memorial Hermann Health System
  		Employer identification number

74-1152597
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 (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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
2012
Open to Public Inspection
Name of the organization
Memorial Hermann Health System
 
Employer identification number

74-1152597
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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.
1a
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 XIII, the text of the footnote to its financial statements that describes these items.
b
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 $  
2
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:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?........
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 3,948,600 3,806,585 3,677,951 3,543,498 3,498,448
b Contributions ........          
c Net investment earnings, gains, and losses 231,546 219,373 172,286 148,951 65,990
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		69,638 69,624 38,574 7,116 14,460
f Administrative expenses .... 5,913 7,734 5,078 7,382 6,480
g End of year balance ...... 4,104,595 3,948,600 3,806,585 3,677,951 3,543,498
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet100.000 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII 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 (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   87,563,444 87,563,444
b Buildings ................   2,528,194,860 1,079,709,151 1,448,485,709
c Leasehold improvements ............   325,778,204 131,571,322 194,206,882
d Equipment ................   1,392,476,612 1,112,182,676 280,293,936
e Other .................   128,590,474 22,663,615 105,926,859
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 2,116,476,830
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other 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) FIXED INCOME 		896,143,000 F

(B) EQUITY SECURITIES 		236,457,000 F

(C) ALTERNATIVE INVESTMENTS 		1,600,000 F






Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 1,134,200,000
Part VIII
Investments—Program 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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
ACCRUED LIABILITIES TO 3RD PARTY 140,114,864
CAPITALIZED LEASES 705,368,000







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 845,482,864
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI 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 XIII.) ............ 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 XIII.) ........... 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 XII 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 XIII.) ............ 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 XIII.) ............ 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 XIII
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Intended Uses of the Organization's Endowment Funds Supplemental Information for Schedule D, Part V. Line 4 The endowment funds of Memorial Hermann Health System consist of permanent endowment funds obtained from donor initiatives for charitable contributions through last will and testament bequests. The permanent funds consist of donations and investment income for which the donor's stipulations restrict the Foundation to using only the income resulting from the investment of the donation on a total return basis. The assets of the permanent funds income may only be used to support the charitable exempt operations, programs and purposes of Memorial Hermann Hospital System through the purchase of supplies, equipment, and other expenditures necessary for the performance of those operations and programs.
ASC 740 Audit Financial Statement Footnote Disclosure Form 990, Schedule D, Part X as disclosed in Part XIII Memorial Hermann Health System does not have an annual financial audit conducted. The financial accounts of the Health System are included in the financial statements that are audited by an independent public accounting firm of the consolidated Memorial Hermann Health System entities and its related affiliates. The paragraph included in the last issued audited financial statements of the Health System was: Taxes The Health System, and certain other affiliates are Texas not-for-profit corporations and have been recognized as tax-exempt pursuant to section 501(c)(3) of the Internal Revenue code. The Health System owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and, therefore, subject to tax. Management annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the accompanying combined balance sheets.
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet 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
2012
Open to Public Inspection
Name of the organization
Memorial Hermann Health System
 
Employer identification number

74-1152597
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
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.
3
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.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining 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, as a factor in determining eligibility for free or discounted care.
4
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"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
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? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (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) .. 		    119,724,523   119,724,523 3.920 %
b Medicaid (from Worksheet 3,
column a) .... 		    488,754,818 497,688,780 -8,933,962  
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		    43,518,792 30,002,895 13,515,897 0.440 %
d Total Financial Assistance
and Means-Tested
Government Programs . 		    651,998,133 527,691,675 124,306,458 4.360 %
Other Benefits
     152,389,215   152,389,215 4.990 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    49,995,508 13,663,072 36,332,437 1.190 %
g Subsidized health services
(from Worksheet 6) .. 		    242,598,589 211,141,654 31,456,935 1.030 %
h Research (from Worksheet 7)     5,445,736 1,962,640 3,483,096 0.110 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    1,715,154   1,715,154 0.060 %
j Total. Other Benefits ..     452,144,202 226,767,366 225,376,837 7.380 %
k Total. Add lines 7d and 7j .     1,104,142,335 754,459,041 349,683,295 11.740 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
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.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy 164 2,047,717 652,690   652,690 0.020 %
8 Workforce development            
9 Other            
10 Total 164 2,047,717 652,690   652,690 0.020 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
627,604,589
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
232,213,698
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
823,015,027
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
1,150,783,025
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-327,767,998
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—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) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?11
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Memorial Hermann Katy Hospital
23900 katy freeway
katy,TX77494
www.memorialhermann.org 		X X         X      
2 Memorial Hermann Northeast Hospital
18951 Memorial North
Humble,TX77338
www.memorialhermann.org 		X X         X      
3 Memorial Hermann Northwest Hospital
1635 North loop west
houston,TX77008
www.memorialhermann.org 		X X         X      
4 Memorial Hermann Southeast Hospital
11800 astoria blvd
houston,TX77089
www.memorialhermann.org 		X X         X      
5 Memorial Hermann Southwest Hospital
7600 beechnut
houston,TX77074
www.memorialhermann.org 		X X   X     X      
6 Memorial Hermann Sugar Land Hospital
17500 west grand parkway south
sugar land,TX77479
www.memorialhermann.org 		X X         X      
7 Memorial Hermann Texas Medical Center
6411 fannin
houston,TX77030
www.memorialhermann.org 		X X   X     X      
8 Memorial Hermann Woodlands Hospital
9250 pinecroft
the woodlands,TX77381
www.memorialhermann.org 		X X         X      
9 Memorial Hermann Memorial City Hosp
921 gessner
houston,TX77024
www.memorialhermann.org 		X X         X      
10 Memorial Hermann Rehab Hospital Katy
909 Frostwood Suite 2100
houston,TX77024
www.memorialhermann.org 		X                  
11 The Institute for Rehabilitation TIRR
1333 moursund street
houston,TX77030
www.memorialhermann.org 		X         X        
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Memorial Hermann Katy Hospital
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 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
b
c
d
e
17 Did 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Memorial Hermann Northeast Hospital
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 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
b
c
d
e
17 Did 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Memorial Hermann Northwest Hospital
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 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
b
c
d
e
17 Did 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Memorial Hermann Southeast Hospital
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 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
b
c
d
e
17 Did 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Memorial Hermann Southwest Hospital
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 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
b
c
d
e
17 Did 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Memorial Hermann Sugar Land Hospital
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 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
b
c
d
e
17 Did 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Memorial Hermann Texas Medical Center
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 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
b
c
d
e
17 Did 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Memorial Hermann Woodlands Hospital
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 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
b
c
d
e
17 Did 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Memorial Hermann Memorial City Hosp
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 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
b
c
d
e
17 Did 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Memorial Hermann Rehab Hospital Katy
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 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
b
c
d
e
17 Did 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
The Institute for Rehabilitation TIRR
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)  
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 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
b
c
d
e
17 Did 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?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
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?21
Name and address Type of Facility (describe)
1 MH Endoscopy Center North Freeway
7333 N Freeway Suite 400
Houston,TX77076 		AMBULATORY SURGICAL CENTER
2 MH Endoscopy &Surg Ctr North Houston
275 Lantern Bend Suite 400
Houston,TX77090 		AMBULATORY SURGICAL CENTER
3 MH Surgery Center Katy
23920 Katy Freeway Suite 200
Katy,TX77494 		AMBULATORY SURGICAL CENTER
4 MH Surgery Center Kingsland
21720 Kingsland Blvd Suite 101
Katy,TX77450 		AMBULATORY SURGICAL CENTER
5 MH Surgery Center Memorial Village
12727 Kimberley Lane Suite 100
Houston,TX77024 		AMBULATORY SURGICAL CENTER
6 MH Surgery Center Northwest
1631 North Loop West Suite 300
Houston,TX77008 		AMBULATORY SURGICAL CENTER
7 MH Surgery Center Richmond
1517 Thompson Rd 100
Richmond,TX77469 		AMBULATORY SURGICAL CENTER
8 MH Surgery Center Southwest
7789 Southwest Freeway Ste 200
Houston,TX77074 		AMBULATORY SURGICAL CENTER
9 MH Surgery Center Sugar Land
17510 West Grand Parkway Suite 200
Sugar Land,TX77479 		AMBULATORY SURGICAL CENTER
10 MH Surgery Center Texas Med Center
6400 Fannin Suite 1500
Houston,TX77030 		AMBULATORY SURGICAL CENTER
11 MH Surgery Center Woodlands Parkway
1441 Woodstead Court 100
The Woodlands,TX77380 		AMBULATORY SURGICAL CENTER
12 MH Surgery Center The Woodlands
9200 Pinecroft Suite 200
The Woodlands,TX77380 		AMBULATORY SURGICAL CENTER
13 MH Surgery Hospital Kingwood
300 Kingwood Medical Drive
Kingwood,TX77339 		AMBULATORY SURGICAL CENTER
14 West Houston Ambulatory Surgical Assoc
970 Campbell Rd
Houston,TX77024 		AMBULATORY SURGICAL CENTER
15 Memorial Hermann 24-Hour Freestanding ER
9950 Woodlands Parkway
Spring,TX77382 		FREESTANDING ER
16 Sugar Land Surgical Hospital
1211 Hwy 6 70
Sugar Land,TX77478 		AMBULATORY SURGICAL CENTER
17 TOPS Surgical Specialty Hospital
17080 Red Oak Drive
Houston,TX77090 		AMBULATORY SURGICAL CENTER
18 Pasadena Doctors Outpatient Surgicenter
3534 Vista Blvd
Pasadena,TX77504 		AMBULATORY SURGICAL CENTER
19 United Surgery Center Southeast
12700 N Featherwood 100
Houston,TX77034 		AMBULATORY SURGICAL CENTER
20 University Place
7480 Beechnut
Houston,TX77074 		Senior Living
21 Memorial Hermann Prevention & Recovery
3043 Gessner
Houston,TX77080 		Drug & Alcohol Rehab
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
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; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
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.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
Community Benefit Report Schedule H Part I Line 6 a Memorial Hermann Health System produces a single community benefit report that highlights all of our corporation's activities. As a hospital system with multiple facilities in a major metropolitan area, our efforts are focused on meeting the needs of the greater community versus individual efforts associated with individual facilities. By focusing on fewer, larger endeavors, the long term impact on the Houston community's health status is greater than would be on an individual basis. In accordance with Texas Administrative code Title 25, Part 1, Chapter 13, Subchapter B, Rule 13.17, Memorial Hermann submits an annual report of Community Benefits Plan to the Texas Department of State Health Services annually.
Financial Assistance and certain other Community Benefits Schedule H Part I Line 7 Line 7a - Financial Assistance at cost is calculated as charity charges times CCR per worksheet 2. Line 7b - Medicaid is calculated as Medicaid charges times CCR per worksheet 2. Line 7c- Costs of other means-tested government programs is calculated as low income government charges times CCR per worksheet 2. Line 7e - Community health improvement services and community benefit operations is dollars spent with other community providers to improve the health of the community. Line 7f- Health professions education is out patient physician/paramedical teaching expenses and revenues as reported per the Medicare Cost Report. Line 7g- Subsidized health services includes the Air Ambulance Program, End Stage Renal Disease Program, and the Obstetrics and Delivery Program. The losses calculated are from the Cost Accounting System. These losses exclude Medicaid and Other indigent Programs but includes, all other services: IP, OP, ER, Private Insurance, Medicare, the Uninsured, etc. Line 7h- Research is research dollars serving the community. The amount comes directly from the Medicare Cost Report. Line 7i - Cash and in-kind contributions for community benefit is community programs not reported elsewhere, along with sponsorships of other organizations.
Community Building Activities Schedule H Part II, Line 7 MEMORIAL HERMANN PROVIDED $652,690 IN PROGRAMS TO THE COMMUNITY FOR HEALTH EDUCATION AND PREVENTION FOR DISEASES AND CHRONIC CONDITIONS, SUPPORT GROUPS, NUTRITION AND FITNESS CLASSES, SCREENINGS FOR DISEASE, EDUCATION FOR CURRENT AND FUTURE HEALTH PROFESSIONALS, AND COMMUNITY EVENTS THAT PROMOTE AWARENESS OF HEALTH ISSUES TO THE PUBLIC.
Bad Debt Methodology & footnote Schedule H Part III Section A, Line 2 & 4 Patient accounts receivable are reported net of estimated allowances for contractual allowances, bad debt, and other discounts. The System's recorded allowances for bad debt are based on expected net collections, after contractual adjustments, primarily from patients. Management routinely assesses these recorded allowances relative to changes in payor mix, cash collections, write-offs, recoveries, and market dynamics. At June 30, 2013 and 2012, the allowance for bad debt was $733,982,000 and $637,779,000, respectively. Unpaid accounts are written off as bad debts upon reaching delinquent status. Charity care accounts are written off as identified or qualified under the System's charity care policy. Bad Debt Cost Reported on Line 2, is based on Bad Debt Charges written off during the reporting period, less any Bad Debt recoveries in the period. Net amount was extended by RCC from Wks 2- Line 11 to impute cost.
Estimate organizations bad debt expense attributable to patients Schedule H Part III Section B, Line 3 Since many of our patients do not complete the Financial Assistance Application Process until they see that their debt is going to outside collectors, there is a wave of older accounts that are in our bad debt status converting to Charity. Each year we do a 2 year look back, and this has remained consistent averaging between 34-37% of accounts allowed in bad debt which do ultimately convert to Charity - Financial Assistance. For the most recent review of Fiscal Year 2011 and Fiscal Year 2012 accounts converting in FY 2013, we see that 37% represents community benefit for FY 2013.
Section B Shortfall costing methodology Schedule H Part III Section B, Line 8 Memorial Hermann Health System operates 11 licensed Hospitals of which 7 are 340-B facilities and 4 are not. When looking at the Medicare Revenue split between the 340-B and non-340-B facilities, we find that 73% of the patient revenues are generated in these safety-net facilities. Therefore, please recognize 73% of the Medicare Loss as a community benefit.
Collection Policy Schedule H Part III Section C, Line 9 b If there is no coverage by a third party and the responsible party cannot pay any or part of the balance due or make acceptable financial arrangements, assistance is provided to the responsible party to complete financial assistance application forms, including application for Medicaid, Crime Victims Compensation, Harris County Hospital District or County Indigent Programs where appropriate. If the patient meets predetermined financial criteria, assistance is provided to the responsible party to complete the charity application for a full or partial charity care write-off.
Input from Representatives Schedule H Section B Part V, Line 3 IN ITS MOST RECENT CHNA, MEMORIAL HERMANN INCLUDED FINDINGS FROM ELEVEN COMPREHENSIVE INTERVIEWS CONDUCTED WITH PEOPLE WHO REPRESENT A BROAD INTEREST IN THE COMMUNITIES, AND WHO HAVE SPECIAL KNOWLEDGE OF AND/OR EXPERTISE IN PUBLIC HEALTH. THESE INDIVIDUALS INCLUDED: CHUCK BEGLEY, PROFESSOR AT THE UNIVERSITY OF TEXAS SCHOOL OF PUBLIC HEALTH; STEPHANIE CONE, EXECUTIVE DIRECTOR AT UNITED WAY OF BRAZORIA COUNTY; CAROL EDWARDS, CEO OF FORT BEND FAMILY HEALTH CENTER; JEANNE HANKS, ASSISTANT DIRECTOR OF OPERATIONS AT ST. LUKE'S EPISCOPAL HEALTH CHARITIES; RANDY JOHNSON, CEO OF MONTGOMERY COUNTY HOSPITAL DISTRICT; LOVELL A. JONES, DIRECTOR OF THE CENTER FOR RESEARCH ON MINORITY HEALTH, UNIVERSITY OF TEXAS M.D. ANDERSON CANCER CENTER; JULIE MARTINEAU, PRESIDENT OF THE UNITED WAY OF MONTGOMERY COUNTY; STEVE MCKERNAN, CEO OF LONE STAR FAMILY HEALTH CENTER; DR. HERMINIA PALACIO, EXECUTIVE DIRECTOR OF THE HEALTH AUTHORITY FOR HARRIS COUNTY AND HARRIS COUNTY PUBLIC HEALTH AND ENVIRONMENTAL SERVICES; CATHY SBRUSCH, DIRECTOR OF PUBLIC HEALTH SERVICES, BRAZORIA COUNTY HEALTH DEPARTMENT; AND STEPHEN WILLIAMS, DIRECTOR - DEPARTMENT OF HEALTH AND HUMAN SERVICES, CITY OF HOUSTON. MEMORIAL HERMANN ALSO INCLUDED IN THE CHNA, FINDINGS FROM AN ELECTRONIC SURVEY DISTRIBUTED TO 550 INDIVIDUALS/ORGANIZATIONS WHO ARE MEMBERS OF THE GATEWAY TO CARE COLLABORATIVE IN HOUSTON.
Address Needs Identified in CHNA Schedule H Part V Section B Line 6I The CHNA was completed in Spring 2013. The implementation plan was finalized in the second quarter of the calendar year 2013 and progress will be reported on the subsequent reports as required. On June 11, 2013 the Community relations committee of the Memorial Hermann Health system board approved the implementation plan. The implementation plans are posted on the Memorial Hermann website at http://www.memorialhermann.org. http://www.memorialhermann.org/locations/katy/community-health-needs-asses sment-katy/ http://www.memorialhermann.org/locations/memorial-city/community-health-ne eds-assessment-memorial-city/ http://www.memorialhermann.org/locations/northwest/community-health-needs- assessment-northwest/ http://www.memorialhermann.org/locations/southeast/community-health-needs- assessment-southeast/ http://www.memorialhermann.org/locations/southwest/community-health-needs- assessment-southwest/ http://www.memorialhermann.org/locations/sugar-land/community-health-needs -assessment-sugar-land/ http://www.memorialhermann.org/locations/the-woodlands/community-health-ne eds-assessment-the-woodlands/ http://www.memorialhermann.org/locations/texas-medical-center/community-he alth-needs-assessment-tmc/ http://tirr.memorialhermann.org/about-tirr-memorial-hermann/community-heal th-needs-assessment-tirr-memorial-hermann/ http://www.memorialhermann.org/locations/katy-rehab/community-health-needs -assessment-katy-rehab/
Did Hospital Address all needs identified Schedule H Part V Section B Line 7 DURING THE CHNA, THE FOLLOWING EIGHT PRIORITIES WERE IDENTIFIED: 1.)EDUCATION AND PREVENTION FOR DISEASES AND CHRONIC CONDITIONS; 2.) ADDRESS ISSUES WITH SERVICE INTEGRATION, SUCH AS COORDINATION AMONG PROVIDERS AND THE FRAGMENTED CONTINUUM OF CARE; 3.) ADDRESS BARRIERS TO PRIMARY CARE, SUCH AS AFFORDABILITY AND SHORTAGE OF PROVIDERS; 4.) ADDRESS UNHEALTHY LIFESTYLES AND BEHAVIORS; 5.) ADDRESS BARRIERS TO MENTAL HEALTHCARE, SUCH AS ACCESS TO SERVICES AND SHORTAGE OF PROVIDERS; 6.) DECREASE HEALTH DISPARITIES BY TARGETING SPECIFIC POPULATIONS; 7.) INCREASED ACCESS TO AFFORDABLE DENTAL CARE; 8.) INCREASED ACCESS TO TRANSPORTATION. MEMORIAL HERMANN WILL ADDRESS THE TOP SIX OF THOSE EIGHT NEEDS. THE NEED FOR "INCREASED ACCESS TO AFFORDABLE DENTAL CARE" AND THE NEED FOR "INCREASED ACCESS TO TRANSPORTATION," ARE NOT ADDRESSED LARGELY DUE TO THEIR POSITIONS (LAST AND SECOND TO LAST) ON THE PRIORITIZED LIST, THE FACT THAT DENTAL AND TRANSPORTATION SERVICES ARE NOT CORE BUSINESS FUNCTIONS OF THE HEALTH SYSTEM AND THE LIMITED CAPACITY OF EACH HOSPITAL TO ADDRESS THOSE NEEDS. FURTHERMORE, THE HOSPITALS DO NOT HAVE THE EXPERTISE TO ADDRESS ACCESS TO TRANSPORTATION, AND THE SYSTEM VIEWS THIS ISSUE AS A LARGER CITY AND COUNTY INFRASTRUCTURE RELATED CONCERN. MEMORIAL HERMANN FULLY SUPPORTS LOCAL GOVERNMENTS IN THEIR EFFORTS TO IMPACT THESE ISSUES
Billing and Collections Schedule H Part V Section B line 15 We do use reporting to credit agencies and lawsuits when there is a liability claim (i.e. MVA), but these are only put into play after we have made reasonable efforts to determine FAP ineligibility. In situations where FAP is deemed to be available, these efforts are not used.
Charity Calculation Worksheet Schedule H Part V Section B Line 20 Memorial Hermann Charity Calculation Memorial Hermann Health System Worksheet Houston, Texas Patient Name: ____________________________ Account #'s:______________________________ Step One: Obtain patient's annual gross family income $____________________ (A) Determine number of members in family ______________ Step Two: Determine income as percentage of Federal Poverty Guidelines ______________% (B) Determine the percentage of account balance that is patient's responsibility________% (C) (Use Hospital Gross Income Eligibility Table on back) Step Three: Determine charity category (B) - Check one _____ Financially Indigent ____ Annual gross family income is less than 200% of federal poverty guideline ____ Adjusted Eligibility for Charity Care Criteria ____ Presumed Charity:_________________________ _____ Medically Indigent Annual gross family income is between 201% & 400% of the federal poverty guidelines ____ Not Eligible Annual gross family income is greater than 400% of the federal poverty guidelines Step Four: Determine percentage of account balance for which the patient is responsible ______________________ X 20% = __________________________(D) Annual Gross Income (A) Maximum Patient Responsibility ______________________ X _________% = __________________________(E) Account Balance Patient Percentage (C) Potential Patient Responsibility The lesser of amount (D) or (E) = __________________________(F) Patient Responsibility Step Five: Determine Charity Discount __________________ minus __________________ = _____________________ Account Balance Patient Responsibility (F) Charity Discount Completed by: ________________________________ ________________________ Hospital Representative Date Approved by: ________________________________ ________________________ Patient Access Department Director Date ________________________________ ________________________ Hospital Financial Analyst Date
Needs assessment Schedule H Part VI, Line 2 Each decision made by Memorial Hermann to invest its people, resources, and talents in community benefit efforts is data driven. Given that 30% of the Houston area is uninsured, numerous community needs analyses center around the University Of Texas School Of Public Health's Houston Area Hospital's Emergency Department Use Study, which Memorial Hermann has participated in since 2003. The study monitors hospital emergency department use in Houston hospitals and is a data source for numerous assessments to understand primary care-related ER use including the characteristics of these patients; particularly those who are children, who are uninsured, and who have Medicaid. The study conducted in 2012 shows that 40.9% of all ER visits and 48.6% of all treated and released ER visits are primary care related. With the desire to change emergency room use comes the need to identify available capacity of our existing safety-net clinics, and what is needed by each entity to increase its capacity to be able to respond to changes in ER usage our community efforts achieve. This study, the Greater Houston Clinic Capacity Analysis, performed in early 2012 by Project Safety-Net and University of Texas School of Public Health, indicates that the community clinics are currently meeting about 30 percent of the demand for primary care visits by the low-income population and the rest is either met by private practice physicians or is left unmet. Further, the study anticipates that safety net providers will only be able to meet 25 percent of the demand under the Affordable Care Act (ACA). It is important to be concerned because a shortage of primary care leads to more people experiencing serious illness requiring expensive specialty care, emergency services and hospitalization. The Health of Houston Study, a recent comprehensive study conducted by the Institute for Health Policy of The University of Texas School of Public Health through stakeholder input and neighborhood surveying, is a continuing source to Memorial Hermann in continued program planning efforts by regularly assessing the health of Houstonians and tracking emerging health issues and health improvements. AS REQUIRED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT-SECTION 501 R (3)-REQUIREMENT OF THE ACA, MEMORIAL HERMANN CONDUCTED COMMUNITY NEEDS ASSESSMENTS FOR EACH OF ITS 11 HOSPITALS. THE STUDIES INCLUDED DEMOGRAPHIC DATA OF HARRIS, FORT BEND, MONTGOMERY, AND BRAZORIA COUNTIES (COUNTIES THAT COMPOSE 89% OF MEMORIAL HERMANN DISCHARGES) A DESCRIPTION OF THE PROCESSES AND METHODOLOGIES, SURVEYS AND INTERVIEWS WITH PUBLIC HEALTH OFFICIALS WHERE PARTICIPATNTS WERE GIVEN THE OPPORTUNITY TO PRIORITIZE COMMUNITY HEALTH NEEDS AND RATE THE IMPORTANCE OF HEALTH CARE INITIATIVES; AND, IDENTIFICATION OF ALL COLLABORATING ORGANIZATIONS AND EXISTING HEALTH CARE FACILITIES AND OTHER RESOURCES WITHIN THE COMMUNITY AVAILABLE TO MEET THE NEEDS IDENTIFIED IN EACH OF THE COMMUNITY NEEDS ASSESSMENTS. THE ANALYSIS INCLUDED A CAREFUL REVIEW OF THE MOST CURRENT HEALTH DATA AVAILABLE AND INPUT FROM NUMEROUS COMMUNITY REPRESENTATIVES WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH. FINDINGS INDICATED THAT THERE WERE EIGHT MAIN NEEDS IN THE COMMUNITIES SERVED BY MEMORIAL HERMANN. THE COMMUNITY HEALTH NEEDS ASSESSMENT TEAM, CONSISTING OF LEADERSHIP FROM MEMORIAL HERMANN HEALTH SYSTEM (MEMORIAL HERMANN), PRIORITIZED THOSE EIGHT NEEDS BY STUDYING THEM WITHIN THE CONTEXT OF THE HOSPITAL'S OVERALL STRATEGIC PLAN AND THE AVAILABILITY OF FINITE RESOURCES, WITH THE FOLLOWING PRIORITIZATION, IN DESCENDING ORDER, RESULTING: 1.) EDUCATION AND PREVENTION FOR DISEASES AND CHRONIC CONDITIONS; 2.) ADDRESS ISSUES WITH SERVICE INTEGRATION, SUCH AS COORDINATION AMONG PROVIDERS AND THE FRAGMENTED CONTINUUM OF CARE; 3.) ADDRESS BARRIERS TO PRIMARY CARE, SUCH AS AFFORDABILITY AND SHORTAGE OF PROVIDERS; 4.) ADDRESS UNHEALTHY LIFESTYLES AND BEHAVIORS; 5.) ADDRESS BARRIERS TO MENTAL HEALTHCARE, SUCH AS ACCESS TO SERVICES AND SHORTAGE OF PROVIDERS; 6.) DECREASE HEALTH DISPARITIES BY TARGETING SPECIFIC POPULATIONS; 7.) INCREASE ACCESS TO AFFORDABLE DENTAL CARE; 8.) INCREASE ACCESS TO TRANSPORTATION. FOLLOWING THE COMMUNITY NEEDS ASSESSMENT, EACH MEMORIAL HERMANN HOSPITAL ALONG WITH THE SUPPORT OF MEMORIAL HERMANN COMMUNITY BENEFIT DEPARTMENT DEVELOPED AN IMPLEMENTATION PLAN WITH SUPPORTING OBJECTIVES, AND IMPLEMENTATION ACTIVITIES AND METRICS. THE PROCESS WILL BE REPORTED TO THE BOARD IN MARCH 2014. On behalf of Memorial Hermann, the Memorial Hermann Community Benefit Corporation ( MHCBC) works with other healthcare providers, government agencies, business leaders and community stakeholders to ensure that all residents of the greater Houston area have access to the care they need to improve their quality of life and the overall health of the community. MHCBC's programs are designed to provide care for uninsured and underinsured children; to reach those Houstonians needing low cost care; to support the existing infrastructure of non-profit clinics and FQHCs; and to educate individuals and their families on how to access the healthcare available to them. Committed to making the greater Houston area a healthier and more vital place to live, MHCBC supports the following initiatives: Memorial Hermann Health Centers for Schools, established in 1995, offers access to primary medical and mental health services to more than 40,500 underserved children at 50 schools in the Greater Houston area. In 2012, asthma exacerbations, emergency room visits and hospitalizations were reduced by 84%. Students receiving mental health therapy realized increase grade point averages, decreased absenteeism, and reduced suspensions/detentions. The Memorial Hermann Mobile Dental Clinic, established in 2000, has two dental vans and provides access to preventative and restorative dental services at all six Health Centers for Schools' sites and is accessible as a "dental home" for 40,500 uninsured and underinsured students from 50 schools. In 2012, no more than 8.1% of students age 4-11 and 6.4% of students age 12+ experienced caries at recall. These outcomes are significant given 80% of initial patients are diagnosed with caries; 33% are diagnosed with five or more caries. A dietitian is available through the Healthy Eating and Lifestyles Program (HELP) designed to educate Health Centers for Schools students and their families on the importance of proper nutrition and exercise. The program is intensive and individual, meeting the student and family where they are on the "stage of change" continuum. Memorial Hermann partnered with project fit America, GE, and Fields Elementary School to introduce a fitness program for students, grades 2nd through 5th, within the schools curriculum. Serving the community since 2008, the Memorial Hermann ER Navigation program places certified Community Health Workers who have the training, cultural understanding and linguistic capacity to help the uninsured, who disproportionately use emergency rooms for healthcare, 'navigate' the complex health system, obtain a medical home, schedule appointments, secure needed social services and cope with future healthcare concerns. A six month pre-post analysis of navigated patients resulted in a 78.2% decline in ER visits. A 12 month pre-post analysis resulted in a 70% decline. The Community Outreach for Personal Empowerment ( COPE) program has a similar philosophy but operates with Masters Level Social Workers and focuses on 'frequent flyers' inpatient as well as ER. The Memorial Hermann Neighborhood Health Centers are strategically located near three of Houston's busiest ERs and provide care to working families without access to insurance and who do not qualify for other programs. The goal is to provide this population with a medical home for routine care, and prevent these cases from escalating to emergencies. At $48/visit, with low cost labs and prescriptions, seven day a week access, and the provision of preventive, acute, as well as chronic care, they are an affordable medical home for newborns to the elderly. Decreased hypertension, management of diabetes, and a place where women feel comfortable returning for their annual well-woman exams are examples of the continuity of care and improved health resulting. Physicians of Sugar Creek is a Memorial Family Practice Residency Training site that offers sliding scale fees for the working poor of Fort Bend County. MHCBC has played numerous and critical roles with a grass-roots Houston collaborative, Gateway to Care and its Provider Health Network (PHN) to recruit physicians, hospitals, and ancillary providers to provide specialty care to uninsured patients with incomes below 150% of poverty. With one in every four primary care visits requiring a referral to a specialist, the Provider Health Network serves as a bridge, connecting uninsured people to the specialty care they desperately need to get well. Recruiting is through numerous avenues-societies, insurance com
Patient Education Schedule H Part VI, Line 3 All Memorial Hermann Acute Care facilities and Rehab facilities have Third Party Qualification vendors on-site or trained financial counselors. Once someone requests or a financial counselor has determined through interaction with the patient and/or guarantor that the patient cannot pay for services, the financial counselors will either screen themselves or the patient/guarantor is referred to the Eligibility vendor on-site to screen for any Federal/State/Local Government program which may cover their services. These vendors act as agents for the patient/guarantor and may at times go to hearings for Medicaid or Disability as a legal representative of the patient. Also, all our entities, including service lines, have posted notices of a patient's right to request charity. Our statements that are sent to patients have documentation on the back informing the patient of Memorial Hermann's Charity policy and their right to request such, (in English and Spanish). Accounts are referred to be processed either on a real time basis by the hospital staff while the patient is still in the hospital or by electronic referral via data download which occur weekly and after the patient has been discharged. The goal is to make contact with the patient for financial screening to determine eligibility for governmental assistance as soon as possible. TIRR Memorial Hermann has embedded case managers and social workers in the hospital-based physician clinic to help patients with their doctors and needs. TIRR Memorial Hermann inpatients and outpatients require a great deal of assistance with a wide range of resources, and case management plays a significant role in providing supportive services to each patient. Social workers provide not only case management, but behavioral counseling as well. If needed, social workers can refer patients to TIRR Memorial Hermann's psychiatrist. Counseling services are available to families as well as to patients. Additional assistance for patients to take advantage of all appropriate health improvement programs available within the community are through Memorial Hermann's navigation services. In 2008, Memorial Hermann launched the ER Navigation program as a response to the community need of educating patients on how to navigate through community resources, increasing access and using healthcare resources appropriately to reduce healthcare costs. Today, the ER Navigation program places a Community Health Worker (CHW) or "navigator" on-site in Memorial Hermann's three busiest emergency rooms to educate patients on the importance of identifying and using a consistent health home rather than relying on emergency rooms for their primary care. Patients eligible for the program are 18 months to age 65 who have accessed the ER for primary care related condition and are uninsured or on Medicaid. Certified CHW training is offered by Memorial Hermann partner, Gateway to Care. CHWs gain the trust of patients by being familiar with the community's culture, language and values and by sharing their knowledge about local healthcare services and programs. CHWs identify clinics that are the best fit for an individual's location, income, language, work hours, bus routes and address issues that may push health care down the priority list--the need for food stamps, rental support and assistance with utilities. They provide patients with clinic referrals, make appointments, arrange transportation, share information and referrals to community and safety net programs, educate about qualifying for and using public benefits and other payment resources, serve as a liaison between the patient and providers and tackle other challenges to appropriate care. CHWs stress the importance of having a health home and provide support and guidance in making and keeping future health appointments. While navigators initially meet with patients during the ER visit, much of their work is done in follow-up, ensuring that a clinic appointment was made, was successful and assisting with the paperwork required for qualification for Medicaid, CHIP or county indigent programs. The primary goal of the ER Navigation program is to find an appropriate health home for patients and provide them with the resources to navigate through future medical concerns. A secondary goal is to reduce the time of delivery of services in cases of chronic and serious illnesses. Similar support of all Memorial Hermann Hospitals is also provided through the COPE (Community Outreach for Personal Empowerment) Program which provides empowering services for uninsured patients to improve their health and well being through education about and coordination with community health services. COPE targets patients who have repetitively been inpatients and ER patients and exhibit the need for one-on-one support to identify, access, and obtain services in their own community. Enrolling these populations into public benefits through all of these venues automatically increases their likelihood of obtaining regular primary and preventative care; the kind of care that ensures health and the potential for a prosperous future while concurrently eliminating the cost burden presently experienced by safety-net providers.
Community Information Schedule H Part VI, Line 4 Memorial Hermann serves "greater Houston," a multi-county area along the Gulf Coast in southeast Texas-where several counties are without hospital district services. The 5th largest metropolitan area in the United States, greater Houston is one of the fastest growing with a population of 6 million. A source of strength in a global economy, Houston prizes its racial and ethnic diversity. According to U.S. Census 2010 estimates, Houston is 25.6% White, 43.8% Hispanic, 23.7% Black or African American, 0.7% Native American, and 6.2% Asian/Pacific Islander. Per capita income is $25,927. 21% of all residents are living below the poverty line. The largest employers in the community include: Memorial Hermann Health System (20,479 employees); The University of Texas M.D. Anderson Cancer Center (15,000 employees); ExxonMobil (13,000 employees); Shell Oil Company (13,000 employees); and Kroger Company (12,000 employees). THE GREATER HOUSTON AREA IS ONE OF THE HARDEST HIT AREAS IN THE "UNINSURED" HEALTHCARE CRISIS with THIRTY PERCENT OF HOUSTON RESIDENTS UNINSURED. HOUSTON'S FAST-GROWING HISPANIC POPULATION ACCOUNTS FOR A LARGE PERCENTAGE OF UNINSURED RESIDENTS. THE RISING RATE OF OBESITY IS THE SINGLE BIGGEST THREAT TO THE GREATER HOUSTON AREA-MORE THAN ONE IN FOUR GREATER HOUSTON RESIDENTS IS OBESE. HEALTH EDUCATION AND PREVENTION AND INCREASED ACCESS TO HEALTHCARE ARE VITAL TO IMPROVING THE OVERALL HEALTH OF RESIDENTS WHOSE LEADING CAUSES OF HEALTH ISSUES ARE MENTAL HEALTH PROBLEMS, DIABETES, OBESITY (ADULT), OBESITY (CHILDREN), SUBSTANCE ABUSE, HEART DISEASE/STROKE, CANCER AND HIGH BLOOD PRESSURE. THE MOST PREVALENT CHRONIC DISEASES ARE DIABETES, OBESITY, HIGH BLOOD PRESSURE, CANCER, HEART FAILURE AND ASTHMA. ONLY 28.4% OF THE POPULATION, AGE 25+, HAS A COLLEGE DEGREE. SO VITAL TO THE WELL-BEING OF INDIVIDUALS AND FAMILIES, THE HOUSTON AREA'S UNEMPLOYMENT RATE IS 6.1%--DOWN FROM ITS HIGHEST LEVEL IN FEBRUARY 2010 AT 8.6%.
Promotion of Community Health Schedule H Part VI Line 5 Memorial Hermann's Promotion of Community Health includes activities conducted by Memorial Hermann staff for patients and the general public that promote disease prevention and education activities as well as healthy living and overall well-being such as: health fairs; state-of-the-art disease screenings; health education conferences, seminars and webinars; support groups for a variety of diseases and health issues; newsletters and brochures and websites designed to provide community health information. Strong referral patterns and connections with community resources and medical homes; and, recruitment of physician specialties that fill an identified community need. To expand its community reach, these Memorial Hermann activities are often held in partnership with healthcare agencies, nonprofit organizations, workplaces, school districts, and civic associations. Memorial Hermann also provides educational opportunities for health professionals and students pursing health careers. Memorial Hermann's employee base is a leader in United Way contributions, Gulf Coast blood drives; and food, clothing, and toy donations. Employees also participate in walks, marathons, and the MS150. MEMORIAL HERMANN USES THE SOFTWARE PROGRAM CBISA (COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY) TO TRACK ALL OF THE COMMUNITY BENEFIT ACTIVITIES CONDUCTED BY ITS 11 HOSPITALS AND ITS SUBSTANCE ABUSE TREATMENT CENTER IN A CENTRAL LOCATION.
Affiliated Health Care System Schedule H Part VI, Line 6 MEMORIAL HERMANN HEALTH SYSTEM IS the SECOND LARGEST NOT-FOR-PROFIT HEALTH SYSTEM IN TEXAS AND SERVES THE GREATER HOUSTON COMMUNITY THROUGH (11) HOSPITALS, A VAST NETWORK OF AFFILIATED PHYSICIANS AND NUMEROUS SPECIALTY PROGRAMS AND SERVICES. MEMORIAL HERMANN IS GOVERNED BY 11 BOARDS OF DIRECTORS, 8 COMMITTEES AND 2 SUBCOMMITTEES TOTALLING 156 MEMBERS REPRESENTATIVE OF THE GREATER HOUSTON BUSINESS, HEALTHCARE AND COMMUNITY LEADERSHIP. MEMORIAL HERMANN COMMUNITY BENEFIT CORPORATION (MHCBC) IS CHARGED WITH TESTING AND MEASURING INNOVATIVE SOLUTIONS THAT REDUCE THE IMPACT OF THE LACK OF ACCESS TO CARE ON THE COMMUNITY, AND OPERATES AND SUPPORTS MANY OF THE INITIATIVES IN THIS APPLICATION. MEMORIAL HERMANN FACILITIES INCLUDE MEMORIAL HERMANN-TEXAS MEDICAL CENTER, THE TEACHING HOSPITAL FOR THE UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON, AND HOME OF ONE OF THE NATION'S BUSIEST LEVEL I TRAUMA CENTERS; (8) SUBURBAN HOSPITALS; (3) PREMIER HEART & VASCULAR INSTITUTES; TIRR MEMORIAL HERMANN, ONE OF THE NATION'S TOP REHABILITATION AND RESEARCH HOSPITALS; MEMORIAL HERMANN REHABILITATION HOSPITAL - KATY; CHILDREN'S MEMORIAL HERMANN HOSPITAL; THE MEMORIAL HERMANN SPORTS MEDICINE INSTITUTE; THE MISCHER NEUROSCIENCE INSTITUTE; (7) CANCER CENTERS; (23) IMAGING CENTERS; (9) BREAST CARE CENTERS; (7) SPORTS MEDICINE AND REHABILITATION CENTERS; (7) WOUND CARE CENTERS; (9) PALLIATIVE CARE CENTERS (21) DIAGNOSTIC LABORATORIES; PARC, A SUBSTANCE ABUSE TREATMENT CENTER; (1) RETIREMENT/ NURSING CENTER; (1) HOME HEALTH AGENCY; AND A HOSPICE PROGRAM. MEMORIAL HERMANN OPERATES THE LIFE FLIGHT AIR AMBULANCE PROGRAM AND ONE OF TWO OF THE CITY'S ONLY BURN TREATMENT CENTERS. THE NATIONAL QUALITY FORUM (NQF) AND THE JOINT COMMISSION HAVE NAMED MEMORIAL HERMANN HEALTH SYSTEM THE 2012 RECIPIENT OF THE JOHN M. EISENBERG PATIENT SAFETY AND QUALITY AWARD AT THE NATIONAL LEVEL (AND FIRST TEXAS HOSPITAL SYSTEM TO BE HONORED). MEMORIAL HERMANN WAS ALSO NAMED ONE OF THE TOP 5 LARGE HEALTH SYSTEMS IN THE NATION ACCORDING TO THE 15 TOP HEALTH SYSTEMS STUDY BY TRUVEN HEALTH (FORMERLY THOMSON REUTERS), A LEADING PROVIDER OF INFORMATION AND SOLUTIONS TO IMPROVE THE COST AND QUALITY OF HEALTHCARE. MEMORIAL HERMANN WAS ELECTED BY THE HOUSTON BUSINESS JOURNAL AS ONE OF THE BEST PLACES TO WORK IN HOUSTON IN 2012. MEMORIAL HERMANN HAS: 20,248 FULL-TIME EMPLOYEES; 9,824 MEDICAL STAFF MEMBERS; 1,712 PHYSICIANS-IN-TRAINING (RESIDENTS AND FELLOWS); 2,517 VOLUNTEERS PROVIDING 304,333 HOURS; 3,364 LICENSED BEDS; 130,598 ADMISSIONS; 924,764 OUTPATIENT VISITS; 76,845 OUTPATIENT SURGERIES; 450,010 EMERGENCY VISITS; 23,111 DELIVERIES; AND 3,197 LIFE FLIGHT AIR AMBULANCE MISSIONS TRANSPORTING 3,294 PATIENTS. SPECIALTIES INCLUDE: BURN TREATMENT, CANCER, CHILDREN'S HEALTH, DIABETES AND ENDOCRINOLOGY, DIGESTIVE HEALTH, EAR, NOSE AND THROAT, EMERGENCIES, HEART & VASCULAR, LYMPHEDEMA, NEUROSURGERY, NEUROLOGY, STROKE, NUTRITION, OPHTHALMOLOGY, ORTHOPEDICS, PHYSICAL AND OCCUPATIONAL THERAPY, REHABILITATION, ROBOTIC SURGERY, SLEEP STUDIES, AND SURGERIES, TRANSPLANT, WEIGHT LOSS, WOMEN'S HEALTH AND MATERNITY AND WOUND CARE.
State Filing Schedule H Part VI Line 7 Memorial Hermann Health System files a community benefit report in Texas that is available on the website http://communitybenefit.memorialhermann.org/about-us/.
Facility reporting groups Schedule H Part VI Line 8 This is not applicable for this filing.
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
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
2012
Open to Public
Inspection
Name of the organization
Memorial Hermann Health System
 
Employer identification number
74-1152597
Part I
General Information on Grants and Assistance
1
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? ....................................
2
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. Part II can be duplicated if additional space is needed.
(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
(1) Houston Baptist University
7502 Fondren Road
Houston,TX77074 		74-1400699 501 c(3) 17,500       General support Sponsorship of fundraising event
(2) GOOD SAMARITAN FOUNDATION
PO Box 271108
Houston,TX772771108 		74-1235398 501 c(3) 31,500       General support Sponsorship of fundraising event
(3) American Cancer Society
P O BOX 572915
HOUSTON,TX772572915 		74-1185665 501 c(3) 25,000       General support Sponsorship of fundraising event
(4) UNIVERSITY OF HOUSTON
4800 Calhoun
Houston,TX772046390 		74-6041411 501 c(3) 6,500       General support Sponsorship of fundraising event
(5) Boy Scouts of America
1911 Bagby
Houston,TX770522786 		74-1109732 501 c(3) 7,250       General support Sponsorship of fundraising event
(6) Junior League Of Houston Inc
1811 Briar Oaks Lane
Houston,TX77027 		74-1185659 501 c(3) 10,000       General support Sponsorship of fundraising events
(7) Arthritis foundation
3701 Kirby Dr Ste 1230
Houston,TX770983926 		74-1495594 501 c(3) 10,000       General support Sponsorship of fundraising event
(8) American College of Healthcare
1 N Franklin St Ste 1700
Chicago,IL606063491 		74-6132171 501 c(3) 10,000       General support Sponsorship of fundraising event
(9) Volunteer Service
921 Gessner
Houston,TX77024 		23-7382611 501 c(3) 6,500       General support Sponsorship of fundraising event
(10) Rice University
6100 Main Street
Houston,TX770051892 		74-1109620 501 c(3) 7,500       General support Sponsorship of fundraising event
(11) houston community college
3100 Main street
Houston,TX77002 		74-1885205 501 c(3) 19,000       General support Sponsorship of fundraising event
(12) FAITH IN PRACTICE
7500 Beechnut St Suite 208
Houston,TX77074 		76-0415986 501 c(3) 10,000       General support Sponsorship of fundraising event
(13) Interfaith Ministries For Greater Houston
3217 Montrose Blvd
Houston,TX770063980 		74-1488102 501 c(3) 6,500       General support Sponsorship of fundraising event
(14) VHA Health Foundation
PO Box 140429
Irving,TX750140429 		22-2710552 501 c(3) 15,000       General support Sponsorship of fundraising event
(15) Houston Area Women's Center
1010 Waugh Dr
Houston,TX77019 		74-2029166 501 c(3) 26,000       General support Sponsorship of fundraising event
(16) Houston Hospice
8811 Gaylord 100
Houston,TX770242923 		74-2092951 501 c(3) 15,000       General support Sponsonship of fundraising event
(17) Houston Symphony
1220 August Suite 270
Houston,TX77057 		74-1157373 501 c(3) 20,000       General support Sponsorship of fundraising event
(18) Finish Line Sports
13895 Southwest Frwy
Sugarland,TX77478 		76-0134642   15,000       General support Sponsorship of fundraising event
(19) CanCare of Houston Inc
9575 Katy Freeway Ste 428
Houston,TX77024 		76-0305357 501 c(3) 39,000       General support Sponsorship of fundraising event
(20) Lake houston Family YMCA
2420 West Lake Houston Parkway
Kingwood,TX77345 		74-1109737 501 c(3) 11,000       General support Sponsorship of fundraising event
(21) Economic Development
1400 Woodloch Forest Dr
THE WOODLANDS,TX77380 		76-0360533 501 c(3) 15,000       General support Sponsorship of fundraising event
(22) Fort Bend Junior Service League
PO Box 17387
Sugar Land,TX77496 		76-0664152 501 c(3) 30,000       General support Sponsorship of fundraising event
(23) Eclipse Soccer Club
3506 Hwy 6 S Ste 185
Sugar Land,TX774784401 		74-2425404 501 c(3) 45,000       General support Sponsorship of fundraising event
(24) University of St Thomas
3800 Montrose Blvd
Houston,TX77006 		74-1277664 501 c(3) 100,000       General support Sponsorship of fundraising event
(25) Neighborhood Centers Inc
PO Box 271389
Houston,TX77277 		23-7062976 501 c(3) 10,000       General support Sponsorship of fundraising event
(26) American Heart Association
POBox 15186
Austin,TX78761 		13-5613797 501 c(3) 160,000       General support Sponsorship of fundraising event
(27) The Men's Center Inc
3809 Main Street
Houston,TX77002 		74-1326185 501 c(3) 6,350       General support Sponsorship of fundraising event
(28) THE ROSE
12700 N Featherwood 260
Houston,TX77034 		76-0193812 501 c(3) 35,000       General support Sponsorship of fundraising event
(29) FORT BEND CARES
14823 SOUTHWEST FREEWAY
SUGAR LAND,TX77478 		33-1112246 501 c(3) 15,000       General support Sponsorship of fundraising event
(30) Houston Ballet Foundation
601 Preston street
Houston,TX77002 		74-1394920 501 c(3) 10,000       General support Sponsorship of fundraising event
(31) DR MARNIE ROSE FOUNDATION
5090 Richmond Ave Pmb-291
Houston,TX77056 		23-7160400 501 c(3) 7,500       General support Sponsorship of fundraising event
(32) Texas Executive Women
4295 San Felipe Suite 340
Houston,TX77027 		76-0270254 501 c(3) 5,150       General support Sponsorship of fundraising event
(33) UT Health Science
700 Fannin Street Ste 1200
Houston,TX77030 		76-1761309 501 c(3) 7,000       General support Sponsorship of fundraising event
(34) TEXAS RUSH SOCCER CLUB
2204 Timberloch Place
THE WOODLANDS,TX77380 		76-0502935 501 c(3) 32,500       General support Sponsorship of fundraising event
(35) Houston Childrens Charity
230 Westcott Suite 202
Houston,TX77007 		76-0135741 501 c(3) 25,000       General support Sponsorship of fundraising event
(36) HERMANN PARK CONSERVANCY
6201-A Golf Course Dr
Houston,TX77030 		76-0327389 501 c(3) 10,000       General support Sponsorship of fundraising event
(37) OPPORTUNITY HOUSTON
PO BOX 297653
HOUSTON,TX77297 		20-8179135 501 c(3) 25,000       General support Sponsorship of fundraising event
(38) NATIONAL FUSION SOCCER CLUB
5826 New Terr Blvd 301
Sugar Land,TX77469 		76-0641089 501 c(3) 33,750       General support Sponsorship of fundraising event
(39) FORT BEND YOUTH FOOTBALL
1306 Ashwood
Sugarland,TX77478 		26-2714233 501 c(3) 30,000       General support Sponsorship of fundraising event
(40) LONE STAR COLLEGE FOUNDATION
5000 RESEARCH FOREST DR
THE WOODLANDS,TX773814399 		76-0336902 501 c(3) 70,060       General support Sponsorship of fundraising event
(41) The Living Bank
PO Box 6725
Houston,TX772656725 		74-1607315 501 c(3) 10,000       General support Sponsorship of fundraising event
(42) IMG College LLC
PO Box 16533
Paletine,IL60055 		20-4546788   7,500       General support Sponsorship of fundraising event
(43) Food Allergy & Anaphylaxis
11781 Lee Jackson Hwy Ste 160
Fairfax,VA22033 		54-1605958 501 c(3) 6,500       General support Sponsorship of fundraising event
(44) Masala Entertainment
2721 Fieldstone
Sugar Land,TX77478 		76-0475810   7,500       General support Sponsorship of fundraising event
(45) Tournament MG LLC
333 Clay St Ste 3600
Houston,TX77002 		27-2853480   15,000       General support Sponsorship of fundraising event
(46) Lamar soccer Club Inc
PO Box 544
richmond,TX77406 		76-0570590 501 c(3) 8,250       General support Sponsorship of fundraising event
(47) Texas Firefighter Summer Games
2109 Evergreen
Plano,TX75075 		45-4400907 501 c(3) 10,000       General support Sponsorship of fundraising event
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
43
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
4
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
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.
Part III can be duplicated 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, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
Schedule I (Form 990) 2012


Additional Data


Software ID:  
Software Version:  


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
2012
Open to Public Inspection
Name of the organization
Memorial Hermann Health System
 
Employer identification number

74-1152597
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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 of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
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? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used 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.
4
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:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
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:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
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 (E) amounts for that individual.
(A) Name and Title (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
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)Wolterman Daniel JDirector and President & CEO (i)
(ii)		 1,106,756
0 		1,231,649
0 		1,060,995
0 		1,824,754
0 		15,128
0 		5,239,282
0 		953,958
0
(2)Duco Bernard A JrChief Legal Officer & Secr. (i)
(ii)		 458,912
0 		320,977
0 		364,784
0 		108,507
0 		9,916
0 		1,263,096
0 		345,152
0
(3)Laraway Dennis LCFO & Treasurer (i)
(ii)		 675,916
0 		456,556
0 		205,292
0 		67,824
0 		13,388
0 		1,418,976
0 		0
0
(4)McVeigh Dennis PCAO & Asst Treas. (i)
(ii)		 289,078
0 		195,128
0 		70,628
0 		73,266
0 		5,007
0 		633,107
0 		32,260
0
(5)Reimer P ReneeChief Risk Officer & Asst Secr (i)
(ii)		 285,552
0 		185,505
0 		10,242
0 		52,750
0 		5,047
0 		539,096
0 		0
0
(6)Shabot M Michael MDChief Medical Officer (i)
(ii)		 504,050
0 		383,787
0 		141,480
0 		119,215
0 		12,966
0 		1,161,498
0 		92,531
0
(7)Stokes Charles DChief Operating Officer (i)
(ii)		 705,690
0 		575,836
0 		83,405
0 		256,179
0 		11,676
0 		1,632,786
0 		44,189
0
(8)Alexander KeithCEO Memorial City Campus (i)
(ii)		 392,138
0 		264,078
0 		74,775
0 		98,062
0 		12,531
0 		841,584
0 		57,677
0
(9)Brace RodneyChief Regional Operations Offi (i)
(ii)		 514,628
0 		362,490
0 		87,268
0 		152,546
0 		10,006
0 		1,126,938
0 		53,156
0
(10)Bradshaw DavidChief Information Planning & M (i)
(ii)		 474,417
0 		346,979
0 		136,839
0 		119,892
0 		12,816
0 		1,090,943
0 		81,897
0
(11)Brownawell H JeffreyChief Revenue Officer (i)
(ii)		 448,975
0 		342,243
0 		308,054
0 		108,189
0 		7,814
0 		1,215,275
0 		269,397
0
(12)Cordola CraigCEO TMC, MH TMC Campus (i)
(ii)		 498,710
0 		291,412
0 		89,418
0 		95,837
0 		12,878
0 		988,255
0 		42,577
0
(13)Garman JimChief Human Resource Officer (i)
(ii)		 479,923
0 		246,907
0 		2,354
0 		49,215
0 		8,661
0 		787,060
0 		0
0
(14)Gaston George HCEO Southeast Campus (i)
(ii)		 389,379
0 		244,982
0 		73,854
0 		89,711
0 		12,515
0 		810,441
0 		40,148
0
(15)Heins Marshall BChief Facility Services Office (i)
(ii)		 444,101
0 		344,746
0 		99,423
0 		118,679
0 		9,713
0 		1,016,662
0 		48,140
0
(16)Metzger PatSystem Executive, Care Managem (i)
(ii)		 243,411
0 		108,902
0 		42,358
0 		56,637
0 		9,206
0 		460,514
0 		30,696
0
(17)Paret CarolChief Community Officer (i)
(ii)		 247,148
0 		167,064
0 		47,324
0 		76,599
0 		9,036
0 		547,171
0 		25,658
0
(18)Trevino Illeana VCEO Foundation (i)
(ii)		 0
288,304 		0
186,365 		0
54,928 		0
61,801 		0
12,169 		0
603,567 		0
40,259
(19)Aulbaugh Carrol EFormer Officer - Chief Financi (i)
(ii)		 99,979
0 		111,295
0 		1,019,999
0 		1,744
0 		3,427
0 		1,236,444
0 		107,307
0
(20)Barbe ScottCEO Katy (i)
(ii)		 361,191
0 		235,905
0 		61,593
0 		90,271
0 		8,170
0 		757,130
0 		44,652
0
(21)Beckstett Douglas GFormer Chief Human Resources O (i)
(ii)		 24,602
0 		66,557
0 		713,938
0 		6,929
0 		2,033
0 		814,059
0 		86,005
0
(22)Sanders G StevenCEO Woodlands (i)
(ii)		 416,981
0 		318,376
0 		104,853
0 		129,935
0 		9,773
0 		979,918
0 		60,797
0
(23)Smith Louis G JrCEO Northeast (i)
(ii)		 344,392
0 		224,163
0 		49,220
0 		70,798
0 		12,356
0 		700,929
0 		30,425
0
(24)Cross Mary A MDFormer Member (i)
(ii)		 0
136,970 		0
0 		0
20,144 		0
12,710 		0
6,990 		0
176,814 		0
0
(25)Asprec Erin SFormer Key EE - CEO Southeast (i)
(ii)		 338,893
0 		218,023
0 		40,927
0 		59,342
0 		12,376
0 		669,561
0 		23,492
0
(26)Brown James BFormer Key EE- CEO OPID/ASC, M (i)
(ii)		 289,049
0 		186,600
0 		43,768
0 		58,689
0 		10,493
0 		588,599
0 		34,662
0
(27)Distefano SusanFormer Key EE - CEO Children's (i)
(ii)		 333,254
0 		203,064
0 		4,011
0 		41,798
0 		11,558
0 		593,685
0 		0
0
(28)Josehart Carl EFormer Key EE- TIRR MH CEO (i)
(ii)		 272,773
0 		142,091
0 		65,323
0 		59,570
0 		4,124
0 		543,881
0 		46,094
0
(29)Kerr GaryFormer Key EE - CEO Northwest, (i)
(ii)		 310,825
0 		223,896
0 		59,527
0 		69,887
0 		8,073
0 		672,208
0 		40,340
0
(30)Lloyd ChristopherFormer Key EE -CEO, MHMD (i)
(ii)		 0
254,911 		0
166,624 		0
53,006 		0
55,194 		0
4,905 		0
534,640 		0
37,588
(31)McCracken AyseFormer Key EE - CEO, MHMG (i)
(ii)		 326,423
0 		170,142
0 		1,222
0 		39,716
0 		1,162
0 		538,665
0 		0
0
(32)FLANAGANTHOMAS JFormer High 5 - COO TMC (i)
(ii)		 307,649
0 		162,891
0 		64,080
0 		68,156
0 		5,094
0 		607,870
0 		31,349
0
(33)PARKSWILLIAM BFormer High 5 - Chief Medical (i)
(ii)		 247,314
0 		116,270
0 		41,576
0 		57,892
0 		8,070
0 		471,122
0 		35,612
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
Severance Payments Form 990 Schedule J Line 4a - Severance Payments Aulbaugh 624,998 Beckstett 494,998
Nonqualified Retirement Plans Form 990 Schedule J Line 4b - Nonqualified Retirement Plans Memorial Hermann Health System sponsors two nonqualified retirement plans for certain executives who are part of a select group of highly compensated or management employees. The first plan is called the Memorial Hermann Supplemental Executive Retirement Plan (SERP). It is a make-up plan and provides for an annual payment (upon achieving full vesting in the qualified retirement plan) equivalent to the amount of the accrual from the employer that is lost to the employee due to the limits on compensation and benefits in the Internal Revenue Code. The second plan is called the Memorial Hermann Health System Select Group 457(b) Deferred Compensation Plan (457). It allows for deferral of base salary for those executives who work for a tax exempt entity of Memorial Hermann and whose base salary is above the qualified plan limit. Contributions to this plan are subject to the IRS federal limit. No matching contributions are made on any deferrals under this plan. Applicable SERP amounts accrued per person: Alexander 15,216 Asprec 11,765 Aulbaugh 37,845 Barbe 14,418 Beckstett 27,688 Brace 30,040 Bradshaw 35,056 Brown 7,766 Brownawell 31,827 Cordola 22,056 Duco 17,494 Flanagan 15,376 Gaston 19,607 Heins 30,954 Josehart 5,583 Kerr 11,489 Lloyd 7,229 McVeigh 13,869 Metzger 6,014 Paret 15,858 Parks 4,877 Reimer 9,556 Sanders 15,159 Shabot 22,395 Smith 10,877 Stokes 32,039 Trevino 10,272 Wolterman 102,134 Applicable 457 amounts distributed per person: Aulbaugh 103,978
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Memorial Hermann Health System
 
Employer identification number
74-1152597
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A Harris County Health Facilities Development Corp
  		56-1284201 414152QU5 04-08-2004 107,652,499 2004A Purchase Land and Equipment X     X   X
B Harris County Heath Facilities Development Corp
  		76-0337885 414152RT7 03-26-2008 184,800,000 2008A Refund Issue 03/11/1998   X   X   X
C Harris County Cultural EDU Facilities Fin Corp
  		76-0337885 414009BD1 11-25-2008 133,200,000 2008D Refund Issue 11/1/2005 X     X   X
D Harris County Cultural Facilities Finance Corp
  		76-0337885 414009EM8 11-30-2010 72,206,221 2010A Refund Issue 3/12/1997   X   X   X
Harris County Cultural Facilities Finance Corp
  		76-0337885 414009ER7 01-05-2011 162,400,000 2010B Refund Issue 5/17/2001   X   X   X
Harris County Cultural Edu Fac Fin Corp
  		76-0337885 414009HD5 04-10-2013 103,585,000 2013C/D Refund Issue 11/25/2008   X   X   X
Harris County Cultural Edu Fac Fin Corp
  		76-0337885 414009GR5 03-28-2013 468,778,930 2013A/B Ref Issue 04/08/04, 11/13/   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0 0 0  
2 Amount of bonds legally defeased . . . . . . . . . . . 63,800,000 0 0  
3 Total proceeds of issue . . . . . . . . . . . . . . 107,652,499 184,800,000 162,400,000  
4 Gross proceeds in reserve funds . . . . . . . . . . . . 8,807,655 0 0  
5 Capitalized interest from proceeds . . . . . . . . . . . 0 0 0  
6 Proceeds in refunding escrows . . . . . . . . . . . . 0 180,324,091 161,600,000  
7 Issuance costs from proceeds . . . . . . . . . . . . 925,250 501,267 800,000  
8 Credit enhancement from proceeds . . . . . . . . . . . 0 3,974,642 0  
9 Working capital expenditures from proceeds . . . . . . . . . 0 0 0  
10 Capital expenditures from proceeds . . . . . . . . . . . 97,919,148 0 0  
11 Other spent proceeds . . . . . . . . . . . . . . 446 0 0  
12 Other unspent proceeds . . . . . . . . . . . . . . 0 0 0  
13 Year of substantial completion . . . . . . . . . . . . 2005 2008 2011
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X X   X      
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X   X    
16 Has the final allocation of proceeds been made? . . . . . . . . X   X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X    
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .   X   X   X    
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X   X   X    
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0.00000% 0.00000% 0.00000%   %
7 Does the bond issue meet the private security or payment test? . . . . .   X   X   X    
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X   X   X    
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of. 0.00000% 0.00000% 0.00000%   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X   X   X    
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . . X   X   X      
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .                
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
               
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X X   X      
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X X   X      
b Name of provider . . . . . . . . . 0
  		JP Morgan
  		JP Morgan
  		 
 
c Term of hedge . . . . . . . . . . 19.2 19.2 28.4  
d Was the hedge superintegrated? . . . . . .   X   X   X    
e Was a hedge terminated? . . . . . . .   X   X   X    
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X   X   X    
b Name of provider . . . . . . . . . 0
  		0
  		0
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X   X   X    
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X   X      
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X      
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Bond information see schedule o 0  
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Memorial Hermann Health System
 
Employer identification number
74-1152597
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A Harris County Health Facilities Development Corp
  		56-1284201 414152QU5 04-08-2004 107,652,499 2004A Purchase Land and Equipment X     X   X
B Harris County Heath Facilities Development Corp
  		76-0337885 414152RT7 03-26-2008 184,800,000 2008A Refund Issue 03/11/1998   X   X   X
C Harris County Cultural EDU Facilities Fin Corp
  		76-0337885 414009BD1 11-25-2008 133,200,000 2008D Refund Issue 11/1/2005 X     X   X
D Harris County Cultural Facilities Finance Corp
  		76-0337885 414009EM8 11-30-2010 72,206,221 2010A Refund Issue 3/12/1997   X   X   X
Harris County Cultural Facilities Finance Corp
  		76-0337885 414009ER7 01-05-2011 162,400,000 2010B Refund Issue 5/17/2001   X   X   X
Harris County Cultural Edu Fac Fin Corp
  		76-0337885 414009HD5 04-10-2013 103,585,000 2013C/D Refund Issue 11/25/2008   X   X   X
Harris County Cultural Edu Fac Fin Corp
  		76-0337885 414009GR5 03-28-2013 468,778,930 2013A/B Ref Issue 04/08/04, 11/13/   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0 0 0  
2 Amount of bonds legally defeased . . . . . . . . . . . 63,800,000 0 0  
3 Total proceeds of issue . . . . . . . . . . . . . . 107,652,499 184,800,000 162,400,000  
4 Gross proceeds in reserve funds . . . . . . . . . . . . 8,807,655 0 0  
5 Capitalized interest from proceeds . . . . . . . . . . . 0 0 0  
6 Proceeds in refunding escrows . . . . . . . . . . . . 0 180,324,091 161,600,000  
7 Issuance costs from proceeds . . . . . . . . . . . . 925,250 501,267 800,000  
8 Credit enhancement from proceeds . . . . . . . . . . . 0 3,974,642 0  
9 Working capital expenditures from proceeds . . . . . . . . . 0 0 0  
10 Capital expenditures from proceeds . . . . . . . . . . . 97,919,148 0 0  
11 Other spent proceeds . . . . . . . . . . . . . . 446 0 0  
12 Other unspent proceeds . . . . . . . . . . . . . . 0 0 0  
13 Year of substantial completion . . . . . . . . . . . . 2005 2008 2011
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X X   X      
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X   X    
16 Has the final allocation of proceeds been made? . . . . . . . . X   X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X    
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .   X   X   X    
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X   X   X    
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0.00000% 0.00000% 0.00000%   %
7 Does the bond issue meet the private security or payment test? . . . . .   X   X   X    
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X   X   X    
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of. 0.00000% 0.00000% 0.00000%   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X   X   X    
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . . X   X   X      
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .                
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
               
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X X   X      
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X X   X      
b Name of provider . . . . . . . . . 0
  		JP Morgan
  		JP Morgan
  		 
 
c Term of hedge . . . . . . . . . . 19.2 19.2 28.4  
d Was the hedge superintegrated? . . . . . .   X   X   X    
e Was a hedge terminated? . . . . . . .   X   X   X    
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X   X   X    
b Name of provider . . . . . . . . . 0
  		0
  		0
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X   X   X    
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X   X      
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X      
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Bond information see schedule o 0  
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Memorial Hermann Health System
 
Employer identification number
74-1152597
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A Harris County Health Facilities Development Corp
  		56-1284201 414152QU5 04-08-2004 107,652,499 2004A Purchase Land and Equipment X     X   X
B Harris County Heath Facilities Development Corp
  		76-0337885 414152RT7 03-26-2008 184,800,000 2008A Refund Issue 03/11/1998   X   X   X
C Harris County Cultural EDU Facilities Fin Corp
  		76-0337885 414009BD1 11-25-2008 133,200,000 2008D Refund Issue 11/1/2005 X     X   X
D Harris County Cultural Facilities Finance Corp
  		76-0337885 414009EM8 11-30-2010 72,206,221 2010A Refund Issue 3/12/1997   X   X   X
Harris County Cultural Facilities Finance Corp
  		76-0337885 414009ER7 01-05-2011 162,400,000 2010B Refund Issue 5/17/2001   X   X   X
Harris County Cultural Edu Fac Fin Corp
  		76-0337885 414009HD5 04-10-2013 103,585,000 2013C/D Refund Issue 11/25/2008   X   X   X
Harris County Cultural Edu Fac Fin Corp
  		76-0337885 414009GR5 03-28-2013 468,778,930 2013A/B Ref Issue 04/08/04, 11/13/   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0 0 0  
2 Amount of bonds legally defeased . . . . . . . . . . . 63,800,000 0 0  
3 Total proceeds of issue . . . . . . . . . . . . . . 107,652,499 184,800,000 162,400,000  
4 Gross proceeds in reserve funds . . . . . . . . . . . . 8,807,655 0 0  
5 Capitalized interest from proceeds . . . . . . . . . . . 0 0 0  
6 Proceeds in refunding escrows . . . . . . . . . . . . 0 180,324,091 161,600,000  
7 Issuance costs from proceeds . . . . . . . . . . . . 925,250 501,267 800,000  
8 Credit enhancement from proceeds . . . . . . . . . . . 0 3,974,642 0  
9 Working capital expenditures from proceeds . . . . . . . . . 0 0 0  
10 Capital expenditures from proceeds . . . . . . . . . . . 97,919,148 0 0  
11 Other spent proceeds . . . . . . . . . . . . . . 446 0 0  
12 Other unspent proceeds . . . . . . . . . . . . . . 0 0 0  
13 Year of substantial completion . . . . . . . . . . . . 2005 2008 2011
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X X   X      
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X   X    
16 Has the final allocation of proceeds been made? . . . . . . . . X   X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X    
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .   X   X   X    
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X   X   X    
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0.00000% 0.00000% 0.00000%   %
7 Does the bond issue meet the private security or payment test? . . . . .   X   X   X    
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X   X   X    
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of. 0.00000% 0.00000% 0.00000%   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X   X   X    
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . . X   X   X      
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .                
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
               
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X X   X      
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X X   X      
b Name of provider . . . . . . . . . 0
  		JP Morgan
  		JP Morgan
  		 
 
c Term of hedge . . . . . . . . . . 19.2 19.2 28.4  
d Was the hedge superintegrated? . . . . . .   X   X   X    
e Was a hedge terminated? . . . . . . .   X   X   X    
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X   X   X    
b Name of provider . . . . . . . . . 0
  		0
  		0
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X   X   X    
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X   X      
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X      
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Bond information see schedule o 0  
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Memorial Hermann Health System
 
Employer identification number
74-1152597
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A Harris County Health Facilities Development Corp
  		56-1284201 414152QU5 04-08-2004 107,652,499 2004A Purchase Land and Equipment X     X   X
B Harris County Heath Facilities Development Corp
  		76-0337885 414152RT7 03-26-2008 184,800,000 2008A Refund Issue 03/11/1998   X   X   X
C Harris County Cultural EDU Facilities Fin Corp
  		76-0337885 414009BD1 11-25-2008 133,200,000 2008D Refund Issue 11/1/2005 X     X   X
D Harris County Cultural Facilities Finance Corp
  		76-0337885 414009EM8 11-30-2010 72,206,221 2010A Refund Issue 3/12/1997   X   X   X
Harris County Cultural Facilities Finance Corp
  		76-0337885 414009ER7 01-05-2011 162,400,000 2010B Refund Issue 5/17/2001   X   X   X
Harris County Cultural Edu Fac Fin Corp
  		76-0337885 414009HD5 04-10-2013 103,585,000 2013C/D Refund Issue 11/25/2008   X   X   X
Harris County Cultural Edu Fac Fin Corp
  		76-0337885 414009GR5 03-28-2013 468,778,930 2013A/B Ref Issue 04/08/04, 11/13/   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0 0 0  
2 Amount of bonds legally defeased . . . . . . . . . . . 63,800,000 0 0  
3 Total proceeds of issue . . . . . . . . . . . . . . 107,652,499 184,800,000 162,400,000  
4 Gross proceeds in reserve funds . . . . . . . . . . . . 8,807,655 0 0  
5 Capitalized interest from proceeds . . . . . . . . . . . 0 0 0  
6 Proceeds in refunding escrows . . . . . . . . . . . . 0 180,324,091 161,600,000  
7 Issuance costs from proceeds . . . . . . . . . . . . 925,250 501,267 800,000  
8 Credit enhancement from proceeds . . . . . . . . . . . 0 3,974,642 0  
9 Working capital expenditures from proceeds . . . . . . . . . 0 0 0  
10 Capital expenditures from proceeds . . . . . . . . . . . 97,919,148 0 0  
11 Other spent proceeds . . . . . . . . . . . . . . 446 0 0  
12 Other unspent proceeds . . . . . . . . . . . . . . 0 0 0  
13 Year of substantial completion . . . . . . . . . . . . 2005 2008 2011
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X X   X      
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X   X   X    
16 Has the final allocation of proceeds been made? . . . . . . . . X   X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X    
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .   X   X   X    
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . . . . . . . . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X   X   X    
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000%   %
6 Total of lines 4 and 5 . . . . . . . . . . . . . . . 0.00000% 0.00000% 0.00000%   %
7 Does the bond issue meet the private security or payment test? . . . . .   X   X   X    
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X   X   X    
b If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of. 0.00000% 0.00000% 0.00000%   %
c If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X   X   X    
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . . X   X   X      
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .                
b Exception to rebate? . . . . . . . .                
c No rebate due? . . . . . . . . . .
               
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .   X X   X      
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X X   X      
b Name of provider . . . . . . . . . 0
  		JP Morgan
  		JP Morgan
  		 
 
c Term of hedge . . . . . . . . . . 19.2 19.2 28.4  
d Was the hedge superintegrated? . . . . . .   X   X   X    
e Was a hedge terminated? . . . . . . .   X   X   X    
Schedule K (Form 990) 2012
Schedule K (Form 990) 2012
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X   X   X    
b Name of provider . . . . . . . . . 0
  		0
  		0
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X   X   X    
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X   X      
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
1 Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X      
Part VI
Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Bond information see schedule o 0  
Schedule K (Form 990) 2012

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet 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, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Memorial Hermann Health System
 
Employer identification number

74-1152597
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) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
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 assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
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 (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) Harmohinder Kochar MD Medical Staff NW 160,642 Medical Staff Fees   No
(2) Christine Strake Family Member 14,257 employment   No
(3) Angela Bell Family Member 61,075 employment   No
(4) Adrienne Pouns Family Member 34,169 employment   No
(5) Todd Aulbaugh Family Member 76,517 employment   No
(6) Ashley McVeigh Family Member 80,754 employment   No
(7) Casey Hedges Family Member 59,226 employment   No
(8) Kerry Mobley Family Member 57,926 employment   No
(9) Periyanan Vaduganathan Medical Staff SE 63,490 Medical Staff Fee   No
(10) Bruce Myers Family Member 32,770 employment   No
(11) Ana Torres Medical Staff NW 60,912 Medical Staff Fee   No
(12) Anil Dara Medical Staff NE 60,912 Medical Staff Fee   No
(13) Kevin Gogola Medical Staff MC 53,299 Medical Staff Fee   No
(14) Sohail Noor Medical Staff Katy 78,235 Medical Staff Fee   No
(15) Oscar Rosales Medical Staff TMC 36,621 Medical Staff Fee   No
(16) Kevin Gigilio Member 72,552 Fees from MHMD   No
(17) Raymond Martin Member 12,000 Fees from MHMD   No
(18) George Peterkin Medical Staff SW 227,425 on call pay and fees from MHMD   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) 2012

Additional Data


Software ID:  
Software Version:  




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
2012
Open to Public
Inspection
Name of the organization
Memorial Hermann Health System
 
Employer identification number

74-1152597
Identifier Return Reference Explanation
Corporate Conflict of Interest Policy Form 990, Part VI, Section B, Line 12c Memorial Hermann Health System utilizes conflict of interest surveys and has codified its procedure in a policy. The policy is monitored by our Corporate Compliance Department through annual surveys of board members, corporate officers, management level employees, and other selected employees, physicians and vendors for all of its entities and related affiliates. In addition to responding to the survey, each recipient affirms that they have received a copy of the policy, has read and understood it, has agreed to comply with it, and understands that Memorial Hermann is a charitable organization that must engage in primarily tax-exempt purpose activities. The Corporate Compliance Department, Chief Legal Officer and the Corporate Audit Committee, consisting of independent board members, receive a report of all items disclosed. The Audit Committee Chair reports the existence of any conflicts to the Corporate Board of Directors.
Compensation Determination Form 990, Part VI, Section B, Line 15a and 15b The process for determining compensation for the Organization's CEO and other top management is described below in the following four sections. *Compensation Philosophy *Components of Executive Compensation *Roles of Compensation Decision Makers *Summary Compensation Philosophy The Compensation Committee has established the following compensation philosophy. Accountable for Business Performance: Compensation should be tied to our long-term and short-term business strategies of each dimension of our business including, but not limited to, Quality & Safety, Service & Satisfaction, Operational Excellence, and Growth & People. Attract, Retain and Motivate: Compensation should reflect the competitive marketplace so the Company can attract, retain and motivate talented executives. Accountable for Individual & Business Unit Performance: Compensation should be tied to our individual and business unit performance. Comply with IRC Section 4958: Compensation programs and pay levels should be "Reasonable" within the definition of IRC Section 4958. Balanced Approach: We should balance any potential strategic, financial, operational and reputational risk with our pay-for-performance philosophy. Components of Executive Compensation Compensation Component - Base Salary Description - Fixed compensation component. Objectives - Attract, retain, and motivate executives by providing a competitive level of fixed compensation based on the executive's responsibilities. Compensation Component - Management Incentive Plan Description - Variable and annual performance-based compensation component. Target amounts for each executive are set by the Compensation Committee. Actual payouts may be less than or greater than the target amounts based on the Company's performance against its short-term goals. Goals are set at a significant "stretch" level such that target performance results in above median payouts. Objectives Align short-term performance with the goals of the Company. Ensure cost-effective and efficient use of Company assets by offering the appropriate amounts and mix of compensation. Compensation Component - Long-Term Incentive Plan Description Variable and three-year performance-based compensation component. Target amounts for each executive are set by the Compensation Committee. Actual payouts may be less than or greater than the target amounts based on the Company's performance against its long-term goals. Goals are set at a significant "stretch" level such that target performance results in above median payouts. Objectives Promote retention, advance pay-for-performance, and reinforce the link between the interests of the executive and the overall long-term success of the Company. Ensure cost-effective and efficient use of Corporate assets by offering the appropriate amounts and mix of compensation. Compensation Component - Deferred Compensation Plan Description - Program designed to promote retention and long-term success of Memorial Hermann by acting as a backstop for our performance-based programs. Objectives - Promote retention by tying the executive to Memorial Hermann for the vesting period. As part of his compensation package, the Compensation Committee presented the CEO and President, Mr. Wolterman, with a retention agreement. Per the terms of this agreement, he will receive a lump sum payment in July 2016. This lump sum payment is being accrued over the life of the retention agreement (July 2009 to July 2016). The 2012 accrual is included in Column C of Part II on the attached Form 990 Schedule J. If Mr. Wolterman voluntarily leaves prior to July 2016, he does not receive any portion of this lump sum payment. Under certain circumstances (e.g., death or disability), Mr. Wolterman, or his beneficiary, would be entitled to a prorated portion of this lump sum payment. All employees are paid by the Corporation or an affiliate health system entity and no time or salary is allocated. Corporate officers perform administrative activities for multiple related entities for which no inter-unit allocation of time or salary is made. The Directors of the Board are voluntary citizens of the community who perform their duties without compensation for hours devoted to Board work. Roles of Compensation Decisions Makers Role of Compensation Committee. The Compensation Committee, which currently consists of ten independent persons, is responsible for the development of the philosophy, policy and objectives that guide our executive pay programs as well as establishing our performance standards and determining the compensation of our senior executives, namely our President's Council. The Compensation Committee retains Towers Watson as their independent compensation consultant to assist the Compensation Committee in the continued development and evaluation of the Company's compensation policies and practices and the Committee's determination of compensation. The Compensation Committee has the sole authority to retain and terminate the independent compensation consultant and to review and approve the consultant's fees and other retention terms. Role of Board of Directors. The Board has retained the authority to approve new executive compensation plans and material amendments to existing executive compensation plans. It has delegated its authority with respect to other executive compensation matters to the Compensation Committee. The Board receives reports from the Compensation Committee on its actions and recommendations following every Compensation Committee meeting. Role of Management. Management provides data, analysis and recommendations for the Compensation Committee's consideration regarding the Company's executive compensation programs and policies and assists the Compensation Committee in carrying out its responsibilities. Management also provides information to the Compensation Committee's independent compensation consultant in connection with the consultant's role in advising the Compensation Committee. The CEO, CHRO and VP Compensation and Benefits typically attend the Committee meetings. The Compensation Committee also meets regularly in executive session outside the presence of management. While the Compensation Committee considers the recommendations of the CEO and the input received from its independent compensation consultant, all compensation decisions for our executives are made by the Compensation Committee. Role of Independent Compensation Consultant. The Committee retains an independent compensation consultant to perform the following duties. Conduct a comprehensive review of the total compensation provided to our executives related to competitive and comparable market practices. Ensure that our compensation programs provide total compensation opportunities that are reasonable for purposes of Intermediate Sanctions (IRC Section 4958). Assess competitiveness of our compensation programs with respect to Healthcare and general industry peer companies. Assist the Compensation Committee with its charter review. Review annual disclosures. Review compensation of "disqualified persons" whose compensation is subject to a reasonableness review under IRC Section 4958. Provide a letter to the Committee regarding the reasonableness of the compensation of our executives and other "disqualified persons" helping to create a rebuttable presumption of reasonableness with regard to executive compensation. Summary In summary, the process for determining compensation for our CEO and other top management balances input from various sources and ensures a focus on performance, risk management, compliance with IRC Section 4958 and our ability to attract, retain and motivate our executives.
Oversight Review of Financial Statements Form 990, Part XII, Line 2c Does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of independent accountant? Memorial Hermann Health System has independent committees for audits, governance, and compensation which perform their respective functions on a consolidated basis for all corporate entities. The audit committee hires the independent accountants and oversees all audits that are conducted within all affiliated entities for financial information, grants and awards, and qualified plans.
Members of Organization Form 990, Part VI, Section A, Line 6 Memorial Hermann Health System has individual members.
Election of Members Form 990, Part VI, Section A, Line 7a The members have the authority to annually elect board members of the organization and to fill any vacancies on the board whose terms have expired.
Decisions of Governing Body Form 990, Part VI, Section A, Line 7b The members have approval authority to approve amendments to, and repeal of the bylaws and certificate of formation, the purchase or sale of all or substantialy all assets of the organization, and the merger or dissolution of the organization.
Disclosure of Organizational Documents Form 990, Part VI, Section C, Line 19 Describe how the organization makes its governing documents, conflict of interest policy, and financial statements available to the public. The articles of incorporation, corporate bylaws, conflict of interest policy and financial statements of Memorial Hermann Health System and its affiliates are generally not made available to the public. If the inquirer provided a valid reason for desiring a copy of the documents that are related to the business interests of any of the Memorial Hermann Health System corporate entities, we would consider doing so.
Review of Form 990 Form 990, Part VI, Section B, Line 11b MEMORIAL HERMANN HEALTH SYSTEM PROVIDES A COPY OF THE FORM 990 TO ALL MEMBERS OF THE GOVERNING BODY VIA A WEBSITE SET UP SPECIFICALLY FOR BOARD MEMBERS TO ACCESS VARIOUS BOARD MEMBER DOCUMENTS. THE FORM 990 IS REVIEWED BY MEMORIAL HERMANN FINANCIAL ACCOUNTING STAFF, BY SPECIFIC DEPARTMENTS INVOLVED IN RELATED SECTIONS OF THE RETURN, BY THE MEMORIAL HERMANN CHIEF ACCOUNTING OFFICER, AND BY MEMORIAL HERMANN'S PUBLIC ACCOUNTING FIRM ERNST & YOUNG, PRIOR TO ITS FILING.
Whistleblower Policy Form 990, Part VI, Section B, Line 13 MHHS has established communication channels to report problems and concerns including a telephone Helpline. Employee partners are encouraged to report problems or concerns either anonymously or in confidence via the Helpline when they deem appropriate. The Helpline establishes an avenue for employee partners or interested parties to report suspected criminal activity, and illegal or unethical conduct occurring within the organization in the event other resolution channels are ineffective or the caller wishes to remain anonymous. The Corporate Compliance Helpline is administered by an outside service in order to protect the anonymity of callers to the Helpline if they so desire to remain anonymous. All those who are employed in the Helpline operation or contracted organizations administering the Helpline are expected to act with utmost discretion and integrity in assuring that information received is acted upon in a reasonable and proper manner. MHHS has established a strict non-retaliation policy to protect, from retaliation, employee partners and others who report problems and concerns in good faith. There shall be no retaliation against a MHHS employee, independent contractor, vendor, allied health professional or medical staff member for reporting or raising a question regarding MHHS's compliance with a law or regulation. Those reporting suspected non-compliance who wish to remain anonymous may do so if they so choose. All reports of suspected non-compliance will be addressed in a confidential manner. The Corporate Compliance Officer or designee will always strive to maintain confidentiality during the compliance review and investigation process; however there may be a point where the identity of a reporter may need to be revealed where appropriate.
Audited Financials Form 990, Part IV, Line 12 Did the organization receive an audited financial statement for the year for which it is completing this return that was prepared in accordance with GAAP? The Health System does not have its financial accounts separately audited nor receive audited financial statements. For the consolidated entities of the Memorial Hermann Health System and its affiliates an independent audit is conducted and audited financial statements are prepared according to GAAP by an independent accounting firm, of which the financial accounts of the Health System is a part.
Tax Exempt Bonds Form 990, Schedule K, Part 1 (f) 2004A Bonds: Reimbursement or payment of routine capital costs incurred in connection with the construction of various improvements to and the acquisition of capital equipment for healthcare facilities of MHHS and Continuing Care and renovation of Memorial Hermann Hospital. Routine capital expenditures include the acquisition of land and additional equipment for existing hospital facilities, including, but not limited to, the upgrade of cardiac catheterization laboratories, renovation of nursing units and operating rooms, and installation and upgrade of CT scanners, MRIs, echocardiography systems and other imaging equipment at existing hospital facilities. The Bonds also financed the expansion of inpatient and outpatient facilities at Memorial Hermann Hospital including the expansion of operating rooms, women's services, imaging services and the neonatal intensive care unit at that hospital. 2008A Bonds: Refunded the maturities of the Series 1998 Bonds and pay costs of issuance of the Series 2008A Bonds. Expansion, renovation, and equipment for Southwest, Southeast, Northwest, The Woodlands, Hermann, Pasadena, Memorial City, Rehabilitation Hospital, Spring Shadows Glen, Spring Shadows Pines; Construction of inpatient/outpatient facilities, equipment and elderly care facilities at 1-10 & Eldridge Road and Highway 290 & FM 1960; Construction of proposed preventative health care facility and equipment at 7701-7737 Southwest Freeway; Construction and equipment for elderly care facilities at Southwest and Southeast. 2008D Bonds: Refunded the Series 2005 Bonds. Renovations of, additions (including elderly care facilities) to and equipment for inpatient/outpatient facilities at Highway 290 & FM 1960, formerly owned and operated by Pasadena Hospital inpatient/outpatient facilities at 1-10 & Eldridge Road, Spring Shadows Pines and the Wellness Center. 2010A Bonds: Refund the Series 1997B Bonds and pay costs of issuance of the Series 2010A Bonds. Renovation, equipment, and construction of elderly care facilities at Southwest & Southeast; renovation and equipment at Northwest; 100,000 sq. ft expansion at the Woodlands; prior acquisition of, renovation and equipment for Pasadena; construction in inpatient/outpatient facilities, equipment and elderly care facilities at 1-10 & Eldridge and Highway 290 & FM 1960. 2010B Bonds: Redeemed all of the Series 2001B Bonds and pay costs of issuance of the 2010B Bonds. Renovations of, additions (including elderly care facilities) to and equipment for acute care hospitals, rehabilitation hospital & Spring Shadows Glen and the proposed inpatient/outpatient facilities at Highway 290 & FM 1960. 2013A Bonds: Bonds were issued to advance refund a portion of the Series 2004A Bonds and all of the Series 2008B bonds. Reimbursement or payment of routine capital costs incurred in connection with the construction of various improvements to and the acquisition of capital equipment for healthcare facilities of MHHS and Continuing Care and renovation of Memorial Hermann Hospital. Routine capital expenditures include the acquisition of land and additional equipment for existing hospital facilities, including, but not limited to, the upgrade of cardiac catheterization laboratories, renovation of nursing units and operating rooms, and installation and upgrade of CT scanners, MRIs, echocardiography systems and other imaging equipment at existing hospital facilities. The Bonds also financed the expansion of inpatient and outpatient facilities at Memorial Hermann Hospital including the expansion of operating rooms, women's services, imaging services and the neonatal intensive care unit at that hospital. Renovations and replacements of, additions to and equipment for Hermann including Children's, Southwest including affiliated long-term acute facility, Southeast, Northwest, Memorial City, The Woodlands, Katy, MHCC Hospital Spring Shadows Pines, Prevention and Recovery Center, and the initial outpatient/inpatient primary healthcare facilities at SH 288 and FM 518, Pearland, Brazoria County. 2013B Bonds: Issued to refund the Series 2008C bonds and pay costs of issuance of the 2013B Bonds. Previously financed projects: 1) the construction and renovation of Northwest, excluding the chapel therein; 2) the construction and renovation of the Woodlands; 3) construction and renovation of inpatient/outpatient facilities at 1-10 & Eldridge and at Highway 290 & FM 1960 including construction and equipping elderly care facilities at such sites; 4) construction and renovation at Southeast and Southwest including construction of elderly care facilities and 544 parking spaces at Southeast; 5) reimbursement/payment of capital equipment for Southwest, Southeast, Northwest, The Woodlands, and Facilities in 3) and 4). 2013C Bonds: Issued to refund the Series 2008D-1 and pay costs of issuance of the 2013C Bonds. Renovations of, additions (including elderly care facilities) to and equipment for inpatient/outpatient facilities at Highway 290 & FM 1960, formerly owned and operated by Pasadena Hospital, inpatient/outpatient facilities at 1-10 & Eldridge Road, Spring Shadows Pines and the Wellness Center. 2013D Bonds: Refund Series 2008D-2 Bonds and pay costs of issuance for the Series 2013D Bonds. Renovations of, additions (including elderly care facilities) to and equipment for inpatient/outpatient facilities at Highway 290 & FM 1960, formerly owned and operated by Pasadena Hospital, inpatient/outpatient facilities at 1-10 & Eldridge Road, Spring Shadows Pines and the Wellness Center.
Changes in Net Assets or Fund Balance 990 Part XI Reconciliation of Net Assets Line 5 RECLASS OF FUND BALANCES OF AFFILIATED COMPANIES (7,738,746) CHANGE IN UNFUNDED PENSION Obligations 55,162,000 RECLASS OF CONTRIBUTIONS 22,100,000 CHANGE IN NONCONTROLLING INTERESTS 1,553,000 TOTAL CHANGES IN FUND BALANCES 71,076,254
Board Medical Plan 990 Part VII Directors Our directors can purchase medical coverage, for themselves and their eligible family members, through our networks at 100% of the premium cost.
Changes to governing documents Form 990, Part VI, Section A, Line 4 IN CONNECTION WITH A CORPORATE GOVERANCE RESTRUCTURING, THE ORGANIZATION ADOPTED A RESTATED CERTIFICATE OF FORMATION EFFECTIVE JANUARY 3, 2013 AND AMENDED BYLAWS EFFECTIVE DECEMBER 31, 2012. THE ORGANIZATION SENT A "NO CHANGE" LETTER TO THE INTERNAL REVENUE SERVICE DESCRIBING THE GOVERNANCE RESTRUCTURING ON NOVEMBER 5, 2012.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Memorial Hermann Health System
 
Employer identification number

74-1152597
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to 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 entity?
Yes No
(1) Memorial Hermann Community Benefits

909 Frostwood Suite 2100

Houston,TX77024
68-0511504 		Healthcare TX 501 (c)3 9 MHHS
 
Yes
 
(2) Memorial Hermann Medical Group

909 Frostwood Suite 2100

Houston,TX77024
20-4923281 		Healthcare TX 501 (c)3 3 MHHS
 
Yes
 
(3) MHS Physicians of Texas

909 Frostwood Suite 2100

Houston,TX77024
76-0385980 		Healthcare TX 501 (c)3 3 MHHS
 
Yes
 
(4) Memorial Hermann Foundation

909 Frostwood Suite 2100

Houston,TX77024
74-1653640 		Fundraising TX 501 (c)3 11a I MHHS
 
Yes
 
(5) Memorial Hermann Information Exchange

909 Frostwood Suite 2100

Houston,TX77024
02-0684202 		Healthcare TX 501 (c)3 3 MHHS
 
Yes
 




For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) The Woodlands POB III LP

909 Frostwood Suite 2100
Houston,TX77024
20-2184543 		Manages Med Build TX na
  		related or exempt -11,430 17,782,472   No     No 89.328 %
(2) Memorial HermannUSP Surgery Ctr III LP

15305 Dallas Parkway Suite 1600 L
Addison,TX75001
20-0707543 		Surgery Center TX na
  		related or exempt 10,691,472 13,888,108   No   Yes   82.000 %
(3) Memorial Hermann Surgery Center Katy LLP

15305 Dallas Parkway Suite 1600 L
Addison,TX75001
20-3360737 		Surgery Center TX na
  		related or exempt 886,118 942,723   No     No 27.000 %
(4) MH Katy Rehab Hospital LLC

909 Frostwood Suite 2100
Houston,TX77024
26-3896057 		Medical Servi TX NA
  		related or exempt 975,442 16,940,620   No   Yes   58.803 %






Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) MHMD

909 Frostwood Suite 2100
Houston,TX77024
76-0074819 		Healthcare TX na
  		C corp -16,675,321 3,391,886 100.000 % Yes  
(2) The Health Professionals Ins Company LTD

Barclays House 3rd Floor
Grand Cayman    
CJ
Insurance CJ na
  		Foreign 10,593,386 62,066,293 100.000 % Yes  
(3) Memorial Hermann Accountable Care Org

909 Frostwood Suite 2100
Houston,TX77024
80-0778181 		Insurance TX NA
  		C Corp -606,379 0 100.000 % Yes  
(4) Memorial Hermann Health Solutions Inc

909 Frostwood Suite 2100
Houston,TX77024
26-4419989 		Insurance TX NA
  		C corp -5,563,777 8,153,341 100.000 % Yes  
(5) Memorial Hermann Health Insurance Co

909 Frostwood Suite 2100
Houston,TX77024
76-0646301 		Insurance TX na
  		C corp -999,547 13,475,899 100.000 % Yes  
(6) Memorial Hermann Health Plan Inc

909 Frostwood Suite 2100
Houston,TX77024
46-2707092 		Insurance TX na
  		C Corp 0 0 100.000 % Yes  


Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
Yes
 
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
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-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Memorial Hermann Medical Group

 R 47,504,903 FMV
(2) MHS Physicians of Texas

 R 4,292,533 FMV




Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(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 V—UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
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


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