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 Community Benefits
Corporation
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

68-0511504
E Telephone number

G Gross receipts $ 5,676,593
F Name and address of principal officer:
Dan Wolterman
909 Frostwood Suite 2100
Houston,TX77024
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
N/A
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: 2001
M State of legal domicile: TX
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Provision of programs to improve the utilization of preventive medical services by the underserved population of Harris County.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 3
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 0
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 43
6 Total number of volunteers (estimate if necessary) ............. 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
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) ......... 5,188,659 5,676,593
9 Program service revenue (Part VIII, line 2g) ......... 0 0
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 0 0
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 5,188,659 5,676,593
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,714,449 1,431,473
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) 2,903,702 3,144,993
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet76,237    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 524,861 602,411
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 5,143,012 5,178,877
19 Revenue less expenses. Subtract line 18 from line 12....... 45,647 497,716
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 4,931,424 5,482,919
21 Total liabilities (Part X, line 26)............. 298,022 351,801
22 Net assets or fund balances. Subtract line 21 from line 20..... 4,633,402 5,131,118
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: THE MISSION OF MEMORIAL HERMANN COMMUNITY BENEFIT CORPORATION (MHCBC) IS TO TEST AND MEASURE INNOVATIVE SOLUTIONS THAT REDUCE THE IMPACT OF THE LACK OF ACCESS TO CARE ON THE INDIVIDUAL, THE HEALTH SYSTEM AND THE COMMUNITY. NEW PROGRAMS ARE PILOTED, AND PROVEN PROGRAMS ARE REPLICATED IN THE COMMUNITY THAT INCLUDE INITIATIVES TO: REMOVE BARRIERS TO HEALTHCARE ACCESS; INCREASE AND STRENGTHEN THE PRIMARY AND SPECIALTY CARE INFRASTRUCTURE; PROVIDE EDUCATION AND INCREASE HEALTHCARE AWARENESS; AND IMPROVE THE USE OF PREVENTATIVE MEDICAL SERVICES.
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 $ 2,678,813 including grants of $   ) (Revenue $   )
4A. ADDRESSING THE NEED FOR A "MEDICAL HOME" FOR THE UNINSURED AND UNDERINSURED, MHCBC PARTNERS WITH THREE SCHOOL DISTRICTS, HOUSTON--THE LARGEST IN TEXAS, PASADENA AND LAMAR CONSOLIDATED, FOR ITS HEALTH CENTERS FOR SCHOOLS PROGRAM DESIGNED TO PROVIDE A "MEDICAL HOME" FOR UNINSURED CHILDREN AND A SECONDARY ACCESS POINT FOR INSURED CHILDREN, K-12TH GRADE. THE HEALTH CENTERS PROVIDE PRIMARY HEALTHCARE, MENTAL HEALTHCARE, AND DENTAL CARE TO MEDICALLY UNDERSERVED, AT-RISK CHILDREN. THE PROGRAM BEGAN IN 1996 WITH TWO SCHOOL-BASED HEALTH CENTERS SERVICING THREE SCHOOLS. TODAY, MEMORIAL HERMANN OPERATES HEALTH CENTERS ON-SITE AT SIX CAMPUSES IN THE GREATER HOUSTON AREA PROVIDING ACCESS TO HEALTHCARE FOR MORE THAN 40,000 STUDENTS AT 49 SCHOOLS. THREE ADDITIONAL CLINICS AND ONE REPLACEMENT CLINIC WILL OPEN IN AUGUST 2014 THROUGH FEDERAL FUNDING DISPERSED BY THE STATE THROUGH DELIVERY SYSTEM REFORM INCENTIVE PAYMENTS (DSRIP) AND THROUGH A CAPITAL GRANT FROM THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA). "FEEDER" PATTERNS ARE ACCOMMODATED, MAKING IT POSSIBLE FOR A CHILD TO RECEIVE CONTINUITY OF CARE FROM PRE-KINDERGARTEN THROUGH TWELFTH GRADE. ALL SERVICES ARE PROVIDED FREE OF CHARGE. THE HEALTH CENTERS FOR SCHOOLS OPERATE MONDAY THROUGH FRIDAY, DURING SCHOOL HOURS, 12 MONTHS A YEAR. THE SCOPE OF SERVICES OFFERED INCLUDES IMMUNIZATIONS, GENERAL AND SPORTS PHYSICALS, ACUTE, CHRONIC AND MINOR INJURY CARE, MENTAL HEALTH THERAPY, SOCIAL SERVICE COUNSELING AND REFERRALS, HEALTH EDUCATION, AND NUTRITIONAL GUIDANCE AS WELL AS OTHER SPECIFIC CARE TO MEET STUDENTS' NEEDS. STAFFING AT EACH CENTER CONSISTS OF A NURSE PRACTITIONER, LICENSED CLINICAL SOCIAL WORKER, LVN AND A RECEPTIONIST, WITH MEDICAL OVERSIGHT PROVIDED BY A MEMORIAL HERMANN FAMILY PRACTITIONER. A DIETITIAN AND CERTIFIED COMMUNITY HEALTH WORKER ROTATE AMONG THE SEVEN CENTERS. THE DIETITIAN DELIVERS 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 SCHOOL CURRICULUM. THE TWO MOBILE DENTAL CLINIC VANS ROTATE AMONG THE HEALTH CENTERS FOR SCHOOLS AND ARE STAFFED BY A DENTIST AND TWO DENTAL ASSISTANTS AND PROVIDE SERVICES THAT INCLUDE PERIODIC ORAL EXAMINATIONS, DIAGNOSTIC X-RAYS, PROPHYLAXIS, FLUORIDE TREATMENTS, ORAL HYGIENE INSTRUCTIONS, SEALANTS, AMALGAM AND COMPOSITE FILLINGS, EXTRACTIONS, STAINLESS STEEL CROWNS, PULPATOMIES, AND ROOT CANALS. THIS PROGRAM HAS SERVED AS A "DENTAL HOME" TO UNINSURED STUDENTS FOR MORE THAN TWELVE YEARS. A THIRD VAN IS BEING ADDED IN 2014 THROUGH THE DSRIP FUNDING. THE PRIMARY GOAL OF HEALTH CENTERS FOR SCHOOLS PROGRAM IS TO BRING INCREASED HEALTH CARE TO CHILDREN WHO WILL OTHERWISE NOT OBTAIN IT AND TO KEEP CHILDREN HEALTHY AND IN SCHOOL SO THEY CAN LEARN THE SKILLS THEY WILL NEED FOR A BRIGHTER FUTURE. FIFTY-EIGHT PERCENT OF THE CHILDREN SERVED AT THE CLINICS DO NOT HAVE ANY TYPE OF HEALTHCARE COVERAGE. TWENTY-FOUR PERCENT HAVE SOME FORM OF MEDICAID. THE REMAINING 18% ARE CHILDREN WHO WILL NOT OBTAIN HEALTHCARE DUE TO TRANSPORTATION ISSUES, WORKING PARENTS UNABLE TO AFFORD A DAY OFF, HIGH PRIVATE INSURANCE DEDUCTIBLES OR SIMPLY A LACK OF PARENT INVOLVEMENT. MORE THAN 95% OF STUDENTS SERVED THROUGH THE PROGRAM ARE ON THE FREE/REDUCED LUNCH PROGRAM, 34% ARE MORE COMFORTABLE SPEAKING, READING AND WRITING IN A LANGUAGE OTHER THAN ENGLISH, AND THE MAJORITY OF CHILDREN SERVED ARE WITHOUT ANOTHER PRIMARY CARE PROVIDER. THE SIX HEALTH CENTERS ARE ACCESSIBLE TO MORE THAN 40,000 CHILDREN AT 49 SCHOOLS IN THE GREATER HOUSTON AREA. AN EVIDENCED-BASED PROGRAM, BENCHMARKS ARE DERIVED FROM THE NATIONAL ASSOCIATION OF SCHOOL BASED HEALTH CENTERS, THE ACADEMY OF PEDIATRICS, AND HEALTHY PEOPLE 2020. IN 2012: 8,605 CHILDREN WERE SERVED IN 20,087 VISITS-87% RETURNED TO THEIR CLASSROOM ON THE SAME DAY. ASTHMA EXACERBATIONS, EMERGENCY ROOM VISITS AND HOSPITALIZATIONS WERE REDUCED BY 84%. .75% OF HEALTH CENTER STUDENTS USED AN ER FOR PRIMARY CARE PURPOSES VERSUS 10.5% OF THE GENERAL PRIMARY CARE PEDIATRIC COMMUNITY. 66.98% OF STUDENTS WITH HIGH CHOLESTEROL REDUCED THEIR CHOLESTEROL; 50% ACHIEVED ACCEPTABLE CHOLESTEROL LEVELS. STUDENTS WHO RECEIVED THERAPY FROM LICENSED CLINICAL SOCIAL WORKERS: IMPROVED GPAS: 2.9 TO 3.2; REDUCED DAYS ABSENT: 1.9 TO 1.3 DAYS; AND REDUCED DETENTION/SUSPENSION INCIDENTS: 1.6 TO.7 DAYS. 93.6% OF STUDENTS WITH 3+ CLINIC VISITS FOR ACUTE OR CHRONIC REASONS RECEIVE A BI-ANNUAL PHYSICAL. 94.2% OF SEXUALLY ACTIVE YOUTH DECREASED THEIR HIGH-RISK BEHAVIORS BY ABSTAINING OR CONSISTENT USE OF BIRTH CONTROL. IN 2012, NO MORE THAN 8.1% OF SUDENTS 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.
4b (Code:   ) (Expenses $ 484,555 including grants of $   ) (Revenue $   )
4B. IN 2012, MEMORIAL HERMANN ONCE AGAIN PARTNERED WITH UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER SCHOOL FOR PUBLIC HEALTH IN A HOUSTON HOSPITALS EMERGENCY DEPARTMENT(ED) USE STUDY THAT REVEALED 40.9% OF ALL ER VISITS AND 48.6% OF ALL TREATED AND RELEASED ER VISITS ARE PRIMARY CARE RELATED. IN 2008, MHCBC LAUNCHED THE ER NAVIGATION PROGRAM AT MEMORIAL HERMANN TO ADDRESS THE PROBLEM OF INAPPROPRIATE ED USE. THE ER NAVIGATION PROGRAM PLACES A COMMUNITY HEALTH WORKER (CHW) OR "NAVIGATOR" ON-SITE IN THREE MEMORIAL HERMANN EMERGENCY ROOMS THAT ARE USED HEAVILY BY THE UNINSURED AND UNDERINSURED IN ORDER TO IDENTIFY MORE APPROPRIATE HEALTH FACILITIES FOR THESE PATIENTS. THE NAVIGATORS, TRAINED AND CERTIFIED BY MEMORIAL HERMANN PARTNER, GATEWAY TO CARE, 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. NAVIGATORS 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. 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. A 6-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. DATA IS ANALYZED IN NUMEROUS WAYS, INCLUDING FREQUENCY OF ER USAGE. 2700 VISITS ARE PROVIDED ANNUALLY WITH A MINIMUM OF THREE FOLLOW-UP CONNECTIONS PER PATIENT. IN 2012, MEMORIAL HERMANN CONDUCTED A SURVEY OF 434 PATIENTS WHO WERE NAVIGATED TO INCREASE KNOWLEDGE ABOUT THE ACTUAL AND PERCEIVED BARRIERS TO UTILIZATION OF OFFICE OR CLINIC-BASED PRIMARY CARE AMONG FREQUENT ER USERS. FINDINGS: PATIENT'S UNCERTAINTY "I NEEDED TO SEE A DOCTOR IMMEDIATELY" (85.9%), PERCEIVED CONVENIENCE OF BOTH HOURS AND LOCATION "NO APPOINTMENT IS NECESSARY" (65.9%), FINANCIAL CONSIDERATIONS "THE ER IS MORE AFFORDABLE THAN OTHER PLACES" (51.6%) AS WELL AS PERCEIVED QUALITY OF CARE "ER DOCTORS PROVIDE BETTER CARE THAN OTHER PLACES" (51.4%) AND "THE ER OFFERS MORE SERVICES THAN OTHER PLACES" (61.8%) ALL INFLUENCED PATIENTS WHO USED THE ER FOR PRIMARY CARE PURPOSES. SIMILAR SUPPORT FOR ALL OF MEMORIAL HERMANN HOSPITALS IS ALSO PROVIDED THROUGH COMMUNITY OUTREACH FOR PERSONAL EMPOWERMENT (COPE) WHICH EMPLOYEES MASTERS LEVEL SOCIAL WORKERS TO FOCUS ON "FREQUENT FLIER" INPATIENTS AS WELL AS ER. THE PROGRAM 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 SERVICE IN THEIR COMMUNITY. ENROLLING THESE POPULATIONS INTO PUBLIC BENEFITS THROUGH ALL OF THESE VENUES AUTOMATICALLY INCREASED THEIR LIKLIHOOD 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.
4c (Code:   ) (Expenses $ 1,311,271 including grants of $ 1,020,969 ) (Revenue $   )
4C. THE MEMORIAL HERMANN NEIGHBORHOOD HEALTH CENTERS ARE LOW-COST CLINICS OPEN EXTENDED HOURS, AND STRATEGICALLY LOCATED NEAR BUSY EMERGENCY CENTERS. DESIGNED TO SERVE AS A "MEDICAL HOME" TO UNINSURED WORKING FAMILIES WHO DO NOT QUALIFY FOR OTHER PROGRAMS, THE CENTERS ACCEPT CASH AND MEDICAID. 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. THE CONTINUITY OF CARE AND IMPROVED HEALTH IS EVIDENT FROM THESE CLINICS WHERE INDIVIDUALS CAN DECREASE THEIR HYPERTENSION, MANAGE THEIR DIABETES, AND WOMEN CAN FEEL COMFORTABLE RETURNING FOR THEIR ANNUAL WELL WOMAN EXAMS. THE CENTERS PROVIDE 12,606 MEDICAL VISITS ANNUALLY AND INCLUDE TREATMENT OF ROUTINE ACUTE PROBLEMS, PREVENTATIVE CARE AND CHRONIC CONDITIONS. SIXTY-FIVE PERCENT OF PATIENTS ARE ESTABLISHED. MHCBC HAS PLAYED NUMEROUS AND CRITICAL ROLES-FINANCIAL AS WELL AS OPERATIONAL-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. THE PRIMARY GOAL OF THE PHN IS TO INCREASE THE HOUSTON AREA'S CAPACITY FOR CHARITABLE CARE BY RECRUITING NEW SPECIALTY PROVIDERS AND MAINTAINING EXISTING PROVIDERS. THE SECONDARY GOAL IS TO CONNECT UNINSURED, INDIGENT PATIENTS TO NEEDED "JUST IN TIME" SPECIALTY CARE TO SUPPORT THEIR MEDICAL HOME. WITH ONE IN EVERY FOUR MEDICAL VISITS REQUIRING A REFERRAL TO A SPECIALIST, THE HOUSTON COMMUNITY WAS IN DESPERATE NEED OF A PHN TO CONNECT UNINSURED PERSONS TO THE SPECIALTY CARE THEY NEED TO GET WELL. TIMELY ACCESS TO SPECIALIZED CARE IMPROVES CLINICAL OUTCOMES AND OVER THE LONG TERM IS LESS COSTLY FOR THE COMMUNITY. PATIENTS ELIGIBLE FOR RECEIVING PHN SERVICES INCLUDE THOSE WHOSE INCOME IS AT 150% OR BELOW THE FEDERAL POVERTY LEVEL, HAVE NO OTHER FORM OF HEALTH INSURANCE OR HEALTH BENEFITS AND HAVE BEEN REFERRED BY A PARTICIPATING VOLUNTEER PHYSICIAN OR HOUSTON AREA SAFETY NET COMMUNITY CLINIC. MHCBC FUNDS ONE-THIRD OF THE PHN'S ANNUAL OPERATING BUDGET AND PLAYS A SIGNIFICANT ROLE IN RECRUITING VOLUNTEER PHYSICIANS IN ALL ASPECTS OF DELIVERING CHARITY CARE. CHRISTUS HEALTH SYSTEM, HOSPITAL CORPORATION OF AMERICA (HCA), THE METHODIST HOSPITAL AND ST. LUKE'S EPISCOPAL HEALTH SYSTEM HAVE JOINED MEMORIAL HERMANN AS PROVIDERS OF INPATIENT AND OUTPATIENT SERVICES IN THIS REGION-WIDE EFFORT TO MEET THE SPECIALIZED CARE NEEDS OF THE UNINSURED INDIVIDUALS AND FAMILIES. THE PHN RELIES ON THE DEDICATION OF 807 PROVIDERS, 32 HOSPITALS AND 105 ANCILLARY PROVIDERS. SINCE NOVEMBER 2006, THE PHN HAS PROVIDED PHYSICIAN, HOSPITAL, DIAGNOSTIC, LABS, RADIOLOGY, PRESCRIPTION ASSISTANCE AND NAVIGATION SERVICES TO MORE THAN 4,700 PATIENTS AMOUNTING TO $19.3 MILLION IN CHARITY CARE. THE PHN IS GENERATING $11 IN MEDICAL SERVICES FOR EVERY $1.00 OF PROGRAM COSTS. THE PHN IS SAVING LIVES AND GETTING PEOPLE BACK TO WORK.
(Code:   ) (Expenses $ 254,004 including grants of $ 254,004 ) (Revenue $   )
Physicians of Sugar Creek
(Code:   ) (Expenses $ 156,500 including grants of $ 156,500 ) (Revenue $   )
Support of Community Health Centers
4d Other program services (Describe in Schedule O.)
(Expenses $ 410,504 including grants of $ 410,504 ) (Revenue $   )
4e Total program service expensesMediumBullet4,885,143
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
 
No
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
 
No
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
Yes
 
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
 
No
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
Yes
 
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....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
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................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
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
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
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........
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...................
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..........................
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.........
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 ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
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...
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
 
No
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...
35b
 
 
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
3
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
43
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
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
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
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
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
3
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
0
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
 
No
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
 
No
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
 
 
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) Caldwell Kirbyjon H........................................................................
Member
 1.0
.......................0.0 		X           0 0 0
(2) Cannon Deborah M........................................................................
Member
 1.0
.......................0.0 		X           0 0 0
(3) Collie Robert M Jr........................................................................
Member
 1.0
.......................0.0 		X           0 0 0
(4) Farris George R........................................................................
Member
 1.0
.......................0.0 		X           0 0 0
(5) Garcia Roland Jr........................................................................
Member
 1.0
.......................0.0 		X           0 0 0
(6) Lee Ethel Kaye........................................................................
Member
 1.0
.......................0.0 		X           0 0 0
(7) Love Jeff B........................................................................
Member
 1.0
.......................0.0 		X           0 0 0
(8) Manning Ramon........................................................................
Member
 1.0
.......................0.0 		X           0 0 0
(9) Martinez Diana Davila........................................................................
Member
 1.0
.......................0.0 		X           0 0 0
(10) Mir Gasper R III........................................................................
Member
 1.0
.......................0.0 		X           0 0 0
(11) Nishikawa Akira MD........................................................................
Member
 1.0
.......................50.0 		X           0 513,283 5,095
(12) Perrin Melinda H........................................................................
Member
 1.0
.......................0.0 		X           0 0 0
(13) Wolterman Daniel J........................................................................
Member; President & CEO
 1.0
.......................50.0 		X   X       0 3,399,400 1,839,882
(14) Duco Bernard A Jr........................................................................
Member, CLO & Secr/Treas
 1.0
.......................50.0 		X   X       0 1,144,673 118,423
(15) Laraway Dennis L........................................................................
Member, CFO & Treasurer
 1.0
.......................50.0 		X   X       0 1,337,764 81,212
(16) McVeigh Dennis P........................................................................
Chief Accounting Officer, Asst
 0.0
.......................50.0 		    X       0 554,834 78,273
(17) Paret Carol J........................................................................
Chief Community Benefit Office
 0.0
.......................50.0 		    X       0 461,536 85,635
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) Reimer P Renee........................................................................
Chief Risk Officer & Assistant
 0.0
.......................50.0 		    X       0 481,299 57,797
(19) Stokes Charles D........................................................................
Chief Operating Officer
 0.0
.......................50.0 		    X       0 1,364,931 267,855
(20) Chalajour Mahasti........................................................................
Dentist
 50.0
.......................0.0 		        X   145,647 0 13,527
(21) Furtado Albert........................................................................
Dentist
 50.0
.......................0.0 		        X   109,655 0 19,709
(22) Harris Teresa A........................................................................
NP/PA MANAGER
 50.0
.......................0.0 		        X   103,018 0 8,390
(23) Kimmey-Walker Lisa L........................................................................
NP/PA MANAGER
 50.0
.......................0.0 		        X   110,668 0 15,325
(24) Scott Ashley E........................................................................
NP/PA MANAGER
 50.0
.......................0.0 		        X   108,748 0 4,807
(25) Aulbaugh Carrol E........................................................................
Former Chief Financial Officer
 0.0
.......................0.0 		          X 0 1,231,273 5,171
(26) Beckstett Douglas G........................................................................
Former Key EE-Chief Human Reso
 0.0
.......................0.0 		          X 0 805,097 8,962
(27) Garman Jim........................................................................
Former Key EE - Chief Human Re
 0.0
.......................50.0 		          X 0 729,184 57,876
(28) Shabot M Michael MD........................................................................
Former Key EE - Chief Medical
 0.0
.......................50.0 		          X 0 1,029,317 132,181




1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 577,736 13,052,591 2,800,120
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet6
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
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 5,533,437
e Government grants (contributions)1e 136,387
f All other contributions, gifts, grants, and
similar amounts not included above1f 		6,769
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 5,676,593
Program Service Revenue Business Code
2a
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 0
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 0      
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss) 0 0
d Net rental income or (loss).......MediumBullet 0      
(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  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See Instructions......MediumBullet 5,676,593      
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 1,431,473 1,431,473
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 .... 0      
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 2,621,259 2,448,223 112,422 60,614
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 115,938 106,374 6,214 3,350
9 Other employee benefits ....... 217,530 199,585 11,659 6,286
10 Payroll taxes ........... 190,266 174,570 10,198 5,498
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 0      
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 .... 131 131    
13 Office expenses ....... 112,534 112,170 364  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 43,398 43,398    
17 Travel ............ 19,830 19,830    
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 5,922 5,922    
20 Interest ........... 0      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 220,039 220,039    
23 Insurance .............. 7,673 7,673    
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 FEES 118,360 72,557 45,803  
b EQUIPMENT RENTAL & MAINTENANCE 35,822 32,085 3,737  
c OTHER EXPENSES 33,995 6,406 27,100 489
d PUBLICATIONS & SUBSCRIPTIONS 2,745 2,745    
e All other expenses 1,962 1,962    
25 Total functional expenses. Add lines 1 through 24e 5,178,877 4,885,143 217,497 76,237
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 ............. 0 1 5,430
2 Savings and temporary cash investments ......... 0 2 0
3 Pledges and grants receivable, net ........... 0 3 23,348
4 Accounts receivable, net ............. 0 4 0
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 .............. 0 8 0
9 Prepaid expenses and deferred charges .......... 0 9 0
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,804,864
b Less: accumulated depreciation ..... 10b 707,839 639,617 10c 1,097,025
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
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 ........... 4,291,807 15 4,357,116
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 4,931,424 16 5,482,919
Liabilities 17 Accounts payable and accrued expenses ......... 298,022 17 351,801
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 0 20 0
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.................... 0 25 0
26 Total liabilities. Add lines 17 through 25......... 298,022 26 351,801
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 .............. 4,633,402 27 5,131,118
28 Temporarily restricted net assets ........... 0 28 0
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 ........... 4,633,402 33 5,131,118
34 Total liabilities and net assets/fund balances ........ 4,931,424 34 5,482,919
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
5,676,593
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
5,178,877
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
497,716
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
4,633,402
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
 
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
5,131,118
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
 
No
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
 
 
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 Community Benefits
Corporation
Employer identification number

68-0511504
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.") . 5,029,425 5,026,500 5,133,760 5,188,659 5,676,593 26,054,937
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......           0
3 Gross receipts from activities that are not an unrelated trade or business under section 513..           0
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...           0
5 The value of services or facilities furnished by a governmental unit to the organization without charge..           0
6 Total. Add lines 1 through 5. 5,029,425 5,026,500 5,133,760 5,188,659 5,676,593 26,054,937
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...           0
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.           0
c Add lines 7a and 7b..           0
8 Public support (Subtract line 7c from line 6.)           26,054,937
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... 5,029,425 5,026,500 5,133,760 5,188,659 5,676,593 26,054,937
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..           0
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.           0
c Add lines 10a and 10b.           0
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.           0
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..           0
13 Total support. (Add lines 9, 10c, 11, and 12.).. 5,029,425 5,026,500 5,133,760 5,188,659 5,676,593 26,054,937
14
Section C. Computation of Public Support Percentage
15
15
100.000 %
16
16
100.000 %
Section D. Computation of Investment Income Percentage
17
17
0 %
18
18
0 %
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 Community Benefits
Corporation
Employer identification number

68-0511504
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 Community Benefits
Corporation 		Employer identification number

68-0511504
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 Community Benefits
Corporation 		Employer identification number

68-0511504
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 Community Benefits
Corporation 		Employer identification number

68-0511504
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 Community Benefits
Corporation
Employer identification number

68-0511504
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 ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
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 Bullet  
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)
 
 
(ii) related organizations ........................
3a(ii)
 
 
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 .................      
b Buildings ................   224,784 91,040 133,744
c Leasehold improvements ............   1,116,923 392,588 724,335
d Equipment ................   396,866 224,211 172,655
e Other .................   66,291   66,291
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 1,097,025
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    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
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
(1) DUE FROM AFFILIATES 4,357,116








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 4,357,116
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 0
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 5,676,593
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 5,676,593
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 5,676,593
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1 5,178,877
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 5,178,877
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 5,178,877
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
Audit Financial Statement Footnote Disclosure for ASC 740 Form 990, Schedule D, Part X Line 2 The Community Benefits Corporation does have an annual financial audit conducted although the financial accounts of the Community Benefits are also 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 Community Benefits was: Income Taxes The Community Benefit is exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code (Code) and did not conduct unrelated business activities during the years ended June 30, 2013 and 2012. Therefore, the Community Benefit has made no provisions for federal income taxes in the accompanying financial statements. The Community Benefit applies the provisions of FASB ASC Topic 740, Income Taxes, which prescribes a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. FASB ASC Topic 740 also provides guidance on de-recognition, classification, interest and penalties, accounting in interim periods, disclosure, and transition. The Community Benefit believes that it has appropriate support for any tax positions taken, and as such, does not have any uncertain tax positions that are material to the financial statements.
Schedule D (Form 990) 2012

Additional Data


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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 Community Benefits
Corporation
Employer identification number
68-0511504
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) Spring Branch Community Health Center
1615 Hillendahl 100
Houston,TX77055 		30-0198705 501(C)(3) 20,000       Funding of healthcare services
(2) South County Community Clinic
101 Pine Manor Dr
Oak Ridge North,TX77385 		75-2634623 501(c)(3) 100,000       Funding of Healthcare Services
(3) Texas One Voice
5120 Woodway Dr Suite 6000
Houston,TX77056 		26-3643763 501(c)(3) 10,000       Funding of healthcare services
(4) Tomagwa Healthcare Ministries
455 School Suite 30
Tomball,TX77375 		76-0280324 501(c)(3) 20,000       Funding of healthcare services
(5) Memorial Hermann Health System
909 Frostwood Suite 2100
Houston,TX77024 		74-1152597 501(C)(3) 1,274,973       Funding of healthcare services














2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
5
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
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
Monitoring the use of Grants and Awards Funding Schedule I, Part I, Line 2 Community agencies can request funds from Memorial Hermann by completing a Proposal Submission Packet which details the agency's mission, services, existing collaborators, and realized and proposed goals. Missions and goals that support Memorial Hermann's community benefit mission of increasing and strengthening the primary and specialty care infrastructure for the uninsured and underinsured community receive high priority. Often a site visit is performed by Memorial Hermann Community Benefit Corporation staff and recommendations are made to the President,CEO and the community relations committee for the ultimate decision.
Schedule I (Form 990) 2012


Additional Data


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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 Community Benefits
Corporation
Employer identification number

68-0511504
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)Nishikawa Akira MDMember (i)
(ii)		 0
396,468 		0
0 		0
116,815 		0
0 		0
5,095 		0
518,378 		0
0
(2)Wolterman Daniel JMember; President & CEO (i)
(ii)		 0
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
(3)Duco Bernard A JrMember, CLO & Secr/Treas (i)
(ii)		 0
458,912 		0
320,977 		0
364,784 		0
108,507 		0
9,916 		0
1,263,096 		0
345,152
(4)Laraway Dennis LMember, CFO & Treasurer (i)
(ii)		 0
675,916 		0
456,556 		0
205,292 		0
67,824 		0
13,388 		0
1,418,976 		0
 
(5)McVeigh Dennis PChief Accounting Officer, Asst (i)
(ii)		 0
289,078 		0
195,128 		0
70,628 		0
73,266 		0
5,007 		0
633,107 		0
32,260
(6)Paret Carol JChief Community Benefit Office (i)
(ii)		 0
247,148 		0
167,064 		0
47,324 		0
76,599 		0
9,036 		0
547,171 		0
25,658
(7)Reimer P ReneeChief Risk Officer & Assistant (i)
(ii)		 0
285,552 		0
185,505 		0
10,242 		0
52,750 		0
5,047 		0
539,096 		0
0
(8)Stokes Charles DChief Operating Officer (i)
(ii)		 0
705,690 		0
575,836 		0
83,405 		0
256,179 		0
11,676 		0
1,632,786 		0
44,189
(9)Chalajour MahastiDentist (i)
(ii)		 144,748
0 		721
0 		178
0 		4,725
0 		8,802
0 		159,174
0 		0
0
(10)Aulbaugh Carrol EFormer Chief Financial Officer (i)
(ii)		 0
99,979 		0
111,295 		0
1,019,999 		0
1,744 		0
3,427 		0
1,236,444 		0
107,307
(11)Beckstett Douglas GFormer Key EE-Chief Human Reso (i)
(ii)		 0
24,602 		0
66,557 		0
713,938 		0
6,929 		0
2,033 		0
814,059 		0
86,005
(12)Garman JimFormer Key EE - Chief Human Re (i)
(ii)		 0
479,923 		0
246,907 		0
2,354 		0
49,215 		0
8,661 		0
787,060 		0
0
(13)Shabot M Michael MDFormer Key EE - Chief Medical (i)
(ii)		 0
504,050 		0
383,787 		0
141,480 		0
119,215 		0
12,966 		0
1,161,498 		0
92,531
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
Non-qualifed Retirement plans Form 990, Schedule J, Line 4-b Memorial Hermann Health System (of which this filer is a part) 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: Aulbaugh 37,845 Beckstett 27,688 Duco 17,494 McVeigh 13,869 Paret 15,858 Reimer 9,556 Shabot 22,395 Stokes 32,039 Wolterman 102,134 Applicable 457 amounts distributed per person: Aulbaugh 103,978
Schedule J (Form 990) 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 Community Benefits
Corporation
Employer identification number

68-0511504
Identifier Return Reference Explanation
Assessment of Community Needs for Healthcare Services Form 990, Part III, Line 1 IN THE GREATER HOUSTON AREA WHERE A STAGGERING 30% ARE UNINSURED, MEMORIAL HERMANN, THROUGH ITS SUBSIDIARY, THE MEMORIAL HERMANN COMMUNITY BENEFIT CORPORATION (MHCBC) ESTABLISHED IN 2007, IMPLEMENTS PROGRAMS TO WORK 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. THE MISSION OF MEMORIAL HERMANN COMMUNITY BENEFIT CORPORATION IS TO TEST AND MEASURE INNOVATIVE SOLUTIONS THAT REDUCE THE IMPACT OF THE LACK OF ACCESS TO CARE ON THE INDIVIDUAL, THE HEALTH SYSTEM AND THE COMMUNITY. NEW PROGRAMS ARE PILOTED, AND PROVEN PROGRAMS ARE REPLICATED IN THE COMMUNITY THAT INCLUDES INITIATIVES TO: REMOVE BARRIERS TO HEALTHCARE ACCESS; INCREASE AND STRENGTHEN THE PRIMARY AND SPECIALTY CARE INFRASTRUCTURE; PROVIDE EDUCATION AND INCREASE HEALTHCARE AWARENESS; AND IMPROVE THE USE OF PREVENTATIVE MEDICAL SERVICES. COMMUNITY BENEFIT CORPORATION FUNDING TENENTS INCLUDE: PROVISION OF PRIMARY AND/OR SPECIALTY CARE FOR THE UNINSURED AND UNDERINSURED; CONTRIBUTION TO THE EXISTING INFRASTRUCTURE OF NON-PROFIT CLINICS AND FQHC'S; COMMITMENT TO MEASUREMENT; EXISTENCE OF COLLABORATIVE PARTNERS; PROGRAMMATIC INCLUSION OF HEALTH EDUCATION AND LITERACY; STRIVE TOWARDS SUSTAINABILITY. EACH DECISION MADE BY MEMORIAL HERMANN TO INVEST ITS PEOPLE, RESOURCES AND TALENTS IN COMMUNITY BENEFIT EFFORTS IS DATA DRIVEN. AS A RESULT OF THE STAGGERING 30% UNINSURED, NUMEROUS NEEDS ASSESSMENTS CENTER AROUND THE UNIVERSITY OF TEXAS SCHOOL OF PUBLIC HEALTH'S HOUSTON AREA HOSPITAL'S EMERGENCY DEPARTMENT USE STUDY. MEMORIAL HERMANN HAS PARTICIPATED IN THIS STUDY 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. MHCBC'S PROGRAMS ARE DESIGNED TO REDUCE THE NUMBER OF ER VISITS IN COMMUNITIES SERVED BY MEMORIAL HERMANN ACUTE CARE HOSPITALS. IN ADDITION TO BEING RESPONSIVE TO THE EMERGENCY ROOM STUDY, AS REQUIRED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT-SECTION 501( C)(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 PARTICIPANTS 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.
Assessment of Community Needs for Healthcare Services 2 Form 990, Part III, Line 4d 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 as well as those stated in attachments 2,3 and 4: CHILDREN AT RISK - SUPPORT OF A POLICY COORDINATOR FOR A FOOD IN SCHOOLS INITIATIVE, WITH THE GOAL OF INCREASING SCHOOL PARTICIPATION IN THE UNIVERSAL FREE BREAKFAST PROGRAM BY CONNECTING AN ADDITIONAL 3,610 STUDENTS TO 649,728 MEALS. INTERFAITH COMMUNITY CLINIC - OPERATIONAL FUNDING FOR THIS PRIVATE NOT-FOR-PROFIT VOLUNTEER BASED HEALTH CARE CLINIC. ITS MISSION IS TO PROVIDE SHORT-TERM MEDICAL CARE, DENTAL CARE, AND SOCIAL SERVICE REFERRALS FOR INDIGENT PERSONS WHO DO NOT HAVE PRIVATE HEALTH INSURANCE AND ARE NOT ELIGIBLE FOR MEDICAID. OPENED IN 1966, THE CLINIC SPECIFICALLY CONCENTRATES ON PROVIDING SERVICES TO MONTGOMERY COUNTY RESIDENTS WHO ARE NOT ELIGIBLE FOR OTHER PROGRAMS AND HAVE NOWHERE ELSE TO TURN. MEMORIAL HERMANN HAS SUPPORTED THE CLINIC SINCE INCEPTION, WITH MEMORIAL HERMANN-THE WOODLANDS PROVIDING AN ADDITIONAL $60,000/MO IN ANCILLARY SERVICES. PHYSICIANS OF SUGAR CREEK - FUNDING OF THE DIFFERENCE BETWEEN COSTS AND SLIDING FEE SCALE PAYMENTS OF CARE PROVIDED BY THIS MEMORIAL FAMILY PRACTICE RESIDENCY TRAINING SITE TO THE WORKING POOR OF FORT BEND COUNTY. PARTNERS FOR COMMUNITY HEALTH - INTERIM COO SERVICES FOR PARTNERS FOR COMMUNITY HEALTH NETWORK, A NEWLY FORMED ORGANIZATION WHICH CONSISTS OF THE AREA FEDERALLY QUALIFIED HEALTH CENTERS AND CHARITY CLINICS. FUNDING AN INTERIM CEO ENSURED IMPLEMENTATION OF THE NEEDED CHANGES TO ESTABLISH THE NEW CORPORATE STRUCTURE. OBESITY RESEARCH CONTRACT SUPPORT TO ANALYZE THE POTENTIAL FOR A DEFINED VISION/ROLE FOR MEMORIAL HERMANN IN THE HOUSTON AREA CHILDHOOD OBESITY ARENA. THE WORK INCLUDED A STUDY OF EXISTING EVIDENCE BASED RESEARCH. SPRING BRANCH COMMUNITY HEALTH CENTER - SUPPORT OF NEWLY ESTABLISHED PREVENTIVE AND MINOR RESTORATIVE DENTAL SERVICES AT THE SPRING BRANCH COMMUNITY HEALTH CENTERS'S SATELLITE PITNER CLINIC. THE PITNER CLINIC DOES NOT RECEIVE ANY FEDERAL FUNDING TO SUPPORT SERVICES PROVIDED TO THE SURROUNDING AREA'S 6,000 UNITS OF LOW INCOME HOUSING ALL WITHIN A QUARTER MILE OF THE CLINIC.
Payroll Record Keeping Form 990, Part V, Line 2a The employees of Memorial Hermann Community Benefits are record-kept and paid through the payroll system of Memorial Hermann Health System and reported under the Memorial Hermann Community Benefits EIN for Form 941 and Form W-2 purposes. All costs of the compensation and benefits of the Community Benefits employees are reimbursed to the Health System. Corporate officers are employees of Memorial Hermann Health System and their salaries and benefits are not allocated amongst the various corporate entities for which they conduct employment activities.
Members or Stockholders Form 990, Part VI, Section A, Line 6 Memorial Hermann Community Benefits has as its sole member Memorial Hermann Health System, both of which are 501(c)(3) non-profit entities.
Elect Governing Body Form 990, Part VI, Section A, Line 7A The member has the authority to annually elect the board members of the organization and to terminate and replace them at its discretion.
Decisions of Governing Body Form 990, Part VI, Section A, Line 7B The member has approval authority over the decisions of the board for amendments to the bylaws and articles of incorporation, annual operating and capital budget, the purchase or sale of substantial assets, and the merger or dissolution of the organization.
Review of Form 990 Form 990, Part VI, Section B, Line 11b Memorial Hermann Community Benefits 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.
Conflict of Interest Policy Form 990, Part VI, Section B, Line 12c Memorial Hermann Community Benefits utilizes a conflict of interest survey 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.
Whistle Blower Policy Form 990, Part VI, Section B, Line 13 Memorial Hermann Community Benefits Corp (MHCBC) is committed to complying with all applicable laws and regulations. We support the efforts of federal and state authorities in identifying incidents of fraud and/or abuse and we have the necessary policies and procedures in place to prevent, detect, report and correct incidents of fraud and/or abuse in accordance with contractual, regulatory and statutory requirements. Recognizing the complexity of the various federal, state, and local laws regulating health care, MHCBC has adopted a Corporate Compliance Program. This Program is designed to assist the Board, the Health System and its employees, medical staff members, and independent contractors to maintain compliance through responsive educational programs, internal monitoring and reporting mechanisms, and compliance Standards of Conduct. Corporate Compliance is "Doing the Right Thing by following government regulations and the law." The MHCBC Compliance Program includes these 7 elements: A Compliance Officer and Committee; to oversee and advise the Compliance Program Compliance Policies and Procedures; to provide written guidance to help you do your job and demonstrate our commitment to compliance, Compliance Training and Education; to ensure appropriate education on areas of legal and regulatory compliance Auditing and Monitoring; to conduct periodic and ongoing auditing and monitoring of high-risk areas and adherence to policies and procedures Corrective Action; to develop plans to resolve identified issues, prevent them from happening again and avoid the risk of the same or similar issues occurring in other areas, departments or facilities Disciplinary Guidelines: may be necessary to encourage prompt reporting of Compliance concerns; to ensure non-retaliation for reporting concerns and to encourage cooperation with compliance investigations Open Lines of Communication: to establish an open environment for reporting compliance concerns - a hotline is available to all employees to call to report compliance concerns and non-retaliation for reporting a compliance concern in good faith Available 24 hours a day, 7 days a week Anonymous and Confidential Callers making reports in good faith are protected from any form of retaliation or adverse action.
Compensation Determination Form 990, Part VI, Section B, Line 15a & 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.
Disclosure of Organizational Documents Form 990, Part VI, Section C, Line 19 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.
Audited Financial Statement Oversight Form 990, Part XII, Line 2c 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.
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 Community Benefits
Corporation
Employer identification number

68-0511504
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 Foundation

909 Frostwood Suite 2100

Houston,TX77024
74-1653640 		Fund raising TX 501(c)3 11a I MHHS
 
Yes
 
(2) Memorial Hermann Health System

909 Frostwood Suite 2100

Houston,TX77024
74-1152597 		Healthcare TX 501(c)3 3 na
 
 
No
(3) Memorial Hermann Medical Group

909 Frostwood Suite 2100

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

909 Frostwood Suite 2100

Houston,TX77024
76-0385980 		Healthcare TX 501(c)3 3 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 		Managed Med Build TX na
  		related or exempt 0 0   No 0   No 0 %
(2) Memorial HermannUSP Surgery Ctr III LP

15305 Dallar Parkway Suite 1600 LB
Addison,TX75001
20-0707543 		Surgery Center TX na
  		related or exempt 0 0   No 0   No 0 %
(3) Memorial Hermann Surgery Center Katy LLP

15305 Dallas Parkway Suite 1600 LB
Addison,TX75001
20-3360737 		Surgery Cente TX na
  		related or exempt 0 0   No 0   No 0 %
(4) MH Katy Rehab Hospital LLC

909 Frostwood suite 2100
houston,TX77024
26-3896057 		medical servi TX na
  		related or exempt 0 0   No 0   No 0 %






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 		Claims Admin TX NA
  		C Corp 0 0 0 % Yes  
(2) Memorial Hermann Health Solutions

909 Frostwood suite 2100
Houston,TX77024
26-4419989 		Insurance TX NA
  		C Corp 0 0 0 % Yes  
(3) Memorial Hermann Health Insurance

909 Frostwood Suite 2100
Houston,TX77024
76-0646301 		Insurance TX NA
  		C Corp 0 0 0 % Yes  
(4) Memorial Hermann Accountable Care Org

909 Frostwood Suite 2100
Houston,TX77024
80-0778181 		Insurance TX NA
  		C Corp 0 0 0 % Yes  
(5) The Health Professionals Ins Company LTD

Barclays House 3rd Floor
Grand Cayman    
CJ
Insurance CJ NA
  		Foreign 0 0 0 % Yes  
(6) Memorial Hermann Health Plan Inc

909 Frostwood Suite 2100
Houston,TX77024
46-2707092 		Insurance TX na
  		C corp 0 0 0 % 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
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
Yes
 
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
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
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
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) NA

      





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


Software ID:  
Software Version: