TY 2018 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Bloemendal MD Lee C...................................................................... Trustee	1.1 ................. 0.5	X		0	0
(2) Ferguson III John R...................................................................... Immediate Past Chair	1.3 ................. 0.3	X		0	0
(3) Haggar III Joseph M...................................................................... Trustee	0.5 ................. 0.2	X		0	0
(4) Hum MD Lawrence...................................................................... Trustee	0.5 ................. 0.2	X		0	0
(5) Hunt Hunter L...................................................................... Trustee	0.8 ................. 0.4	X		0	0
(6) Montgomery Lynn A...................................................................... Trustee	1.1 ................. 0.4	X		0	0
(7) Reeves Kenneth W...................................................................... Trustee	0.9 ................. 0.2	X		0	0
(8) Stripling MD Dennis...................................................................... Vice Chairman	1.2 ................. 0.4	X		0	0
(9) Tatum Stephen L...................................................................... Trustee	1.2 ................. 0.4	X		0	0
(10) Turner Wesley R...................................................................... Chairman	1.2 ................. 0.2	X		0	0
(11) Vigness MD Richard M...................................................................... Trustee	1.4 ................. 0.7	X		9,900	0
(12) Washington Bernice J...................................................................... Trustee	1.1 ................. 0.5	X		0	0
(13) Weeks DNP Susan L...................................................................... Trustee	1.1 ................. 0.5	X		0	0
(14) Wilder Jr Charles John...................................................................... Trustee	1.4 ................. 0.3	X		0	0
(15) Wynne James Y...................................................................... Trustee	0.8 ................. 0.6	X		0	0
(16) Berdan Barclay E...................................................................... Chief Executive Officer	38.25 ................. 6.75	X	X	2,347,905	302,734
(17) Canose Jeffrey L...................................................................... EVP Sr & COO THR	40.0 ................. 5.0		X	1,528,574	189,975

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Varga Daniel W........................................................................ EVP Sr & Chief Clinical Officr	40.0 .......................5.0	X				1,493,713	0	251,579
(19) Long Ronald R........................................................................ EVP & Chief Financial Officer	40.0 .......................5.0	X				1,377,596	0	67,174
(20) Lester Mark C........................................................................ EVP Zone Clinical Leader	40.0 .......................5.0	X				1,325,587	0	50,996
(21) McWhorter Ricky E........................................................................ EVP & Chief Financial Officer	40.0 .......................5.0	X				1,097,946	0	95,736
(22) McClung Brett S........................................................................ EVP Zone Operations Leader	40.0 .......................5.0	X				924,596	0	73,349
(23) Ransom Elizabeth........................................................................ EVP Zone Clinical Leader	40.0 .......................5.0	X				894,456	0	70,017
(24) Kramer Kenneth J........................................................................ EVP General Counsel	40.0 .......................5.0	X				879,443	0	137,715
(25) King James Kirk........................................................................ EVP Zone Operations Leader	40.0 .......................5.0	X				874,110	0	150,838
(26) Miao Winjie Tang........................................................................ EVP Chief Experience Officer	40.0 .......................5.0	X				867,863	0	262,366
(27) Berenzweig Harold K........................................................................ EVP Zone Clinical Leader	40.0 .......................5.0	X				853,069	0	61,838
(28) Parobek Jr James S........................................................................ EVP Physician Enterprise THR	40.0 .......................5.0	X				851,619	0	146,923
(29) Kirby Michelle Riddle........................................................................ EVP Chief People Officer	40.0 .......................5.0	X				747,181	0	102,123
(30) Shinkus Clark Joan Frances........................................................................ EVP Chief Nursing Executive	40.0 .......................5.0	X				649,100	0	59,059
(31) Jackson David W........................................................................ Chief Accounting Officer/Asst	40.0 .......................5.0	X				397,637	0	76,300
(32) Cantu Stacy G........................................................................ VP Chief Gov Offr & Corp Secr	40.0 .......................5.0	X				320,135	0	55,394
(33) Warner MD John........................................................................ EVP/CEO Univ Hosp/EVP, SE Zone	1.0 .......................0.0	X				0	0	0
(34) Velasco Ferdinand T........................................................................ SVP & Chief Hlth Info Officer	40.0 .......................0.0		X			710,174	0	118,937
(35) Jones Robert Douglas........................................................................ SVP & Chief Investment Officer	40.0 .......................0.0		X			662,163	0	109,433
(36) Sudomir Jr Joseph M........................................................................ SVP Chief Info Officer	40.0 .......................0.0		X			644,680	0	193,697
(37) Bujnowski Aaron Mark........................................................................ SVP & Chief Strategy Officer	40.0 .......................0.0		X			568,798	0	66,834
(38) Mitchell John D........................................................................ SVP Business Development	40.0 .......................0.0		X			567,484	0	97,952
(39) Tesmer David J........................................................................ SVP Community Engag & Advocacy	40.0 .......................0.0		X			533,811	0	100,107
(40) Holmes Kevin B........................................................................ SVP Real Estate Devl & Deploy	40.0 .......................0.0		X			491,260	0	106,735
(41) Craft Brian........................................................................ SVP Financial Operations	40.0 .......................0.0		X			461,871	0	89,549
(42) Pearson George........................................................................ SVP Med Stf Affrs Phys Rltns	40.0 .......................0.0		X			439,252	0	54,928
(43) Clinton Shaun........................................................................ SVP Supply Chain Management	40.0 .......................0.0		X			377,438	0	59,501
(44) Szablowski Paul A........................................................................ SVP Brand Experience	40.0 .......................0.0		X			357,491	0	34,567
(45) McAllister Deena A........................................................................ SVP Brand Experience	40.0 .......................0.0		X			343,796	0	48,357
(46) Cox Kathleen B........................................................................ SVP Integrated Experience	40.0 .......................0.0		X			307,247	0	68,701
(47) Saldana Luis Eduardo........................................................................ CMIO	40.0 .......................0.0		X			430,574	0	63,641
(48) Caldwell Thomas J........................................................................ VP Sports Medicine	40.0 .......................0.0		X			412,703	0	41,609
(49) Beck Jesse St John........................................................................ VP Strategic Marketing	40.0 .......................0.0		X			407,126	0	56,907
(50) Robinson Mary C........................................................................ VP Prof Prac Rsrch & Magnet	40.0 .......................0.0		X			406,686	0	58,305
(51) Salsberry David C........................................................................ Chief Revenue Officer	40.0 .......................0.0		X			392,160	0	76,007
(52) Auzenne Dana S........................................................................ VP Health Care Economics	40.0 .......................0.0		X			386,772	0	73,439
(53) Sullivan Jon M........................................................................ VP Real Estate Operations	40.0 .......................0.0		X			380,437	0	63,947
(54) Reeves Sandra G........................................................................ VP Treas/Asst Chief Invest Off	40.0 .......................0.0			X		377,782	0	67,922
(55) Ball Randell L........................................................................ VP System Pharmacy Officer	40.0 .......................0.0			X		375,951	0	56,897
(56) Madzik Elizabeth May........................................................................ VP & Chief Compliance Officer	40.0 .......................0.0			X		374,766	0	54,769
(57) Winsper Sheri M........................................................................ VP Quality & Patient Safety	40.0 .......................0.0			X		371,199	0	30,348
(58) Dawson Carla S........................................................................ VP Total Health & Rewards	40.0 .......................0.0			X		363,236	0	47,879
(59) Hawthorne Douglas D........................................................................ Former Officer	0.0 .......................40.0				X	0	443,478	65,341
(60) Schornick Amy C........................................................................ Former Key Employee	0.0 .......................0.0				X	332,748	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
Austin Industries Inc, 3535 Travis St 300 DALLAS,TX75204	Construction	104,067,531
PWC Advisory Services LLC, PO Box 952282 DALLAS,TX75395	Consulting	27,509,974
Oxford Global Resources Inc, PO Box 3256 BOSTON,MA02241	consulting Services	5,438,773
Huron Consulting Group Inc, 92 Hayden Avenue LEXINGTON,MA02421	Consulting	5,062,500
Stewart Organization Inc, PO Box 166078 IRVING,TX75016	Printer Services	4,411,136
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 193

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

Texas Health Resources w o 926 5471

Employer identification number

75-2702388

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 12, check only one box.)

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

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

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

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

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

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

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

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................24

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

(i) Name of supported organization	(ii) EIN	(iii) Type of organization (described on lines 1- 10 above (see instructions))	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN		Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(A) TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL	750972805	3	Yes		0	43,815,341
(B) TEXAS HEALTH HARRIS METHODIST HOSPITAL ALLIANCE	451502252	3		No	0	17,969,733
(C) TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE	751748586	3		No	0	6,469,139
(D) TEXAS HEALTH HARRIS METHODIST HOSPITAL CLEBURNE	751977850	3		No	0	11,409,492
(E) TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH	756001743	3	Yes		0	114,092,724
(F) TEXAS HEALTH HARRIS METHODIST HOSPITAL HEB	751438726	3		No	0	36,184,371
(G) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST	752678857	3		No	0	38,526,235
(H) TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE	751752253	3		No	0	7,853,457
(I) TEXAS HEALTH PHYSICIANS GROUP	752613493	10		No	0	50,943,703
(J) TEXAS HEALTH RESOURCES FOUNDATION	752022128	7		No	0	654,473
(K) TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN	752890358	3		No	0	12,788,161
(L) TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS	751047527	3	Yes		0	85,314,857
(M) TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON	432008974	3		No	0	30,971,202
(N) TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN	752771437	3		No	0	6,763,617
(O) TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO	752770738	3		No	0	52,134,944
(P) TEXAS HEALTH RESEARCH & EDUCATION INSTITUTE	752562191	4		No	0	328,663
(Q) TEXAS HEALTH SPECIALTY HOSPITAL FORT WORTH	751648589	3		No	0	1,031,230
(R) TEXAS HEALTH OUTPATIENT SURGERY CENTER ALLIANCE	800800294	3		No	0	0
(S) TEXAS HEALTH BACK CARE	474724257	10		No	0	0
(T) TEXAS HEALTH RECOVERY AND WELLNESS CENTER	812813227	3		No	0	1,056,027
(U) TEXAS HEALTH SEAY BEHAVIORAL HEALTH HOSPITAL	812792484	3		No	0	0
(V) TEXAS HEALTH SPRINGWOOD BEHAVIORAL HEALTH HOSPITAL	812798838	3		No	0	0
(W) TEXAS HEALTH BEHAVIORAL HEALTH HOSPITAL CORINTH	814317635	3		No	0	0
(X) TEXAS HEALTH MEDICAL SUPPORT	812833150	10		No	0	207,804
Total 24						518,515,173

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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 VI.)..
11	Total support. Add lines 7 through 10

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2017. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2017. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2017. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Yes

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2018

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Yes

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

Yes

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Yes

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Yes

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Yes

Schedule A (Form 990 or 990-EZ) 2018

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2018

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2018 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation
Supported Organizations - Part IV, Section A, Line 1	The governing documents of Texas Health Resources (THR) do not list all supported organizations by name. The documents specifically list Texas Health Presbyterian Hospital Dallas, Texas Health Harris Methodist Hospital Fort Worth and Texas Health Arlington Memorial Hospital. The documents also allow THR to support other hospitals and health care delivery organizations which are closely related in purpose or function through common control, ownership, and/or management. THR has not specifically listed the names of all supported organizations to ease the administrative burden of updating the governing documents when new hospitals are added to the system or when an entity changes its name.
Additional Support - Part IV, Section A, Line 6	Texas Health Resources (THR) provides minimal support to various national charitable organizations such as the March of Dimes, American Heart Association, and others who perform an activity that is in line with THR's charitable mission. They also provide support to local schools, city wide activities, and community development groups. As a large healthcare system in North Central Texas, THR takes an active role in the communities they serve. In doing so, THR makes donations, largely at the direction of the supported organizations, to various groups, or sponsor activities that benefit the community. The support to each group is minimal, and is not the organizations primary source of support.
Working Relationship-Part IV, Section D, Lines 2	THR is the controlling "parent" organization of a large health care system in North Texas. THR serves as a functionally-integrated supporting organization to all the controlled supported organizations providing centralized management. THR appoints or approves the board members of each controlled entity within the system. The current THR board members also serve on the board of each wholly owned hospital within the system. THR officers serve on the Boards of the controlled entities as well as some non-controlled entities in the system. Systemwide policies and standards are established by THR. The system investment policies are established at the THR level. THR approves the operating budgets, capital budgets, and future goals for the system as a whole. THR has established a single authority matrix used system wide. In this matrix, THR has ultimate control for the majority of the decisions made throughout the system.
Officer/Board Appointments-Part IV, Section E, Line 3a	The THR board approves all board members and board officers for each entity in the system. The THR board members also serve as the board of the wholly owned hospitals within the system. THR has a centralized recruitment, selection and placement process for the hiring/promotions of officers for all system entities. The human resources department is maintained at the system level and not by the individual entities. All supporting entity officers are interviewed by THR and entity personnel, with THR having the final decision on new hire placements and promotions.
Substantial Direction-Part IV, Section E, Line 3b	As discussed in detail in the explanation to Schedule A, Part IV, Section D, Line 3, THR is the parent organization providing centralized management to the supported organizations in the system. As the parent organization THR is able to exercise a substantial degree of direction over the supported organizations through control of the board, setting policies, hiring officers, and the use of the authority matrix. Officers of THR are present at board meetings of the supported organizations as a liaison and provide a conduit for the supported organizations to voice opinions and concerns to THR.

Schedule A (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

Texas Health Resources w o 926 5471

Employer identification number

75-2702388

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 its Form 990PF, Part I, line 2, to certify that it doesn't 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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization Texas Health Resources w o 926 5471

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization Texas Health Resources w o 926 5471		Employer identification number 75-2702388

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization Texas Health Resources w o 926 5471			Employer identification number 75-2702388
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

Texas Health Resources w o 926 5471

Employer identification number

75-2702388

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2018

Page 2

Part II-A

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

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

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

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

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) Total

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2018

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

Yes

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

Yes

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

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

Yes

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

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

Yes

388,822

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

Yes

1,162,380

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

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

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

1,551,202

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Schedule C, Part II-B, Line 1 - Details of Lobbying Activities	Texas Health Resources (THR) is the parent organization for a healthcare system consisting of hospitals and other related healthcare organizations. The amount of expenses paid, or incurred in connection with lobbying activities reported on this return represent the expenses incurred on behalf of THR and all its affiliates. Total expenses for the system were $4,488,937,000 for the year ended December 31, 2018. Of this amount $1,551,202(.03%) is used in connection with lobbying activities. Officers and/or Board members of THR may, to an insubstantial degree, make comments or statements concerning legislation that may affect either the healthcare industry or the health status of the communities that THR serves. In pursuing this activity, officers and/or Board members may engage in conversations and/or write letters to various federal, state, and local officials regarding such matters on a personal level, and not as a representative of the organization. A portion of the dues paid to Healthcare Associations are used by these organizations to support lobbying activities related to the healthcare industry. The amount of time and money involved in the activities described above is negligible. In no case has either THR, or any person acting on behalf of THR, intervened in any political campaign. THR policy prohibits this type of activity for THR System employees.

Return Reference

Explanation

Schedule C, Part II-B, Line 1 - Details of Lobbying Activities

Texas Health Resources (THR) is the parent organization for a healthcare system consisting of hospitals and other related healthcare organizations. The amount of expenses paid, or incurred in connection with lobbying activities reported on this return represent the expenses incurred on behalf of THR and all its affiliates. Total expenses for the system were $4,488,937,000 for the year ended December 31, 2018. Of this amount $1,551,202(.03%) is used in connection with lobbying activities. Officers and/or Board members of THR may, to an insubstantial degree, make comments or statements concerning legislation that may affect either the healthcare industry or the health status of the communities that THR serves. In pursuing this activity, officers and/or Board members may engage in conversations and/or write letters to various federal, state, and local officials regarding such matters on a personal level, and not as a representative of the organization. A portion of the dues paid to Healthcare Associations are used by these organizations to support lobbying activities related to the healthcare industry. The amount of time and money involved in the activities described above is negligible. In no case has either THR, or any person acting on behalf of THR, intervened in any political campaign. THR policy prohibits this type of activity for THR System employees.

Schedule C (Form 990 or 990EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Texas Health Resources w o 926 5471

Employer identification number

75-2702388

Part I

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

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

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

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

Yes No

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

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

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

Yes No

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" on Form 990, Part IV, line 8.

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

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

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

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

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

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2018

Page 2

Part III

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

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. 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 .....	83,913,111		83,913,111
b	Buildings ....	190,890,601	147,666,123	43,224,478
c	Leasehold improvements	315,485,833	118,435,506	197,050,327
d	Equipment ....	508,718,364	376,266,373	132,451,991
e	Other .....	194,688,861		194,688,861
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				651,328,768

Schedule D (Form 990) 2018

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1)CONTROLLED ENT INVEST/EARNINGS	260,076,998	C
(2)OTHER INVESTMENTS/EARNINGS	213,897,121	C
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	473,974,119

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	-9,950
SECURITY DEPOSIT	6,400
TRUSTEE FUNDS-SUPP RETIREMENT	4,848,829
POST RETIREMENT BENEFITS	1,126,187
UNAMORTIZED RENT	6,775,155
ASSET RETIREMENT OBLIGATION	1,477,985
MALPRACTICE TRUST RESERVE	30,446,354
INTERCOMPANY PAYABLE	-867,709
MINORITY INTEREST	88,911,385
OTHER MISC LIABILITIES	253,152
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	132,967,788
2. Liability for uncertain tax positions. 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) 2018

Page 4

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

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

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.

Return Reference	Explanation

Schedule D (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization
Texas Health Resources w o 926 5471

Employer identification number

75-2702388

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in region
	Central America and the Caribbean	Investments	55,266,013
















3a	Sub-total .....		55,266,013
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)		55,266,013

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2018

Schedule F (Form 990) 2018

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2018

Schedule F (Form 990) 2018Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

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

Schedule F (Form 990) 2018

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2018

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

ReturnReference	Explanation
Part I, Line 3f - Investments	The amount in column f reflects investments based on an accrual method of accounting.
Part I, Line 3 - Investments	THR has a wholly owned captive, Grace Indemnity Company SPC, Ltd (Grace), domiciled in the Grand Cayman Islands. This entity is used to pay claims for the self-insured activity of the THR system. Although Grace is domiciled offshore, its investments are primarily in US government securities and US investment grade corporate bonds, all of which are custodied in Chicago, Illinois. While the majority of the investments held by Grace are not offshore, Grace does have a minimum balance that is maintained in a Grand Cayman bank account and used for operating purposes. A target maximum balance of uninvested cash of approximately $100,000 is in maintained in this off-shore fund. As part of a diverse portfolio, THR recently began exploring alternative investment opportunities including certain investments which have foreign activity. THR maintains a minority interest (not more than 10%) in these alternative investments.

Schedule F (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Texas Health Resources w o 926 5471

Employer identification number

75-2702388

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

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

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

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

Yes

200% 250% 300% 350% 400% Other 500 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

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

Yes

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	5,125,520	510,871	4,614,649	1.830 %
b	Medicaid (from Worksheet 3, column a) . . . . .	12,842,173	4,360,562	8,481,611	3.370 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	171,652	52,147	119,505	0.050 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	18,139,345	4,923,580	13,215,765	5.250 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	4,165,449		4,165,449	1.650 %
f	Health professions education (from Worksheet 5) . . .	6,189,049		6,189,049	2.460 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	490,585		490,585	0.190 %
j	Total. Other Benefits . .	10,845,083		10,845,083	4.300 %
k	Total. Add lines 7d and 7j .	28,984,428	4,923,580	24,060,848	9.550 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

Page

Part II

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

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	100,638	100,638	0.040 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1,272	1,272
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	101,910	101,910	0.040 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

24,076,740

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

44,785,343

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

94,252,575

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

-49,467,232

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1Flower Mound Hosp	Hospital	53.6 %	46.4 %
2Greenville Surg Ctr	Ambulatory Surgery Center	57.5 %	42.5 %
3Physician Med Ctr	Hospital	53.63 %	46.37 %
4Rockwall Regional	Hospital	61.87 %	38.13 %
5Southlake Specialty	Short Stay Hospital	54.03 %	45.97 %
6Surg Caregivers FW	Ambulatory Surgery Center	56.42 %	43.58 %
7TH Flower Mound Orth	Orthopedic Surgery Center	51 %	49 %
8THR-STT Rockwall ASC	Ambulatory Surgery Center	51 %	49 %
9THR-STT Southlake	Ambulatory Surgery Center	51 %	49 %
10USMD Arlington	Short Stay Hospital	51 %	49 %
11USMD Fort Worth	Short Stay Hospital	50.965 %	49.035 %
12Denton Surgery Ctr	Ambulatory Surgery Center	64 %	36 %
13TH Craig Ranch	Ambulatory Surgery Center	51.5 %	48.5 %
14N Dallas Surgical	Ambulatory Surgery Center	51 %	49 %
15TH Spine Ctr Allen	Ambulatory Surgery Center	51 %	49 %
16Wilson Creek Surgery	Ambulatory Surgery Center	51 %	49 %
17North Texas ACO	Accountable Care Organization	50 %	50 %
18TH Surgery Ctr Prest	Ambulatory Surgery Center	53.05 %	46.95 %
19Arlington Surgery Ce	Ambulatory Surgery Center	52.75 %	47.25 %
20Opthalmology Surgery	Ambulatory Surgery Center	51 %	49 %
21Park Hill Surgery Ct	Ambulatory Surgery Center	51 %	49 %
22TH Surgery Ctr Allia	Ambulatory Surgery Center	77.58 %	22.42 %
23TH Surgery Ctr Bedfo	Ambulatory Surgery Center	51 %	49 %
24TH Ortho Alliance	Ambulatory Surgery Center	51 %	49 %
25TH Spine Alliance	Ambulatory Surgery Center	51 %	49 %
26TH Surg Ctr Irving	Ambulatory Surgery Center	51 %	49 %
27TH Surg Ctr Rockwall	Ambulatory Surgery Center	51 %	49 %

Schedule H (Form 990) 2018

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?6Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Texas Health Flower Mound 4400 Long Prairie Rd Flower Mound,TX75028 www.texashealthflowermound.com TDH #100056	X	X	X
2	Texas Health Rockwall 3150 Horizon Rd Rockwall,TX75032 www.texashealthrockwall.com TDH #008599	X	X	X
3	USMD Hospital at Arlington 801 W Interstate 20 Arlington,TX76017 www.usmdarlington.com TDH #007990	X	X	X
4	Texas Health Southlake 1545 E Southlake Blvd Southlake,TX76092 www.texashealthsouthlake.com TDH #008128	X	X	X
5	Physicians Medical Center 6020 Parker Rd Plano,TX75093 www.thcds.com TDH #008153	X	X	X
6	USMD Hospital at Fort Worth 5900 Dirks Rd Fort Worth,TX76132 www.usmdfortworth.com TDH #008614	X	X	X

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	Texas Health Flower Mound
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Section C

Other website (list url): See Section C

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): See Section C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Texas Health Flower Mound
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 500.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See Section C

The FAP application form was widely available on a website (list url):

See Section C

A plain language summary of the FAP was widely available on a website (list url):
See Section C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	Texas Health Flower Mound
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	Texas Health Flower Mound
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	Texas Health Rockwall
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Section C

Other website (list url): www.texashealth.org/CHNA

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): www.texashealth.org/chna

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Texas Health Rockwall
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 500.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See Section C

The FAP application form was widely available on a website (list url):

See Section C

A plain language summary of the FAP was widely available on a website (list url):
See Section C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	Texas Health Rockwall
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	Texas Health Rockwall
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a prospective Medicare or Medicaid method

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	USMD Hospital at Arlington
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Section C

Other website (list url): www.texashealth.org/CHNA

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): www.texashealth.org/chna

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	USMD Hospital at Arlington
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 500.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See Section C

The FAP application form was widely available on a website (list url):

See Section C

A plain language summary of the FAP was widely available on a website (list url):
See Section C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	USMD Hospital at Arlington
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	USMD Hospital at Arlington
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a prospective Medicare or Medicaid method

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	Texas Health Southlake
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Section C

Other website (list url): www.texashealth.org/CHNA

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): www.texashealth.org/chna

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Texas Health Southlake
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 500.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See Section C

The FAP application form was widely available on a website (list url):

See Section C

A plain language summary of the FAP was widely available on a website (list url):
See Section C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	Texas Health Southlake
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	Texas Health Southlake
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a prospective Medicare or Medicaid method

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	Physicians Medical Center
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Section C

Other website (list url): www.texashealth.org/CHNA

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): www.texashealth.org/CHNA

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Physicians Medical Center
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 500.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See Section C

The FAP application form was widely available on a website (list url):

See Section C

A plain language summary of the FAP was widely available on a website (list url):
See Section C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	Physicians Medical Center
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	Physicians Medical Center
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a prospective Medicare or Medicaid method

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	USMD Hospital at Fort Worth
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 16

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Section C

Other website (list url): WWW.TexasHealth.org/CHNA

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 17

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): WWw.TexasHealth.ORG/CHNA

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	USMD Hospital at Fort Worth
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 500.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

See Section C

The FAP application form was widely available on a website (list url):

See Section C

A plain language summary of the FAP was widely available on a website (list url):
See Section C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	USMD Hospital at Fort Worth
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	USMD Hospital at Fort Worth
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a prospective Medicare or Medicaid method

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Texas Health Resources	Facility #1 Texas Health Flower Mound Part V. Section B, Line 3e Facility #1 The CHNA contains a prioritized description of the significant health needs of the community as identified through the CHNA. Part V. Section B, Line 5 Facility #1 Texas Health Flower Mounds (THFM) Community Health Needs Assessment (CHNA) was a one-year collaborative process which utilized qualitative and quantitative data to assess the health needs of persons in the communities served by the hospital. As a means to further understand the needs of the community, THFM gathered feedback through key informant interviews conducted between 11/20/2015 and 12/7/2015, focus group discussions and an online community survey. Key informants and focus group participants included, but were not limited to: faith community representatives, public health officials, lay community members, school officials and city administration. Seven persons with interests specific to the health of THFMs community participated in a focus group, two served as key informants and 16 individuals responded to the online survey. The online survey was conducted only in English. While the online survey may not have reached medically underserved, low-income or minority populations directly, organizations serving those populations were present at the focus group and served as key informants; these organizations included: the Childrens Advocacy Center, the Community Christian Association, Court Appointed Special Advocates (CASA), Denton County Public Health, the City of Flower Mound Fire Department, Health Plan Finders, Special Abilities of North Texas, and North Central Texas College. In order to gain a comprehensive understanding of the significant health needs for THFMs service area, the findings from all three data sources (secondary data, interviews and focus groups, and the online community survey) were compared and studied together. The top five to seven health needs identified by each data source were analyzed for areas of overlap with the other two data sources. Health needs were determined to be significant if they were cited as a top need in at least two of the three data sources. Part V. Section B, Line 6a Facility #1 The CHNA for THFM was conducted in collaboration with Texas Health Denton. Part V. Section B, Line 7a Facility #1 The CHNA is available on the hospitals website at https://www.texashealthflowermound.com/about-us/community-health-needs-ass essment. Part V. Section B, Line 7b Facility #1 The CHNA is available on the following website: https://www.texashealth.org/community-engagement/community-health-improvem ent-chi/community-health-needs-assessment Part V. Section B, Line 10a Facility #1 The most recently adopted implementation strategy is available on the following website: https://www.texashealth.org/community-engagement/community-health-improvem ent-chi/community-health-needs-assessment Part V. Section B, Line 11 Facility #1 Following a CHNA conducted in 2016 in collaboration with Texas Health Presbyterian Hospital Denton (THDN), THFM adopted an implementation strategy in May 2017. THFM is part of the Texas Health Resources healthcare system (Texas Health), which developed a system-wide community benefit strategy to leverage internal and external resources and increase its ability to impact community health needs. The significant health needs across the Texas Health system were: 1. Mental Health & Substance Abuse 2. Exercise, Nutrition, & Weight 3. Access to Health Services and Healthcare Navigation & Literacy 4. Older Adults & Aging From 2017-2019, THFM has committed to implement strategies and activities aimed at addressing these four areas. Mental Health & Substance Abuse is categorized as Behavioral Health; Exercise, Nutrition, & Weight is grouped under Chronic Disease, which has been a strategic area of focus for Community Health Improvement since the 2013 CHNA; Access to Health Services and Healthcare Navigation & Literacy is jointly titled Awareness, Health Literacy, & Navigation; and Older Adults and Aging. In 2018, Texas Health Flower Mound addressed the significant health needs identified by supporting the implementation strategy of Texas Health Denton with the following approaches: 1. Behavioral Health 1a. In 2018 the Texas Health Community Impact Leadership Council for the Denton/Wise region, which serves the THFM community, released a Request for Proposal to provide support to community organizations to deliver behavioral health services to underserved communities. It also addressed behavioral health needs that were identified in the 2016 Community Health Needs Assessment. Programs will promote mental health among youth, specifically resilience. Programs will start implementation of behavioral health services in 2019. 2. Chronic Disease Prevention & Management 2a. Continued implementation of evidence-based chronic disease self-management programs in partnership with the Community Council of Greater Dallas/Area Agency on Aging of Dallas County, North Central Texas Council of Governments Area Agency on Aging, Sixty and Better, Tarrant County Public Health, and the United Way of Tarrant County/Area Agency on Aging of Tarrant County. 2b. Managed and strengthened Delivery System Reform Incentive Payment (DSRIP) programs under the Medicaid 1115 Waiver through the Healthy Education and Lifestyle Program (HELP). The program is designed to address underserved persons with chronic disease(s), such as hypertension, diabetes, high cholesterol. The program operates from a three-pronged approach: group and individual education, clinical management and social determinants of health support. 3. Awareness, Literacy, & Navigation (ALN) 3a. Invested in offering a free online community resource guide called Aunt Bertha that provides a database of free and reduced-cost social services. 3b. Managed and strengthened DSRIP programs under the Medicaid 1115 Waiver to provide Emergency Department (ED) navigation programs to underserved populations. 3c. Managed and strengthened operations of Clinic Connects grant program for optimal performance to address awareness, literacy, and navigation through grants awarded to community clinics. 4. Older Adults and Aging 4a. Continued the implementation of A Matter of Balance Fall Prevention Program in partnership with the Community Council of Greater Dallas/Area Agency on Aging of Dallas County, North Central Texas Council of Governments Area Agency on Aging, Sixty and Better, Tarrant County Public Health, and the United Way of Tarrant County/Area Agency on Aging of Tarrant County. All significant health needs identified are being addressed by the hospital in one of the categories listed above. Part V. Section B, Lines 16 a, b & c Facility #1 The FAP, FAP Application and the Plain Language Summary of the FAP were widely available at the following website: https://www.texashealth.org/patient-and-visitor-information/billing-and-pa yment-information/financial-help-for-those-in-need Facility #2 Texas Health Rockwall Part V. Section B, Line 3e Facility #2 The CHNA contains a prioritized description of the significant health needs of the community as identified through the CHNA. Part V. Section B, Line 5 Facility #2 Texas Health Rockwalls (THRW) Community Health Needs Assessment (CHNA) was a one-year collaborative process which utilized qualitative and quantitative data to assess the health needs of persons in the communities served by the hospital. As a means to further understand the needs of the community, THRW gathered feedback through key informant interviews conducted between 11/20/2015 and 1/22/2016, focus group discussions and an online community survey. Key informants and focus group participants included, but were not limited to: faith community representatives, public health officials, lay community members, school officials and city administration. Five persons with interests specific to the health of THRWs community participated in a focus group, three served as key informants and 14 individuals responded to the online survey. The online survey was conducted only in English. While the online survey may not have reached medically underserved, low-income or minority populations directly, organizations serving those populations were present at the focus group and served as key informants; these organizations included: the Blue Ribbon News, Meals on Wheels Senior Services of Rockwall County, Helping Hands, Rockwall Independent School District, and the YMCA of Metropolitan Dallas. In order to gain a comprehensive understanding of the significant health needs for THRWs service area, the findings from all three data sets (secondary data, interviews and focus groups, and the online community survey) were compared and studied together. The top five to seven health needs identified by each data source were analyzed for areas of overlap with the other two data sources. Health needs were determined to be significant if they were cited as a top need

Schedule H (Form 990) 2018

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?23
Name and address		Type of Facility (describe)
1	Health Imaging Partners LLC 8610 Explorer Dr 300 Colorado Springs,CO80920	Outpatient Diagnostic Imaging
2	TX Health Surgery Center Preston Plaza 17950 Preston Rd Ste 75 Dallas,TX75252	Ambulatory Surgery Center
3	Opthalmology Surgery Center Dallas LLC 10740 N Central Expy Dallas,TX75231	Ambulatory Surgery Center
4	TX Health Surgery Center Alliance LLC 10840 Texas Health Trail Ste 100 Fort Worth,TX76244	Ambulatory Surgery Center
5	Fort Worth Endoscopy Centers LLC 900 W Magnolia Ave 101 Fort Worth,TX76104	Endoscopy Center
6	Surgical Caregivers of Fort Worth 2001 W Rosedale St Fort Worth,TX76104	Ambulatory Surgery Center
7	TX Health Surgery Center Rockwall LLC 3144 Horizon Rd Ste 120 Rockwall,TX75032	Ambulatory Surgery Center
8	TX Health Flower Mound Ortho Surg Ctr 5000 Long Prairie Rd Flower Mound,TX75028	Ambulatory Surgery Center
9	Park Hill Surgery Center LLC 3455 Locke Ave Fort Worth,TX76107	Ambulatory Surgery Center
10	TX Health Craig Ranch Surgery Ctr LLC 8080 State Hwy 121 Ste 100 McKinney,TX75070	Ambulatory Surgery Center
11	THR-STT Southlake ASC LLC 1545 E Southlake Blvd Southlake,TX76092	Ambulatory Surgery Center
12	Denton Surgery Center LLC 207 North Bonnie Brea Denton,TX76201	Ambulatory Surgery Center
13	Greenville Surgery Center LLC 7150 Greenville Ave Ste 200 Dallas,TX75231	Ambulatory Surgery Center
14	TX Health Orthopedic Surg Ctr Alliance 9848 N Beach St Fort Worth,TX76244	Ambultory Surgery Center
15	Cleburne Surgical Center LLC 2010 W Katherine P Raines Blvd Ste Cleburne,TX76033	Ambulatory Surgery Center
16	TX Health Surgery Center Bedford LLC 1605 Airport Freeway Ste 100 Bedford,TX76021	Ambulatory Surgery Center
17	Wilson Creek Surgical Center LLC 8855 Synergy Dr McKinney,TX75070	Ambulatory Surgery Center
18	Arlington Surgery Center LLC 918 N Davis Dr Arlington,TX76012	Ambulatory Surgery Center
19	TX Health Spine Surgery Center Allen LLC 1120 Raintree Cir Ste 100 Allen,TX75013	Ambultory Surgery Center
20	THR-STT Rockwall ASC LLC 1545 E Southlake Blvd Southlake,TX76092	Ambulatory Surgery Center
21	North Dallas Surgical Center LLC 17980 Dallas Pkwy Ste 100 Dallas,TX75287	Ambulatory Surgery Center
22	TX Health Surgery Center Irving LLC 2120 N McArthur Blvd Ste 200 Irving,TX75061	Ambulatory Surgery Center
23	TX Health Spine Surgery Ctr Alliance LLC 1545 E Southlake Blvd Ste 100 Southlake,TX76092	Ambulatory Surgery Center

Schedule H (Form 990) 2018

Page 10

Part VI

Supplemental Information

Provide the following information.

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

Form and Line Reference

Explanation

Texas Health Resources

Part I, Line 3c - Patient Eligibility The Schedule H for Texas Health Resources (THR) is filed solely because it has an ownership interest in six taxable joint ventures operating as hospitals. THR is a functionally integrated supporting organization and does not operate its own hospital. THR supports a system of faith-based, non-profit hospitals, an employed physician organization and an organization for medical research and education. THR has adopted a Financial Assistance Policy (FAP) which covers its wholly owned non-profit hospitals and most of its hospital joint ventures. Patients with a family income at or below 200% of applicable Federal Poverty Guidelines (FPG) may be eligible for free care if the patient lacks sufficient funds and assets to pay the out-of-pocket portion of their hospital bill. Patients with family income above 200% of applicable FPG who have unpaid medical bills exceeding a specified percentage of the patient's annual gross income, as determined on a sliding scale based on FPG, may be deemed medically indigent and eligible for charity care. The patient may be eligible for a charity adjustment up to 100% of the unpaid balance of their hospital bill in excess of a specified patient responsible amount if the patient has insufficient funds/assets to pay his hospital bill without incurring an undue financial hardship. The patient responsible amount is based on a percentage of the patient's annual income in relation to FPG. A determination as to whether or not a patient has insufficient funds and/or assets to pay for purposes of determining both financial and medical indigence is made at the time a patient's financial assistance application is reviewed. Assets considered when determining eligibility include cash, stocks, bonds and other financial assets that can be readily converted to cash. An additional process to screen for charity patients using publicly available financial information is also in place for patients not submitting a financial assistance application. Part I, Line 7 Cost-to-Charge Ratio A cost-to-charge ratio is used to compute the amounts reported on Lines 7a-7c. The cost-to-charge ratio is derived from Worksheet 2 Ratio of Patient Care Cost-to-Charges, as found in the Schedule H Instructions. The amounts reported on Lines 7e-7i were computed using direct costs, as determined by a cash outlay. Part II - Community Building The organization participates in community building activities that aim to address the socio-economic factors that influence the overall health of individuals in the communities served. As identified in the community health needs assessment, there are areas of need that are not in alignment with the operations of a hospital system. Our volunteerism, collaborations and partnerships with various aid organizations and various area coalitions aid in addressing the socio-economic factors that are the backbone for many underlying health concerns. Part III, Lines 2, 3 & 4 - Bad Debts Bad debt expense is not included as a community benefit for purposes of reporting community benefits. Each patient qualifying for charity care is treated as a charity patient and no charges related to that patient are included in bad debt expense. Each joint venture hospital estimates bad debt expense utilizing various methods, analytical tools and benchmarks. Typically, bad debt expense is based upon a combination of factors including, but not limited to, aging of receivables, analyzing revenue trends in the healthcare industry and payor class, and assessing historical collection experience considering business and economic conditions. Part III, Line 8 - Medicare Shortfall The state of Texas treats any Medicare shortfall as a community benefit for meeting the state statutory requirements for charity care & community benefit. For state purposes, the shortfall is computed by comparing actual Medicare reimbursements with the estimated cost the hospital incurs in providing these services to Medicare patients. Cost is determined by applying a cost-to-charge ratio (with costs determined in accordance with generally accepted accounting principles) to billed charges. THR is the parent company of a healthcare system filing a combined community benefit report in Texas. THR is not a hospital and does not have Medicare data to report to the state of Texas. The data provided for Sch H is THRs share of operations from its taxable joint ventures which operate hospitals in Texas. The Medicare amounts reported on Sch H are from the taxable joint venture hospitals cost accounting systems. The taxable joint ventures are not required to file community benefit reports with or report Medicare shortfalls to the state of Texas. Part III, Line 9b - Debt Collection During the year, standard collection procedures were in place and uniformly applicable to all patient accounts. Except to the extent a patient receives a recovery from any third party or other source, no attempts are made to collect unpaid charges from patient accounts approved for adjustment under the Financial Assistance Policy. Part VI, Line 2 - Needs Assessment In 2016, Texas Health Resources (Texas Health) completed a community health needs assessment (CHNA) for 23 facilities through the following steps: - Demographic analysis by zip code tabulation area - Secondary data analysis of health indicators - Community input data collection and analysis via key informant interviews, focus groups, and a community survey - Synthesis of secondary data and community input data to identify most pressing health needs - Prioritization of health needs using standard criteria elected by Texas Health To objectively prioritize the health needs identified by the data analysis and synthesis, each Texas Health facility used the following criteria: alignment with national, state, or local initiatives; magnitude; economic burden on the community; severity; and opportunity to intervene at a prevention level. The top priority health needs across the Texas Health system were Mental Health & Substance Abuse; Exercise, Nutrition, & Weight; Access to Health Services and Healthcare Navigation & Literacy; and Older Adults & Aging. Part VI, Line 3 - Patient Education A description of the Financial Assistance Policy (FAP), the Plain Language Summary of the FAP (PLS) and the FAP application are available on the THR website at www.TexasHealth.org in English and other languages. The PLS is included in the patients admission packets. Signs alerting patients of financial assistance and related contact information are posted in various areas of the hospital including admissions & registration and the emergency room. Additionally, financial assistance information is provided verbally and in writing to self-pay patients by financial counselors. As part of the financial counseling meeting, patients are screened for potential eligibility in other governmental assistance programs. If it is determined that the patient is potentially eligible for governmental assistance, the counselor will assist the patient in completing forms necessary to apply for the assistance. At the same time, patients are provided with a financial assistance application. The patient is informed that the hospital is a non-profit organization offering financial assistance to patients deemed medically or financially indigent. The PLS is included on the back of our patient bills. The patient is informed of how to qualify for financial assistance, how to ask for help, necessary documentation, and THR's collection process. The onsite financial counselors may assist the patient in completing the application and obtain available verification information. The counselors will continue to contact the patient to ensure all forms and verifications needed to file an application for governmental assistance and financial assistance have been provided. In certain cases, self-pay patients who are discharged before seeing a financial counselor receive both a phone call and a letter to alert them to the existence of the FAP. Each bill sent for hospital services also contains contact information alerting patients that Texas Health has a FAP. Part VI, Line 4 - Community Information THR does not operate its own hospitals, but has ownership in six joint ventures operating as hospitals. The joint ventures operate hospitals in various communities throughout North Texas. The communities served by the hospitals include those designated as medically underserved areas (MUA) and vary in age and race. The population of the communities range from 296,000 to 1.3 million and the percentage of the households in these communities who are uninsured varies from 4.1% to 5.4%. The median income of the communities served by the hospitals ranges from $53,000 to $86,000 with a range of 6.9% to 17.7% of the population in these communities living below the federal poverty level. Part VI, Line 5 - Promotion of Community Health The board of trustees is comprised of community m

Schedule H (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Texas Health Resources w o 926 5471

Employer identification number
75-2702388

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 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 noncash assistance	(h) Purpose of grant or assistance
(1) TX Health Resources Foundation 612 E Lamar Blvd Arlington,TX76011	75-2022128	501(c)(3)		10,000	FMV	Awards & Event Pymts	General Purpose
(2) March of Dimes Foundation 555 Hemphill St 202 Fort Worth,TX76104	13-1846366	501(c)(3)	37,500	6,840	FMV	Consultant Pymt	General Purpose
(3) American Cancer Society 8900 John W Carpenter Fwy Dallas,TX75247	13-1788491	501(c)(3)	35,000				General Purpose
(4) DFW Hospital Council 300 Decker Drive 300 Irving,TX75062	75-1254380	501(C)(6)	9,655				General Purpose
(5) Fort Worth Chamber of Commerce 777 Taylor St 900 Fort Worth,TX76102	75-0275060	501(C)(6)	8,300				General Purpose
(6) Fort Worth Stockshow Syndicate PO Box 17005 Fort Worth,TX76102	75-1790417	501(C)(3)	10,810				General Purpose
(7) Kwanzaafest Inc 510 E 5th St Dallas,TX75203	75-2851704	501(C)(3)	10,000				General Purpose
(8) Cancer Support Community North Texas PO Box 601744 Dallas,TX75360	75-2633654	501(c)(3)		205,367	FMV	Rent Payment	Cancer Support
(9) Communities Foundation of Texas 5500 Caruth Haven Ln Dallas,TX75225	75-0964565	501(c)(3)	10,000				General Purpose
(10) American Heart Assocation 7272 Greenville Avenue Dallas,TX75231	13-5613797	501(c(3)		20,741	FMV	Consultant Pymt	General Purpose
(11) Healthcare Leadership Council 750 9th St NW 500 Washington,DC20001	36-3668803	501(c)(6)	35,000				General Purpose
(12) North Texas Commission 8445 Freeport Pkwy 640 Irving,TX75063	75-1364760	501(c)(6)	7,500				General Purpose
(13) Southwestern Health Resources 5323 Harry Hines Blvd Dallas,TX75390	81-1555446	501(c)(3)	386,864				Healthcare Management
(14) Southwestern Health Resources JOC 5323 Harry Hines Blvd Dallas,TX75390	81-1575989	501(c)(3)	596,957				Healthcare Management
(15) North Texas Healthy Communities 612 E Lamar Blvd Ste 600 Arlington,TX76011	46-4513182	501(c)(3)	10,083,652				General Purpose

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2018

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

Part I, Line 2 - Procedures for Monitoring Grants

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

Schedule I (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Texas Health Resources w o 926 5471

Employer identification number

75-2702388

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

Yes

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

Yes

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

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

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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

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

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

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

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

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

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

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

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

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2018

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 on 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 in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Berdan Barclay E Chief Executive Officer	(i) (ii)	1,199,718 ------------- 0	890,661 ------------- 0	257,526 ------------- 0	259,398 ------------- 0	43,336 ------------- 0	2,650,639 ------------- 0	207,003 ------------- 0
2Canose Jeffrey L EVP Sr & COO THR	(i) (ii)	846,285 ------------- 0	497,960 ------------- 0	184,329 ------------- 0	147,838 ------------- 0	42,137 ------------- 0	1,718,549 ------------- 0	112,689 ------------- 0
3Varga Daniel W EVP Sr & Chief Clinical Officr	(i) (ii)	704,252 ------------- 0	631,136 ------------- 0	158,325 ------------- 0	199,774 ------------- 0	51,805 ------------- 0	1,745,292 ------------- 0	147,788 ------------- 0
4Long Ronald R EVP & Chief Financial Officer	(i) (ii)	704,489 ------------- 0	522,441 ------------- 0	150,666 ------------- 0	20,625 ------------- 0	46,549 ------------- 0	1,444,770 ------------- 0	223,733 ------------- 0
5Lester Mark C EVP Zone Clinical Leader	(i) (ii)	296,895 ------------- 0	378,697 ------------- 0	649,995 ------------- 0	16,500 ------------- 0	34,496 ------------- 0	1,376,583 ------------- 0	163,642 ------------- 0
6McWhorter Ricky E EVP & Chief Financial Officer	(i) (ii)	411,087 ------------- 0	611,800 ------------- 0	75,059 ------------- 0	61,424 ------------- 0	34,312 ------------- 0	1,193,682 ------------- 0	460,488 ------------- 0
7McClung Brett S EVP Zone Operations Leader	(i) (ii)	516,611 ------------- 0	291,950 ------------- 0	116,035 ------------- 0	20,625 ------------- 0	52,724 ------------- 0	997,945 ------------- 0	81,911 ------------- 0
8Ransom Elizabeth EVP Zone Clinical Leader	(i) (ii)	498,388 ------------- 0	283,353 ------------- 0	112,715 ------------- 0	20,625 ------------- 0	49,392 ------------- 0	964,473 ------------- 0	82,167 ------------- 0
9Kramer Kenneth J EVP General Counsel	(i) (ii)	498,252 ------------- 0	252,677 ------------- 0	128,514 ------------- 0	98,360 ------------- 0	39,355 ------------- 0	1,017,158 ------------- 0	50,254 ------------- 0
10King James Kirk EVP Zone Operations Leader	(i) (ii)	512,688 ------------- 0	241,960 ------------- 0	119,462 ------------- 0	99,714 ------------- 0	51,124 ------------- 0	1,024,948 ------------- 0	75,344 ------------- 0
11Miao Winjie Tang EVP Chief Experience Officer	(i) (ii)	534,388 ------------- 0	223,043 ------------- 0	110,432 ------------- 0	234,830 ------------- 0	27,536 ------------- 0	1,130,229 ------------- 0	27,618 ------------- 0
12Berenzweig Harold K EVP Zone Clinical Leader	(i) (ii)	513,374 ------------- 0	250,830 ------------- 0	88,865 ------------- 0	20,625 ------------- 0	41,213 ------------- 0	914,907 ------------- 0	82,585 ------------- 0
13Parobek Jr James S EVP Physician Enterprise THR	(i) (ii)	474,389 ------------- 0	272,496 ------------- 0	104,734 ------------- 0	91,804 ------------- 0	55,119 ------------- 0	998,542 ------------- 0	63,452 ------------- 0
14Kirby Michelle Riddle EVP Chief People Officer	(i) (ii)	435,438 ------------- 0	218,576 ------------- 0	93,167 ------------- 0	92,685 ------------- 0	9,438 ------------- 0	849,304 ------------- 0	43,350 ------------- 0
15Shinkus Clark Joan Frances EVP Chief Nursing Executive	(i) (ii)	400,232 ------------- 0	176,985 ------------- 0	71,883 ------------- 0	14,896 ------------- 0	44,163 ------------- 0	708,159 ------------- 0	42,934 ------------- 0
16Jackson David W Chief Accounting Officer/Asst	(i) (ii)	275,133 ------------- 0	70,616 ------------- 0	51,888 ------------- 0	43,044 ------------- 0	33,256 ------------- 0	473,937 ------------- 0	0 ------------- 0
17Cantu Stacy G VP Chief Gov Offr & Corp Secr	(i) (ii)	224,390 ------------- 0	66,978 ------------- 0	28,767 ------------- 0	11,282 ------------- 0	44,112 ------------- 0	375,529 ------------- 0	0 ------------- 0
18Velasco Ferdinand T SVP & Chief Hlth Info Officer	(i) (ii)	438,939 ------------- 0	195,035 ------------- 0	76,200 ------------- 0	68,742 ------------- 0	50,195 ------------- 0	829,111 ------------- 0	45,216 ------------- 0
19Jones Robert Douglas SVP & Chief Investment Officer	(i) (ii)	404,458 ------------- 0	180,814 ------------- 0	76,891 ------------- 0	63,300 ------------- 0	46,133 ------------- 0	771,596 ------------- 0	38,121 ------------- 0
20Sudomir Jr Joseph M SVP Chief Info Officer	(i) (ii)	413,988 ------------- 0	149,168 ------------- 0	81,524 ------------- 0	148,714 ------------- 0	44,983 ------------- 0	838,377 ------------- 0	13,115 ------------- 0
21Bujnowski Aaron Mark SVP & Chief Strategy Officer	(i) (ii)	340,422 ------------- 0	147,144 ------------- 0	81,232 ------------- 0	16,500 ------------- 0	50,334 ------------- 0	635,632 ------------- 0	31,150 ------------- 0
22Mitchell John D SVP Business Development	(i) (ii)	323,919 ------------- 0	157,901 ------------- 0	85,664 ------------- 0	54,616 ------------- 0	43,336 ------------- 0	665,436 ------------- 0	31,519 ------------- 0
23Tesmer David J SVP Community Engag & Advocacy	(i) (ii)	333,701 ------------- 0	146,228 ------------- 0	53,882 ------------- 0	61,012 ------------- 0	39,095 ------------- 0	633,918 ------------- 0	36,337 ------------- 0
24Holmes Kevin B SVP Real Estate Devl & Deploy	(i) (ii)	282,763 ------------- 0	131,642 ------------- 0	76,855 ------------- 0	51,550 ------------- 0	55,185 ------------- 0	597,995 ------------- 0	32,789 ------------- 0
25Craft Brian SVP Financial Operations	(i) (ii)	311,851 ------------- 0	97,295 ------------- 0	52,725 ------------- 0	47,541 ------------- 0	42,008 ------------- 0	551,420 ------------- 0	0 ------------- 0
26Pearson George SVP Med Stf Affrs Phys Rltns	(i) (ii)	253,321 ------------- 0	114,785 ------------- 0	71,146 ------------- 0	18,422 ------------- 0	36,506 ------------- 0	494,180 ------------- 0	30,342 ------------- 0
27Clinton Shaun SVP Supply Chain Management	(i) (ii)	256,357 ------------- 0	71,362 ------------- 0	49,719 ------------- 0	33,875 ------------- 0	25,626 ------------- 0	436,939 ------------- 0	0 ------------- 0
28Szablowski Paul A SVP Brand Experience	(i) (ii)	71,397 ------------- 0	109,830 ------------- 0	176,264 ------------- 0	5,160 ------------- 0	29,407 ------------- 0	392,058 ------------- 0	0 ------------- 0
29McAllister Deena A SVP Brand Experience	(i) (ii)	249,435 ------------- 0	60,604 ------------- 0	33,757 ------------- 0	10,965 ------------- 0	37,392 ------------- 0	392,153 ------------- 0	0 ------------- 0
30Cox Kathleen B SVP Integrated Experience	(i) (ii)	232,633 ------------- 0	36,526 ------------- 0	38,088 ------------- 0	42,699 ------------- 0	26,002 ------------- 0	375,948 ------------- 0	0 ------------- 0
31Saldana Luis Eduardo CMIO	(i) (ii)	397,924 ------------- 0	31,880 ------------- 0	770 ------------- 0	20,625 ------------- 0	43,016 ------------- 0	494,215 ------------- 0	0 ------------- 0
32Caldwell Thomas J VP Sports Medicine	(i) (ii)	255,144 ------------- 0	110,000 ------------- 0	47,559 ------------- 0	------------- 0	41,609 ------------- 0	454,312 ------------- 0	0 ------------- 0
33Beck Jesse St John VP Strategic Marketing	(i) (ii)	267,892 ------------- 0	93,341 ------------- 0	45,893 ------------- 0	23,645 ------------- 0	33,262 ------------- 0	464,033 ------------- 0	22,213 ------------- 0
34Robinson Mary C VP Prof Prac Rsrch & Magnet	(i) (ii)	268,517 ------------- 0	103,417 ------------- 0	34,752 ------------- 0	20,625 ------------- 0	37,680 ------------- 0	464,991 ------------- 0	16,422 ------------- 0
35Salsberry David C Chief Revenue Officer	(i) (ii)	326,481 ------------- 0	------------- 0	65,679 ------------- 0	33,959 ------------- 0	42,048 ------------- 0	468,167 ------------- 0	0 ------------- 0
36Auzenne Dana S VP Health Care Economics	(i) (ii)	270,218 ------------- 0	71,405 ------------- 0	45,149 ------------- 0	20,625 ------------- 0	52,814 ------------- 0	460,211 ------------- 0	0 ------------- 0
37Sullivan Jon M VP Real Estate Operations	(i) (ii)	248,396 ------------- 0	69,642 ------------- 0	62,399 ------------- 0	20,625 ------------- 0	43,322 ------------- 0	444,384 ------------- 0	0 ------------- 0
38Schornick Amy C Former Key Employee	(i) (ii)	0 ------------- 0	0 ------------- 0	332,748 ------------- 0	0 ------------- 0	0 ------------- 0	332,748 ------------- 0	0 ------------- 0
39Hawthorne Douglas D Former Officer	(i) (ii)	0 ------------- 273,812	0 ------------- 98,946	0 ------------- 70,720	0 ------------- 20,625	0 ------------- 44,716	0 ------------- 508,819	0 ------------- 90,298
40Reeves Sandra G VP Treas/Asst Chief Invest Off	(i) (ii)	263,207 ------------- 0	66,615 ------------- 0	47,960 ------------- 0	20,484 ------------- 0	47,438 ------------- 0	445,704 ------------- 0	0 ------------- 0
41Ball Randell L VP System Pharmacy Officer	(i) (ii)	267,074 ------------- 0	69,409 ------------- 0	39,468 ------------- 0	20,625 ------------- 0	36,272 ------------- 0	432,848 ------------- 0	0 ------------- 0
42Madzik Elizabeth May VP & Chief Compliance Officer	(i) (ii)	247,450 ------------- 0	64,279 ------------- 0	63,037 ------------- 0	20,625 ------------- 0	34,144 ------------- 0	429,535 ------------- 0	0 ------------- 0
43Winsper Sheri M VP Quality & Patient Safety	(i) (ii)	251,320 ------------- 0	68,520 ------------- 0	51,359 ------------- 0	20,625 ------------- 0	9,723 ------------- 0	401,547 ------------- 0	0 ------------- 0
44Dawson Carla S VP Total Health & Rewards	(i) (ii)	246,519 ------------- 0	64,150 ------------- 0	52,567 ------------- 0	20,625 ------------- 0	27,254 ------------- 0	411,115 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2018

Page 3

Part III

Supplemental Information

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.

Return Reference	Explanation
SCHEDULE J, PART I, LINE 1A - FIRST CLASS TRAVEL	THE THR BOARD APPROVED FIRST CLASS TRAVEL FOR THE CEO ASSOCIATED WITH BUSINESS TRAVEL ON BEHALF OF THE SYSTEM. NO COSTS ASSOCIATED WITH THIS ARE ADDED TO THE TAXABLE WAGES OF THE CEO. ALL OTHER THR PERSONNEL FOLLOW A SYSTEM TRAVEL POLICY WHICH REIMBURSES BUSINESS AIR TRAVEL AT THE MOST ECONOMICAL FARE REASONABLY AVAILABLE.
SCHEDULE J, PART I, LINE 1A - Gross Up Payments	Certain imputed income is grossed-up to include employment taxes paid on the listed person's behalf. All tax indemnification payments provided to the employees are included in the taxable compensation of the employee.
SCHEDULE J, PART I, LINE 1A - DISCRETIONARY SPENDING ACCOUNT	EACH EXECUTIVE AT THE VICE PRESIDENT LEVEL AND ABOVE RECEIVES A PERK ALLOWANCE WHICH IS INCLUDED IN THE TAXABLE COMPENSATION OF THE EMPLOYEE. THIS ALLOWANCE COVERS COSTS SUCH AS BUSINESS USE OF THEIR PERSONAL VEHICLES IN LIEU OF REIMBURSEMENT FOR AUTO MILEAGE. It also allows access to certain executive benefits including individual Long Term Disability, Long Term Care, and Individual Life insurance.
Schedule J, Part I, Line 1a Personal Services	The CEO is provided financial planning and tax preparation services. These services are included in the taxable compensation of the CEO.
SCHEDULE J, PART I, LINE 4A - POSITION ELIMINATION	THR'S separation pay plan provides payments to employees whose positions were eliminated by the organization. The separation pay is based on the employee's years of service and the level of the affected position. The employee listed qualified for severance based on an involuntary separation from service without a comparable position being open and available at the time of separation. Schornick, Amy $323,498 Lester, Mark $516,044
SCHEDULE J, PART I, LINE 4A - SEVERANCE SETTLEMENT	The settlement payment was paid out as part of a mutually agreed upon employment transition agreement that resulted in a separation of employment from THR. Schornick, Amy C. $9,250 Szablowski, Paul $132,100
Schedule J, Part I, Line 4b - Nonqualified Retirement Plan	Participation in the plan is made available to a select group of management and highly compensated employees as determined by the THR Board of Trustees, who are providing service in key position of management and responsibility. For the active restoration account (Account balances after 12/31/2009) SERP benefits vest while the participant is employed if the participant: * Reaches age 65 * Becomes disabled or dies, * Reaches the following years of service: 2 Years - 25%; 3 Years - 50%; 4 Years - 75% and 5 or more years - 100% Participants must be employed on Dec 1 to qualify for the current year's SERP Benefit unless separation is due to death, disability, retirement (Age 65) or early retirement (separation from service at or after age 55 with 75 years of combined age and continuous service with the system.) SERP benefits are calculated each Dec 1. Vested balances are taxed to the employee and the net balances begin accruing earnings. Vested balances are paid in cash lump sum within a 90-day period commencing on the earlier of death, disability, or separation from service. The deferred portion is included in Sch. J, Part II, column C. In frozen restoration accounts (account balances prior to 1/1/2010), the participant or beneficiary shall be taxed on his or her vested SERP benefits upon the earliest of: * Continued employment in THR until age 68 * Termination of employment for disability or death * Involuntary termination of employment without reasonable cause; or * Satisfying a 24 month non-compete period following his/her termination of employment. Payment follows the before mentioned events, except in the case of involuntary separation when the participant must wait 24 months to receive the previously taxed benefit. Payouts to the following employees were made during the year. The amounts below are included in the amount reported on Sch. J, Part II, Column B(iii) and Column (F). Beck, Jesse St. John 19,638 Berdan, Barclay E. 207,003 Berenzweig, Harold K 82,585 Bujnowski, Aaron Mark 31,150 Canose, Jeffrey L 112,689 Hawthorne, Douglas D. 90,298 Holmes, Kevin B. 32,789 Jones, Robert Douglas 38,121 King, James Kirk 75,344 Kirby, Michelle Riddle 43,350 Kramer, Kenneth J. 50,254 Lester, Mark C 280,268 Long, Ronald R 232,123 McClung, Brett S. 81,911 McWhorter, Ricky E. 460,488 Miao, Winjie Tang 27,618 Mitchell, John D. 31,519 Parobek Jr, James S 52,439 Pearson, George 30,342 Robinson, Mary C. 16,422 Shinkus Clark, Joan 42,934 Sudomir Jr, Joseph M 13,115 Szablowski, Paul A 18,712 Tesmer, David J. 36,337 Varga, Daniel W 117,388 Velasco, Ferdinand T. 45,811

Schedule J (Form 990) 2018

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Texas Health Resources w o 926 5471

Employer identification number
75-2702388

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Tarrant Cnty Cultural Education Facility Fin Corp	04-3833551	87638RCL5	10-30-2008	366,120,000	Refund 1/31/89 & 5/14/03 Bonds		X		X		X
B	Tarrant Cnty Cultural Education Facility FIN Corp	04-3833551	87638TEE9	11-23-2010	151,950,525	Redeem 10/30/08 Series D F & G		X		X		X
C	Tarrant Cnty Cultural Education Facility FIN Corp	04-3833551		11-30-2010	135,000,000	Construction& Equip Health Facilit		X		X		X
D	Tarrant Cnty Cultural Education Facility FIN Corp	04-3833551	87638TEH2	10-04-2012	50,000,000	Construction & Equip Health Facili		X		X		X
	Tarrant Cnty Cultural Education Facility FIN Corp	04-3833551	87638TEZ2	05-21-2015	60,535,400	Construction & Equip Health Facili		X		X		X
	Tarrant Cnty Cultural Education Facility FIN Corp	04-3833551	87638TFM0	11-18-2016	708,403,645	Refund 2007A Bonds & Capital Impro		X		X		X
	Tarrant Cnty Cultural Education Facility FIN Corp	04-3833551	87638TFP3	10-19-2017	133,470,000	Refund 2007B Bonds & Construction		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	216,940,000		0		1,025,000		0
2 Amount of bonds legally defeased ..............	0		0		0		0
3 Total proceeds of issue ..................	366,264,054		151,950,525		135,000,000		50,037,844
4 Gross proceeds in reserve funds .............	0		0		0		0
5 Capitalized interest from proceeds .............	0		0		0		0
6 Proceeds in refunding escrows ...............	0		0		0		0
7 Issuance costs from proceeds ...............	1,868,320		1,525,525		444,565		0
8 Credit enhancement from proceeds .............	0		0		0		0
9 Working capital expenditures from proceeds .............	0		0		0		0
10 Capital expenditures from proceeds .............	178,040,202		134,555,431		134,555,435		50,037,844
11 Other spent proceeds .............	186,355,532		15,869,569		0		0
12 Other unspent proceeds .............	0		0		0		0
13 Year of substantial completion .............	2009		2010		2013		2014
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X		X			X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X			X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X			X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.610 %		1.580 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %		0 %
6 Total of lines 4 and 5 .............	1.610 %		1.580 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........	X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X	X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Part I, Column e and Part II, Line 3	All bonds issued The amount of total proceeds of issue reported in Part II, Line 3 differs from the amount of the issue price reported in Part I, Column e. The difference relates to cumulative investment earnings.
Part IV, Line 2C, Column A	Rebate Calculations for the 2008 Series were completed 10/30/2018.
Part IV, Line 2C, Column B & C	Rebate Calculations for the 2010 Series were completed 12/21/2015.
Part IV, Line 2C, Column D	Rebate calculations for the 2012 Series were completed 10/17/17.

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Texas Health Resources w o 926 5471

Employer identification number
75-2702388

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Tarrant Cnty Cultural Education Facility Fin Corp	04-3833551	87638RCL5	10-30-2008	366,120,000	Refund 1/31/89 & 5/14/03 Bonds		X		X		X
B	Tarrant Cnty Cultural Education Facility FIN Corp	04-3833551	87638TEE9	11-23-2010	151,950,525	Redeem 10/30/08 Series D F & G		X		X		X
C	Tarrant Cnty Cultural Education Facility FIN Corp	04-3833551		11-30-2010	135,000,000	Construction& Equip Health Facilit		X		X		X
D	Tarrant Cnty Cultural Education Facility FIN Corp	04-3833551	87638TEH2	10-04-2012	50,000,000	Construction & Equip Health Facili		X		X		X
	Tarrant Cnty Cultural Education Facility FIN Corp	04-3833551	87638TEZ2	05-21-2015	60,535,400	Construction & Equip Health Facili		X		X		X
	Tarrant Cnty Cultural Education Facility FIN Corp	04-3833551	87638TFM0	11-18-2016	708,403,645	Refund 2007A Bonds & Capital Impro		X		X		X
	Tarrant Cnty Cultural Education Facility FIN Corp	04-3833551	87638TFP3	10-19-2017	133,470,000	Refund 2007B Bonds & Construction		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	216,940,000		0		1,025,000		0
2 Amount of bonds legally defeased ..............	0		0		0		0
3 Total proceeds of issue ..................	366,264,054		151,950,525		135,000,000		50,037,844
4 Gross proceeds in reserve funds .............	0		0		0		0
5 Capitalized interest from proceeds .............	0		0		0		0
6 Proceeds in refunding escrows ...............	0		0		0		0
7 Issuance costs from proceeds ...............	1,868,320		1,525,525		444,565		0
8 Credit enhancement from proceeds .............	0		0		0		0
9 Working capital expenditures from proceeds .............	0		0		0		0
10 Capital expenditures from proceeds .............	178,040,202		134,555,431		134,555,435		50,037,844
11 Other spent proceeds .............	186,355,532		15,869,569		0		0
12 Other unspent proceeds .............	0		0		0		0
13 Year of substantial completion .............	2009		2010		2013		2014
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X		X			X		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X			X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X			X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.610 %		1.580 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %		0 %		0 %		0 %
6 Total of lines 4 and 5 .............	1.610 %		1.580 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X		X
b Exception to rebate? ........		X		X		X		X
c No rebate due? .........	X		X		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X	X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........

Schedule K (Form 990) 2018

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X		X
b Name of provider ..........	0		0		0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
Part I, Column e and Part II, Line 3	All bonds issued The amount of total proceeds of issue reported in Part II, Line 3 differs from the amount of the issue price reported in Part I, Column e. The difference relates to cumulative investment earnings.
Part IV, Line 2C, Column A	Rebate Calculations for the 2008 Series were completed 10/30/2018.
Part IV, Line 2C, Column B & C	Rebate Calculations for the 2010 Series were completed 12/21/2015.
Part IV, Line 2C, Column D	Rebate calculations for the 2012 Series were completed 10/17/17.

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Texas Health Resources w o 926 5471

Employer identification number

75-2702388

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

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

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

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

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No
(1) Berdan Barclay	Officer	Split Dollar Life		X		470,253		No	Yes		Yes
(2) Canose Jeffrey L	Officer	Split Dollar Life		X		279,040		No	Yes		Yes
(3) Hawthorne Douglas	Former	Split Dollar Life		X		987,178		No	Yes		Yes
(4) Holmes Kevin B	Key Employee	Split Dollar Life		X		130,469		No	Yes		Yes
(5) Kirby Michelle R	Key Employee	Split Dollar Life		X		62,732		No	Yes		Yes
(6) Kramer Kenneth Jr	Officer	Split Dollar Life		X		150,799		No	Yes		Yes
(7) Long Ronald R	Officer	Split Dollar Life		X		771,290		No	Yes		Yes
(8) Pearson George L	Key Employee	Split Dollar Life		X		194,722		No	Yes		Yes
(9) Tesmer David J	Key Employee	Split Dollar Life		X		86,108		No	Yes		Yes
(10) McClung Brett	Officer	Split Dollar Life		X		108,400		No	Yes		Yes
(11) King James Kirk	Officer	Split Dollar Life		X		128,966		No	Yes		Yes
Total ............... $						3,369,957

Part III

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2018

Page 2

Part IV

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

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

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

Texas Health Resources w o 926 5471

Employer identification number

75-2702388

Return Reference	Explanation
990, Part VI, Section A, Line 2 - Business Relationship	Texas Health Resources (THR) and its related organizations included in the THR healthcare system encourage employees to become involved in philanthropic endeavors in their communities. As a result, THR healthcare system employees who are serving as officers, board members, or key employees may, from time to time, also serve on the boards of various community organizations such as church boards, United Way, etc. There may be a business relationship as a result of multiple THR employees serving on the same community boards. THR employees serve as the corporate officers of each subsidiary organization. As THR system employees, all officers have a business relationship within the organizations of the THR healthcare system. THR also appoints system officers to the boards of various controlled joint ventures. As THR system employees, various officers of the organization may have a business relationship through serving on THR controlled joint venture boards.
990, Part VI, Section B, Line 11b - Form 990 Filing	The Texas Health Resources (THR) tax department staff prepares the Forms 990 for THR and all of its wholly controlled affiliates. In order to accurately prepare the returns, the tax staff works closely with various other departments to gather and review the information needed to complete the return. The departments involved in this process include, but are not limited to accounting, finance, treasury, human resources, payroll, legal, governance, and corporate compliance. The returns are then reviewed twice within the tax department before being given to the Financial Reporting department to review and to ensure that the financial information is accurate and up to date. All THR System Forms 990 are provided to members of the Audit and Compliance Committee of the THR Board, giving them an opportunity to review, comment and ask questions regarding the Forms 990. The tax department Vice President provides an overview presentation to the committee highlighting various areas of the Form 990. A resolution to approve all of the returns is voted upon at this meeting. Once the Audit and Compliance Committee has approved the returns, each return is then reviewed and signed by the Chief Accounting Officer/Assistant Secretary. The members of the governing Boards are provided a copy of the Form 990 for their respective entity after the Audit and Compliance Committee approval process and before the Form 990 is filed.
990, Part VI, Section B, Line 12c - Conflict of Interest	Texas Health Resources (THR) has adopted a Conflict of Interest Policy that applies to THR and all of its wholly owned or wholly controlled affiliates. During the first quarter of each fiscal year, a Duality and Conflict of Interest Statement Form is distributed by the THR Chief Compliance Officer to all board members, officers, contracted medical directors, employees with a title of manager or above, employed physicians, and certain committee members and other employees based upon function. All disclosed conflicts are reviewed by the THR Chief Compliance Officer. A report, listing each reported Duality of Interest or Conflict of Interest is given to both the Chair of the Governing body and the President of the Corporation with which the reporting person is affiliated. The THR Board of Trustees receives a report when the Annual Disclosure process is complete. Progressive corrective action is taken for any identified noncompliance which may include removal from a board or committee or physician/employee counseling if the person fails to provide the disclosure. In addition, THR monitors physician payments through a public database implemented by CMS. Management plans are executed as needed based upon disclosures. THR also educates the Boards and workforce annually through either a web based or live compliance training.
990, Part VI, Section B, Lines 15 a&b - Compensation Determination	Texas Health Resources (THR) used the following methods to establish the compensation of the organization's CEO, officer and key employees. * The Compensation committee (which includes independent persons) performs reviews and makes recommendations to the THR Board. * Independent consultants may be hired. * Compensation surveys or studies are utilized. * Approval by the Board or Compensation committee is required. The board of THR hires an independent third party compensation consultant to review base pay of the CEO annually. Every 3 years, the independent third party compensation consultant is hired to review all aspects of executive compensation, which includes a review and confirmation of the executive compensation philosophy. Each year the compensation committee of the THR board of trustees reviews a detailed report analyzing CEO, Executive, and Senior officer compensation packages.
990, Part VI, Section C, Line 19 - Public Disclosure	The organization does not make its governing documents or conflict of interest policy available to the public. The consolidated financial statements of Texas Health Resources (THR) are made available to the public on the website www.dacbond.com. Consolidated financial statements are posted to this website quarterly and the audited financial statements are posted annually. The financial statements of the wholly controlled affiliates of THR are not posted to the website nor are they generally made available to the public in any other manner.
990, Part XI, Line 9 - Other Changes in Fund Balance	Controlled Joint Venture Treasury Shares ($1,228,778) Adjustment for Intercompany Transactions of a Controlled Group $86,826,626 The intercompany adjustment eliminated the receivable/payable balance as of the end of the year between Texas Health Resources (THR) and all wholly controlled tax-exempt entities included in the THR Healthcare System. The adjustment represents current year activity. The THR Healthcare System records all related transactions through the intercompany Receivable/Payable accounts for each entity. The types of transactions recorded in the Intercompany accounts include management fees charged by the parent organization, services purchased between related organizations, supplies purchased by a centralized purchasing department, daily cash sweeps and similar transactions.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Texas Health Resources w o 926 5471

Employer identification number

75-2702388

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on 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
(1) Texas Health Partners LLC 612 E Lamar Blvd Arlington,TX76011 02-0546958	Mgmt Co	TX	16,765,668	4,118,741	TH Resources
(2) THR-SCA Holdings LLC 612 E Lamar Blvd Arlington,TX76011 46-1096461	Holding Co	TX	29,744,436	100,357,181	TH Resources
(3) Texas Health Resources Trust 612 E Lamar Blvd Arlington,TX76011 30-6406740	Investments	TX	31,549,648	148,810,172	TH Resources
(4) Texas Health Medsynergies LLC 612 E Lamar Blvd Arlington,TX76011 80-0272951	Mgmt Co	TX	0	0	TH Resources

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Johnson County Community Care Corp 612 E Lamar Blvd Arlington,TX76011 45-2793120	Indigent Care	TX	501(c)(3)	12a	TH Cleburne		No
(2)Huguley Medical Associates Inc 11801 South Freeway Burleson,TX76028 75-2547668	Phys Clinic	TX	501(c)(3)	3	TH Huguley		No
(3)North Texas Healthy Communities 612 E Lamar Blvd Arlington,TX76011 46-4513182	Comm Support	TX	501(c)(3)	7	TH Resources	Yes
(4)Southwestern Health Resources JOC 5323 Harry Hines Blvd Dallas,TX75390 81-1575989	Mgmt Org	TX	501(c)(3)	12b	TH Resources	Yes
(5)Texas Health Arlington Memorial Hospital 800 West Randol Mill Rd Arlington,TX76012 75-0972805	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(6)Texas Health Back Care 9229 LBJ Freeway Dallas,TX75243 47-4724257	Phys. Clinic	TX	501(c)(3)	10	TH Phys Grp		No
(7)TH Behavioral Health Hospital Corinth 612 E Lamar Blvd Arlington,TX76011 81-4317635	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(8)Texas Health Medical Support 612 E Lamar Blvd Arlington,TX76011 81-2833150	Spec Drugs	TX	501(c)(3)	10	TH Resources	Yes
(9)Texas Health Alliance 10864 Texas Health Trail Fort Worth,TX76244 45-1502252	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(10)Texas Health Azle 108 Denver Trail Azle,TX76020 75-1748586	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(11)Texas Health Cleburne 201 Walls Dr Cleburne,TX76033 75-1977850	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(12)Texas Health Fort Worth 1301 Pennsylvania Ave Fort Worth,TX76104 75-6001743	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(13)Texas Health Hurst-Euless-Bedford 1600 Hospital Parkway Bedford,TX76022 75-1438726	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(14)Texas Health Southwest Fort Worth 6100 Harris Parkway Fort Worth,TX76132 75-2678857	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(15)Texas Health Stephenville 411 Belknap Stephenville,TX76401 75-1752253	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(16)Texas Health Frisco 612 E Lamar Blvd Arlington,TX76011 83-1954982	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(17)Texas Health Mansfield 612 E Lamar Blvd Arlington,TX76011 83-1869297	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(18)Texas Health Huguley Inc 11801 S Freeway Burleson,TX76028 45-2694620	Hospital	FL	501(c)(3)	3	TH Resources	Yes
(19)TX Health Outpatient Surg Ctr Alliance 10840 Texas Health Trail Fort Worth,TX76244 80-0800294	Inactive	TX	501(c)(3)	3	TH Alliance		No
(20)Texas Health Physicians Group 9229 LBJ Freeway Dallas,TX75243 75-2613493	Phys. Clinic	TX	501(c)(3)	10	TH Resources	Yes
(21)TH Recovery and Wellness Center 240 Miller Road Mansfield,TX76063 81-2813227	Resd Trmt Ctr	TX	501(c)(3)	3	TH Resources	Yes
(22)Texas Health Resources Foundation 612 E Lamar Blvd Arlington,TX76011 75-2022128	Fundraising	TX	501(c)(3)	7	TH Resources	Yes
(23)Texas Health Allen 1105 Central Expressway N Allen,TX75013 75-2890358	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(24)Texas Health Dallas 8200 Walnut Hill Ln Dallas,TX75231 75-1047527	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(25)Texas Health Denton 3000 North Interstate 35 Denton,TX76201 43-2008974	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(26)Texas Health Kaufman 850 Ed Hall Drive Kaufman,TX75142 75-2771437	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(27)Texas Health Plano 6200 W Parker Rd Plano,TX75093 75-2770738	Hospital	TX	501(c)(3)	3	TH Resources	Yes
(28)TX Health Research & Education Institute 612 E Lamar Blvd Arlington,TX76011 75-2562191	Edu& Research	TX	501(c)(3)	4	TH Resources	Yes
(29)Texas Health Resources 612 E Lamar Blvd Arlington,TX76011 75-2702388	System Mgmt	TX	501(c)(3)	12c	NA		No
(30)TH Behavioral Health Hospital Plano 6110 W Parker Rd Plano,TX75093 81-2792484	Inactive	TX	501(c)(3)	3	TH Resources	Yes
(31)TH Behavioral Health Hospital Bedford 2717 Tibbets Dr Bedford,TX76022 81-2798838	Inactive	TX	501(c)(3)	3	TH Resources	Yes
(32)TH Specialty Hospital Fort Worth 1301 Pennsylvania Ave Fort Worth,TX76104 75-1648589	LT Hospital	TX	501(c)(3)	3	TH Resources	Yes
(33)WW Ward Endowment Fund Trust 612 E Lamar Blvd Arlington,TX76011 75-6196065	Nursing Grant	TX	501(c)(3)	12a	TH Foundatio		No
(34)Healthy Tarrant County Collaboration PO Box 8040 Fort Worth,TX76124 43-2087946	Support Org	TX	501(c)(3)	12a	NA		No
(35)Dallas County Indigent Care Corporation PO Box 655999 Dallas,TX75265 26-0610562	Support ORg	TX	501(c)(3)	12a	NA		No
(36)Tarrant County Indigent Care Corporation 612 E Lamar Blvd Arlington,TX76011 26-0648532	Support Org	TX	501(c)(3)	12a	NA		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2018

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) AMH Cath Labs LLC 811 Wright St Arlington,TX76012 20-3003947	Hospital	TX	NA
(2) Arlington Surgery Center LLC 918 N Davis Dr Arlington,TX76012 75-2055800	Amb Surg Ctr	TX	THR-sca Holding	Related	1,684,243	2,152,452		No	0	Yes		52.753 %
(3) Cleburne Imaging LLC PO Box 820519 Dallas,TX75382 46-0767278	Medical Imagi	TX	na
(4) Cleburne Surgical Center LLC 2010 W Katherine P Raines Blvd St Cleburne,TX76033 20-3742012	Amb Surg Ctr	TX	THR-SCA Holding	Related	2,352,312	2,913,659		No	0	Yes		51.000 %
(5) Denton Surgery Center LLC 207 North Bonnie Brea Denton,TX76201 47-0926556	Amb Surg Ctr	TX	THR-SCA Holding	Related	2,556,358	3,469,269		No	0	Yes		63.995 %
(6) Flower Mound Hospital Partners LLC 4400 Long Prairie Rd Flower Mound,TX75028 26-0684968	Hospital	TX	TH Resources	Related	26,911,422	74,510,757		No	2,118	Yes		53.597 %
(7) Fort Worth Endoscopy Centers LLC 900 W Magnolia Ave 101 Fort Worth,TX76104 77-0368346	Endoscopy Ctr	TX	THR-SCA Holding	Related	10,154,289	6,395,414		No	0	Yes		51.000 %
(8) FTH DFW Partners LLC 1401 E Trinity Mills Rd Carrollton,TX75006 47-3381640	Hospital/ER	TX	TH Resources	Related	-49,360,440	70,029,662		No	0		No	51.000 %
(9) Greenville Surgery Center LLC 7150 Greenville Ave Ste 200 Dallas,TX75231 74-2411643	Amb Surg Ctr	TX	THR-SCA Holding	Related	2,306,383	3,262,431		No	0	Yes		57.500 %
(10) Health Imaging Partners LLC 8610 Explorer Drive Ste 300 Colorado Springs,CO80920 27-1385885	Medical Imagi	TX	TH Resources	Related	20,101,651	34,084,481		No	0		No	51.000 %
(11) North Dallas Surgical Center LLC 17980 Dallas Parkway Ste 100 Dallas,TX75287 27-2248103	Amb Surg Ctr	TX	THR-SCA Holding	Related	1,107,577	1,596,629		No	0	Yes		51.000 %
(12) Opthalmology Surgery Center of Dallas LL 10740 N Central Expy Dallas,TX75231 26-1914835	Amb Surg Ctr	TX	THR-SCA Holding	Related	12,803,171	9,317,546		No	0	Yes		51.000 %
(13) Park Hill Surgery Center LLC 3455 Locke Ave Fort Worth,TX76107 45-1484375	Amb Surg Ctr	TX	THR-SCA Holding	Related	3,763,725	4,251,300		No	0	Yes		51.000 %
(14) Physicians Medical Center LLC 6020 W Parker Rd Plano,TX75093 48-1281376	Hospital	TX	TH Resources	Related	17,068,151	18,574,598		No	0	Yes		53.629 %
(15) Presbyterian Cancer Ctr-Dallas LLC PO Box 819067 Dallas,TX75381 26-0422749	Cancer Ctr	TX	NA
(16) Rockwall Regional Hospital LLC 3150 Horizon Rd Rockwall,TX75032 20-2848116	Hospital	TX	TH Resources	Related	15,249,232	46,053,056		No	1,597	Yes		62.038 %
(17) Southlake Specialty Hospital LLC 1545 E Southlake Blvd Southlake,TX76092 02-0555370	Hospital	TX	TH Resources	Related	9,445,158	17,504,757		No	0	Yes		54.158 %
(18) Surgical Caregivers of Fort Worth LLC 2001 W Rosedale Street Fort Worth,TX76104 75-1925497	Amb Surg Ctr	TX	THR-SCA Holding	Related	3,339,399	5,623,372		No	0	Yes		56.423 %
(19) Texas Health Craig Ranch Surgery Center 8080 State Hwy 121 Ste 100 McKinney,TX75070 38-3897811	Amb Surg Ctr	TX	THR-SCA Holding	Related	3,827,258	4,226,788		No	0	Yes		51.500 %
(20) Texas Health Spine Surgery Center Allen 1120 Raintree Cir Ste 100 Allen,TX75013 30-0957868	Amb Surg Ctr	TX	TH Resources	Related	-141,181	2,041,768		No	0	Yes		51.000 %
(21) Texas Health Spine Surgery Center Allian 1545 E Southlake Blvd Ste 100 Southlake,TX76092 32-0571301	Inactive	TX	TH Resources	Related	0	408,000		No	0	Yes		51.000 %
(22) Texas Health Orthopedic Surgery Center A 9848 North Beach St Fort Worth,TX76244 81-4977249	Amb Surg Ctr	TX	THR-SCA Holding	Related	-490,342	3,155,592		No	0	Yes		51.000 %
(23) Texas Health Surgery Center Alliance LLC 10840 Texas Health Trail Ste 100 Fort Worth,TX76244 82-2296081	Amb Surg Ctr	TX	THR-SCA Holding	Related	1,056,842	7,414,752		No	0	Yes		77.583 %
(24) Texas Health Surgery Center Bedford LLC 1605 Airport Freeway Suite 100 Bedford,TX76021 82-1307876	Amb Surg Ctr	TX	THR-SCA Holding	Related	965,246	2,548,209		No	0	Yes		51.006 %
(25) Texas Health Surgery Center Irving LLC 2120 N MacArthur Blvdd Ste 200 Irving,TX75061 83-1085415	Amb Surg Ctr	TX	THR-SCA Holding	Related	-141,012	412,923		No	0	Yes		51.000 %
(26) Texas Health Flower Mound Orthopedic Sur 5000 Long Prairie Road Flower Mound,TX75028 80-0866449	Amb Surg Ctr	TX	THR-SCA Holding	Related	4,398,283	4,897,582		No	0	Yes		51.000 %
(27) Texas Health Surgery Center Preston Plaz 17950 Preston Road Ste 75 Dallas,TX75252 20-3991622	Amb Surg Ctr	TX	THR-SCA Holding	Related	6,916,907	21,378,894		No	0	Yes		53.048 %
(28) Texas Health Surgery Center Rockwall LLC 3144 Horizon Rd Ste 120 Rockwall,TX75028 47-4425996	Amb Surg Ctr	TX	THR-SCA Holding	Related	45,952	5,089,693		No	0	Yes		51.000 %
(29) Texas Health Surgery Center South Arling 569 Brookwood Village ste 901 Birmingham,AL35209 99-9999999	Inactive	TX	THR-SCA Holding	Related	0	0		No	0	Yes		51.000 %
(30) Texas Institute for Surgery LLP 7715 Greenville Ave Ste 100 Dallas,TX75231 77-0628004	Hospital	TX	na						0
(31) THR-STT Rockwall ASC LLC 1545 E Southlake Blvd Southlake,TX76092 26-2429878	Amb Surg Ctr	TX	TH Resources	Related	2,122,761	1,734,283		No	0	Yes		67.295 %
(32) THR-STT Southlake ASC LLC 1545 E Southlake Blvd Southlake,TX76092 20-1728912	Amb Surg Ctr	TX	TH Resources	Related	3,806,600	4,136,856		No	0	Yes		85.387 %
(33) USMD Hospital at Arlington LP 801 I -20 West Arlington,TX76017 73-1662763	Hospital	TX	TH Resources	Related	6,297,224	28,525,916		No	0		No	51.000 %
(34) USMD Hospital at Fort Worth LP 5900 Altamesa Blvd Fort Worth,TX76132 20-3571243	Hospital	TX	TH Resources	Related	1,130,921	9,539,467		No	0		No	50.965 %
(35) Wilson Creek Surigcal Center LLC 8855 synergy Dr McKinney,TX75070 27-4816583	Amb Surg Ctr	TX	THR-SCA Holding	Related	3,868,575	2,502,194		No	0	Yes		51.000 %
(36) Women's Specialty Surgery Center of Dall 8230 Walnut Hill Ln Ste 101 Dallas,TX75231 27-4816583	Amb Surg Ctr	TX	na

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(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		Yes	No
(1) Grace Indemnity Company Ltd 1159 Caribbean Plaza Grand Cayman KY 1-1102 CJ 98-1209573	Captive Insur	CJ	TH Resources	C Corp	1,006,091	33,657,723	100.000 %	Yes
(2) Texas Health Biomedical Advancement Cent 612 E Lamar Blvd Arlington,TX76011 75-2636884	Research	TX	NA	C Corp					No
(3) THR Primary Care Ext Physcian Network 612 E Lamar Blvd Arlington,TX76011 46-5365421	Inactive	TX	TH Resources	C Corp	0	0	100.000 %	Yes
(4) Charitable Remainder Trusts (4) 612 E Lamar Blvd Arlington,TX76011	CR Trust	TX	NA	Trust					No

Schedule R (Form 990) 2018

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on 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

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 .....................

Yes

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

Yes

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

Yes

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

Yes

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

f Dividends from related organization(s) ............................

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

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

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

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

Yes

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

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

Yes

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Fort Worth Endoscopy Center LLC	a	656,110	Lease
(2) Health Imaging Partners LLC	a	323,321	Lease
(3) Texas Health Spine Surgery Center Allen LLC	a	28,910	Lease
(4) Texas Health Surgery Center Alliance LLC	a	763,534	Lease
(5) Flower Mound Hospital Partners LLC	c	24,334,521	JV Agreement
(6) Fort Worth Endoscopy Center LLC	c	9,912,170	JV Agreement
(7) Greenville Surgery Center LLC	c	2,039,568	JV Agreement
(8) Health Imaging Partners LLC	c	17,848,811	JV Agreement
(9) Physician Medical Center LLC	c	17,011,843	JV Agreement
(10) Rockwall Regional Hospital LLC	c	12,436,838	JV Agreement
(11) Southlake Specialty Hospital LLC	c	9,405,597	JV Agreement
(12) Surgical CareGivers of Fort Worth LLC	c	3,272,044	JV Agreement
(13) Texas Health Craig Ranch Surgery Center LLC	c	4,285,630	JV Agreement
(14) TH Flower Mound Orthopedic Surgery Center	c	4,102,627	JV Agreement
(15) Texas Health Surgery Center Preston Plaza LLC	c	6,945,285	JV Agreement
(16) THRSTT Rockwall ASC LLC	c	2,222,525	JV Agreement
(17) THRSTT Southlake ASC LLC	c	3,644,772	JV Agreement
(18) USMD Hospital at Arlington LP	c	4,200,442	JV Agreement
(19) USMD Hospital at Fort Worth LP	c	401,361	JV Agreement
(20) Wilson Creek Surgical Center LLC	c	3,728,545	JV Agreement
(21) North Dallas Surgical Center LLC	c	1,036,437	JV Agreement
(22) Opthalmology Surgery Center of Dallas	c	11,973,795	JV Agreement
(23) Park Hill Surgery Center LLC	c	2,032,441	JV Agreement
(24) Texas Health Surgery Center Bedford LLC	c	238,436	JV Agreement
(25) Cleburne Surgical Center LLC	c	2,453,108	JV Agreement
(26) Arlington Surgery Center LLC	c	1,602,082	JV Agreement
(27) Texas Health Surgery Center Alliance LLC	b	408,000	JV Agreement
(28) Texas Health surgery Center Bedford LLC	b	408,218	JV Agreement
(29) Cleburne Surgical Center LLC	l	169,414	Monthly Billing
(30) Greenville Surgery Center LLC	l	141,310	Monthly Billing
(31) Health Imaging Partners LLC	l	1,740,001	Monthly Billing
(32) North Dallas Surgical Center LLC	l	121,135	Monthly Billing
(33) Opthalmology Surgery Center of Dallas LLC	l	316,991	Monthly Billing
(34) Physicians Medical Center LLC	l	4,415,725	Monthly Billing
(35) Rockwall Regional Hospital LLC	l	9,221,321	Monthly Billing
(36) Surgical Caregivers of Fort Worth	l	195,915	Monthly Billing
(37) Southlake Specialty Hospital LLC	l	4,748,522	Monthly Billing
(38) Denton Surgery Center LLC	l	139,662	Monthly Billing
(39) THR-STT Southlake ASC LLC	l	100,000	Monthly Billing
(40) Fort Worth Endoscopy Center LLC	l	401,595	Monthly Billing
(41) Texas Health Craig Ranch Surgery Center LLC	l	102,888	Monthly Billing
(42) TH Flower Mound Orthopedic Surgery Ctr LLC	l	186,844	Monthly Billing
(43) TH Surgery Center Preston Plaza LLC	l	357,617	Monthly Billing
(44) USMD Hospital at Arlington LP	l	100,000	Monthly Billing
(45) USMD Hospital at Fort Worth LP	l	100,000	Monthly Billing
(46) Wilson Creek Surgical Center LLC	l	164,112	Monthly Billing
(47) Flower Mound Hospital Partners LLC	l	11,662,149	Monthly Billing
(48) Denton Surgery Center LLC	q	71,005	Interco Billing
(49) Flower Mound Hospital Partners LLC	q	726,550	Interco Billing
(50) Fort Worth Endoscopy Center LLC	q	150,031	Interco Billing
(51) Health Imaging Partners	q	587,662	Interco Billing
(52) Physicians Medical Center LLC	q	452,385	Interco Billing
(53) Rockwall Regional Hospital LLC	q	555,267	Interco Billing
(54) Southlake Specialty Hospital LLC	q	343,890	Interco Billing
(55) Texas Health Craig Ranch Surgery Ctr LLC	q	82,238	Interco Billing
(56) TH Flower Mound Orthopedic Surgery Ctr LLC	q	83,349	Interco Billing
(57) TH Surgery Center Preston Plaza LLC	q	127,275	Interco Billing
(58) THR-STT Southlake ASC LLC	q	53,213	Interco Billing
(59) Wilson Creek Surgical Center LLC	q	64,961	Interco billing
(60) Arlington Surgery Center LLC	l	140,115	Interco Billing
(61) Park Hill Surgery Center LLC	l	273,858	Interco Billing
(62) Texas Health Surgery Center Alliance LLC	l	111,609	Interco Billing
(63) Flower Mound Hospital Partners LLC	l	11,662,149	Interco Billing
(64) Texas Health Surgery Center Bedford LLC	l	91,472	Interco Billing
(65) Opthalmology Surgery Center of Dallas LLC	q	203,668	Interco Billing
(66) Cleburne Surgical Center LLC	q	63,990	INterco Billing
(67) TH Orthopedic Surgery Center Alliance LLC	b	1,020,000	Interco Billing
(68) Surgical Caregivers of Fort Worth	q	80,431	Interco Billing
(69) Texas Health Surgery Center Irving LLC	b	491,951	Interco Billing
(70) Texas Health Surgery Center Rockwall LLC	b	826,011	Interco Billing
(71) Denton Surgery Center LLC	c	2,971,217	Interco Billing
(72) Ophthalmology Surgery Ctr of Dallas LLC	d	95,000	Interco Billing
(73) Grace Indemnity Company LTD	R	11,761,689	Cash Trans.
(74) Grace Indemnity Company LTD	S	16,119,156	Cash Trans.
(75) TH Surgery Center Alliance LLC	l	157,500	Interco Billing
(76) Texas Health Surgery Center Irving LLC	l	112,500	Interco Billing
(77) Texas Health Surgery Center Rockwall LLC	l	84,952	Interco Billing

Schedule R (Form 990) 2018

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2018

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference

Explanation

Schedule R, Part V, Line 2 - Related Transaction

Texas Health Resources (THR) is the parent organization of a large healthcare system made up of both wholly owned entities as well as related controlled joint ventures as listed on Schedule R. THR's role is to plan, manage and coordinate the activities of the affiliated healthcare system in order to maximize opportunities to deliver cost effective quality medical care to residents of north central Texas. THR provides direction and oversight to its wholly owned affiliates through centralized services. They also provide oversight for the controlled joint ventures. As an integral part of providing centralized services to the affiliates, THR maintains intercompany receivable/payable accounts, most of which do not fall within the scope of IRC Section 512(b)(13). The range of centralized services provided by THR include information services, managed care contracting, Human Resources, revenue cycle, billing and collections, patient access/admissions, legal, tax, compliance, supply chain, quality, business development, insurance, treasury, marketing, general accounting, real estate services, coding, transcription and strategic planning. In addition, THR does daily cash sweeps of all controlled tax exempt entity cash accounts. As a result, THR has numerous daily transactions with controlled tax exempt entities, none of which fall within the scope of IRC Section 512(b)(13). A management fee is charged for the centralized services and reported on Form 990, Part VII, Section B as a professional services fee. Transactions with related tax exempt organizations falling within the meaning of centralized services as described above, are not listed on Schedule R, Part V, Line 2.

Schedule R (Form 990) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Through its affiliates, THR operates an integrated healthcare system with services and facilities throughout north central texas to improve healthcare.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	16
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	15
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	4,765
6	Total number of volunteers (estimate if necessary) .............	6	15
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	15,051,046
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	1,473,681

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,886,823	2,272,683
9	Program service revenue (Part VIII, line 2g) .........	779,906,688	807,584,279
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	275,809,442	307,188,248
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	12,591,768	8,913,694
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	1,070,194,721	1,125,958,904
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	766,174	11,532,911
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)	338,957,953	354,694,640
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	340,404,354	356,275,243
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	680,128,481	722,502,794
19	Revenue less expenses. Subtract line 18 from line 12.......	390,066,240	403,456,110
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	6,325,783,685	6,365,601,470
21	Total liabilities (Part X, line 26).............	2,342,827,516	2,396,545,092
22	Net assets or fund balances. Subtract line 21 from line 20.....	3,982,956,169	3,969,056,378

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 722,502,794 including grants of $ 11,532,911 ) (Revenue $ 811,511,874 )
	Founded in 1997, Texas Health Resources (THR) provides direction and oversight to its wholly-controlled affiliates. The range of centralized services provided by THR include information services, managed care contracting, human resources, revenue cycle, legal, tax, compliance, supply chain, business development, insurance, treasury, marketing, general accounting, and strategic planning. THR operates professional office buildings leased primarily to physicians who are members of the medical staff of THR affiliated hospitals. THR also operates, manages and coordinates physician services through Texas Health Physicians Group (THPG), a wholly owned affiliate of THR. THPG is a network of primary and specialty care physician practices providing the north Texas area community access to quality health care delivered either through an office setting or through a hospital program.

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses722,502,794

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	28,918,035	443,478	4,060,425

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	2,272,683
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		2,272,683

		Business Code
2a	MANAGEMENT FEE	622110	595,762,336	583,828,901	11,933,435
b	JV ACTIVITY	622110	143,638,571	141,863,918	1,774,653
c	RENTAL FEE	531120	66,526,659	66,526,659
d	INCENTIVE/RISK SHARING	622110	1,517,773	1,517,773
e	EDUCATION REVENUE	624190	138,940	138,940
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		807,584,279

3 Investment income (including dividends, interest, and othersimilar amounts) ......			101,610,373			101,610,373
4 Income from investment of tax-exempt bond proceeds			1,134,692			1,134,692
5 Royalties...........			1,146,870			1,146,870
		(ii) Personal	(i) Real
6a	Gross rents		1,060,101
b	Less: rental expenses		1,303
c	Rental income or (loss)	0	1,058,798
d	Net rental income or (loss)......			1,058,798		138,217	920,581
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		1,901,228,141
b	Less: cost or other basis and sales expenses	2,020,355	1,694,764,603
c	Gain or (loss)	-2,020,355	206,463,538
d	Net gain or (loss).....			204,443,183			204,443,183
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		0
b	Less: cost of goods sold ..b		0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	SUPPLY CHAIN MGMT		541614	2,662,116	2,435,198	226,918
b	MEDICAL RECORDS		812990	1,474,163			1,474,163
c	TELECOMMUNICATIONS		517100	982,535	4,712	977,823
d	All other revenue ....			1,589,212	1,487,685		101,527
e	Total. Add lines 11a–11d ......			6,708,026
12	Total revenue. See Instructions......			1,125,958,904	797,803,786	15,051,046	310,831,389

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	11,532,911	11,532,911
2	Grants and other assistance to domestic individuals. See Part IV, line 22	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	28,717,807	28,717,807
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	256,452,691	256,452,691	0	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	12,910,744	12,910,744
9	Other employee benefits .......	37,416,787	37,416,787
10	Payroll taxes ...........	19,196,611	19,196,611
11	Fees for services (non-employees):
a	Management ......	28,234,600	28,234,600
b	Legal .........	4,651,160	4,651,160
c	Accounting ...........	2,249,034	2,249,034
d	Lobbying ...........	388,822	388,822
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	16,965,073	16,965,073
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	59,627,628	59,627,628
12	Advertising and promotion ....	9,630,275	9,630,275
13	Office expenses .......	9,892,110	9,892,110
14	Information technology ......	87,360,499	87,360,499
15	Royalties ..	0
16	Occupancy ...........	29,958,051	29,958,051
17	Travel ............	1,834,333	1,834,333
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	1,034,339	1,034,339
20	Interest ...........	38,592,278	38,592,278
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	44,106,657	44,106,657
23	Insurance ...	502,904	502,904
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	REPAIRS & MAINTENANCE	7,391,384	7,391,384
b	LICENSE/DUES EXPENSE	4,709,277	4,709,277
c	BAD DEBTS	2,530,071	2,530,071
d	SUPPLIES	2,397,676	2,397,676
e	All other expenses	4,219,072	4,219,072
25	Total functional expenses. Add lines 1 through 24e	722,502,794	722,502,794	0	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			15,912,728	1	25,043,482
2	Savings and temporary cash investments .........			384,815,090	2	389,543,050
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			105,018,992	4	114,369,901
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
				3,397,546	5	3,369,957
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 ....			8,036,653	7	9,931,233
8	Inventories for sale or use ........			8,364,715	8	8,850,459
9	Prepaid expenses and deferred charges ......			54,414,176	9	49,938,295
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,293,696,770
b	Less: accumulated depreciation	10b	642,368,002	538,233,064	10c	651,328,768
11	Investments—publicly traded securities .			4,584,502,432	11	4,414,399,456
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			405,817,240	13	473,974,119
14	Intangible assets ...............			60,320,259	14	44,069,633
15	Other assets. See Part IV, line 11 ...........			156,950,790	15	180,783,117
16	Total assets. Add lines 1 through 15 (must equal line 34)...			6,325,783,685	16	6,365,601,470

17	Accounts payable and accrued expenses .....	273,715,360	17	345,168,031
18	Grants payable ...	270,912	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	1,373,712,751	20	1,370,755,755
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 ..	560,992,350	23	547,653,518
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	134,136,143	25	132,967,788
26	Total liabilities. Add lines 17 through 25..	2,342,827,516	26	2,396,545,092

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	3,982,956,169	27	3,969,056,378
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 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 ...........	3,982,956,169	33	3,969,056,378
34	Total liabilities and net assets/fund balances ........	6,325,783,685	34	6,365,601,470

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No