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As a hospital system with multiple facilities in a major metropolitan area, our efforts are focused on meeting the needs of the greater community versus individual efforts associated with individual facilities. By focusing on fewer, larger endeavors, the long term impact on the Houston community's health status is greater than it would be on an individual basis."},{"form_and_line_reference":"Schedule H Part I Line 7","explanation":"Line 7a - Financial Assistance at cost is calculated as charity charges times CCR per worksheet 2. Line 7b - Medicaid is calculated as Medicaid charges times CCR per worksheet 2. Line 7c- Costs of other means-tested government programs is calculated as low income government charges times CCR per worksheet 2. Line 7f- Health professions education is out patient physician/paramedical teaching expenses and revenues as reported per the Medicare Cost Report. Line 7h- Research is research dollars serving the community. The amount comes directly from the Medicare Cost Report."},{"form_and_line_reference":"Schedule H Part III Section A, Line 4","explanation":"Memorial Hermann Healthcare System's recorded allowances for bad debt are based on expected net collections, after contractual adjustments, primarily from patients. Management routinely assesses these recorded allowances relative to changes in payor mix, cash collections, write-offs, recoveries, and market dynamics. Unpaid accounts are written off as bad debts upon reaching delinquent status."},{"form_and_line_reference":"Schedule H Part III Section B, Line 8","explanation":"While we are not a proponent of capturing Medicare Shortfall as a community benefit, we do concede that we do serve the senior population as a part of our mission to improve the health of the greater Houston area, and with that fact we know that 6.9% of our Inpatient Medicare Days are from SSI individuals. SSI represents the low income seniors, so you could make the case that 6.9% of this number is the portion serving the low income seniors. Supplemental Security Income (SSI) is a Federal income supplement program funded by general tax revenues (not Social Security taxes): It is designed to help aged, blind, and disabled people, who have little or no income; and it provides cash to meet basic needs for food, clothing, and shelter. The cost calculated on line 6, is using the RCC reported on worksheet 2 extended against the Medicare billed charges for this Hospital provider. This methodology was used to be consistent with the other reported cost number in this filing."},{"form_and_line_reference":"Schedule H Part III Section C, Line 9 b","explanation":"If there is no coverage by a third party and the responsible party cannot pay any or part of the balance due or make acceptable financial arrangements, assistance is provided to the responsible party to complete financial assistance application forms, including application for Medicaid, Crime Victims Compensation, Harris County Hospital District or County Indigent Programs where appropriate. 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JONES, DIRECTOR OF THE CENTER FOR RESEARCH ON MINORITY HEALTH, UNIVERSITY OF TEXAS M.D. ANDERSON CANCER CENTER; JULIE MARTINEAU, PRESIDENT OF THE UNITED WAY OF MONTGOMERY COUNTY; STEVE MCKERNAN, CEO OF LONE STAR FAMILY HEALTH CENTER; DR. HERMINIA PALACIO, EXECUTIVE DIRECTOR OF THE HEALTH AUTHORITY FOR HARRIS COUNTY AND HARRIS COUNTY PUBLIC HEALTH AND ENVIRONMENTAL SERVICES; CATHY SBRUSCH, DIRECTOR OF PUBLIC HEALTH SERVICES, BRAZORIA COUNTY HEALTH DEPARTMENT; AND STEPHEN WILLIAMS, DIRECTOR - DEPARTMENT OF HEALTH AND HUMAN SERVICES, CITY OF HOUSTON. MEMORIAL HERMANN ALSO INCLUDED IN THE CHNA, FINDINGS FROM AN ELECTRONIC SURVEY DISTRIBUTED TO 550 INDIVIDUALS/ORGANIZATIONS WHO ARE MEMBERS OF THE GATEWAY TO CARE COLLABORATIVE IN HOUSTON."},{"form_and_line_reference":"Schedule H Part V Section B Line 6i","explanation":"The CHNA was completed in Spring 2013 following the period covered in this Schedule H. The CHNA was completed before the June 30, 2013 fiscal year end of Memorial Hermann and its affiliates and would have been the fiscal year end of TIRR if not for the merger of TIRR into Memorial Hermann Hospital System effective December 31, 2012 with Memorial Hermann Hospital System being the surviving entity. The Implementation Plan was finalized in the second quarter of calendar year 2013 and progress will be reported on in subsequent reports as required."},{"form_and_line_reference":"Schedule H Part V Section B Line 7","explanation":"DURING THE CHNA, THE FOLLOWING EIGHT PRIORITIES WERE IDENTIFIED: 1.)EDUCATION AND PREVENTION FOR DISEASES AND CHRONIC CONDITIONS; 2.) ADDRESS ISSUES WITH SERVICE INTEGRATION, SUCH AS COORDINATION AMONG PROVIDERS AND THE FRAGMENTED CONTINUUM OF CARE; 3.) ADDRESS BARRIERS TO PRIMARY CARE, SUCH AS AFFORDABILITY AND SHORTAGE OF PROVIDERS; 4.) ADDRESS UNHEALTHY LIFESTYLES AND BEHAVIORS; 5.) ADDRESS BARRIERS TO MENTAL HEALTHCARE, SUCH AS ACCESS TO SERVICES AND SHORTAGE OF PROVIDERS; 6.) DECREASE HEALTH DISPARITIES BY TARGETING SPECIFIC POPULATIONS; 7.) INCREASED ACCESS TO AFFORDABLE DENTAL CARE; 8.) INCREASED ACCESS TO TRANSPORTATION. 2.)TIRR MEMORIAL HERMANN WILL ADDRESS THE TOP SIX OF THOSE EIGHT NEEDS. THE NEED FOR \"INCREASED ACCESS TO AFFORDABLE DENTAL CARE\" AND THE NEED FOR \"INCREASED ACCESS TO TRANSPORTATION,\" ARE NOT ADDRESSED LARGELY DUE TO THEIR POSITIONS (LAST AND SECOND TO LAST) ON THE PRIORITIZED LIST, THE FACT THAT DENTAL AND TRANSPORTATION SERVICES ARE NOT CORE BUSINESS FUNCTIONS OF THE HEALTH SYSTEM AND THE LIMITED CAPACITY OF EACH HOSPITAL TO ADDRESS THOSE NEEDS. FURTHERMORE, THE HOSPITALS DO NOT HAVE THE EXPERTISE TO ADDRESS ACCESS TO TRANSPORTATION, AND THE SYSTEM VIEWS THIS ISSUE AS A LARGER CITY AND COUNTY INFRASTRUCTURE RELATED CONCERN. MEMORIAL HERMANN FULLY SUPPORTS LOCAL GOVERNMENTS IN THEIR EFFORTS TO IMPACT THESE ISSUES."},{"form_and_line_reference":"Schedule H Part V Section B line 15","explanation":"Full policy available upon request, signage declaring that we have a policy and how to access the benefit are located in ER and admission points."},{"form_and_line_reference":"Schedule H Part V Section B line 16","explanation":"We do use reporting to credit agencies and lawsuits when there is a liability claim (i.e. Motor vehicle accidents), but these are only put into play AFTER we have made reasonable efforts to determine FAP ineligibility. In situations where FAP is deemed to be available, these efforts are not used."},{"form_and_line_reference":"Schedule H Part V Section B Line 20d","explanation":"ELIGIBILITY GUIDELINES A. Financial Indigents (Patient portion ZERO) 1. Financially Indigent shall refer to a person who has no insurance and whose annual gross income qualifies the person to receive assistance on a sliding scale basis according to the Memorial Hermann Gross Income Eligibility Table which is adjusted periodically pursuant to revisions of the Federal Poverty Guidelines. 2. In no event will Memorial Hermann (the system) establish eligibility income level criteria for financially indigent patients for charity care lower than criteria required under the Texas Indigent Health Care and Treatment Act or higher than 200 percent of the Federal Poverty Income Guidelines or higher than applicable law requires. The System may, however, adjust the eligibility for charity care criteria from time to time based on the financial resources of the System and as necessary to meet legal requirements and the charity care needs of the community. 3. Co-payments may be indicated for patients, however at no time should the Co-Payment be allowed to discourage a patient from receiving medically necessary care, particularly in an urgent or emergency situation. B. Medically Indigent (Patient portion sliding scale) 1. Medically Indigent in most cases will be a patient for whom the balance of the hospital bill exceeds 20% of the person's annual gross income and who is unable to pay all or a portion of the bill balance resulting from a catastrophic illness or injury. 2. If the patient's annual gross household income exceeds four hundred percent (400%) of the Federal Poverty Guidelines and the hospital bill is over two times the patient's annual income, the patient will be responsible for the amount of the bill not less than 20% of the patient's annual gross income or 10% of the balance whichever is greater. However, the total responsibility will not be less than 20% of the patient's annual gross income. 3. If a determination is made that a patient has the ability to pay all or a portion of the remainder of the bill, such a determination does not prevent a re-assessment of the patient's ability to pay at a later date. 4. If an uninsured patient's income exceeds one hundred percent (100%) of the poverty guidelines but does not exceed four hundred percent (400%) of the current Federal Poverty Guidelines the patient will be responsible for a percentage of the bill balance or co-pay. The patient's percentage will be based on a sliding scale listed on the Hospital's Gross Annual Income Eligibility requirements."},{"form_and_line_reference":"Schedule H Part VI, Line 2","explanation":"Each decision made by Memorial Hermann to invest its people, resources, and talents in community benefit efforts is data driven. Given that 30% of the Houston area is uninsured, numerous community needs analyses center around the University of Texas School of Public Health's Houston Area Hospital's Emergency Department Use Study, which Memorial Hermann has participated in since 2003. The study monitors hospital emergency department use in Houston hospitals and is a data source for numerous assessments to understand primary care-related ER use including the characteristics of these patients; particularly those who are children, who are uninsured, and who have Medicaid. The study conducted in 2012 shows that 40.9% of all ER visits and 48.6% of all treated and released ER visits are primary care related. With the desire to change emergency room use comes the need to identify available capacity of our existing safety-net clinics, and what is needed by each entity to increase its capacity to be able to respond to changes in ER usage our community efforts achieve. This study, the Greater Houston Clinic Capacity Analysis, performed in early 2012 by Project Safety-Net and University of Texas School of Public Health, indicates that the community clinics are currently meeting about 30 percent of the demand for primary care visits by the low-income population and the rest is either met by private practice physicians or is left unmet. Further, the study anticipates that safety net providers will only be able to meet 25 percent of the demand under the Affordable Care Act (ACA). It is important to be concerned because a shortage of primary care leads to more people experiencing serious illness requiring expensive specialty care, emergency services and hospitalization. AS REQUIRED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT-SECTION 501 (r) (3)-REQUIREMENT OF THE ACA, MEMORIAL HERMANN has CONDUCTED COMMUNITY NEEDS ASSESSMENTS FOR EACH OF ITS 11 HOSPITALS. THE STUDIES INCLUDED DEMOGRAPHIC DATA OF HARRIS, FORT BEND, MONTGOMERY, AND BRAZORIA COUNTIES (COUNTIES THAT COMPOSE 89% OF MEMORIAL HERMANN DISCHARGES. THE GOAL OF THE ASSESSMENT WAS TO CLARIFY THE HEALTH NEEDS OF MEMORIAL HERMANN TIRR'S STUDY AREA, DEFINED AS HARRIS COUNTY THAT REPRESENTS 46.3% OF THE HOSPITAL'S INPATIENT DISCHARGES. RECOGNIZED AS ONE OF THE LEADING REHABILITATION HOSPITALS IN THE COUNTRY, TIRR MEMORIAL HERMANN SERVES AS A MODEL SYSTEM FOR INTERDISCIPLINARY REHABILITATION SERVICES, PATIENT CARE, EDUCATION AND A CENTER OF RESEARCH. PATIENTS ARE REFERRED ON A LOCAL, STATEWIDE, NATIONAL AND GLOBAL BASIS. THE ANALYSIS INCLUDED A CAREFUL REVIEW OF THE MOST CURRENT HEALTH DATA AVAILABLE AND INPUT FROM NUMEROUS COMMUNITY REPRESENTATIVES WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH. FINDINGS INDICATED THAT THERE WERE EIGHT MAIN NEEDS IN THE COMMUNITIES SERVED BY TIRR MEMORIAL HERMANN. THE CHNA TEAM, CONSISTING OF LEADERSHIP FROM MEMORIAL HERMANN HEALTH SYSTEM (MEMORIAL HERMANN), PRIORITIZED THOSE EIGHT NEEDS BY STUDYING THEM WITHIN THE CONTEXT OF THE HOSPITAL'S OVERALL STRATEGIC PLAN AND THE AVAILABILITY OF FINITE RESOURCES, WITH THE FOLLOWING PRIORITIZATION, IN DESCENDING ORDER, RESULTING: 1.) EDUCATION AND PREVENTION FOR DISEASES AND CHRONIC CONDITIONS; 2.) ADDRESS ISSUES WITH SERVICE INTEGRATION, SUCH AS COORDINATION AMONG PROVIDERS AND THE FRAGMENTED CONTINUUM OF CARE; 3.) ADDRESS BARRIERS TO PRIMARY CARE, SUCH AS AFFORDABILITY AND SHORTAGE OF PROVIDERS; 4.) ADDRESS UNHEALTHY LIFESTYLES AND BEHAVIORS; 5.) ADDRESS BARRIERS TO MENTAL HEALTHCARE, SUCH AS ACCESS TO SERVICES AND SHORTAGE OF PROVIDERS; 6.) DECREASE HEALTH DISPARITIES BY TARGETING SPECIFIC POPULATIONS; 7.) INCREASED ACCESS TO AFFORDABLE DENTAL CARE; 8.) INCREASED ACCESS TO TRANSPORTATION. THIS IMPLEMENTATION PLAN ADDRESSES THE TOP SIX OF THOSE EIGHT NEEDS. THE NEED FOR \"INCREASED ACCESS TO AFFORDABLE DENTAL CARE\" AND THE NEED FOR \"INCREASED ACCESS TO TRANSPORTATION,\" ARE NOT ADDRESSED LARGELY DUE TO THEIR POSITIONS (LAST AND SECOND TO LAST) ON THE PRIORITIZED LIST, THE FACT THAT DENTAL AND TRANSPORTATION SERVICES ARE NOT CORE BUSINESS FUNCTIONS OF THE HEALTH SYSTEM AND THE LIMITED CAPACITY OF EACH HOSPITAL TO ADDRESS THOSE NEEDS. FURTHERMORE, THE HOSPITALS DO NOT HAVE THE EXPERTISE TO ADDRESS ACCESS TO TRANSPORTATION, AND Memorial Hermann VIEWS THIS ISSUE AS A LARGER CITY AND COUNTY INFRASTRUCTURE RELATED CONCERN. MEMORIAL HERMANN FULLY SUPPORTS LOCAL GOVERNMENTS IN THEIR EFFORTS TO IMPACT THESE ISSUES."},{"form_and_line_reference":"Schedule H Part VI, Line 3","explanation":"All Memorial Hermann Acute Care facilities and Rehab facilities have Third Party Qualification vendors on-site. Once someone requests or a financial counselor has determined through interaction with the patient and/or guarantor that the patient cannot pay for services, the patient/guarantor is referred to the Eligibility vendor on-site to screen for any Federal/State/Local Government program which may cover their services. These vendors act as agents for the patient/guarantor and may at times go to hearings for Medicaid or Disability as a legal representative of the patient. Also, all our entities, including service lines, have posted notices of a patient's right to request charity. Our statements that are sent to patients have documentation on the back informing the patient of Memorial Hermann's Charity policy and their right to request such, (in English and Spanish). Accounts are referred to be processed either on a real time basis by the hospital staff while the patient is still in the hospital or by electronic referral via data download which occur weekly and after the patient has been discharged. The goal is to make contact with the patient for financial screening to determine eligibility for governmental assistance as soon as possible. TIRR Memorial Hermann has embedded case managers and social workers in the hospital-based physician clinic to help patients with their doctors and needs. TIRR Memorial Hermann inpatients and outpatients require a great deal of assistance with a wide range of resources, and case management plays a significant role in providing supportive services to each patient. Social workers provide not only case management, but behavioral counseling as well. If needed, social workers can refer patients to TIRR Memorial Hermann's psychiatrist. Counseling services are available to families as well as to patients."},{"form_and_line_reference":"Schedule H Part VI, Line 4","explanation":"Memorial Hermann serves \"greater Houston,\" a multi-county area along the Gulf Coast in southeast Texas-where several counties are without hospital district services. The 5th largest metropolitan area in the United States, greater Houston is one of the fastest growing with a population of 6 million. A source of strength in a global economy, Houston prizes its racial and ethnic diversity. According to U.S. Census 2010 estimates, Houston is 25.6% White, 43.8% Hispanic, 23.7% Black or African American, 0.7% Native American, and 6.2% Asian/Pacific Islander. More than 45% of individuals ages five and up are living in homes where English is not the primary language. Per capita income is $25,927. In Houston, 21.5% of all residents are living below the poverty line-21% higher than the rate for Texas. Only 28.4% of the population, age 25+, has a college degree. So vital to the well-being of individuals and families, the Houston area's unemployment rate is 6.1% down from its highest level in February 2010 at 8.6%. Rated as a global city, Houston's economy has a broad industrial base in energy, manufacturing, aeronautics, and transportation. It is also a leader in the health care sector and oilfield equipment. The largest employers in the community include: Memorial Hermann Healthcare System (20,000 employees); The University of Texas M.D. Anderson Cancer Center (15,000 employees); ExxonMobil (13,000 employees); Shell Oil Company (13,000 employees); and Kroger Company (12,000 employees). The greater Houston area is one of the hardest hit areas in the \"uninsured\" healthcare crisis--thirty percent of Houston's residents are uninsured. In comparison, Texas's uninsured rate-the highest ever recorded in the nation--is 25.5% compared to 17% nationwide. Houston's fast-growing Hispanic population accounts for a large percentage of uninsured residents. The rising rate of obesity is the single biggest threat to the greater Houston area-more than one in four greater Houston residents is obese. Health education and prevention and increased access to healthcare are vital to improving the overall health of residents whose leading causes of health issues are mental health problems, diabetes, obesity (adult), obesity (children), substance abuse, heart disease/stroke, cancer and high blood pressure. The most prevalent chronic diseases are diabetes, obesity, high blood pressure, cancer, heart failure, asthma and alzheimer's."},{"form_and_line_reference":"Schedule H Part VI Line 5","explanation":"Memorial Hermann's Promotion of Community Health includes activities conducted by Memorial Hermann staff for patients and the general public that promote disease prevention and education activities as well as healthy living and overall well-being such as: health fairs; state-of-the-art disease screenings; health education conferences, seminars and webinars; support groups for a variety of diseases and health issues; newsletters, brochures and websites designed to provide community health information; employee participation in walks, marathons, and the MS150; strong referral patterns and connections with community resources and medical homes; and, recruitment of physician specialties that fill an identified community need . To expand its community reach, these Memorial Hermann activities are often held in partnership with healthcare agencies, nonprofit organizations, workplaces, school districts, and civic associations. Memorial Hermann also provides educational opportunities for health professionals. Memorial Hermann's employee base is a leader in United Way contributions, Gulf Coast blood drives; and food, clothing, and toy donations. TIRR Memorial Hermann provides promotion of community health activities specific to its patient population. TIRR Memorial Hermann provides comprehensive medical rehabilitation for individuals who have experienced: traumatic brain injury, stroke, spinal cord injury, amputation, multiple trauma, multiple sclerosis, Parkinson's disease, other neurological or neuromuscular disorders, and complex orthopedic injuries. A national leader in medical rehabilitation and research, TIRR Memorial Hermann transforms lives and inspires hope in people whose lives have been significantly altered by an illness or injury. TIRR Memorial Hermann's community needs the same education and access to prevention programs for the chronic diseases of diabetes, heart disease, cancer, and Alzheimer's as the general population, however TIRR Memorial Hermann's focuses on addressing education and prevention of the health conditions of this specialty hospital's expertise. Nevertheless, the interrelated chronic conditions of diabetes, heart disease, cancer, and Alzheimer's can be escalating secondary conditions, and must be addressed, if not through direct services, then through an effective referral network such as Memorial Hermann Health System provides. TIRR Memorial Hermann has a growing hospital-based physician clinic, intended as a rehabilitation medical home, which provides TIRR Memorial Hermann patients with access to primary care as well as cardiology, psychiatry, podiatry, dental, gynecology, and urology care not only under one roof, but with physicians who are comfortable treating them. By creating support for co-morbidities and creating a medical home environment, patients have increased primary care and specialty accessibility and reduced emergency room usage. In FY 2012, TIRR Memorial Hermann provided the following programs to patients, community members, and industry professionals: Rehabilitation Solutions: An annual conference for nurses, social workers, case managers, certified disability management specialists and certified rehabilitation counselors to provide education on advances in rehabilitation, readmission prevention and continuity of care - 200 individuals participated. Internships/teaching sites for over 100 schools world-wide, in several disciplines. Training is provided to medical/allied healthcare professionals in the field of rehabilitation so that individuals are better able to serve those with disabilities, advance the continuum of care and become informed on how rehabilitation affects healthcare. Support Groups: Parkinson's, Stroke, Brain Injury, and Spinal Cord Injury. A full-time librarian staffs the TIRR Memorial Hermann resource library that provides current information on brain and neurological impairments and spinal cord injuries, assists with signing up for community resources, and provides journal articles for those doing research or for those looking into new techniques for clinical care. Up to date website on Caregiver and Community Resources dedicated to community education and research on brain injury and stroke."},{"form_and_line_reference":"Schedule H Part VI, Line 6","explanation":"Memorial Hermann Healthcare System is the largest not-for-profit healthcare system in Texas and serves the greater Houston community through (11) hospitals, a vast network of affiliated physicians and numerous specialty programs and services. Life-saving facilities include: Memorial Hermann-Texas Medical Center, the teaching hospital for The University of Texas Medical School at Houston and home of one of the nation's busiest Level I trauma centers; (8) suburban hospitals; (3) premier Heart & Vascular Institutes; TIRR Memorial Hermann, one of the nation's top rehabilitation and research hospitals; Children's Memorial Hermann Hospital; the Memorial Hermann Sports Medicine Institute; the Mischer Neuroscience Institute; (7) Cancer Centers; (23) Imaging Centers; (7) sports medicine and rehabilitation centers; (21) diagnostic laboratories; PaRC, a substance abuse treatment center; (1) retirement/ nursing center; and (1) home health agency. Memorial Hermann operates the Life Flight air ambulance program and the city's only burn treatment center. In January 2012, Memorial Hermann Healthcare System was the only hospital system in Houston and one of only two in Texas named one of the nation's top 15 health systems by Thomson Reuters, a leading provider of information and solutions to improve the cost and quality of healthcare. Memorial Hermann has 3,364 licensed beds; 20,000 full-time employees; 9,824 medical staff members; 1,712 physicians-in-training (residents and fellows), and 2,517 volunteers providing 304,333 hours. Memorial Hermann is governed by 13 Boards of Directors totaling 143 members representative of the greater Houston business, healthcare and community leadership. Memorial Hermann's annual services include: 130,598 admissions; 924,764 outpatient visits; 79,275 outpatient surgeries; 450,010 emergency visits; 23,111 deliveries; and 3,197 Life Flight air ambulance missions. Memorial Hermann takes a leadership role in regional efforts to improve the health and quality of life of the community."},{"form_and_line_reference":"Schedule H Part VI Line 7","explanation":"Memorial Hermann Healthcare System files a community benefit report in Texas that is available on the website http://communitybenefit.memorialhermann.org/about-us/."},{"form_and_line_reference":"Schedule H Part VI Line 8","explanation":"This is not applicable for this filing."}]},"ScheduleI":{"reported_domestic_org_grants":0,"reported_domestic_individual_grants":0,"total_domestic_grants":0},"ScheduleF":{"reported_foreign_grants":0},"ScheduleJ":{"compensation_process":{"compensation_committee":true,"independent_consultant":true,"form_990_of_other_organizations":true,"compensation_survey_or_study":true,"board_or_committee_approval":true},"compensation_arrangements":{"compensation_based_on_revenue_filing_org":false,"compensation_based_on_revenue_related_orgs":false,"compensation_based_on_net_earnings_filing_org":false,"compensation_based_on_net_earnings_related_orgs":false,"nonfixed_payments":false,"initial_contract_exception":false,"severance_payment":false,"supplemental_nonqualified_retirement_plan":true,"equity_based_compensation_arrangement":false},"compensation":[{"person_name":"Wolterman Daniel J","title":"Member; President","base_compensation_filing_org":0,"bonus_filing_org":0,"bonus_related_orgs":1231649,"compensation_based_on_related_orgs":565735,"comp_report_prior_990_filing_org":0,"comp_report_prior_990_related_orgs":0,"deferred_compensation_filing_org":0,"deferred_compensation_related_orgs":1131662,"nontaxable_benefits_filing_org":0,"nontaxable_benefits_related_orgs":7884,"other_compensation_filing_org":0,"other_compensation_related_orgs":-1057,"total_compensation_filing_org":0,"total_compensation_related_orgs":2935873,"name":"Wolterman Daniel J"},{"person_name":"Cordola Craig A","title":"CEO TMC 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Secretar","base_compensation_filing_org":0,"bonus_filing_org":0,"bonus_related_orgs":320977,"compensation_based_on_related_orgs":233746,"comp_report_prior_990_filing_org":0,"comp_report_prior_990_related_orgs":0,"deferred_compensation_filing_org":0,"deferred_compensation_related_orgs":62503,"nontaxable_benefits_filing_org":0,"nontaxable_benefits_related_orgs":5108,"other_compensation_filing_org":0,"other_compensation_related_orgs":-1747,"total_compensation_filing_org":0,"total_compensation_related_orgs":620587,"name":"Duco Bernard A Jr"},{"person_name":"Josehart Carl E","title":"TIRR Memorial Hermann 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Officer","base_compensation_filing_org":0,"bonus_filing_org":0,"bonus_related_orgs":111295,"compensation_based_on_related_orgs":0,"comp_report_prior_990_filing_org":0,"comp_report_prior_990_related_orgs":0,"deferred_compensation_filing_org":0,"deferred_compensation_related_orgs":0,"nontaxable_benefits_filing_org":0,"nontaxable_benefits_related_orgs":0,"other_compensation_filing_org":0,"other_compensation_related_orgs":0,"total_compensation_filing_org":0,"total_compensation_related_orgs":111295,"name":"Aulbaugh Carrol E"},{"person_name":"Trevino Illeana V","title":"CEO 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30324"}],"officers_directors_key_employees":[{"title":"Member","average_hours_per_week":1.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":0,"other_compensation":0,"individual_trustee_or_director":true},{"title":"Member","average_hours_per_week":1.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":0,"other_compensation":0,"individual_trustee_or_director":true},{"title":"Chairman","average_hours_per_week":1.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":0,"other_compensation":0,"individual_trustee_or_director":true},{"title":"Member","average_hours_per_week":1.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":0,"other_compensation":0,"individual_trustee_or_director":true},{"title":"Member","average_hours_per_week":1.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":0,"other_compensation":0,"individual_trustee_or_director":true},{"title":"Member","average_hours_per_week":1.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":0,"other_compensation":0,"individual_trustee_or_director":true},{"title":"Member","average_hours_per_week":1.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":0,"other_compensation":0,"individual_trustee_or_director":true},{"title":"Member; President","average_hours_per_week":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":2528811,"other_compensation":1752709,"individual_trustee_or_director":true,"officer":true},{"title":"Member","average_hours_per_week":1.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":0,"other_compensation":0,"individual_trustee_or_director":true},{"title":"Member","average_hours_per_week":1.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":0,"other_compensation":0,"individual_trustee_or_director":true},{"title":"Chief Financial Officer & Trea","average_hours_per_week":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":1266085,"other_compensation":61644,"officer":true},{"title":"CEO TMC, MH TMC Campus","average_hours_per_week":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":748575,"other_compensation":103932,"officer":true},{"title":"Chief Legal Officer & Secretar","average_hours_per_week":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":829099,"other_compensation":224498,"officer":true},{"title":"TIRR MH CEO","average_hours_per_week":50.0,"reportable_comp_from_org":411284,"reportable_comp_from_related_orgs":0,"other_compensation":66421,"officer":true},{"title":"Chief Financial Officer","average_hours_per_week":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":272764,"other_compensation":24947,"officer":true},{"title":"Chief Accounting Officer","average_hours_per_week":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":547076,"other_compensation":84713,"officer":true},{"title":"Chief Risk & Insurance Officer","average_hours_per_week":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":400448,"other_compensation":46435,"officer":true},{"title":"Chief Operating Officer","average_hours_per_week":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":1311189,"other_compensation":225166,"officer":true},{"title":"Director of Pharmacy","average_hours_per_week":50.0,"reportable_comp_from_org":179834,"reportable_comp_from_related_orgs":0,"other_compensation":21994,"key_employee":true},{"title":"Chief Nursing Officer","average_hours_per_week":50.0,"reportable_comp_from_org":258385,"reportable_comp_from_related_orgs":0,"other_compensation":46379,"key_employee":true},{"title":"Director of Business Developme","average_hours_per_week":50.0,"reportable_comp_from_org":164142,"reportable_comp_from_related_orgs":0,"other_compensation":16210,"key_employee":true},{"title":"Director of Neuropsychology","average_hours_per_week":50.0,"reportable_comp_from_org":203616,"reportable_comp_from_related_orgs":0,"other_compensation":24547,"key_employee":true},{"title":"Chief Human Resources Officer","average_hours_per_week":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":918878,"other_compensation":43589,"key_employee":true},{"title":"Chief Human Resource Officer","average_hours_per_week":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":229777,"other_compensation":22806,"key_employee":true},{"title":"Chief Medical Officer","average_hours_per_week":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":1210558,"other_compensation":152925,"key_employee":true},{"title":"Director of Rehab","average_hours_per_week":50.0,"reportable_comp_from_org":130044,"reportable_comp_from_related_orgs":0,"other_compensation":7865,"highest_compensated_employee":true},{"title":"Director Case Management","average_hours_per_week":50.0,"reportable_comp_from_org":152956,"reportable_comp_from_related_orgs":0,"other_compensation":16314,"highest_compensated_employee":true},{"title":"Director of Patient Care","average_hours_per_week":50.0,"reportable_comp_from_org":128075,"reportable_comp_from_related_orgs":0,"other_compensation":16780,"highest_compensated_employee":true},{"title":"Director of Patient Care","average_hours_per_week":50.0,"reportable_comp_from_org":147290,"reportable_comp_from_related_orgs":0,"other_compensation":17401,"highest_compensated_employee":true},{"title":"RN","average_hours_per_week":50.0,"reportable_comp_from_org":131519,"reportable_comp_from_related_orgs":0,"other_compensation":10821,"highest_compensated_employee":true},{"title":"CEO Foundation","average_hours_per_week":0.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":604753,"other_compensation":76844,"former":true},{"title":"Director Healthcare Improvemen","average_hours_per_week":0.0,"reportable_comp_from_org":122221,"reportable_comp_from_related_orgs":0,"other_compensation":8212,"former":true}]},"ScheduleA":{"public_charity_status":{"hospital_170b1_aiii":true}},"ScheduleB":{"attached":true,"required":true},"ScheduleD":{"land_buildings_equipment":{"land":{"other_cost_or_other_basis":1,"book_value":1},"buildings":{"other_cost_or_other_basis":34201623,"book_value":10053468,"depreciation":24148155},"leasehold_improvements":{"other_cost_or_other_basis":1717642,"book_value":183358,"depreciation":1534284},"equipment":{"other_cost_or_other_basis":11353409,"book_value":1774602,"depreciation":9578807},"other_land_buildings":{"other_cost_or_other_basis":5552381,"book_value":4938827,"depreciation":613554},"total_book_value":16950256},"other_liabilities":{"federal_income_tax_liability":0,"liabilities":[{"description":"UNEARNED REVENUES","amount":474660},{"description":"INTERCOMPANY PAYABLES","amount":4084216}],"total_liability":4558876},"supplemental_information":[{"identifier":"ASC 740 Audit Financial Statement Footnote Disclosure","form_and_line_reference":"Form 990, Schedule D, Part X","explanation":"The Institute for Rehabilitation and Research (TIRR) does not have a financial audit conducted. The financial accounts of TIRR are included in the financial statements that are audited of the consolidated Memorial Hermann Healthcare System and affiliates. The paragraph included in the last issued financial statements was: Taxes The System, MHHS, and certain other affiliates are Texas not-for-profit corporations and have been recognized as tax-exempt pursuant to section 501(c)(3) of the Internal Revenue code. The System owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and, therefore, subject to tax. Management annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the accompanying combined balance sheets."}]},"ScheduleH":{"policies":{"financial_assistance_policy":true,"written_policy":true,"policy_applied_to_all_hospitals":true,"fpg_reference_free_care":true,"free_care_percent_200":true,"fpg_reference_discounted_care":true,"discounted_care_percent_400":true,"free_or_discounted_care_medically_indigent":true,"financial_assistance_budget":true,"expenses_exceed_budget":false,"annual_community_benefit_report":true,"report_publicly_available":true},"bad_debt_medicare_collections":{"bad_debt_expense_reported":false,"bad_debt_expense":-265310,"bad_debt_expense_attributable_to_financial_assistance":0,"reimbursed_by_medicare":14607882,"cost_of_care_reimbursed_by_medicare":21840657,"medicare_surplus_or_shortfall":-7232775,"cost_to_charge_ratio":true,"written_debt_collection_policy":true,"financial_assistance_provision":true},"community_benefit":{"financial_assistance_at_cost":{"total_community_benefit_expense":424003,"net_community_benefit_expense":424003,"total_expense_percentage":0.0056},"unreimbursed_medicaid":{"total_community_benefit_expense":5851523,"direct_offsetting_revenue":3087019,"net_community_benefit_expense":2764504,"total_expense_percentage":0.0368},"unreimbursed_costs":{"total_community_benefit_expense":1087070,"direct_offsetting_revenue":1533689,"net_community_benefit_expense":-446619},"total_financial_assistance":{"total_community_benefit_expense":7362596,"direct_offsetting_revenue":4620708,"net_community_benefit_expense":2741888,"total_expense_percentage":0.0424},"health_professions_education":{"total_community_benefit_expense":1020186,"direct_offsetting_revenue":177474,"net_community_benefit_expense":842712,"total_expense_percentage":0.0112},"research":{"total_community_benefit_expense":6857004,"direct_offsetting_revenue":4661019,"net_community_benefit_expense":2195985,"total_expense_percentage":0.0292},"total_other_benefits":{"total_community_benefit_expense":7877190,"direct_offsetting_revenue":4838493,"net_community_benefit_expense":3038697,"total_expense_percentage":0.0404},"total_community_benefits":{"total_community_benefit_expense":15239786,"direct_offsetting_revenue":9459201,"net_community_benefit_expense":5780585,"total_expense_percentage":0.0828}},"hospital_facility_count":1,"hospital_facilities":[{"facility_number":1,"business_name_line1":"The Institute for Rehabilitation (TIRR)","address_line1":"1333 Moursund Street","city":"Houston","state":"TX","zip":"77030","licensed_hospital":true,"research_facility":true,"name":"The Institute for Rehabilitation (TIRR)","address":"1333 Moursund Street, Houston, TX, 77030"}],"facility_policies":[{"business_name_line1":"The Institute for Rehabilitation (TIRR)","facility_number":1,"eligibility_criteria_explained":true,"fpg_family_income_limit_free_discounted":true,"fpg_family_income_limit_free_care_percentage":200.0,"fpg_family_income_limit_discounted_care_percentage":400.0,"fpg_used_determine_discounted_care":true,"income_level_criteria":true,"asset_level_criteria":true,"medical_indigency_criteria":true,"insurance_status_criteria":true,"basis_explained":true,"application_financial_assistance_explanation":true,"other_method_used":true,"includes_publicity_measures":true,"fap_available_on_request_no_charge":true,"fap_actions_on_nonpayment":true,"posted_in_admission_office":true,"posted_in_emergency_room":true,"collection_activities":false,"nondiscriminatory_emergency_care_policy":true,"medicaid_medicare":true,"state_regulation":true,"uninsured_discount":true,"amounts_generally_billed":false,"gross_charges":false,"name":"The Institute for Rehabilitation (TIRR)"}],"supplemental_information":[{"form_and_line_reference":"Schedule H Part I Line 6 a","explanation":"Memorial Hermann Healthcare System produces a single community benefit report that highlights all of our corporation's activities. As a hospital system with multiple facilities in a major metropolitan area, our efforts are focused on meeting the needs of the greater community versus individual efforts associated with individual facilities. By focusing on fewer, larger endeavors, the long term impact on the Houston community's health status is greater than would be on an individual basis."},{"form_and_line_reference":"Schedule H Part III Section A, Line 4","explanation":"PATIENT ACCOUNTS RECEIVABLES ARE REPORED NET OF ESTIMATED ALLOWANCES FOR CONTRACTUAL ALLOWANCE, BAD DEBT, AND OTHER DISCOUNTS. WE RECORD BAD DEBT BASED ON THE ANTICIPATED UNREALIZABLE PORTION OF NET REVENUE. THESE ARE ESTIMATES BASED ON ACCOUNT AGE, FINANCIAL CLASS, AND VARYING OTHER CRITERA. THE NEGATIVE AMOUNT IN LINE 2 FOR THIS REPORTING; THIS IS THE RESULT OF A LARGE INTERNATIONAL ACCOUNT THAT WAS ALLOWED FOR IN THE PRIOR YEAR AS BAD DEBT BUT WAS Subsequently PAID IN THE CURRENT PERIOD. WE MAINTAIN THAT NO PORTION OF THESE DOLLARS SHOULD BE COUNTED AS A COMMUNITY BENEFIT, AS SUCH THE EXTENDED AMOUNT IN LINE 3 IS REPORTED AS ZERO."},{"form_and_line_reference":"Schedule H Part III Section B, Line 8","explanation":"TO PROVIDE CLARITY AROUND MEDICARE AND THE LOW INCOME, WE WOULD LIKE TO POINT OUT THAT THE PUBLISHED SSI FOR THIS PROVIDER IS 7.21%, AS SUCH, WE BELIEVE THAT, AS A MINIMUM 7.21% SHOULD BE INCLUDED AS A COMMUNITY BENEFIT."},{"form_and_line_reference":"Schedule H Part III Section C, Line 9 b","explanation":"If there is no coverage by a third party and the responsible party cannot pay any or part of the balance due or make acceptable financial arrangements, assistance is provided to the responsible party to complete financial assistance application forms, including application for Medicaid, Crime Victims Compensation, Harris County Hospital District or County Indigent Programs where appropriate. If the patient meets predetermined financial criteria, assistance is provided to the responsible party to complete the charity application for a full or partial charity care write-off."},{"form_and_line_reference":"Schedule H Part VI, Line 3","explanation":"All Memorial Hermann Acute Care facilities and Rehab facilities have Third Party Qualification vendors on-site. Once someone requests or a financial counselor has determined through interaction with the patient and/or guarantor that the patient cannot pay for services, the patient/guarantor is referred to the Eligibility vendor on-site to screen for any Federal/State/Local Government program which may cover their services. These vendors act as agents for the patient/guarantor and may at times go to hearings for Medicaid or Disability as a legal representative of the patient. Also, all our entities, including service lines, have posted notices of a patient's right to request charity. Our statements that are sent to patients have documentation on the back informing the patient of Memorial Hermann's Charity policy and their right to request such, (in English and Spanish). Accounts are referred to be processed either on a real time basis by the hospital staff while the patient is still in the hospital or by electronic referral via data download which occur weekly and after the patient has been discharged. The goal is to make contact with the patient for financial screening to determine eligibility for governmental assistance as soon as possible. Additional assistance for patients to take advantage of all appropriate health improvement programs available within the community are through Memorial Hermann's navigation services. Memorial Hermann's navigation services inform patients of their eligibility for assistance under federal, state or local government programs or under Memorial Hermann's financial assistance policy. In 2008, MHCBC launched the ER Navigation program at Memorial Hermann as a response to the community need of educating patients on how to navigate through their existing resources, increasing access and using healthcare resources appropriately to reduce healthcare costs. Today, the ER Navigation program places a Community Health Worker (CHW) or \"navigator\" on-site in Memorial Hermann's three busiest emergency rooms to educate patients on the importance of identifying and using a consistent health home rather than relying on emergency rooms for their primary care. Patients eligible for the program are 18 months to age 65 who frequently use the ER for primary care and are uninsured or on Medicaid. Certified CHW training is offered by Memorial Hermann partner, Gateway to Care. CHWs gain the trust of patients by being familiar with the community's culture, language and values and by sharing their knowledge about local healthcare services and programs. CHWs identify clinics that are the best fit for an individual's location, income, language, work hours, bus routes and address issues that may push health care down the priority list--the need for food stamps, rental support and assistance with utilities. They provide patients with clinic referrals, make appointments, arrange transportation, share information and referrals to community and safety net programs, educate about qualifying for and using public benefits and other payment resources, serve as a liaison between the patient and providers and tackle other challenges to appropriate care. CHWs stress the importance of having a health home and provide support and guidance in making and keeping future health appointments. While navigators initially meet with patients during the ER visit, much of their work is done in follow-up, ensuring that a clinic appointment was made, was successful and assisting with the paperwork required for qualification for Medicaid, CHIP or county indigent programs. The primary goal of the ER Navigation program is to find an appropriate health home for patients and provide them with the resources to navigate through future medical concerns. A secondary goal is to reduce the time of delivery of services in cases of chronic and serious illnesses. Similar support of all Memorial Hermann Hospitals is also provided through the COPE (Care Management Community Program Eligibility) Program which provides empowering services for uninsured patients to improve their health and well being through education about and coordination with community health services. COPE targets patients who have repetitively been inpatients and ER patients and exhibit the need for one- on-one support to identify, access, and obtain services in their own community. Enrolling these populations into public benefits through all of these venues automatically increases their likelihood of obtaining regular primary and preventative care; the kind of care that ensures health and the potential for a prosperous future while concurrently eliminating the cost burden presently experienced by safety-net providers."},{"form_and_line_reference":"Schedule H Part VI, Line 4","explanation":"Memorial Hermann serves \"greater Houston,\" a multi-county area along the Gulf Coast in southeast Texas-where several counties are without hospital district services. The 6th largest metropolitan area in the United States, greater Houston is one of the fastest growing with a population of 5.9 million-a 25.2% growth rate since the 1990 census. A source of strength in a global economy, Houston prizes its racial and ethnic diversity. According to U.S. Census 2010 estimates, Houston is 25.6% White, 43.8% Hispanic, 23.7% Black or African American, 0.7% Native American, and 6.2% Asian/Pacific Islander. Per capita income is $25,927. In Houston, 21% of all residents are living below the poverty line-20% higher than the rate for Texas. The largest employers in the community include: Memorial Hermann Healthcare System (19,500 employees); The University of Texas M.D. Anderson Cancer Center (15,000 employees); ExxonMobil (13,000 employees); Shell Oil Company (13,000 employees); and Kroger Company (12,000 employees). The Houston area has experienced a recent dip in the unemployment rate to below 8% which is still double what it was before the recession. Unfortunately, communities within the region are still facing 9% or higher unemployment. A staple in Houston, the healthcare industry remains one of the more stable industries in the region. This sector is projected to add 10,300 jobs in 2012. The greater Houston area is one of the hardest hit areas in the healthcare/uninsured crisis--thirty-one percent of Houston's residents are uninsured. In comparison, Texas's uninsured rate -- although the highest of all states --is 24.6% (one out of every four Texans is uninsured-more than six million Texans) and the national rate is 16.3%. Houston's fast-growing Hispanic population accounts for a large percentage of uninsured residents. In fact, even after healthcare reform is fully implemented, estimates are that 15% of Houston area residents will remain uninsured. This situation is exacerbated by state budget cutbacks decreasing funding to vital health programs and reducing Medicaid reimbursements. Memorial Hermann is committed to ensuring that the greater Houston community receives the healthcare it deserves. Health education and prevention and increased access to healthcare are vital to improving the overall health of residents whose leading causes of health issues mirror the nation's (heart disease, cancer, strokes, accidents, chronic respiratory disease and diabetes)."},{"form_and_line_reference":"Schedule H Part VI, Line 6","explanation":"Memorial Hermann Healthcare System is the largest not-for-profit healthcare system in Texas and serves the greater Houston community through (11) hospitals, a vast network of affiliated physicians and numerous specialty programs and services. Life-saving facilities include: Memorial Hermann-Texas Medical Center, the teaching hospital for The University of Texas Medical School at Houston and home of one of the nation's busiest Level I trauma centers; (8) suburban hospitals; (3) premier Heart & Vascular Institutes; TIRR Memorial Hermann, one of the nation's top rehabilitation and research hospitals; Children's Memorial Hermann Hospital; the Memorial Hermann Sports Medicine Institute; the Mischer Neuroscience Institute; (9) Cancer Centers; (21) Imaging Centers; (27) sports medicine and rehabilitation centers; (12) diagnostic laboratories; PaRC, a substance abuse treatment center; (1) retirement/ nursing center; and (1) home health agency. Memorial Hermann operates the Life Flight air ambulance program and the city's only burn treatment center. Memorial Hermann Community Benefit Corporation (MHCBC) addresses the health needs of the community through the community service initiatives listed above. In January 2012, Memorial Hermann Healthcare System was the only hospital system in Houston and one of only two in Texas named one of the nation's top 15 health systems by Thomson Reuters, a leading provider of information and solutions to improve the cost and quality of healthcare. Memorial Hermann has 3,375 licensed beds; 19,500 full-time employees; 4,178 medical staff members; 1,324 physicians-in-training (residents and fellows), and 2,972 volunteers providing 380,768 hours. Memorial Hermann is governed by 13 Boards of Directors totaling 143 members representative of the greater Houston business, healthcare and community leadership. Memorial Hermann's annual services include: 131,002 admissions; 827,060 outpatient visits; 74,720 outpatient surgeries; 433,191 emergency visits; 24,174 deliveries; and 2,960 Life Flight air ambulance missions. Memorial Hermann takes a leadership role in regional efforts to improve the health and quality of life of the community. In addition to Life Flight and the Burn Treatment Center, Memorial Hermann operates the nation's first complete citywide chest pain center network and the region's largest stroke network, offering the community faster access to life saving care."},{"form_and_line_reference":"Schedule H Part VI, Line 2","explanation":"Each decision made by Memorial Hermann to invest its people, resources, and talents in community benefit efforts is data driven. Given that 31% of the Houston area is uninsured, numerous community needs analyses center around the University of Texas School of Public Health's Houston Area Hospital's Emergency Department Use Study, which Memorial Hermann has participated in since 2003. The study monitors hospital emergency department use in Houston hospitals and is a data source for numerous assessments to understand primary care-related ER use including the characteristics of these patients; particularly those who are children, who are uninsured, and who have Medicaid. The study conducted in 2012 shows that 40.9% of all ER visits and 48.6% of all treated and released ER visits are primary care related. With the desire to change emergency room use comes the need to identify available capacity of our existing safety-net clinics, and what is needed by each entity to increase its capacity to be able to respond to changes in ER usage our community efforts achieve. This study, the Greater Houston Clinic Capacity Analysis, performed in early 2012 by Project Safety-Net and University of Texas School of Public Health, indicates that the community clinics are currently meeting about 30 percent of the demand for primary care visits by the low-income population and the rest is either met by private practice physicians or is left unmet. Further, the study anticipates that safety net providers will only be able to meet 25 percent of the demand under the Affordable Care Act (ACA). It is important to be concerned because a shortage of primary care leads to more people experiencing serious illness requiring expensive specialty care, emergency services and hospitalization. As required by the Community Health Needs Assessment-Section 501(r)(3)--Requirement of the ACA, Memorial Hermann is conducting community needs assessments for each of its 11 hospitals to be completed in 2013. The studies will include demographic data of Harris, Fortbend, Montgomery, and Brazoria counties (counties that compose 89% of Memorial Hermann discharges), a description of the processes and methodologies, surveys and interviews with public health officials where participants were given the opportunity to prioritize community health needs and rate the importance of health care initiatives, identification of all collaborating organizations and existing health care facilities and other resources within the community available to meet the needs identified in each of the community needs assessments. The University of Texas School of Public Health's Health Care Safety Net Review will be included in the assessment. Once community needs have been prioritized, Memorial Hermann will develop appropriate objectives, action plans and metrics. The process will be complete and information available to the public in spring 2013. The Health of Houston Study, a recent comprehensive study conducted by the Institute for Health Policy of The University of Texas School of Public Health through stakeholder input and neighborhood surveying, will be a continuing source to Memorial Hermann in continued program planning efforts by regularly assessing the health of Houstonians and tracking emerging health issues and health improvements. On behalf of Memorial Hermann, it is the MHCBC's mission to implement programs to work with other healthcare providers, government agencies, business leaders and community stakeholders to ensure that all residents of the greater Houston area have access to the care they need to improve their quality of life and the overall health of the community. MHCBC's programs are designed to provide care for uninsured and underinsured children; to reach those Houstonians needing low cost care; to support the existing infrastructure of non-profit clinics and FQHCs; and to educate individuals and their families on how to access the healthcare available to them. Committed to making the greater Houston area a healthier and more vital place to live, MHCBC supports the following initiatives: Memorial Hermann Health Centers for Schools, established in 1995, offers access to primary medical and mental health services to more than 38,300 underserved children at 49 schools in the Greater Houston area. In 2011, asthma exacerbations, emergency room visits and hospitalizations were reduced by 83%. The Memorial Hermann Mobile Dental Clinic, established in 2000, has two dental vans and provides access to preventative and restorative dental services at all six Health Centers for Schools' sites and is accessible as a \"dental home\" for 38,300 uninsured and underinsured students from 49 schools. In 2011, no more than 25% of patients at recall of both age groups experienced caries. These outcomes are significant given 80% of initial patients are diagnosed with caries; 33% are diagnosed with five or more caries. A dietitian is available through the Healthy Eating and Lifestyles Program (HELP) designed to educate Health Centers for Schools children and their families on the importance of proper nutrition and exercise. In 2011, 77% of enrolled students reduced their BMI; 67% reduced their cholesterol levels. Serving the community since 2008, the Memorial Hermann ER Navigation program places certified Community Health Workers who have the training, cultural understanding and linguistic capacity to help the uninsured, who disproportionately use emergency rooms for healthcare, 'navigate' the complex health system, obtain a medical home, schedule appointments, secure needed social services and cope with future healthcare concerns. Since its inception, the ER Navigation Program has navigated 18,270 patients. MHCBC's COPE program has a similar philosophy but operates with Masters Level Social Workers and focuses on 'frequent flyers' inpatient as well as ER. The Memorial Hermann Neighborhood Health Centers are strategically located near three of Houston's busiest ERs and provide care to working families without access to insurance and who do not qualify for other programs. The goal is to provide this population with a medical home for routine care, and prevent these cases from escalating to emergencies. At $48/visit, with low cost labs and prescriptions, seven day a week access, and the provision of preventive, acute, as well as chronic care, they are an affordable medical home for newborns to the elderly. Decreased hypertension, management of diabetes, and a place where women feel comfortable returning for their annual well-woman exams are examples of the continuity of care and improved health resulting. MHCBC has played numerous and critical roles with a grass-roots Houston collaborative, Gateway to Care and its Provider Health Network (PHN) to recruit physicians, hospitals, and ancillary providers to provide specialty care to uninsured patients with incomes below 150% of poverty. With one in every four primary care visits requiring a referral to a specialist, the Provider Health Network serves as a bridge, connecting uninsured people to the specialty care they desperately need to get well. Recruiting is through numerous avenues-societies, insurance companies, etc.-to rally the resulting city-wide effort. The PHN has provided significant opportunities for our own medical staffs to participate in caring for the uninsured. The provision of an organized effort with a designated staff for monitoring referrals is welcomed by the medical community as they desperately want to be a part of a solution, but fear being overwhelmed. Community Clinic (private-not-for-profit and FQHC) Initiatives receive MHCBC funding and support to fill target population gaps by providing primary healthcare and chronic illness care to uninsured children and adults. Children at Risk: MHCBC supports a Policy Coordinator for a Food in Schools initiative with the goal of increasing participation in the Universal Free Breakfast program by connecting an additional 3,610 students to 649,728 meals. The Disease Management Program is a free program that reduces hospital visits by supplementing the patient-physician relationship to ensure patients with Congestive Heart Failure and Diabetes have medical homes, stay healthier in between appointments and are accountable for their own health. It serves 2,265 patients and is growing. Data indicates a cost savings from ER visits, observation and inpatient costs of $10,694,529. Project Fit is a noprofit, national grassroots organization that develops and promotes exemplary fitness programs for students, grades 2nd through 5th, within the school curriculum. MHCBC has a Project Fit site at Field Elementary and plans to expand this program as funding permits. Approximately 500 kids participate in the program. Community Education Initiatives are offered by Memorial Hermann Healthcare System at each of its 11 hospitals and PARC, its substance abuse treatment center. These initiatives offer free screenings an"},{"form_and_line_reference":"Schedule H Part V Section B line 14","explanation":"Full policy available upon request, signage declaring that we have a policy and how to access the benefit are located in ER and admission points."},{"form_and_line_reference":"Schedule H Part V Section B line 15","explanation":"We do use reporting to credit agencies and lawsuits when there is a liablity claim (i.e. MVA), but these are only put into play AFTER we have made reasonable efforts to determine FAP ineligibility. In situations where FAP is deemed to be available, these efforts are not used."},{"form_and_line_reference":"Scedule H Part V Section B Line 19","explanation":"Memorial Hermann Charity Calculation Memorial Hermann Hospital System Worksheet Houston, Texas Patient Name: ____________________________ Account #'s:______________________________ Step One: Obtain patient's annual gross family income $____________________ (A) Determine number of members in family ______________ Step Two: Determine income as percentage of Federal Poverty Guidelines ______________% (B) Determine the percentage of account balance that is patient's responsibility________% (C) (Use Hospital Gross Income Eligibility Table on back) Step Three: Determine charity category (B) - Check one _____ Financially Indigent ____ Annual gross family income is less than 200% of federal poverty guideline ____ Adjusted Eligibility for Charity Care Criteria ____ Presumed Charity:_________________________ _____ Medically Indigent Annual gross family income is between 201% & 400% of the federal poverty guidelines ____ Not Eligible Annual gross family income is greater than 400% of the federal poverty guidelines Step Four: Determine percentage of account balance for which the patient is responsible ______________________ X 20% = __________________________(D) Annual Gross Income (A) Maximum Patient Responsibility ______________________ X _________% = __________________________(E) Account Balance Patient Percentage (C) Potential Patient Responsibility The lesser of amount (D) or (E) = __________________________(F) Patient Responsibility Step Five: Determine Charity Discount __________________ minus __________________ = _____________________ Account Balance Patient Responsibility (F) Charity Discount Completed by: ________________________________ ________________________ Hospital Representative Date Approved by: ________________________________ ________________________ Patient Access Department Director Date ________________________________ ________________________ Hospital Financial Analyst Date"},{"form_and_line_reference":"Schedule H Part VI #5","explanation":"Memorial Hermann's Promotion of Community Health includes activities conducted by Memorial Hermann staff for patients and the general public that promote disease prevention and education activities as well as healthy living and overall well-being such as: health fairs; state-of-the-art disease screenings; health education conferences, seminars and webinars; support groups for a variety of diseases and health issues; newsletters, brochures and websites designed to provide community health information; employee participation in walks, marathons, and the MS150; strong referral patterns and connections with community resources and medical homes; and, recruitment of physician specialties that fill an identified community need . To expand its community reach, these Memorial Hermann activities are often held in partnership with healthcare agencies, nonprofit organizations, workplaces, school districts, and civic associations. Memorial Hermann also provides educational opportunities for health professionals. Memorial Hermann's employee base is a leader in United Way contributions, Gulf Coast blood drives; and food, clothing, and toy donations."},{"form_and_line_reference":"Schedule H Part I Line 7","explanation":"Line 7a - Financial Assistance at cost is calculated as charity charges times CCR per worksheet 2. Line 7b - Medicaid is calculated as Medicaid charges times CCR per worksheet 2. Line 7c- Costs of other means-tested government programs is calculated as low income government charges times CCR per worksheet 2. Line 7f- Health professions education is out patient physician/paramedical teaching expenses and revenues as reported per the Medicare Cost Report. Line 7h- Research is research dollars serving the community. The amount comes directly from the Medicare Cost Report."},{"form_and_line_reference":"Schedule H Part VI Line 7","explanation":"Memorial Hermann Healthcare System files a community benefit report in Texas that is available on the website 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The first plan is a make-up plan and provides for an annual payment (upon achieving full vesting in the qualified retirement plan) equivalent to the amount of contribution from the employer that is lost to the employee due to the limits on compensation and benefits in the Internal Revenue Code. The second plan is called the Deferred Compensation Plan, and it provides for a payment (upon full vesting in the plan). In this plan, certain executives who are part of a select group of highly compensated or management employees are provided with a payment such that the total retirement contribution for the participant is based on a percentage of the participant's base salary. For example, someone earning a base salary in the range of $200,000 to $350,000 will receive a payment such that the total amount of retirement contributions from the qualified cash balance pension plan, the make-up plan and this plan equal 20%. Base salary range >$600,000 Total Contributions 27.5% of base salary $350,000 to $600,000 24% $200,000 to $350,000 20% < $200,000 17.9% AULBAUGH, CARROL 143,188 BECKSTETT, DOUGLAS 105,857 CORDOLA, CRAIG 52,684 DUCO, BERNARD A. JR 84,772 EULIARTE, MARY ANN 21,123 JOSEHART, CARL E. 48,715 McVEIGH, DENNIS 49,636 SHABOT, MICHAEL 368,227 STOKES, CHARLES 62,559 TREVINO, ILLEANA V. 160,159 WOLTERMAN, DAN 319,924"},{"identifier":"Non-Fixed Payments","form_and_line_reference":"Form 990, Schedule J, Line 7","explanation":"Memorial Hermann Healthcare System (of which this filer is a part) sponsors an executive compensation philosophy that is based on competitive market and pay-for-performance principles.The Compensation Committee of the System implements this philosophy by, generally, setting base salaries at the median of the organizations talent market and using an annual incentive plan and long-term incentive plan that make incentive payments based on the achievement of performance goals determined by the Committee at the beginning of the year for the annual plan or at the beginning of the three year cycle for the long-term performance plan. 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The financial accounts of TIRR are included in the financial statements that are audited of the consolidated Memorial Hermann Healthcare System and affiliates. The paragraph included in the last issued financial statements was: Taxes The System, MHHS, and certain other affiliates are Texas not-for-profit corporations exempt from federal income tax. The System owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and, therefore, subject to tax. Management annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the accompanying combined balance sheets."}]},"ScheduleH":{"policies":{"financial_assistance_policy":true,"written_policy":true,"policy_applied_to_all_hospitals":true,"fpg_reference_free_care":true,"free_care_percent_200":true,"fpg_reference_discounted_care":true,"discounted_care_percent_400":true,"free_or_discounted_care_medically_indigent":true,"financial_assistance_budget":true,"expenses_exceed_budget":false,"annual_community_benefit_report":false},"bad_debt_medicare_collections":{"bad_debt_expense_reported":false,"bad_debt_expense":614508,"reimbursed_by_medicare":13274343,"cost_of_care_reimbursed_by_medicare":20585839,"medicare_surplus_or_shortfall":-7311496,"cost_to_charge_ratio":true,"written_debt_collection_policy":true,"financial_assistance_provision":true},"community_benefit":{"financial_assistance_at_cost":{"total_community_benefit_expense":1094489,"net_community_benefit_expense":1094489,"total_expense_percentage":0.015},"unreimbursed_medicaid":{"total_community_benefit_expense":5074833,"direct_offsetting_revenue":2379745,"net_community_benefit_expense":2695088,"total_expense_percentage":0.038},"unreimbursed_costs":{"total_community_benefit_expense":518698,"direct_offsetting_revenue":693919,"net_community_benefit_expense":-175211,"total_expense_percentage":0.002},"total_financial_assistance":{"total_community_benefit_expense":6688020,"direct_offsetting_revenue":3073664,"net_community_benefit_expense":3614366,"total_expense_percentage":0.051},"health_professions_education":{"total_community_benefit_expense":1203903,"direct_offsetting_revenue":119340,"net_community_benefit_expense":1804563,"total_expense_percentage":0.015},"research":{"total_community_benefit_expense":6164561,"direct_offsetting_revenue":5312133,"net_community_benefit_expense":852428,"total_expense_percentage":0.012},"total_other_benefits":{"total_community_benefit_expense":7368464,"direct_offsetting_revenue":5431473,"net_community_benefit_expense":2656991,"total_expense_percentage":0.027},"total_community_benefits":{"total_community_benefit_expense":14056484,"direct_offsetting_revenue":8505137,"net_community_benefit_expense":6271357,"total_expense_percentage":0.078}},"hospital_facility_count":1,"hospital_facilities":[{"facility_number":1,"business_name_line1":"The Institute for Rehabilitation (TIRR)","address_line1":"1333 Moursund Street","city":"Houston","state":"TX","zip":"77030","licensed_hospital":true,"research_facility":true,"name":"The Institute for Rehabilitation (TIRR)","address":"1333 Moursund Street, Houston, TX, 77030"}],"facility_policies":[{"business_name_line1":"The Institute for Rehabilitation (TIRR)","facility_number":1,"name":"The Institute for Rehabilitation (TIRR)"}],"other_health_care_facility_count":1,"other_health_care_facilities":[{"business_name_line1":"TIRR KIRBY GLEN","address_line1":"2455 South Braeswood","city":"Houston","state":"TX","zip":"77030","facility_type":"Outpatient Clinic","name":"TIRR KIRBY GLEN","address":"2455 South Braeswood, Houston, TX, 77030"}],"supplemental_information":[{"form_and_line_reference":"Schedule H Part I Line 6 a","explanation":"Memorial Hermann Healthcare System produces a single community benefit report that highlights all of our corporation's activities. As a hospital system with multiple facilities in a major metropolitan area, our efforts are focused on meeting the needs of the greater community versus individual efforts associated with individual facilities. By focusing on fewer, larger endeavors, the long term impact on the Houston community's health status is greater than would be on an individual basis."},{"form_and_line_reference":"Schedule H Part III Section A, Line 4","explanation":"Patient accounts receivable are reported net of estimated allowances for contractual allowances, bad debt, charity care, and other discounts. The Systems recorded allowances for bad debt and charity care are based on expected net collections, after contractual adjustments, primarily from patients. Management routinely assesses these recorded allowances relative to changes in payor mix, cash collections, write-offs, recoveries, and market dynamics. At June 30, 2011 and 2010, the allowance for bad debt was $534,358,000 and $465,426,000, respectively, and the allowance for charity care was $40,113,000 and $40,269,000, respectively. Unpaid accounts are written off as bad debts upon reaching delinquent status. Charity care accounts are written off as identified or qualified under the Systems charity care policy. Bad Debt Cost Reported on Line 2, is based on Bad Debt Charges written off during the reporting period, less any Bad Debt recoveries in the period. Net amount was extended by RCC from Wks 2- Line 11 to impute cost. Line 3 is zero since anyone in Bad Debt status that quailfies for CHARITY is treated as a recovery of Bad Debt and said dollars are moved to the Charity line in Wks 1."},{"form_and_line_reference":"Schedule H Part III Section B, Line 8","explanation":"Memorial Hermann Hospital System operates 9 licensed Hospitals within this EIN, of which 6 are 340-B facilities and 3 are not. When looking at the Medicare Revenue split between the 340-B and non-340-B facilities, we find that 77% of the patient revenues are generated in these low income facilities. Therefore, please recognize 77% of the Medicare Loss as a community benefit."},{"form_and_line_reference":"Schedule H Part III Section C, Line 9 b","explanation":"If there is no coverage by a third party and the responsible party cannot pay any or part of the balance due or make acceptable financial arrangements, assistance is provided to the responsible party to complete financial assistance application forms, including application for Medicaid, Crime Victims Compensation, Harris County Hospital District or County Indigent Programs where appropriate. The application process must be complete and account resolved within 60 days. If the patient meets predetermined financial criteria, assistance is provided to the responsible party to complete charity application for a full or partial charity care write-off."},{"form_and_line_reference":"Schedule H Part VI, Line 3","explanation":"All Memorial Hermann Acute Care facilities and Rehab facilities have Third Party Qualification vendors on-site. Once someone requests or a financial counselor has determined through interaction with the patient and/or guarantor that the patient cannot pay for services, the patient/guarantor is referred to the Eligibility vendor on-site to screen for any Federal/State/Local Government program which may cover their services. These vendors act as agents for the patient/guarantor and may at times go to hearings for Medicaid or Disability as a legal representative of the patient. Also, all our entities including service lines have posted notices of a patient's right to request charity. Our statements that are sent to patients have documentation on the back informing the patient of Memorial Hermann's Charity policy and their right to request such, (in English and Spanish). Accounts are referred to be processed either on a real time basis by the hospital staff while the patient is still in the hospital or by electronic referral via data download which occur weekly and after the patient has been discharged. The goal is to make contact with the patient for financial screening to determine eligibility for governmental assistance as soon as possible. Additional assistance for patients to take advantage of all appropriate health improvement programs available within the community are through Memorial Hermann's navigation services. Patient Navigators (also known as Community Health Workers) meet uninsured persons where they are in the healthcare continuum and help them to move forward to achieve mutually agreed upon goals, which includes finding and obtaining a Primary Care Physician or Medical Home. They are located in three Memorial Hermann ERs and work with uninsured families to: 1) secure county, state, and federal benefits; 2) to connect with an accessible community clinic that addresses their specific needs; and 3) to be a contact for future needs. Similar support of all Memorial Hermann Hospitals is also provided through the COPE (Care Management Community Program Eligibility) Program which provides empowering services for uninsured patients to improve their health and well being through education about and coordination with community health services. COPE targets patients who have repetitively been inpatients and ER patients and exhibit the need for one- on-one support to identify, access, and obtain services in their own community. Enrolling these populations into public benefits through all of these venues automatically increases their likelihood of obtaining regular primary and preventative care; the kind of care that ensures health and the potential for a prosperous future while concurrently eliminating the cost burden presently experienced by safety-net providers."},{"form_and_line_reference":"Schedule H Part VI, Line 4","explanation":"Houston is home to the world's largest medical center. People come from all over the world to obtain the highest quality care, based on the latest research. Unfortunately, a large portion of Houston's own residents face barriers to accessing these world class services. In Houston's Harris County, 1.1 million of the 3.5 million residents have no health insurance. Twelve percent (12%) of the nation is uninsured; 26% of Texas is uninsured; and 32% of Houston's population is insured. There are eleven Memorial Hermann acute care hospitals in the Houston metropolitan area, and with 25% of the market share and some of the city's busiest emergency rooms (including one of only two level 1 trauma centers), a more than significant percent of any area healthcare crisis cannot help but fall to Memorial Hermann. With 103 years of service, Memorial Hermann remains dedicated to respond to the needs of the community regardless of the magnitude. Houston's Harris County, the County in which eight of Memorial Hermann's acute care hospitals reside, is the third most populated county in the nation. The population is an ethnic melting pot of 42% Anglo, 34% Hispanic, 17% African American, and 6% Asian. Over the next five years, the Hispanic population will increase to 37%. This has an additional significant public health impact as residents of Hispanic descent have lower rates of health insurance coverage than other sectors of the population. Forty-nine percent of Houston's Hispanic community is presently uninsured. The unemployment rate has remained fairly steady at 5.5%, as the Houston economy has been somewhat resilient during these months of economic uncertainty due to our diversity. The single largest private employer is Wal-Mart. Other large private employers include our own Memorial Hermann, Continental Airlines, and Exxon Mobil. The overall largest employer is the Houston Independent School District (HISD), the seventh largest school district in the nation. Memorial Hermann has been named into HISD's Hall of Fame, an award which recognizes a forged viable partnership. Seventy-two percent (72%) of the uninsured are actually working individuals and families. The reasons are complex but include the fact that only 53% of Texas employers offer health benefits to their employees - seven percentage points below the national average. Additionally, the Texas Medicaid program, the statewide system of coverage for the very poor and predominantly for poor children, is quite limited in comparison to other states' programs. Imagine serving a community in which one in every three people is uninsured and remaining financially viable. The course chosen by Memorial Hermann is to systematically work through a variety of evidence based community initiatives that work to close the gap for children and families. Other Information Through our fifteen-year history with school-based health care (a program in which we place full-time primary care clinics on the school campuses of the community's most at-risk children); we have learned to quantitatively show the improved health status of providing a medical, mental health, and dental home to at-risk children. The annual budget of $1.5 million for this program is the best indicator of Memorial Hermann's commitment and the documented outcomes are the best indicator that the right program in the right setting can make a difference. Over the years this approach has been applied to additional key initiatives that address the issue of healthcare access for the underserved. From the provision and support of accessible primary and specialty care services to the educational programs to support the infrastructure of each, we are committed to finding ways to serve the uninsured. Following are some of the core programs, all of which center around access to care, and specifically access in which all populations have a medical home on which they can call for their preventive, acute care, and long term needs. Memorial Hermann's Health Centers for Schools program, established in 1996, operate as medical, mental health, and dental homes to underserved children at 33 schools in the greater Houston area, making access to free healthcare services available to 25,500 youth. Eighty-four percent of the children seen at the clinics are on the free/reduced lunch program, a national indicator for poverty. Outcome data validates the impact the program is having: reductions in ER visits, absenteeism, cholesterol, asthma exacerbations, and dental caries are just a sample of the measurable outcomes realized by bringing a medical, mental health and dental home to children. Memorial Hermann's Neighborhood Health Centers are strategically located near three of Houston's busiest ERs and provide care to working families without access to insurance and who do not qualify for other programs. The goal is to provide these citizens with a medical home for routine care, and prevent these cases from escalating to ERs. At $48/visit, with low cost labs and prescriptions, seven day a week access, and the provision of preventive, acute, as well as chronic care, they are an affordable medical home for newborns to the elderly. Decreased hypertension, management of diabetes, and a place where women feel comfortable returning for their annual well-woman exams are examples of the continuity of care and improved health resulting. Memorial Hermann supports the operating costs of each center prior to break-even. Patient Navigators (also known as Community Health Workers) meet uninsured persons where they are in the healthcare continuum and help them to move forward to achieve mutually agreed upon goals, which includes finding and obtaining a Primary Care Physician or Medical Home. They help clients understand their qualification for public benefits; understand how to utilize public benefits; and tackle the barriers that keep them from accessing their safety-net options. Patient Navigators are used in a variety of settings, including emergency rooms to connect and guide uninsured persons through the healthcare system. Memorial Hermann has played numerous and critical roles with a grass-roots Houston collaborative, Gateway to Care and its Provider Health Network (PHN) to recruit physicians, hospitals, and ancillary providers to provide specialty care to uninsured patients with incomes below 150% of poverty. With one in every four primary care visits requiring a referral to a specialist, the Provider Health Network serves as a bridge, connecting uninsured people to the specialty care they desperately need to get well. Recruiting is through numerous avenues-societies, insurance companies, etc.-to rally the resulting city-wide effort. The PHN has provided significant opportunities for our own medical staffs to participate in caring for the uninsured. The provision of an organized effort with a designated staff for monitoring referrals is welcomed by the medical community as they desperately want to be a part of a solution, but fear being overwhelmed. In the PHN, everyone plays a part. Adjacent to Harris County is Montgomery County, where one of our hospitals resides. The collaborative, the Montgomery County Healthcare Alliance is emulating the successful Harris County Provider Health Network, and Memorial Hermann has been a strong financial supporter. Federally Qualified Health Centers (FQHC's) and not-for-profit private clinics struggle with the payer distribution challenges required to be successful. They are essential to the city's existing safety-net infrastructure, yet struggle more in Houston than other communities because of the area's high uninsured rate. Memorial Hermann annually supports several area clinics with monetary donations to help this essential primary medical, mental health, and dental clinics remain in operation."},{"form_and_line_reference":"Schedule H Part VI, Line 6","explanation":"As the business of healthcare gets more difficult and the pressure on operational performance intensifies, staying true to our mission and values takes dedicated focus and resources. To devote to this area the time and focus required, Memorial Hermann Healthcare System has been divided into two components-one focusing on internal operations and the other focusing on our external environment and strategy. The external components include a Community Benefits Corporation, led by a Chief Community Benefits Officer. The separation and focus was supported by the governing board which desired increased definition and structure for the expanding scope and nature of our community efforts. The Chief Community Benefits Officer reports directly to Memorial Hermann's president and is responsible for the development, implementation, and success of a formalized community benefit program that guides the system expenditures and quantifies the resulting community values. This position is responsible for a 3-year strategic plan. The eleven Memorial Hermann Hospitals contribute five million dollars annually to the Community Benefits Corporation (CBC) and, in turn, the CBC is charged with the creation, implementation, and sustenance of solutions. The CBC is focused on eliminating the roadblocks that prevent access to healthcare--lack of education, accessibility, insurance status, and capacity--and partners with numerous sectors of the community to sustain this focus. All of the programs described in #6 above, fall within the scope of the CBC."},{"form_and_line_reference":"Schedule H Part VI, Line 2","explanation":"Each decision made by Memorial Hermann Community Benefits Corporation to invest its people, resources, and talents in community benefit efforts is data driven. Given that 31% of the Houston area is uninsured, numerous community needs analyses center around the University of Texas School of Public Health's HOUSTON AREA HOSPITALS EMERGENCY DEPARTMENT USE STUDY, which Memorial Hermann has participated in since 2003. The study monitors hospital emergency department use in Houston hospitals and is a data source for numerous assessments to understand primary care-related ER use including the characteristics of these patients; particularly those who are children, who are uninsured, and who have Medicaid. The study conducted in 2011 shows that 41% of all ER visits and 48% of all treated and released ER visits are primary care related. With the desire to change emergency room use comes the need to identify available capacity of our existing safety-net clinics, and what is needed by each entity to increase its capacity to be able to respond to changes in ER usage our community efforts achieve. This study, the GREATER HOUSTON CLINIC CAPACITY ANALYSIS, performed in early 2012 by Project Safety-Net and University of Texas School of Public Health, indicates that the community clinics are currently meeting about 30 percent of the demand for primary care visits by the low-income population and the rest is either met by private practice physicians or is left unmet. Further, the study anticipates that safety net providers will only be able to meet 25 percent of the demand under the Affordable Care Act (ACA). It is important to be concerned because a shortage of primary care leads to more people experiencing serious illness requiring expensive specialty care, emergency services and hospitalization. It is the MHCBC's mission to implement programs to work with other healthcare providers, government agencies, business leaders and community stakeholders to ensure that all residents of the greater Houston area have access to the care they need to improve their quality of life and the overall health of the community. MHCBC's programs are designed to provide care for uninsured and underinsured children; to reach those Houstonians needing low cost care; to support the existing infrastructure of non-profit clinics and FQHCs; and to educate individuals and their families on how to access the healthcare available to them. THE HEALTH OF HOUSTON STUDY, a recent comprehensive study conducted by the Institute for Health Policy of The University of Texas School of Public Health through stakeholder input and neighborhood surveying will be a continuing source to MHCBC in continued program planning efforts by biennially assessing the health of Houstonians and tracking emerging health issues and health improvements. Committed to making the greater Houston area a healthier and more vital place to live, MHCBC supports the following initiatives: \" Memorial Hermann Health Centers for Schools, established in 1995, offers access to primary medical and mental health services to more than 38,300 underserved children at 49 schools in the Greater Houston area. In 2011, asthma exacerbations, emergency room visits and hospitalizations were reduced by 83%. The Memorial Hermann Mobile Dental Clinic, established in 2000, has two dental vans and provides access to preventative and restorative dental services at all six Health Centers for Schools' sites and is accessible as a \"dental home\" for 38,300 uninsured and underinsured students from 49 schools. In 2011, no more than 25% of patients at recall of both age groups experienced caries. These outcomes are significant given 80% of initial patients are diagnosed with caries; 33% are diagnosed with five or more caries. A dietitian is available through the Health Eating and Lifestyles Program (HELP) designed to educate Health Centers for Schools children and their families on the importance of proper nutrition and exercise. In 2011, 77% of enrolled students reduced their BMI; 67% reduced their cholesterol levels. Serving the community since 2008, the Memorial Hermann ER Navigation program places certified Community Health Workers who have the training, cultural understanding and linguistic capacity to help the uninsured, who disproportionately use emergency rooms for healthcare, 'navigate' the complex health system, obtain a medical home, schedule appointments, secure needed social services and cope with future healthcare concerns. Since its inception, the ER Navigation Program has navigated 18,270 patients. The Memorial Hermann Neighborhood Health Centers are strategically located near three of Houston's busiest ERs and provide care to working families without access to insurance and who do not qualify for other programs. The goal is to provide this population with a medical home for routine care, and prevent these cases from escalating to emergencies. At $48/visit, with low cost labs and prescriptions, seven day a week access, and the provision of preventive, acute, as well as chronic care, they are an affordable medical home for newborns to the elderly. Decreased hypertension, management of diabetes, and a place where women feel comfortable returning for their annual well-woman exams are examples of the continuity of care and improved health resulting. MHCBC has played numerous and critical roles with a grass-roots Houston collaborative, Gateway to Care and its Provider Health Network (PHN) to recruit physicians, hospitals, and ancillary providers to provide specialty care to uninsured patients with incomes below 150% of poverty. With one in every four primary care visits requiring a referral to a specialist, the Provider Health Network serves as a bridge, connecting uninsured people to the specialty care they desperately need to get well. Recruiting is through numerous avenues-societies, insurance companies, etc.-to rally the resulting city-wide effort. The PHN has provided significant opportunities for our own medical staffs to participate in caring for the uninsured. The provision of an organized effort with a designated staff for monitoring referrals is welcomed by the medical community as they desperately want to be a part of a solution, but fear being overwhelmed. Community Clinic (private-not-for-profit and FQHC) Initiatives receive MHCBC funding and support to fill target population gaps by providing primary healthcare and chronic illness care to uninsured children and adults. Children at Risk: MHCBC supports a Policy Coordinator for a Food in Schools initiative with the goal of increasing participation in the Universal Free Breakfast program by connecting an additional 3,610 students to 649,728 meals. Patient Education of Eligibility for Assistance: Assistance for patients to take advantage of all appropriate health improvement programs available within the community are through MHCBC's navigation services. In 2008, MHCBC launched the ER Navigation program at Memorial Hermann as a natural response to the community need of educating patients on how to navigate through their existing resources, increasing access and using healthcare resources appropriately to reduce healthcare costs. Today, the ER Navigation program places a Community Health Worker (CHW) or \"navigator\" on-site in Memorial Hermann's three busiest emergency rooms to educate patients on the importance of identifying and using a consistent health home rather than relying on emergency rooms for their primary care. Patients eligible for the program are 18 months to age 65 who frequently use the ER for primary care and are uninsured or Medicaid. Certified CHW training is offered by Memorial Hermann partner, Gateway to Care. CHWs gain the trust of patients by being familiar with the community's culture, language and values and by sharing their knowledge about local healthcare services and programs. CHWs identify clinics that are the best fit for an individual's location, income, language, work hours, bus routes and address issues that may push health care down the priority list--the need for food stamps, rental support and assistance with utilities. They provide patients with clinic referrals, make appointments, arrange transportation, share information and referrals to community and safety net programs, educate about qualifying for and using public benefits and other payment resources, serve as a liaison between the patient and providers and tackle other challenges to appropriate care. CHW's stress the importance of having a health home and provide support and guidance in making and keeping future health appointments. While navigators initially meet with patients during the ER visit, much of their work is done in follow-up, ensuring that a clinic appointment was made, was successful and assisting with the paperwork required for qualification for Medicaid, CHIP or county indigent programs. The primary goal of the ER Navigation program is to find an appropriate 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President","average_hours_per_week":0.0,"average_hours_per_week_related_org":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":1796327,"other_compensation":1139546,"individual_trustee_or_director":true,"officer":true},{"title":"CEO TMC Campuses","average_hours_per_week":0.0,"average_hours_per_week_related_org":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":564737,"other_compensation":60654,"officer":true},{"title":"Chief Legal Officer & Secretar","average_hours_per_week":0.0,"average_hours_per_week_related_org":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":552976,"other_compensation":67611,"officer":true},{"title":"TIRR Memorial Hermann CEO","average_hours_per_week":50.0,"average_hours_per_week_related_org":0.0,"reportable_comp_from_org":295242,"reportable_comp_from_related_orgs":0,"other_compensation":32768,"officer":true},{"title":"Chief Financial Officer & Trea","average_hours_per_week":0.0,"average_hours_per_week_related_org":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":800907,"other_compensation":39618,"officer":true},{"title":"Chief Accounting Officer& Asst","average_hours_per_week":0.0,"average_hours_per_week_related_org":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":351942,"other_compensation":42278,"officer":true},{"title":"Chief Risk Officer & Assistant","average_hours_per_week":0.0,"average_hours_per_week_related_org":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":335393,"other_compensation":30937,"officer":true},{"title":"Chief Operating Officer","average_hours_per_week":0.0,"average_hours_per_week_related_org":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":936483,"other_compensation":151153,"officer":true},{"title":"Director of Pharmacy","average_hours_per_week":50.0,"average_hours_per_week_related_org":0.0,"reportable_comp_from_org":113901,"reportable_comp_from_related_orgs":0,"other_compensation":10997,"highest_compensated_employee":true},{"title":"Chief Nursing Officer","average_hours_per_week":50.0,"average_hours_per_week_related_org":0.0,"reportable_comp_from_org":167069,"reportable_comp_from_related_orgs":0,"other_compensation":22686,"highest_compensated_employee":true},{"title":"Director of Business Developme","average_hours_per_week":50.0,"average_hours_per_week_related_org":0.0,"reportable_comp_from_org":105981,"reportable_comp_from_related_orgs":0,"other_compensation":8104,"highest_compensated_employee":true},{"title":"Director Case Management","average_hours_per_week":50.0,"average_hours_per_week_related_org":0.0,"reportable_comp_from_org":103139,"reportable_comp_from_related_orgs":0,"other_compensation":8157,"highest_compensated_employee":true},{"title":"Director of Neuropsychology","average_hours_per_week":50.0,"average_hours_per_week_related_org":0.0,"reportable_comp_from_org":124808,"reportable_comp_from_related_orgs":0,"other_compensation":12274,"highest_compensated_employee":true},{"title":"Former Chief Financial Officer","average_hours_per_week":0.0,"average_hours_per_week_related_org":0.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":111295,"other_compensation":0,"former":true},{"title":"CEO Foundation","average_hours_per_week":0.0,"average_hours_per_week_related_org":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":335604,"other_compensation":38375,"former":true},{"title":"Chief Human Resource Officer","average_hours_per_week":0.0,"average_hours_per_week_related_org":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":485015,"other_compensation":28776,"former":true},{"title":"Chief Medical Officer","average_hours_per_week":0.0,"average_hours_per_week_related_org":50.0,"reportable_comp_from_org":0,"reportable_comp_from_related_orgs":651557,"other_compensation":79162,"former":true}]},"ScheduleA":{"public_charity_status":{"hospital_170b1_aiii":true}},"ScheduleB":{"attached":true,"required":true},"ScheduleD":{"other_liabilities":{"federal_income_tax_liability":0,"total_liability":0,"footnote_text":true},"supplemental_information":[{"identifier":"ASC 740 Audit Financial Statement Footnote Disclosure","form_and_line_reference":"Form 990, Schedule D, Part X","explanation":"The Institute for Rehabilitation and Research (TIRR) does not have a financial audit conducted. The financial accounts of TIRR are included in the financial statements that are audited of the consolidated Memorial Hermann Healthcare System and affiliates. The paragraph included in the last issued financial statements was: Taxes The System, MHHS, and certain other affiliates are Texas not-for-profit corporations and have been recognized as tax-exempt pursuant to section 501(c)(3) of the Internal Revenue code. The System owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and, therefore, subject to tax. Management annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the accompanying combined balance sheets."}]},"ScheduleH":{"policies":{"financial_assistance_policy":true,"written_policy":true,"policy_applied_to_all_hospitals":true,"fpg_reference_free_care":true,"free_care_percent_200":true,"fpg_reference_discounted_care":true,"discounted_care_percent_400":true,"free_or_discounted_care_medically_indigent":true,"financial_assistance_budget":true,"expenses_exceed_budget":false,"annual_community_benefit_report":true,"report_publicly_available":true},"bad_debt_medicare_collections":{"bad_debt_expense_reported":false,"bad_debt_expense":237029,"bad_debt_expense_attributable_to_financial_assistance":80590,"reimbursed_by_medicare":6741567,"cost_of_care_reimbursed_by_medicare":10617179,"medicare_surplus_or_shortfall":-3875612,"cost_to_charge_ratio":true,"written_debt_collection_policy":true,"financial_assistance_provision":true},"community_benefit":{"financial_assistance_at_cost":{"total_community_benefit_expense":213828,"net_community_benefit_expense":213828,"total_expense_percentage":0.0054},"unreimbursed_medicaid":{"total_community_benefit_expense":2433883,"direct_offsetting_revenue":1483754,"net_community_benefit_expense":950129,"total_expense_percentage":0.024},"unreimbursed_costs":{"total_community_benefit_expense":533841,"direct_offsetting_revenue":766844,"net_community_benefit_expense":-233003},"total_financial_assistance":{"total_community_benefit_expense":3181552,"direct_offsetting_revenue":2250598,"net_community_benefit_expense":930954,"total_expense_percentage":0.0294},"health_professions_education":{"total_community_benefit_expense":801975,"direct_offsetting_revenue":77812,"net_community_benefit_expense":724163,"total_expense_percentage":0.0183},"research":{"total_community_benefit_expense":2974982,"direct_offsetting_revenue":2330509,"net_community_benefit_expense":644473,"total_expense_percentage":0.0163},"total_other_benefits":{"total_community_benefit_expense":3776957,"direct_offsetting_revenue":2408321,"net_community_benefit_expense":1368636,"total_expense_percentage":0.0346},"total_community_benefits":{"total_community_benefit_expense":6958509,"direct_offsetting_revenue":4658919,"net_community_benefit_expense":2299590,"total_expense_percentage":0.064}},"hospital_facility_count":1,"hospital_facilities":[{"facility_number":1,"business_name_line1":"TIRR Memorial Hermann","address_line1":"1333 Moursund Street","city":"Houston","state":"TX","zip":"77030","licensed_hospital":true,"research_facility":true,"name":"TIRR Memorial Hermann","address":"1333 Moursund Street, Houston, TX, 77030"}],"facility_policies":[{"business_name_line1":"TIRR Memorial Hermann","facility_number":1,"chna_conducted":true,"community_definition":true,"community_demographics":true,"existing_resources":true,"how_data_obtained":true,"community_health_needs":true,"other_health_issues":true,"community_health_needs_identification_process":true,"consulting_process":true,"chna_conducted_year":13,"took_into_account_others_input":true,"chna_conducted_with_other_facilities":false,"chna_report_widely_available":true,"report_available_on_own_website":true,"paper_copy_public_inspection":true,"organization_incurred_excise_tax":false,"all_needs_addressed":false,"eligibility_criteria_explained":true,"fpg_family_income_limit_free_discounted":true,"fpg_family_income_limit_free_care_percentage":200.0,"fpg_family_income_limit_discounted_care_percentage":400.0,"fpg_used_determine_discounted_care":true,"income_level_criteria":true,"asset_level_criteria":true,"medical_indigency_criteria":true,"insurance_status_criteria":true,"basis_explained":true,"application_financial_assistance_explanation":true,"other_method_used":true,"includes_publicity_measures":true,"fap_available_on_request_no_charge":true,"fap_actions_on_nonpayment":true,"posted_in_admission_office":true,"posted_in_emergency_room":true,"collection_activities":false,"nondiscriminatory_emergency_care_policy":true,"medicaid_medicare":true,"state_regulation":true,"uninsured_discount":true,"amounts_generally_billed":false,"gross_charges":false,"information_gaps":true,"other_needs_addressed":true,"name":"TIRR Memorial Hermann"}],"supplemental_information":[{"form_and_line_reference":"Schedule H Part I Line 6 a","explanation":"Memorial Hermann Healthcare System produces a single community benefit report that highlights all of our corporation's activities. As a hospital system with multiple facilities in a major metropolitan area, our efforts are focused on meeting the needs of the greater community versus individual efforts associated with individual facilities. By focusing on fewer, larger endeavors, the long term impact on the Houston community's health status is greater than it would be on an individual basis."},{"form_and_line_reference":"Schedule H Part I Line 7","explanation":"Line 7a - Financial Assistance at cost is calculated as charity charges times CCR per worksheet 2. Line 7b - Medicaid is calculated as Medicaid charges times CCR per worksheet 2. Line 7c- Costs of other means-tested government programs is calculated as low income government charges times CCR per worksheet 2. Line 7f- Health professions education is out patient physician/paramedical teaching expenses and revenues as reported per the Medicare Cost Report. Line 7h- Research is research dollars serving the community. The amount comes directly from the Medicare Cost Report."},{"form_and_line_reference":"Schedule H Part III Section A, Line 4","explanation":"Memorial Hermann Healthcare System's recorded allowances for bad debt are based on expected net collections, after contractual adjustments, primarily from patients. Management routinely assesses these recorded allowances relative to changes in payor mix, cash collections, write-offs, recoveries, and market dynamics. Unpaid accounts are written off as bad debts upon reaching delinquent status."},{"form_and_line_reference":"Schedule H Part III Section B, Line 8","explanation":"While we are not a proponent of capturing Medicare Shortfall as a community benefit, we do concede that we do serve the senior population as a part of our mission to improve the health of the greater Houston area, and with that fact we know that 6.9% of our Inpatient Medicare Days are from SSI individuals. SSI represents the low income seniors, so you could make the case that 6.9% of this number is the portion serving the low income seniors. Supplemental Security Income (SSI) is a Federal income supplement program funded by general tax revenues (not Social Security taxes): It is designed to help aged, blind, and disabled people, who have little or no income; and it provides cash to meet basic needs for food, clothing, and shelter. The cost calculated on line 6, is using the RCC reported on worksheet 2 extended against the Medicare billed charges for this Hospital provider. This methodology was used to be consistent with the other reported cost number in this filing."},{"form_and_line_reference":"Schedule H Part III Section C, Line 9 b","explanation":"If there is no coverage by a third party and the responsible party cannot pay any or part of the balance due or make acceptable financial arrangements, assistance is provided to the responsible party to complete financial assistance application forms, including application for Medicaid, Crime Victims Compensation, Harris County Hospital District or County Indigent Programs where appropriate. If the patient meets predetermined financial criteria, assistance is provided to the responsible party to complete the charity application for a full or partial charity care write-off."},{"form_and_line_reference":"Schedule H Part V Section B, Line 3","explanation":"IN ITS MOST RECENT CHNA, MEMORIAL HERMANN INCLUDED FINDINGS FROM ELEVEN COMPREHENSIVE INTERVIEWS CONDUCTED WITH PEOPLE WHO REPRESENT A BROAD INTEREST IN THE COMMUNITIES, AND WHO HAVE SPECIAL KNOWLEDGE OF AND/OR EXPERTISE IN PUBLIC HEALTH. THESE INDIVIDUALS INCLUDED: CHUCK BEGLEY, PROFESSOR AT THE UNIVERSITY OF TEXAS SCHOOL OF PUBLIC HEALTH; STEPHANIE CONE, EXECUTIVE DIRECTOR AT UNITED WAY OF BRAZORIA COUNTY; CAROL EDWARDS, CEO OF FORT BEND FAMILY HEALTH CENTER; JEANNE HANKS, ASSISTANT DIRECTOR OF OPERATIONS AT ST. LUKE'S EPISCOPAL HEALTH CHARITIES; RANDY JOHNSON, CEO OF MONTGOMERY COUNTY HOSPITAL DISTRICT; LOVELL A. JONES, DIRECTOR OF THE CENTER FOR RESEARCH ON MINORITY HEALTH, UNIVERSITY OF TEXAS M.D. ANDERSON CANCER CENTER; JULIE MARTINEAU, PRESIDENT OF THE UNITED WAY OF MONTGOMERY COUNTY; STEVE MCKERNAN, CEO OF LONE STAR FAMILY HEALTH CENTER; DR. HERMINIA PALACIO, EXECUTIVE DIRECTOR OF THE HEALTH AUTHORITY FOR HARRIS COUNTY AND HARRIS COUNTY PUBLIC HEALTH AND ENVIRONMENTAL SERVICES; CATHY SBRUSCH, DIRECTOR OF PUBLIC HEALTH SERVICES, BRAZORIA COUNTY HEALTH DEPARTMENT; AND STEPHEN WILLIAMS, DIRECTOR - DEPARTMENT OF HEALTH AND HUMAN SERVICES, CITY OF HOUSTON. MEMORIAL HERMANN ALSO INCLUDED IN THE CHNA, FINDINGS FROM AN ELECTRONIC SURVEY DISTRIBUTED TO 550 INDIVIDUALS/ORGANIZATIONS WHO ARE MEMBERS OF THE GATEWAY TO CARE COLLABORATIVE IN HOUSTON."},{"form_and_line_reference":"Schedule H Part V Section B Line 6i","explanation":"The CHNA was completed in Spring 2013 following the period covered in this Schedule H. The CHNA was completed before the June 30, 2013 fiscal year end of Memorial Hermann and its affiliates and would have been the fiscal year end of TIRR if not for the merger of TIRR into Memorial Hermann Hospital System effective December 31, 2012 with Memorial Hermann Hospital System being the surviving entity. The Implementation Plan was finalized in the second quarter of calendar year 2013 and progress will be reported on in subsequent reports as required."},{"form_and_line_reference":"Schedule H Part V Section B Line 7","explanation":"DURING THE CHNA, THE FOLLOWING EIGHT PRIORITIES WERE IDENTIFIED: 1.)EDUCATION AND PREVENTION FOR DISEASES AND CHRONIC CONDITIONS; 2.) ADDRESS ISSUES WITH SERVICE INTEGRATION, SUCH AS COORDINATION AMONG PROVIDERS AND THE FRAGMENTED CONTINUUM OF CARE; 3.) ADDRESS BARRIERS TO PRIMARY CARE, SUCH AS AFFORDABILITY AND SHORTAGE OF PROVIDERS; 4.) ADDRESS UNHEALTHY LIFESTYLES AND BEHAVIORS; 5.) ADDRESS BARRIERS TO MENTAL HEALTHCARE, SUCH AS ACCESS TO SERVICES AND SHORTAGE OF PROVIDERS; 6.) DECREASE HEALTH DISPARITIES BY TARGETING SPECIFIC POPULATIONS; 7.) INCREASED ACCESS TO AFFORDABLE DENTAL CARE; 8.) INCREASED ACCESS TO TRANSPORTATION. 2.)TIRR MEMORIAL HERMANN WILL ADDRESS THE TOP SIX OF THOSE EIGHT NEEDS. THE NEED FOR \"INCREASED ACCESS TO AFFORDABLE DENTAL CARE\" AND THE NEED FOR \"INCREASED ACCESS TO TRANSPORTATION,\" ARE NOT ADDRESSED LARGELY DUE TO THEIR POSITIONS (LAST AND SECOND TO LAST) ON THE PRIORITIZED LIST, THE FACT THAT DENTAL AND TRANSPORTATION SERVICES ARE NOT CORE BUSINESS FUNCTIONS OF THE HEALTH SYSTEM AND THE LIMITED CAPACITY OF EACH HOSPITAL TO ADDRESS THOSE NEEDS. FURTHERMORE, THE HOSPITALS DO NOT HAVE THE EXPERTISE TO ADDRESS ACCESS TO TRANSPORTATION, AND THE SYSTEM VIEWS THIS ISSUE AS A LARGER CITY AND COUNTY INFRASTRUCTURE RELATED CONCERN. MEMORIAL HERMANN FULLY SUPPORTS LOCAL GOVERNMENTS IN THEIR EFFORTS TO IMPACT THESE ISSUES."},{"form_and_line_reference":"Schedule H Part V Section B line 15","explanation":"Full policy available upon request, signage declaring that we have a policy and how to access the benefit are located in ER and admission points."},{"form_and_line_reference":"Schedule H Part V Section B line 16","explanation":"We do use reporting to credit agencies and lawsuits when there is a liability claim (i.e. Motor vehicle accidents), but these are only put into play AFTER we have made reasonable efforts to determine FAP ineligibility. In situations where FAP is deemed to be available, these efforts are not used."},{"form_and_line_reference":"Schedule H Part V Section B Line 20d","explanation":"ELIGIBILITY GUIDELINES A. Financial Indigents (Patient portion ZERO) 1. Financially Indigent shall refer to a person who has no insurance and whose annual gross income qualifies the person to receive assistance on a sliding scale basis according to the Memorial Hermann Gross Income Eligibility Table which is adjusted periodically pursuant to revisions of the Federal Poverty Guidelines. 2. In no event will Memorial Hermann (the system) establish eligibility income level criteria for financially indigent patients for charity care lower than criteria required under the Texas Indigent Health Care and Treatment Act or higher than 200 percent of the Federal Poverty Income Guidelines or higher than applicable law requires. The System may, however, adjust the eligibility for charity care criteria from time to time based on the financial resources of the System and as necessary to meet legal requirements and the charity care needs of the community. 3. Co-payments may be indicated for patients, however at no time should the Co-Payment be allowed to discourage a patient from receiving medically necessary care, particularly in an urgent or emergency situation. B. Medically Indigent (Patient portion sliding scale) 1. Medically Indigent in most cases will be a patient for whom the balance of the hospital bill exceeds 20% of the person's annual gross income and who is unable to pay all or a portion of the bill balance resulting from a catastrophic illness or injury. 2. If the patient's annual gross household income exceeds four hundred percent (400%) of the Federal Poverty Guidelines and the hospital bill is over two times the patient's annual income, the patient will be responsible for the amount of the bill not less than 20% of the patient's annual gross income or 10% of the balance whichever is greater. However, the total responsibility will not be less than 20% of the patient's annual gross income. 3. If a determination is made that a patient has the ability to pay all or a portion of the remainder of the bill, such a determination does not prevent a re-assessment of the patient's ability to pay at a later date. 4. If an uninsured patient's income exceeds one hundred percent (100%) of the poverty guidelines but does not exceed four hundred percent (400%) of the current Federal Poverty Guidelines the patient will be responsible for a percentage of the bill balance or co-pay. The patient's percentage will be based on a sliding scale listed on the Hospital's Gross Annual Income Eligibility requirements."},{"form_and_line_reference":"Schedule H Part VI, Line 2","explanation":"Each decision made by Memorial Hermann to invest its people, resources, and talents in community benefit efforts is data driven. Given that 30% of the Houston area is uninsured, numerous community needs analyses center around the University of Texas School of Public Health's Houston Area Hospital's Emergency Department Use Study, which Memorial Hermann has participated in since 2003. The study monitors hospital emergency department use in Houston hospitals and is a data source for numerous assessments to understand primary care-related ER use including the characteristics of these patients; particularly those who are children, who are uninsured, and who have Medicaid. The study conducted in 2012 shows that 40.9% of all ER visits and 48.6% of all treated and released ER visits are primary care related. With the desire to change emergency room use comes the need to identify available capacity of our existing safety-net clinics, and what is needed by each entity to increase its capacity to be able to respond to changes in ER usage our community efforts achieve. This study, the Greater Houston Clinic Capacity Analysis, performed in early 2012 by Project Safety-Net and University of Texas School of Public Health, indicates that the community clinics are currently meeting about 30 percent of the demand for primary care visits by the low-income population and the rest is either met by private practice physicians or is left unmet. Further, the study anticipates that safety net providers will only be able to meet 25 percent of the demand under the Affordable Care Act (ACA). It is important to be concerned because a shortage of primary care leads to more people experiencing serious illness requiring expensive specialty care, emergency services and hospitalization. AS REQUIRED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT-SECTION 501 (r) (3)-REQUIREMENT OF THE ACA, MEMORIAL HERMANN has CONDUCTED COMMUNITY NEEDS ASSESSMENTS FOR EACH OF ITS 11 HOSPITALS. THE STUDIES INCLUDED DEMOGRAPHIC DATA OF HARRIS, FORT BEND, MONTGOMERY, AND BRAZORIA COUNTIES (COUNTIES THAT COMPOSE 89% OF MEMORIAL HERMANN DISCHARGES. THE GOAL OF THE ASSESSMENT WAS TO CLARIFY THE HEALTH NEEDS OF MEMORIAL HERMANN TIRR'S STUDY AREA, DEFINED AS HARRIS COUNTY THAT REPRESENTS 46.3% OF THE HOSPITAL'S INPATIENT DISCHARGES. RECOGNIZED AS ONE OF THE LEADING REHABILITATION HOSPITALS IN THE COUNTRY, TIRR MEMORIAL HERMANN SERVES AS A MODEL SYSTEM FOR INTERDISCIPLINARY REHABILITATION SERVICES, PATIENT CARE, EDUCATION AND A CENTER OF RESEARCH. PATIENTS ARE REFERRED ON A LOCAL, STATEWIDE, NATIONAL AND GLOBAL BASIS. THE ANALYSIS INCLUDED A CAREFUL REVIEW OF THE MOST CURRENT HEALTH DATA AVAILABLE AND INPUT FROM NUMEROUS COMMUNITY REPRESENTATIVES WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH. FINDINGS INDICATED THAT THERE WERE EIGHT MAIN NEEDS IN THE COMMUNITIES SERVED BY TIRR MEMORIAL HERMANN. THE CHNA TEAM, CONSISTING OF LEADERSHIP FROM MEMORIAL HERMANN HEALTH SYSTEM (MEMORIAL HERMANN), PRIORITIZED THOSE EIGHT NEEDS BY STUDYING THEM WITHIN THE CONTEXT OF THE HOSPITAL'S OVERALL STRATEGIC PLAN AND THE AVAILABILITY OF FINITE RESOURCES, WITH THE FOLLOWING PRIORITIZATION, IN DESCENDING ORDER, RESULTING: 1.) EDUCATION AND PREVENTION FOR DISEASES AND CHRONIC CONDITIONS; 2.) ADDRESS ISSUES WITH SERVICE INTEGRATION, SUCH AS COORDINATION AMONG PROVIDERS AND THE FRAGMENTED CONTINUUM OF CARE; 3.) ADDRESS BARRIERS TO PRIMARY CARE, SUCH AS AFFORDABILITY AND SHORTAGE OF PROVIDERS; 4.) ADDRESS UNHEALTHY LIFESTYLES AND BEHAVIORS; 5.) ADDRESS BARRIERS TO MENTAL HEALTHCARE, SUCH AS ACCESS TO SERVICES AND SHORTAGE OF PROVIDERS; 6.) DECREASE HEALTH DISPARITIES BY TARGETING SPECIFIC POPULATIONS; 7.) INCREASED ACCESS TO AFFORDABLE DENTAL CARE; 8.) INCREASED ACCESS TO TRANSPORTATION. THIS IMPLEMENTATION PLAN ADDRESSES THE TOP SIX OF THOSE EIGHT NEEDS. THE NEED FOR \"INCREASED ACCESS TO AFFORDABLE DENTAL CARE\" AND THE NEED FOR \"INCREASED ACCESS TO TRANSPORTATION,\" ARE NOT ADDRESSED LARGELY DUE TO THEIR POSITIONS (LAST AND SECOND TO LAST) ON THE PRIORITIZED LIST, THE FACT THAT DENTAL AND TRANSPORTATION SERVICES ARE NOT CORE BUSINESS FUNCTIONS OF THE HEALTH SYSTEM AND THE LIMITED CAPACITY OF EACH HOSPITAL TO ADDRESS THOSE NEEDS. FURTHERMORE, THE HOSPITALS DO NOT HAVE THE EXPERTISE TO ADDRESS ACCESS TO TRANSPORTATION, AND Memorial Hermann VIEWS THIS ISSUE AS A LARGER CITY AND COUNTY INFRASTRUCTURE RELATED CONCERN. MEMORIAL HERMANN FULLY SUPPORTS LOCAL GOVERNMENTS IN THEIR EFFORTS TO IMPACT THESE ISSUES."},{"form_and_line_reference":"Schedule H Part VI, Line 3","explanation":"All Memorial Hermann Acute Care facilities and Rehab facilities have Third Party Qualification vendors on-site. Once someone requests or a financial counselor has determined through interaction with the patient and/or guarantor that the patient cannot pay for services, the patient/guarantor is referred to the Eligibility vendor on-site to screen for any Federal/State/Local Government program which may cover their services. These vendors act as agents for the patient/guarantor and may at times go to hearings for Medicaid or Disability as a legal representative of the patient. Also, all our entities, including service lines, have posted notices of a patient's right to request charity. Our statements that are sent to patients have documentation on the back informing the patient of Memorial Hermann's Charity policy and their right to request such, (in English and Spanish). Accounts are referred to be processed either on a real time basis by the hospital staff while the patient is still in the hospital or by electronic referral via data download which occur weekly and after the patient has been discharged. The goal is to make contact with the patient for financial screening to determine eligibility for governmental assistance as soon as possible. TIRR Memorial Hermann has embedded case managers and social workers in the hospital-based physician clinic to help patients with their doctors and needs. TIRR Memorial Hermann inpatients and outpatients require a great deal of assistance with a wide range of resources, and case management plays a significant role in providing supportive services to each patient. Social workers provide not only case management, but behavioral counseling as well. If needed, social workers can refer patients to TIRR Memorial Hermann's psychiatrist. Counseling services are available to families as well as to patients."},{"form_and_line_reference":"Schedule H Part VI, Line 4","explanation":"Memorial Hermann serves \"greater Houston,\" a multi-county area along the Gulf Coast in southeast Texas-where several counties are without hospital district services. The 5th largest metropolitan area in the United States, greater Houston is one of the fastest growing with a population of 6 million. A source of strength in a global economy, Houston prizes its racial and ethnic diversity. According to U.S. Census 2010 estimates, Houston is 25.6% White, 43.8% Hispanic, 23.7% Black or African American, 0.7% Native American, and 6.2% Asian/Pacific Islander. More than 45% of individuals ages five and up are living in homes where English is not the primary language. Per capita income is $25,927. In Houston, 21.5% of all residents are living below the poverty line-21% higher than the rate for Texas. Only 28.4% of the population, age 25+, has a college degree. So vital to the well-being of individuals and families, the Houston area's unemployment rate is 6.1% down from its highest level in February 2010 at 8.6%. Rated as a global city, Houston's economy has a broad industrial base in energy, manufacturing, aeronautics, and transportation. It is also a leader in the health care sector and oilfield equipment. The largest employers in the community include: Memorial Hermann Healthcare System (20,000 employees); The University of Texas M.D. Anderson Cancer Center (15,000 employees); ExxonMobil (13,000 employees); Shell Oil Company (13,000 employees); and Kroger Company (12,000 employees). The greater Houston area is one of the hardest hit areas in the \"uninsured\" healthcare crisis--thirty percent of Houston's residents are uninsured. In comparison, Texas's uninsured rate-the highest ever recorded in the nation--is 25.5% compared to 17% nationwide. Houston's fast-growing Hispanic population accounts for a large percentage of uninsured residents. The rising rate of obesity is the single biggest threat to the greater Houston area-more than one in four greater Houston residents is obese. Health education and prevention and increased access to healthcare are vital to improving the overall health of residents whose leading causes of health issues are mental health problems, diabetes, obesity (adult), obesity (children), substance abuse, heart disease/stroke, cancer and high blood pressure. The most prevalent chronic diseases are diabetes, obesity, high blood pressure, cancer, heart failure, asthma and alzheimer's."},{"form_and_line_reference":"Schedule H Part VI Line 5","explanation":"Memorial Hermann's Promotion of Community Health includes activities conducted by Memorial Hermann staff for patients and the general public that promote disease prevention and education activities as well as healthy living and overall well-being such as: health fairs; state-of-the-art disease screenings; health education conferences, seminars and webinars; support groups for a variety of diseases and health issues; newsletters, brochures and websites designed to provide community health information; employee participation in walks, marathons, and the MS150; strong referral patterns and connections with community resources and medical homes; and, recruitment of physician specialties that fill an identified community need . To expand its community reach, these Memorial Hermann activities are often held in partnership with healthcare agencies, nonprofit organizations, workplaces, school districts, and civic associations. Memorial Hermann also provides educational opportunities for health professionals. Memorial Hermann's employee base is a leader in United Way contributions, Gulf Coast blood drives; and food, clothing, and toy donations. TIRR Memorial Hermann provides promotion of community health activities specific to its patient population. TIRR Memorial Hermann provides comprehensive medical rehabilitation for individuals who have experienced: traumatic brain injury, stroke, spinal cord injury, amputation, multiple trauma, multiple sclerosis, Parkinson's disease, other neurological or neuromuscular disorders, and complex orthopedic injuries. A national leader in medical rehabilitation and research, TIRR Memorial Hermann transforms lives and inspires hope in people whose lives have been significantly altered by an illness or injury. TIRR Memorial Hermann's community needs the same education and access to prevention programs for the chronic diseases of diabetes, heart disease, cancer, and Alzheimer's as the general population, however TIRR Memorial Hermann's focuses on addressing education and prevention of the health conditions of this specialty hospital's expertise. Nevertheless, the interrelated chronic conditions of diabetes, heart disease, cancer, and Alzheimer's can be escalating secondary conditions, and must be addressed, if not through direct services, then through an effective referral network such as Memorial Hermann Health System provides. TIRR Memorial Hermann has a growing hospital-based physician clinic, intended as a rehabilitation medical home, which provides TIRR Memorial Hermann patients with access to primary care as well as cardiology, psychiatry, podiatry, dental, gynecology, and urology care not only under one roof, but with physicians who are comfortable treating them. By creating support for co-morbidities and creating a medical home environment, patients have increased primary care and specialty accessibility and reduced emergency room usage. In FY 2012, TIRR Memorial Hermann provided the following programs to patients, community members, and industry professionals: Rehabilitation Solutions: An annual conference for nurses, social workers, case managers, certified disability management specialists and certified rehabilitation counselors to provide education on advances in rehabilitation, readmission prevention and continuity of care - 200 individuals participated. Internships/teaching sites for over 100 schools world-wide, in several disciplines. Training is provided to medical/allied healthcare professionals in the field of rehabilitation so that individuals are better able to serve those with disabilities, advance the continuum of care and become informed on how rehabilitation affects healthcare. Support Groups: Parkinson's, Stroke, Brain Injury, and Spinal Cord Injury. A full-time librarian staffs the TIRR Memorial Hermann resource library that provides current information on brain and neurological impairments and spinal cord injuries, assists with signing up for community resources, and provides journal articles for those doing research or for those looking into new techniques for clinical care. Up to date website on Caregiver and Community Resources dedicated to community education and research on brain injury and stroke."},{"form_and_line_reference":"Schedule H Part VI, Line 6","explanation":"Memorial Hermann Healthcare System is the largest not-for-profit healthcare system in Texas and serves the greater Houston community through (11) hospitals, a vast network of affiliated physicians and numerous specialty programs and services. Life-saving facilities include: Memorial Hermann-Texas Medical Center, the teaching hospital for The University of Texas Medical School at Houston and home of one of the nation's busiest Level I trauma centers; (8) suburban hospitals; (3) premier Heart & Vascular Institutes; TIRR Memorial Hermann, one of the nation's top rehabilitation and research hospitals; Children's Memorial Hermann Hospital; the Memorial Hermann Sports Medicine Institute; the Mischer Neuroscience Institute; (7) Cancer Centers; (23) Imaging Centers; (7) sports medicine and rehabilitation centers; (21) diagnostic laboratories; PaRC, a substance abuse treatment center; (1) retirement/ nursing center; and (1) home health agency. Memorial Hermann operates the Life Flight air ambulance program and the city's only burn treatment center. In January 2012, Memorial Hermann Healthcare System was the only hospital system in Houston and one of only two in Texas named one of the nation's top 15 health systems by Thomson Reuters, a leading provider of information and solutions to improve the cost and quality of healthcare. Memorial Hermann has 3,364 licensed beds; 20,000 full-time employees; 9,824 medical staff members; 1,712 physicians-in-training (residents and fellows), and 2,517 volunteers providing 304,333 hours. Memorial Hermann is governed by 13 Boards of Directors totaling 143 members representative of the greater Houston business, healthcare and community leadership. Memorial Hermann's annual services include: 130,598 admissions; 924,764 outpatient visits; 79,275 outpatient surgeries; 450,010 emergency visits; 23,111 deliveries; and 3,197 Life Flight air ambulance missions. Memorial Hermann takes a leadership role in regional efforts to improve the health and quality of life of the community."},{"form_and_line_reference":"Schedule H Part VI Line 7","explanation":"Memorial Hermann Healthcare System files a community benefit report in Texas that is available on the website http://communitybenefit.memorialhermann.org/about-us/."},{"form_and_line_reference":"Schedule H Part VI Line 8","explanation":"This is not applicable for this filing."}]},"ScheduleI":{"reported_domestic_org_grants":0,"reported_domestic_individual_grants":0,"total_domestic_grants":0},"ScheduleF":{"reported_foreign_grants":0},"ScheduleJ":{"compensation_process":{"compensation_committee":true,"independent_consultant":true,"form_990_of_other_organizations":true,"compensation_survey_or_study":true,"board_or_committee_approval":true},"compensation_arrangements":{"compensation_based_on_revenue_filing_org":false,"compensation_based_on_revenue_related_orgs":false,"compensation_based_on_net_earnings_filing_org":false,"compensation_based_on_net_earnings_related_orgs":false,"nonfixed_payments":false,"initial_contract_exception":false,"severance_payment":false,"supplemental_nonqualified_retirement_plan":true,"equity_based_compensation_arrangement":false},"compensation":[{"person_name":"Wolterman Daniel J","title":"Member; 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The first plan is called the Memorial Hermann Supplemental Executive Retirement Plan. It is a make-up plan and provides for an annual payment (upon achieving full vesting in the qualified retirement plan) equivalent to the amount of the accrual from the employer that is lost to the employee due to the limits on compensation and benefits in the Internal Revenue Code. The second plan is called the Memorial Hermann Health System Select Group 457(b) Deferred Compensation Plan. It allows for deferral of base salary for those executives who work for a tax exempt entity of Memorial Hermann and whose base salary is above the qualified plan limit. Contributions to this plan are subject to the IRS federal limit. No matching contributions are made on any deferrals under this plan. Applicable amounts accrued per person: Cordola 8,138 Duco 9,509 Euliarte 394 Josehart 2,279 McVeigh 11,616 Reimer 3,116 Shabot 14,360 Stokes 18,013 Trevino 4,161 Wolterman 50,804"}]},"ScheduleN":{"termination_or_liquidation":{"assets_distributed":true,"liabilities_paid":true,"bonds_outstanding":false,"required_to_notify_attorney_general":true,"attorney_general_notified":true},"successor_relationships":{"director_of_successor":true,"employee_of_successor":true,"owner_of_successor":false},"liquidations":[{"person_name":"Memorial Hermann Hospital System","ein":741152597,"irc_section":"501(c)3","distribution_date":"2012-12-31T00:00:00","description":"Cash & Investments","fair_market_value":482985,"method_of_fmv_determination":"Book Value","address_line1":"909 Frostwood 2100 Houston Tx 77","city":"Houston","state":"TX","zip":"77024","name":"Memorial Hermann Hospital System","address":"909 Frostwood 2100 Houston Tx 77, Houston, TX, 77024"},{"person_name":"Memorial Hermann Hospital System","ein":741152597,"irc_section":"501(c)3","distribution_date":"2012-12-31T00:00:00","description":"Accounts Receivable","fair_market_value":13782872,"method_of_fmv_determination":"Book Value","address_line1":"909 Frostwood 2100 Houston Tx 77","city":"Houston","state":"TX","zip":"77024","name":"Memorial Hermann Hospital System","address":"909 Frostwood 2100 Houston Tx 77, Houston, TX, 77024"},{"person_name":"Memorial Hermann Hopsital System","ein":741152597,"irc_section":"501(c)3","distribution_date":"2012-12-31T00:00:00","description":"Inventory","fair_market_value":121457,"method_of_fmv_determination":"Book Value","address_line1":"909 Frostwood 2100 Houston Tx 77","city":"Houston","state":"TX","zip":"77024","name":"Memorial Hermann Hopsital System","address":"909 Frostwood 2100 Houston Tx 77, Houston, TX, 77024"},{"person_name":"Memorial Hermann Hospital System","ein":741152597,"irc_section":"501(c)3","distribution_date":"2012-12-31T00:00:00","description":"Prepaids","fair_market_value":56496,"method_of_fmv_determination":"Book Value","address_line1":"909 Frostwood 2100 Houston Tx 77","city":"Houston","state":"TX","zip":"77024","name":"Memorial Hermann Hospital System","address":"909 Frostwood 2100 Houston Tx 77, Houston, TX, 77024"},{"person_name":"Memorial Hermann Hospital System","ein":741152597,"irc_section":"501(c)3","distribution_date":"2012-12-31T00:00:00","description":"Property, Plant & Equipment","fair_market_value":13745958,"method_of_fmv_determination":"Book Value","address_line1":"909 Frostwood 2100 Houston Tx 77","city":"Houston","state":"TX","zip":"77024","name":"Memorial Hermann Hospital System","address":"909 Frostwood 2100 Houston Tx 77, Houston, TX, 77024"},{"person_name":"Memorial Hermann Hopsital System","ein":741152597,"irc_section":"501(c)3","distribution_date":"2012-12-31T00:00:00","description":"Intercompany Receivables","fair_market_value":4186961,"method_of_fmv_determination":"Book Value","address_line1":"909 Frostwood 2100 Houston Tx 77","city":"Houston","state":"TX","zip":"77024","name":"Memorial Hermann Hopsital System","address":"909 Frostwood 2100 Houston Tx 77, Houston, TX, 77024"}],"supplemental_information":[{"identifier":"Daniel J Wolterman","form_and_line_reference":"Schedule N Part 1 2a","explanation":"As part of an internal corporate restructuring, The Institute for Rehabilitation and Research (TIRR) merged into Memorial Hermann Hospital System effective December 31, 2012 with Memorial Hermann Hospital System being the surviving entity. At the time of the merger, Memorial Hermann Hospital System was renamed Memorial Hermann Health System. This individual served on the TIRR Board of Directors prior to the merger and WAS appointed as a member of the Memorial Hermann Health System Board of Directors effective January 1, 2013."},{"identifier":"Carl E Josehart","form_and_line_reference":"Schedule N Part 1 2b","explanation":"As part of an internal corporate restructuring, The Institute for Rehabilitation and Research (TIRR) merged into Memorial Hermann Hospital System effective December 31, 2012 with Memorial Hermann Hospital System being the surviving entity. At the time of the merger, Memorial Hermann Hospital System was renamed Memorial Hermann Health System. This individual served on the TIRR Board of Directors prior to the merger and WAS not appointed as a member of the Memorial Hermann Health System Board of Directors but was retained as an employee of Memorial Hermann Health System effective January 1, 2013."}]},"ScheduleR":{"tax_exempt_organizations":[{"ein":741152597,"business_name_line1":"Memorial Hermann Hospital System","primary_activities":"Healthcare","exempt_code_section":"501(c)3","public_charity_status":"3","controlled_organization":false,"legal_domicile_state":"TX","direct_controlling_business_name_line1":"MHHCS","address_line1":"909 Frostwood Suite 2100","city":"Houston","state":"TX","zip":"77024","name":"Memorial Hermann Hospital System","address":"909 Frostwood Suite 2100, Houston, TX, 77024"},{"ein":204923281,"business_name_line1":"Memorial Hermann Medical 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