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Baylor Scott & White Health

Our Children’s House at Baylor

Annual Report of Community Benefits

1400 Eighth Avenue

Fort Worth, Texas 76104

Taxpayer ID # 75-1765385

For the Fiscal Year Ended June 30, 2015

Our Children’s House at Baylor Community Benefit Report: FY 2015 Page 1

Baylor Scott & White Health Our Children’s House at Baylor

Annual Report of Community Benefits 1400 Eighth Avenue

Fort Worth, Texas 76104 Taxpayer ID # 75-1765385

For the Fiscal Year Ended June 30, 2015

Table of Contents Letter from the President I. Effective Dates of the Report II. Hospital Description III. Hospital Mission Statement IV. Description of the Community Served V. Identified Community Health Needs by Priority VI. Programs Addressing Identified Community Health Needs VII. Charity Care and Government-Sponsored Indigent Health Care Provided VIII. Government-Sponsored Health Care Provided IX. Other Types of Community Benefits Provided

A. Community Benefit Operations B. Community Health Improvement Services C. Medical Education D. Financial Donations E. In Kind Donations F. Subsidized Health Care Services

X. Total Operating Expenses and Calculation of the Ratio of Cost to Charge XI. Report of Community Benefits Provided During Fiscal Year 2015


June 30, 2015 Dear Fellow Texan: Our Children’s House at Baylor is committed to fulfilling its mission to operate within an integrated health care system which exists to serve people as an extension of the Christian ministry of healing by offering a continuum of quality services with a commitment to patient care, medical education, research, and community service. Our Children’s House at Baylor has served residents of Dallas County since 1993 when it opened its doors as the Pediatric Center for Restorative Care. The hospital was designed to meet the growing needs of children with disabilities and their families and is the only center of its kind in the Southwest. As this community benefit report demonstrates, Our Children’s House at Baylor provides quality patient care, including support and educational services for parents and children that are otherwise not available in the community, and training for allied health professionals. Our Children’s House at Baylor is also proud to support organizations in the community which provide a variety of services to persons with disabilities. This partnering enhances our goal of helping children become as independent as possible, reintegrate into the community and achieve a productive, satisfying lifestyle. The activities, which Our Children’s House at Baylor supports, enable persons with disabilities to illustrate to the community their abilities and contributions. I encourage you to give me feedback for this report. Please address comments to me, in care of Jennifer Coleman, Senior Vice President, Public Affairs, Baylor Scott and White Health, 3500 Gaston Avenue, Suite 150, Dallas, Texas 75246. Sincerely,

Liz Youngblood President


Baylor Scott & White Health Our Children’s House at Baylor

Annual Report of Community Benefits 1208 N. Hall St.

Dallas, TX 75204 Taxpayer ID# 75-1765385

For the Fiscal Year Ended June 30, 2015 I. Effective Dates of the Report

The annual report of community benefits provided is for the fiscal year ended June 30, 2015(Fiscal Year 2015).

II. Hospital Description Highlighted paragraphs require update

Our Children’s House at Baylor (Hospital), an affiliate of Baylor Scott & White Health(BSWH), is a 54-bed licensed pediatric hospital serving children from infancy through age 18. The Hospital provides care for developmental or birth disorders, traumatic injury and severe illness through both inpatient and outpatient health care. Children come to the Hospital with a variety of conditions including communication disorders, developmental delay, traumatic injury, feeding disorders, congenital disorders, chromosomal abnormalities, premature birth and more. Parents of patients at the Hospital find an extraordinary amount of support, education and counseling. An average inpatient length of stay is one month due to the time required to equip parents as they transition from the Hospital to caring for their child at home. The Hospital outpatient services offer specialized care long after patients return home to their families. Services at the Hospital include:

- Child life services - Day neuro program (both inpatient and outpatient) - Feeding program - Inpatient and outpatient headache treatment - Pulmonary services - Rehabilitation services - Sleep studies - Care coordination/case management - Medical management provided by pediatric nurse practitioners, pediatric hospitalists, pediatric physical medicine physicians and pediatric pulmonologists - Neuropsychology/psychology - Nursing care - Occupational therapy - On-site education - Physical therapy - Respiratory therapy - Social work/psychosocial needs - Speech-language pathology

- Spiritual support and counseling.


The Hospital’s child life services (Child Life) consists of certified child life specialists trained to help children and their families cope with being in the Hospital. Child Life is affirmed by the American Academy of Pediatrics as “an essential component of quality pediatric health care” and facilitates a child’s plan of care through medical play, teaching techniques for coping and supporting the child’s growth and development. Whether the child is being treated for developmental delays, birth disorders, traumatic injury or severe illness, a child life specialist interacts with every inpatient child. These services are provided free of charge. The Pediatric day neuro rehabilitation program offers services to children living at home who still need intensive, concentrated therapy. The program bridges inpatient care with traditional, less intensive outpatient care and serves children ages 5 – 18 who have an acquired brain injury and are making rapid gains in the acute phase of their recovery process. This intensive, cognitive-based therapy program is designed to help a child diagnosed with traumatic brain injury, stroke, seizure disorder or brain tumors optimize his or her rehabilitation potential. Physicians and therapists may determine, as a part of discharge planning, that a child may benefit from this hospital-based program. If so, the child’s case manager will help manage the transition. The feeding program at the Hospital specializes in teaching children to eat and drink as independently as possible. Whether this means transitioning from tube feedings to solid foods or overcoming disruptive mealtime behaviors, the Hospital will help when eating problems affect the health and growth of a child. The goal of the Pediatric Headache Center is to provide diagnosis and treatments to help children who experience severe headaches regain an improved quality of life. A child or teen suffering from severe headaches could be negatively impacted in school performance, regular activities, productivity and the whole family. The Pediatric Headache Center offers in-depth solutions for headache pain. At every step, the Hospital takes extra care to understand a child and his or her condition. Specialists also work with family to help identify possible triggers or stress a child may be experiencing. The pulmonary program was designed for children who need short-term tracheotomy/ventilator assistance and those with long-term tracheotomy/ventilator dependencies who will return home. The Hospital’s teams of pediatric specialists monitor all patients on a 24-hour basis. Patients are placed on a portable ventilator and may receive therapies outside of their rooms in either the living or therapy areas. With nine outpatient clinics throughout the Dallas/Fort Worth Metroplex area, the Hospital uses its revenue after expenses to improve the health of Dallas and surrounding communities through patient care, education, and community service. In the fiscal year ending June 30, 2015, the Hospital had 944 total admits resulting in a total of 8,461 days of care. As part of the Hospital’s commitment to the community, the Hospital provides financial assistance in the form of charity care to patients who are indigent and satisfy certain requirements. Additionally, the Hospital is committed to treating patients who are eligible for means tested government programs such as Medicaid which is provided regardless of the reimbursement shortfall, and thereby relieves the state and federal government of the


burden of paying the full cost of care for these patients. Often, patients are unaware of the federal, state and local programs open to them for financial assistance, or they are unable to access them due to the cumbersome enrollment process required to receive these benefits. The Hospital offers assistance in enrollment to these government programs or extends financial assistance in the form of charity care through the Hospital’s Financial Assistance Policy which can be located on the Hospital’s website at BaylorHealth.com/FinancialAssistance. In addition to the Hospital’s Financial Assistance Policy, as part of a large faith based integrated health care delivery system (System) the areas of medical education, research, subsidized services and community health education and screenings are initiatives that take place across the System, and also comprise a significant portion of the Hospital’s community benefit program.

III. Hospital Mission Statement . Our Children’s House at Baylor exists to serve all people by providing personalized

health and wellness through exemplary care, education and research as a Christian ministry of healing.

IV. Description of Community Served

Located in Dallas County, the Hospital serves the Central Region of the System and its total service area (TSA) included ZIP codes from Dallas, Collin, Denton, Ellis, Henderson, Hunt, Kaufman, Rockwall and Tarrant counties.¹

¹ The TSA is defined by the health care industry standard eighty percent rule (fifty percent of inpatient volume from the primary service area plus thirty per cent of the inpatient volume from secondary service area). To ensure that a true representation of the community is served, the outlier Zip codes are removed, missing Zip codes adjacent to the facility are included and Zip codes needed to complete the contiguous service area are included.


Based on population alone, Texas is the second largest state in the nation with more than 25 million people. From 2000 to 2010, Texas experienced a 20 percent growth in population, as compared to only a 9.7 percent increase nationally. Originally, the North Texas Region was defined to include Collin, Dallas, Denton, Ellis, Fannin, Grayson, Kaufman, Navarro, and Rockwall counties. There is considerable in-migration from the original counties to Dallas County for health care services.

Average household income, $76,541, is below the average for both Texas and the U.S.

o 10.0 percent of the population have household incomes below the Federal Poverty Level (FPL), compared to 9.7 percent living below the FPL in the Dallas/Fort Worth Metroplex.

o 9.4 percent living below the FPL in the United States. o The community inpatient payer mix is comprised of the following: 35.1percent Managed care, 18.8percent Medicaid, 34.7percent Medicare, 11percent Self Pay/Charity Care, and 0.5percent Other.

White non-Hispanics represent 48.1 percent of the population, followed by Hispanics, Black non- Hispanics, Asians, and others, respectively. Approximately 44 percent of Dallas/Fort Worth residents are New Americans (defined as either foreign born or the children of foreign born) of which 46 percent are undocumented. English is not the language spoken in 32 percent of homes in North Texas and over 239 languages are spoken in the North Texas Area, with more than 1/3 reflecting African cultures new to the region.

The most prevalent age group is 35-54 years (27.6 percent), followed by the 0-14 age group (20.2 percent).

While 15.1 percent of adults have less than some high school level of education, approximately 85 percent of adults have at least a high school degree.

Medically underserved: The Hospital service area contains 25 medically underserved areas or populations. Dallas County has significant Health Professional Shortage Area (HPSA) and Medically Underserved Areas (MUA) that overlap and Kaufman County is a county- level HPSA with no MUAs.

V. Identified Community Health Needs

During the fiscal year ending June 30, 2013, the Hospital conducted a Community Health Needs Assessment (CHNA) to assess the health care needs of the community. The CHNA took into account input from persons who represent the broad interest of the community served by the Hospital, including those with special knowledge of or expertise in public health. The CHNA has been made widely available to the public and is located on the website at the following address, BaylorHealth.com/Community. A summary of the CHNA is outlined below including the list of the needs identified in the assessment. Creating healthy communities requires a high level of mutual understanding and collaboration with community individuals and partner groups. The development of this assessment brings together information from community health leaders and providers along with local residents for the purposes of researching, prioritizing and documenting the community health needs for the geographies served by the Hospital. This health


assessment will serve as the foundation for community health improvement efforts for next three years. The FY 2013 CHNA brings together a variety of health status information. This assessment consolidates information from the recent community health needs assessment conducted for the Texas’ Regional Healthcare Partnership Region 9 (Region 9 RHP), the Dallas County Community Health Needs Assessment and the Consumer Health Report conducted by the National Research Corporation (NRC) for Baylor Dallas each of which takes into account input from person who represent the broad interest of the community including those with special knowledge of or expertise in public health. The identified community health needs as outlined below were reviewed and prioritized with input from the BSWH Senior Leadership, the BSWH Mission and Community Benefit Committee and approved by the BSWH Board of Trustees. The methodology for prioritization can be found in the CHNA executive summary. Although each identified need is prioritized as high, medium or low, the Hospital will address all identified needs in the Plan. The importance and benefits of compiling information from other recognized assessments are as follows: 1) Increases knowledge of community health needs and resources, 2) Creates a common understanding of the priorities of the community's health needs, 3) Enhances relationships and mutual understanding between and among stakeholders, 4) Provides a basis upon which community stakeholders can make decisions about how they can contribute to improving the health of the community, 5) Provides rationale for current and potential funders to support efforts to improve the health of the community, 6) Creates opportunities for collaboration in delivery of services to the community and 7) Provides guidance to the hospital how it can align its services and community benefit programs to best meet needs. In developing a plan to address all identified community health needs, the Hospital and the System found that aggregating the needs allows for significant, crosscutting initiatives. Therefore, this community health implementation plan organizes the needs as follows:

Identified Community Needs A. Access to Care for Low Income/Underserved B. Behavioral Health C. Emergency Department and Urgent Care D. Health Care Infrastructure E. Multiple Chronic Conditions F. Patient Safety and Hospital Acquired Conditions G. Preventive Health Screenings

VI. Programs Addressing Identified Community Health Needs

Program Title: Donations – Financial Description: Our Childrens' House at Baylor supports other non-profit organizations whose missions parallel the mission of OCH.


Organizations Receiving Donations:

Ronald McDonald House of Dallas - Ronald McDonald House of Dallas (RMHD) is the only organization that provides a temporary home-away-from-home for families whose children are receiving treatment for a serious illness or injury at a Dallas area hospital. In an effort to lessen the burden, reduce stress, keep the family intact, and enhance the quality of life for these families, RMHD provides temporary housing in a caring home-like atmosphere. Ronald McDonald House program was built on the simple idea that nothing else should matter when a family is focused on healing their child – not where they can afford to stay, where they will get their next meal, or where they will lay their head at night to rest.

The ARC of Texas - “The Arc of Texas promotes, protects, and advocates for the human rights and self-determination of Texans with intellectual and developmental disabilities.” The Arc teaches individuals and their families how to effectively advocate for themselves and the people they care about. The Arc offers an array of effective trainings in advocacy, education, and independent living. The Arc has a wealth of knowledge on all aspects of interest to individuals and families of people with disabilities.

Down Syndrome Guild of Dallas Buddy Walk - The Mission of the Down Syndrome Guild is to provide accurate and current information, resources, and support for people with Down syndrome, their families and the community.

Especially Needed - Especially Needed was founded in June of 2010 by Heather Astuto. Especially Needed is working diligently to close the gaps and fill the needs of the community we serve, providing resources to individuals with special needs and their families as well as supporting local business partners.

Autism Speaks - Autism Speaks was founded in February 2005 by Bob and Suzanne Wright, grandparents of a child with autism. Their longtime friend Bernie Marcus donated $25 million to help financially launch the organization. Since then, Autism Speaks has grown into the world's leading autism science and advocacy organization, dedicated to funding research into the causes, prevention, treatments and a cure for autism; increasing awareness of autism spectrum disorders; and advocating for the needs of individuals with autism and their families.

Needs Addressed Under This Program:

Multiple Chronic Conditions

Behavioral Health

Program Title: Donations In Kind – Faith in Action Initiatives Description: The office of Faith in Action Initiatives 2nd Life program provides monetary and medical supplies and equipment reclamation from Baylor Scott & White Health and community partners for the purpose of providing for the health care needs of populations both locally and internationally whose needs cannot be met through their own organization. Needs Addressed Under This Program:

Access to Care for Low Income/Underserved Program Title: Child Life Services


Description: The Hospital’s child life services (Child Life) consists of certified child life specialists trained to help children and their families cope with being in the Hospital. Child Life is affirmed by the American Academy of Pediatrics as “an essential component of quality pediatric health care” and facilitates a child’s plan of care through medical play, teaching techniques for coping and supporting the child’s growth and development. Whether the child is being treated for developmental delays, birth disorders, traumatic injury or severe illness, a child life specialist interacts with every inpatient child. These services are provided free of charge. Needs Addressed Under This Program:


Health Care Infrastructure Program Title: Community Benefit Operations Description: The Hospital provides assigned staff to carry out services that specifically benefit the community. This includes conducting a community health needs and/or assets assessment, dedicated staff to perform various services in the community as well as the provision of other services associated with community benefit strategy and operations. Needs Addressed Under This Program:


Healthcare Infrastructure

Preventive Health Screenings Program Title: Community Health Education and Outreach Description: Our Children's House at Baylor provides a variety of free educational presentations, training sessions, and monthly support groups for parents and children. In addition they provide several specialized sessions where children with disabilities could learn important social skills out in the community. This includes a comprehensive feeding assessment that involves an occupational therapist to assess texture and/or sensory deficits, a speech therapist to assess oral motor, chewing, and swallowing skills, a dietitian to assess nutritional needs, and a behavioral feeding specialist to assess possible behavioral barriers to feeding. Parents learn to reinforce new techniques and therapies to help a child's mealtimes become successful. Persons Served: 825 Needs Addressed Under This Program:

Health Care Infrastructure


Behavioral Health Program Title: Holiday Programming for Children and Families Description: The Hospital tries to alleviate some of that sadness of being homesick during the holidays. Normalization is very important in a child’s hospitalization, and making holidays memorable to patients and families is part of that. Since some of our


patients can’t go home for the holiday we provide those special events here in the hospital. Persons Served: 830 Needs Addressed Under This Program:

Behavioral Health Program Title: Parent Education Workshops Description: Our Children's House at Baylor provides a variety of free educational presentations, training sessions, and monthly support groups for parents and children. In addition they provide several specialized sessions where children with disabilities could learn important social skills out in the community. Parents know that children with special needs have gifts and talents—it’s just a matter of unleashing their full potential, and making sure that parents have the right information, tools and support to help them. The Hospital also started an educational library as well as an online library to provide information that may help parents better understand their child's growth and development as well as articles designed for parents of children with special needs. Persons Served: 70 Needs Addressed Under This Program:

Behavioral Health


Patient Safety and Hospital Acquired Conditions Program Title: Medical Education - Nursing Description: Our Children's House at Baylor provides undergraduate/vocational training to students enrolled in an outside organization. Staff time counts only those hours used when staff nurses are taken away from their routine duties. A clinical setting for undergraduate training and internship for pother health professions, technicians, and physical therapists, - when there is no work requirement tied to training. Persons Served: 112 Needs Addressed Under This Program:

Access to Care for Low Income/Under-served Program Title: News Media Generated Community Health Education Description: The Public Relations Team uses news media and social media efforts to equip the community with the latest health and wellness information as well as information on when and how to connect with health care professionals, hospitals, and other health care institutions. The scope of the efforts includes but is not limited to:

• public health • disease-specific or injury-specific information • identifying community resources for meeting health needs • the development of tools and resources needed to get credible information to patients

This is accomplished through:

• publishing educational and diagnostic opportunities


• providing timely, relevant health content on social media sites • hosting electronic education events • maintaining health education blogs • promoting the System health library • monitoring and engaging government agencies and industry associations relative to connecting providers and patients • promoting the tools and resources needed to improve the quality, cost- effectiveness, efficiency, patient-centeredness, safety and access to health care.

The Public Relations Team produces opportunities for free health and wellness education for all people – whether they are insured, uninsured or under insured patients – through well-developed relationships with news media outlets. The goal of the team’s work is to educate the public about health issues.

Stories Published:

Title: Ramadan Observance to Honor Patients Faith Narrative: Christian Ministry of Healing Brings Ramadan to Our Children’s House at Baylor. July 2014 was the holy month of Ramadan. Observing Ramadan is one of the foundational five pillars of the Islamic faith. It is a time for prayer, fasting during daylight hours and honoring Islam by abstaining from physical pleasures.

Unfortunately, it was also when an accident brought the injured 7-year-old son of a devout Muslim family to Our Children’s House at Baylor (OCH).

While children don’t participate in the Ramadan fast until puberty, it is important to follow halal—the dietary obligations of Islamic law. Halal is a purification restriction that isn’t limited to food, but it does have a significant bearing on the types of food allowed, meat in particular—how the animal is blessed, slaughtered and prepared. So it was especially important to the family that halal nutrition would be served during their son’s extended rehabilitation. The Office of Mission & Ministry provides family resource packets to Muslim patients and families at admission. The packets, donated by a local mosque, are gender-specific, and include head coverings, the Holy Quran, prayer beads and a prayer rug.

Feeding the body and the soul Enter Chaplain James Paul Qazilbash and Aramark’s nutrition team. James Paul sought out one of our Muslim physicians who works in another Baylor Scott & White Health facility and was able to tell where the family could obtain halal food and meals. But since the family didn’t have transportation, that solution wouldn’t suffice for the long-term stay at OCH, where a rehabilitation patient stay averages up to 28.5 days or longer. That’s when Aramark’s team stepped in. Clinical dietitians Emily Lukowski and Sheri Vancura sat down with the child’s father and aunt to understand their religious and cultural practices around food. Sheri took over the case for the duration of the family’s stay. James Paul and Christine Murphy, clinical dietitian manager, made a handout about the Islamic faith and Ramadan along with the pertinent information about the guest trays and dietary needs for the patient’s chart, so everyone was made aware.


Diet technician Rebecca Poston and LaTachie Smith, nutrition services hostess, coordinated with Baylor University Medical Center at Dallas nutrition services to make sure only allowed foods would be sent to the family. Lunch and dinner trays were ordered for the father, who saved them for his meals after sundown. The family was very happy with the food and service, but mostly, they were tremendously thankful that we learned about them, their faith and we took it very seriously. It’s all about patient centeredness, “Food is both a healing property and a spiritual expression for many,” notes Terri Nuss, vice president, patient centeredness. “Diversity expresses itself in many ways, and dietary norms and customs are some of the more obvious ways. But we can’t make assumptions based on someone’s name, dress or other characteristics; we must be responsive and respectful by asking each patient and his or her family how we can best meet their physical, emotional and spiritual needs. This story is a great example of asking about patient needs, listening and then following through.”

A ministry of healing. James Paul reflects, “It is so apparent how the partnership, skill and compassion of our nutrition team exemplify Dr. Truett’s vision to create a place for people of all faiths to come for compassionate care and to come to us with confidence. Working alongside team members like the Aramark staff is a daily reminder that Dr. Truett’s vision is not simply a quote from 1903, but a calling that our nutrition services staff carries out with diligence, compassion and attentiveness for all of our patients and families at Our Children’s House.”

Did you know? We offer prayer kits to Muslim patients and families from local Mosques. The kit includes a prayer rug, gender-appropriate head covering for males or females, Holy Quran and a Book of Hadith—a Muslim prayer book. Since Muslims pray five times each day, we also invite and encourage their regular use of our chapels for prayer and reflection. For our Jewish patients and families we also prepare kosher meals. While kosher and halal are similar in practice, they are not the same nor are they interchangeable. Vegetarian and vegan meals are available for those, such as Buddhists and others, whose practice is to abstain from meat and/or other animal products. And for our large base of Indian patients in Irving, Baylor Medical Center at Irving will soon be offering Indian foods that specifically fit their culture and taste. Needs Addressed Under This Program:

Behavioral Health

VII. Charity Care and Government-Sponsored Indigent Health Care Provided For Fiscal Year 2015, Our Children’s House at Baylor provided $7,875,361.00 in unreimbursed costs of charity care and government-sponsored indigent health care.


VIII. Government-Sponsored Health Care Provided For Fiscal Year 2015, Our Children’s House at Baylor provided $97,136.00 in unreimbursed costs of government-sponsored health care.

IX. Other Types of Community Benefits Provided $186,601

Our Children’s House at Baylor is committed to improving the quality of life for the many citizens living and working in its area. Our Children’s House at Baylor was pleased to allocate funds to the following community benefit activities.

A. Community Benefit Operations $1,190

B. Community Health Improvement Services $1,400

C. Medical Education $14,597

D. Financial Donations $2,328

E. In Kind Donations $4,704

F. Subsidized Health Care Services $162,382

X. Total Operating Expenses and Calculation of the Ratio of Cost to Charge

As required by Section 311.046 (a) (4), Our Children’s House at Baylor reports $ 34,825,158 in total operating expenses. As required by Section 311.046(1) (5), the ratio of cost to charges was 52.22%. Please see the attached worksheet for the full calculation.

XI. Report of Community Benefit Provided During Fiscal Year 2015

In a commitment to fulfill its mission, Our Children’s House at Baylor benefit to the community, conservatively estimated, was $8,159,098.00 for Fiscal Year 2015. Our Children’s House at Baylor is filing its Annual Statement of Community Benefits Standard (Statement) as a consolidated system with the other affiliated hospitals of BSW excluding those that qualify as Medicaid disproportionate share hospitals). Through community benefit activities, BSW-affiliated hospitals provided: quality patient care and subsidized services otherwise not available in the community; medical education, training for medical technicians, hospital chaplains, nurses, and future physicians; and medical research that will speed the time between scientific finding and its application to improving medical care. Any comments or suggestions in regard to the community benefit activities are greatly welcomed and may be addressed to Jennifer Coleman, Senior Vice President, Consumer Affairs, Baylor Scott and White Health, 3600 Gaston Avenue, Suite 150, Dallas, Texas 75246.


For the Fiscal Year Ended June 30, 2014 34,825,158

Total Patient Revenues (a) 63,796,822

(from 2014 Medicare Cost Report, Worksheet G-3, Line 1)

Total Operating Expenses (b) 33,124,371

(from 2014 Medicare Cost Report, Worksheet A, Line 118, Col. 7)

Initial Ratio of Cost to Charge ((b) divided by (a)) (c) 51.92%

Application of Initial Ratio of Cost to Charge to Bad-Debt Expense

Bad Debt Expense (d) 365,484

(from 2015 audited financial statements)

Multiply "Bad Debt Expense" by "Initial Ratio of Cost to Charge" ((d)*(c)) (e) 189,759

Add the allowable "Bad-Debt Expense" to "Total Operating Expenses" ((b) + (e)) (f) 33,314,130

Calculation of Ratio of Cost to Charge ((f) divided by (a)) (g) 52.22%

Our Children's House at Baylor

Calculation of the Ratio of Cost to Charge

Section 311.046(a)(5)

Total Operating Expenses

Section 311.046(a)(4)

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