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SUTTER HEALTH PACIFIC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
SUTTER HEALTH PACIFIC (EIN 99-0298651)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-15
IRS object ID
202213199349323761
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-11-15T15:45:44-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1560 MISSION ST STE 1600AddressLine1Txt
CitySAN FRANCISCOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94105ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN990298651EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SUTTER HEALTH PACIFICBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% MARK WHEELERInCareOfNm
Business Name ControlSUTTBusinessNameControlTxt
Phone9162866665PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line191-2301 OLD FORT WEAVER ROADAddressLine1Txt
CityEWA BEACHCityNm
State AbbreviationHIStateAbbreviationCd
ZIP96706ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMARK WHEELERPersonNm
Person TitleINTERIM CFOPersonTitleTxt
Phone8086772580PhoneNum
Signature2022-11-11SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstMARKPersonFirstNm
Person LastWHEELERPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonEva NittaPreparerPersonNm
PTINP01286320PTIN
Phone4158948000PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1KAHI MOHALABusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerJAMES E CONFORTIPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line191-2301 OLD FORT WEAVER ROADAddressLine1Txt
CityEWA BEACHCityNm
State AbbreviationHIStateAbbreviationCd
ZIP96706ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$20,658,165GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.SUTTERHEALTH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1992FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionSEE SCHEDULE OActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee317TotalEmployeeCnt
Total Volunteers10TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$2,135,010PYContributionsGrantsAmt
CY Contributions Grants$322,904CYContributionsGrantsAmt
PY Program Service Revenue$21,901,819PYProgramServiceRevenueAmt
CY Program Service Revenue$20,332,798CYProgramServiceRevenueAmt
PY Investment Income$8,723PYInvestmentIncomeAmt
CY Investment Income$2,463CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$24,045,552PYTotalRevenueAmt
CY Total Revenue$20,658,165CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$19,243,581PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$19,332,902CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$151,549CYTotalFundraisingExpenseAmt
PY Other Expenses$7,182,748PYOtherExpensesAmt
CY Other Expenses$7,051,629CYOtherExpensesAmt
PY Total Expenses$26,426,329PYTotalExpensesAmt
CY Total Expenses$26,384,531CYTotalExpensesAmt
PY Revenues Less Expenses-$2,380,777PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$5,726,366CYRevenuesLessExpensesAmt
Total Assets BOY$17,279,695TotalAssetsBOYAmt
Total Assets EOY$19,859,145TotalAssetsEOYAmt
Total Liabilities BOY$4,190,633TotalLiabilitiesBOYAmt
Total Liabilities EOY$4,359,402TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$13,089,062NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$15,499,743NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionSEE SCHEDULE OMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$22,694,105ExpenseAmt
Grant$0GrantAmt
Revenue$20,332,798RevenueAmt
DescSEE SCHEDULE ODesc
Total Program Service Expenses$22,694,105TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsfalseDonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document30IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee317EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMARK WHEELERPersonNm
Phone5305451409PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line191-2301 OLD FORT WEAVER ROADAddressLine1Txt
CityEWA BEACHCityNm
State AbbreviationHIStateAbbreviationCd
ZIP96706ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
JAMES E CONFORTI
President, SH Pacific2.040.0Yes (X)Yes (X)$0$2,036,409$557,262
Rishi Sikka MD
President, SHS Ent.1.040.0Yes (X)$0$1,452,351$205,966
Penny Westfall
SH VP, CLO, SH0.040.0$0$778,774$1,812Yes (X)
Claudia Crist
CEO, Kahi2.040.0Yes (X)Yes (X)$0$591,638$59,459
Kevin W Kuich MD
Chief Medical Officer40.00.0$511,344$0$28,615Yes (X)
Steven Chaplin MD
Psychiatrist40.00.0Yes (X)$333,677$0$24,925
Elena Sharipova MD
Psychiatrist40.00.0$322,515$0$33,480Yes (X)
Ben Kirk
Sec, Deputy Gen Counsel - SAC1.040.0Yes (X)$0$268,591$46,746
Quin Ogawa
CFO SHP40.00.0Yes (X)$245,670$0$13,284
Maureen Kumar
Director - Human Resources40.00.0$190,735$0$16,030Yes (X)
Michelle M Fernandez
Director, Patient Care40.00.0$185,853$0$9,708Yes (X)
Eduardo Jones
Director of Behavioral Health40.00.0$163,677$0$23,044Yes (X)
Ruth Ann Becker
Director (PT YR)1.00.0Yes (X)$0$0$0
Katherine W Bennett
Director1.00.0Yes (X)$0$0$0
Dee Jay Mailer
Director1.00.0Yes (X)$0$0$0
Cameron Nekota
Director/Chair2.00.0Yes (X)Yes (X)$0$0$0
Gidget DG Ruscetta
Director1.00.0Yes (X)$0$0$0
Paul Singer
Director (PT YR)1.00.0Yes (X)$0$0$0
Charles Sted
Director1.01.0Yes (X)$0$0$0
Millard Brown
Director1.00.0Yes (X)$0$0$0
Nicholas Hughey
Director1.00.0Yes (X)$0$0$0
Evan Leong
Director1.00.0Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,953,471TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,127,763TotReportableCompRltdOrgAmt
Total Other Compensation$1,020,331TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K37IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Locumtenenscom LLC
PO Box 405547ATLANTAGA30384PSYCHIATRY SERVICES$703,719
Jackson and Coker Holdings LLC
PO Box 277638ATLANTAGA30384PSYCHIATRY SERVICES$489,799
Vista Staffing Solutions IN
2800 E Cottonwood Pkwy STE 400COTTONWOOD HEIGHTSUT841217296PSYCHIATRY SERVICES$282,731
Universal Protection SVC LP
161 Washington St STE 600CONSHOHOCKENPA194282083Security Services$125,696
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Government Grants$278,885GovernmentGrantsAmt
All Other Contributions$44,019AllOtherContributionsAmt
Total Contributions$322,904TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPATIENT SERVICE REVENUEDesc
Business623990BusinessCd
Total Revenue Column$20,332,798TotalRevenueColumnAmt
Related Or Exempt Func Income$20,332,798RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$20,332,798TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,242TotalRevenueColumnAmt
Exclusion$2,242ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$221SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$221SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$221TotalRevenueColumnAmt
Exclusion$221ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$20,658,165TotalRevenueColumnAmt
Related Or Exempt Func Income$20,332,798RelatedOrExemptFuncIncomeAmt
Exclusion$2,463ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,100,164TotalAmt
Program Services$449,508ProgramServicesAmt
Management And General$650,656ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$11,664,464TotalAmt
Program Services$10,964,449ProgramServicesAmt
Management And General$618,319ManagementAndGeneralAmt
Fundraising$81,696FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$451,244TotalAmt
Program Services$424,164ProgramServicesAmt
Management And General$23,920ManagementAndGeneralAmt
Fundraising$3,160FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$5,022,608TotalAmt
Program Services$4,247,465ProgramServicesAmt
Management And General$750,187ManagementAndGeneralAmt
Fundraising$24,956FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,094,422TotalAmt
Program Services$986,232ProgramServicesAmt
Management And General$99,289ManagementAndGeneralAmt
Fundraising$8,901FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$38,846TotalAmt
Management And General$38,846ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$2,000TotalAmt
Management And General$2,000ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$9,459TotalAmt
Management And General$9,459ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,510,566TotalAmt
Program Services$1,510,566ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$10,461TotalAmt
Program Services$10,461ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$635,013TotalAmt
Program Services$460,829ProgramServicesAmt
Management And General$171,166ManagementAndGeneralAmt
Fundraising$3,018FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$218,532TotalAmt
Program Services$584ProgramServicesAmt
Management And General$217,948ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$679,501TotalAmt
Program Services$679,201ProgramServicesAmt
Management And General$300ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$80,558TotalAmt
Program Services$75,763ProgramServicesAmt
Management And General$4,795ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$4,832TotalAmt
Program Services$3,997ProgramServicesAmt
Management And General$835ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$228,900TotalAmt
Program Services$228,900ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$662,456TotalAmt
Program Services$662,456ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$290,597TotalAmt
Program Services$290,597ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
PURCHASED SERVICES$988,951$848,508$140,176$267
SYSTEM ALLOCATION$935,257$169,180$763,820$2,257
FOOD$368,096$368,096
MEDICAL SUPPLIES$238,611$213,540$71$25,000

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$148,993TotalAmt
Program Services$99,609ProgramServicesAmt
Management And General$47,090ManagementAndGeneralAmt
Fundraising$2,294FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$26,384,531TotalAmt
Program Services$22,694,105ProgramServicesAmt
Management And General$3,538,877ManagementAndGeneralAmt
Fundraising$151,549FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,042,790BOYAmt
EOY$364,108EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,035,899BOYAmt
EOY$7,639,653EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$4,855BOYAmt
EOY$4,881EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$270,411BOYAmt
EOY$350,949EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$22,562,957LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$11,066,031LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$11,773,421BOYAmt
EOY$11,496,926EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$152,319BOYAmt
EOY$2,628EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$17,279,695BOYAmt
EOY$19,859,145EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,306,483BOYAmt
EOY$1,443,984EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,884,150BOYAmt
EOY$2,915,418EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,190,633BOYAmt
EOY$4,359,402EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$13,010,487BOYAmt
EOY$15,441,774EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$78,575BOYAmt
EOY$57,969EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$13,089,062BOYAmt
EOY$15,499,743EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$17,279,695BOYAmt
EOY$19,859,145EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$5,726,366ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$2,251NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$8,139,298OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$2,000OtherActivitiesAmt
Total Lobbying Expenditures$2,000TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE C, PART II-B, LINE 1IFormAndLineReferenceDesc
ExplanationOTHER ACTIVITIES: PAID CONSULTANTS THAT PERFORMED LOBBYING ACTIVITIES.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$8,115,975OtherCostOrOtherBasisAmt
Book Value$8,115,975BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$12,555,862OtherCostOrOtherBasisAmt
Depreciation$9,578,056DepreciationAmt
Book Value$2,977,806BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,405,612OtherCostOrOtherBasisAmt
Depreciation$1,172,137DepreciationAmt
Book Value$233,475BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$485,508OtherCostOrOtherBasisAmt
Depreciation$315,838DepreciationAmt
Book Value$169,670BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$11,496,926TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
INSURANCE LIABILITIES$1,479,401
OTHER LIABILITIES$1,436,017
FieldValueIRS element (for citing)
Total Liability$2,915,418TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PART X, LINE 2FormAndLineReferenceDesc
ExplanationTHIS ORGANIZATION WAS PART OF A CONSOLIDATED FINANCIAL SYSTEM AUDIT. THE ASC 740 AUDIT FOOTNOTE DISCLOSURE FOR THE SUTTER SYSTEM IS AS FOLLOWS: SUTTER HEALTH AND MANY AFFILIATES HAVE BEEN DETERMINED TO BE EXEMPT ORGANIZATIONS BY THE INTERNAL REVENUE SERVICE AND THE CALIFORNIA FRANCHISE TAX BOARD AND GENERALLY ARE NOT SUBJECT TO TAXES ON INCOME. CERTAIN ACTIVITIES OF SUTTER ARE SUBJECT TO INCOME TAXES; HOWEVER, SUCH ACTIVITIES ARE NOT SIGNIFICANT TO THE CONSOLIDATED FINANCIAL STATEMENTS. WITH RESPECT TO ITS TAXABLE ACTIVITIES, SUTTER RECORDS INCOME TAXES USING THE LIABILITY METHOD, UNDER WHICH DEFERRED TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON THE DIFFERENCES BETWEEN THE FINANCIAL ACCOUNTING AND TAX BASIS OF ASSETS AND LIABILITIES. DEFERRED TAX ASSETS OR LIABILITIES AT THE END OF EACH PERIOD ARE DETERMINED USING THE CURRENTLY ENACTED TAX RATE EXPECTED TO APPLY TO TAXABLE INCOME IN THE PERIODS THAT THE DEFERRED TAX ASSET OR LIABILITY IS EXPECTED TO BE REALIZED OR SETTLED. SUTTER RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS, ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE STATUTE OF LIMITATIONS FOR TAX YEARS 2018 THROUGH 2020 REMAINS OPEN IN U.S. TAX JURISDICTIONS IN WHICH SUTTER AND ITS AFFILIATES ARE SUBJECT TO TAXATION. SUTTER RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. THERE WERE NO SUCH UNCERTAIN TAX POSITIONS RECOGNIZED FOR THE YEARS ENDED DECEMBER 31, 2021 AND 2020.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other400.FreeCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetfalseFinancialAssistanceBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs5ActivitiesOrProgramsCnt
Persons Served8PersonsServedCnt
Total Community Benefit Expns$9,945TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$9,945NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served178PersonsServedCnt
Total Community Benefit Expns$9,164TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$9,164NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$1,792TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,792NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs9ActivitiesOrProgramsCnt
Persons Served186PersonsServedCnt
Total Community Benefit Expns$20,901TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$20,901NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs9ActivitiesOrProgramsCnt
Persons Served186PersonsServedCnt
Total Community Benefit Expns$20,901TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$20,901NetCommunityBenefitExpnsAmt
Total Expense0.00080TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served2PersonsServedCnt
Total Community Benefit Expns$15,369TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$15,369NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served78PersonsServedCnt
Total Community Benefit Expns$1,763TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,763NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Activities Or Programs12ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$51,509TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$51,509NetCommunityBenefitExpnsAmt
Total Expense0.00200TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs14ActivitiesOrProgramsCnt
Persons Served80PersonsServedCnt
Total Community Benefit Expns$68,641TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$68,641NetCommunityBenefitExpnsAmt
Total Expense0.00270TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReportedInd
Reimbursed By Medicare$1,996,918ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$0CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$1,996,918MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SUTTER HEALTH PACIFIC - KAHI MOHALABusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line191-2301 OLD FORT WEAVER ROADAddressLine1Txt
CityEWA BEACHCityNm
State AbbreviationHIStateAbbreviationCd
ZIP96706ZIPCd
FieldValueIRS element (for citing)
Website Addresshttps://www.sutterhealth.org/kahiWebsiteAddressTxt
State LicenseLICENSE #33-HStateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1SUTTER HEALTH PACIFIC - KAHI MOHALABusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted19CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE PART V, SECTION COwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLSEE PART V, SECTION COtherWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt19ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLSEE PART V, SECTION CStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care400.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care0.FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Other MethodYes (X)OtherMethodInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSEE PART V, SECTION CFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE PART V, SECTION CFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE PART V, SECTION CFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Prospective Medicare MedicaidYes (X)ProspectiveMedicareMedicaidInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART V, SECTION B, LINE 3ETHE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA.
SCHEDULE H, PART V, SECTION B, LINE 5IN CONDUCTING ITS MOST RECENT CHNA, SUTTER HEALTH PACIFIC - KAHI MOHALA DID TAKE INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY IN THE HOSPITAL'S SERVICE AREA. DEDICATED TO SERVING AND ENHANCING HAWAII'S NONPROFIT AND PUBLIC SECTORS, ISLANDER INSTITUTE ASSISTED WITH COLLECTING COMMUNITY INPUT IN THE FORM OF MEETINGS WHICH INDICATED COMMUNITY NEEDS AND THE DEGREE OF COMMUNITY READINESS TO JOIN IN FORMING SOLUTIONS AND KEY INFORMANT INTERVIEWS WHICH PROVIDED EXPERT OPINIONS ON VARIOUS COMMUNITY NEEDS, POSSIBLE SOLUTIONS, SYSTEMIC FACTORS AND/OR EVALUATION OF ORGANIZATIONAL READINESS FOR PARTNERSHIPS. ISLANDER INSTITUTE CONVENED 21 COMMUNITY MEETINGS IN TOTAL TO ENGAGE EVERYDAY PEOPLE IN DISCUSSIONS AROUND HEALTH IN THEIR COMMUNITIES. A SPECIFIC EFFORT WAS MADE TO LEARN ABOUT THE EXPERIENCE OF HEALTH IN VULNERABLE COMMUNITIES, INCLUDING DISADVANTAGED MINORITIES, RURAL RESIDENTS, YOUTH, SENIORS, PLACES THAT ARE MEDICALLY UNDERSERVED, AND PEOPLE WITH LOW INCOMES. THE MEETINGS WERE NOT LIMITED TO THESE POPULATIONS AND INCLUDED A DIVERSE SAMPLE OF GEOGRAPHIES, AGES, ETHNICITIES, AND SOCIOECONOMIC BACKGROUNDS. SPECIAL ATTENTION WAS GIVEN TO ENSURE THE MEETINGS WERE NOT MERELY EXTRACTING INFORMATION FROM PEOPLE AND COMMUNITIES. RATHER, THE PURPOSE OF THE MEETINGS WAS TO BUILD RELATIONSHIPS BY LISTENING, ENGAGING, UNDERSTANDING VALUES, AND BUILDING RECIPROCITY. ISLANDER INSTITUTE PARTNERED WITH ORGANIZATIONS AND INDIVIDUALS WITH STRONG CONNECTIONS WITHIN THEIR COMMUNITIES TO ORGANIZE AND HOST THESE MEETINGS. ALL THE HOSTS WORK IN COMMUNITY HEALTH, COMMUNITY SERVICE AND/OR COMMUNITY BUILDING AND ENGAGE ON ISSUES AFFECTING HEALTH AND WELLBEING. AS HOSTS, THEY PLAYED A CRITICAL ROLE IN CREATING A SAFE SPACE AND INVITING THE RIGHT PEOPLE INTO THE SPACE, INCLUDING PATIENTS, STAFF, OR COMMUNITY MEMBERS WHO HAD IMPORTANT STORIES AND COULD FEEL COMFORTABLE SHARING THEM. THE MEETINGS WERE KEPT RELATIVELY SMALL-BETWEEN FIVE TO 25 PEOPLE-AND DESIGNED TO MAXIMIZE EVERYONE'S COMFORT LEVEL, WHICH WOULD ALLOW ALL TO MEANINGFULLY PARTICIPATE AND FOR THE CONVERSATION TO GO DEEPER. PARTICIPANTS WERE TOLD THAT THEY WOULD NOT BE PERSONALLY IDENTIFIED IN THE REPORT. IN THIS CHNA, THEY ARE IDENTIFIED BASED ON ATTRIBUTES THAT MIGHT BE HELPFUL TO GIVE CONTEXT TO THEIR INPUT, SUCH AS THEIR AREA OF RESIDENCE OR BACKGROUND. ISLANDER INSTITUTE CREATED AN INITIAL LIST OF PEOPLE WHO COULD SHED LIGHT ON QUESTIONS OF HEALTH, SOCIAL DETERMINANTS, AND THE CIRCUMSTANCES IN VARIOUS COMMUNITIES. THE INITIAL LIST INCLUDED EXPERTS AND AUTHORITIES WITH WHOM ISLANDER INSTITUTE HAD EXISTING RELATIONSHIPS BASED ON ITS MANY YEARS OF WORKING IN HAWAII. THROUGHOUT THE MONTHS OF CONVERSATIONS, PEOPLE SUGGESTED OTHERS TO TALK TO AND HELPED MAKE CONNECTIONS. IN TOTAL, ISLANDER INSTITUTE SPOKE WITH ROUGHLY 200 PEOPLE FROM SIX ISLANDS IN PERSON OR OVER THE PHONE, IN A ONE-ON-ONE FORMAT OR IN SMALL GROUPS, AND IN FORMAL OR INFORMAL SETTINGS. AMONG THE KEY INFORMANTS, ISLANDER INSTITUTE ALSO MET WITH REPRESENTATIVES OF EACH OF THE 19 PARTICIPATING HOSPITAL FACILITIES TO BEST UNDERSTAND THEIR ENGAGEMENT WITH THE CHNA AND THE COMMUNITIES THEY SERVE. THESE CONVERSATIONS HELPED ILLUMINATE INTERESTS, CAPACITIES, AND MISSIONS OF EACH FACILITY AND SHED LIGHT ON LIMITATIONS AND USES OF PREVIOUS CHNAS AND THE POTENTIAL FOR THIS CHNA. THE FINDINGS FROM KEY INFORMANT INTERVIEWS IN KAHI MOHALA'S CHNA ARE AVAILABLE AT HTTPS://WWW.SUTTERHEALTH.ORG/KAHI/FOR-PATIENTS/COMMUNITY-HEALTH-NEEDS-ASSE SSMENT
SCHEDULE H, PART V, SECTION B, LINES 6A AND 6BTHE HEALTHCARE ASSOCIATION OF HAWAII (HAH) LED THIS COLLABORATION TO CONDUCT STATE- AND COUNTY-WIDE ASSESSMENTS FOR ITS MEMBERS. NINETEEN MEMBER HOSPITALS IN HAWAII PARTICIPATED IN THE CHNA PROJECT: . ADVENTIST HEALTH CASTLE . KAHI MOHALA . KAHUKU MEDICAL CENTER . KAISER FOUNDATION HOSPITAL - HONOLULU . KAPI'OLANI MEDICAL CENTER . KUAKINI MEDICAL CENTER . KULA HOSPITAL . LANA'I COMMUNITY HOSPITAL . MAUI MEMORIAL MEDICAL CENTER . MOLOKAI GENERAL HOSPITAL . NORTH HAWAI'I COMMUNITY HOSPITAL . PALI MOMI MEDICAL CENTER . THE QUEEN'S MEDICAL CENTER . THE QUEEN'S MEDICAN CENTER - WEST O'AHU . REHABILITATION HOSPITAL OF THE PACIFIC . SHRINERS HOSPITALS FOR CHILDREN - HONOLULU . STRAUB MEDICAL CENTER . WAHIAWA GENERAL HOSPITAL . WILCOX MEDICAL CENTER HAH AIMS TO BE THE UNIFYING VOICE OF HAWAII'S HEALTHCARE PROVIDERS AND AN AUTHORITATIVE AND RESPECTED LEADER IN SHAPING HAWAII'S HEALTHCARE POLICY. FOUNDED IN 1939, HAH REPRESENTS THE STATE'S HOSPITALS, NURSING FACILITIES, ASSISTED LIVING FACILITIES, HOME HEALTH AGENCIES, HOSPICES, AND OTHER HEALTHCARE PROVIDERS. HAH WORKS WITH COMMITTED PARTNERS AND STAKEHOLDERS TO ESTABLISH A MORE EQUITABLE, SUSTAINABLE HEALTHCARE SYSTEM DRIVEN TO IMPROVE QUALITY, EFFICIENCY, AND EFFECTIVENESS FOR PATIENTS AND COMMUNITIES.
SCHEDULE H, PART V, SECTION B, LINE 7AHOSPITAL FACILITY WEBSITE: HTTPS://WWW.SUTTERHEALTH.ORG/KAHI/FOR-PATIENTS/COMMUNITY-HEALTH-NEEDS- ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 7B: OTHER WEBSITE: HTTPS://WWW.SUTTERHEALTH.ORG/FOR-PATIENTS/COMMUNITY-HEALTH-NEEDS- ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 10A: IMPLEMENTATION STRATEGY: https://www.sutterhealth.org/pdf/for-patients/chna/ kahi-mohala-2019-2021-implementation-strategy.pdf
SCHEDULE H, PART V, SECTION B, LINE 11THE FOLLOWING SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED IN THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT ARE NEEDS THAT KAHI MOHALA INTENDS TO ADDRESS THROUGH ITS IMPLEMENTATION STRATEGY: . PROVIDE ACCESSIBLE, PROACTIVE SUPPORT FOR THOSE WITH HIGH NEEDS. IDENTIFY, DEVELOP, AND STRENGTHEN OUTREACH, EARLY INTERVENTION, FREE HEALTHCARE SERVICES, MENTAL HEALTH, AND ORAL HEALTH FOR THOSE WHO ARE STRUGGLING WITH HOUSELESSNESS, MENTAL ILLNESS, AND ADDICTION. . STRENGTHEN FAMILIES. CREATE THE CONDITIONS AND OPPORTUNITIES FOR FAMILIES TO BE HEALING FORCES FOR ITS OWN MEMBERS, INCLUDING ADDRESSING FINANCIAL STRESS THAT WILL ENABLE MORE HEALTHY TIME TOGETHER. . INVEST IN TEENAGERS AND HEALTHY STARTS. INVEST IN HEALTH AND EDUCATION AT THE EARLIEST STAGES OF LIFE. SUPPORT SCHOOL-BASED STRUCTURES, COMMUNITY-BASED ACTIVITIES, AND YOUTH EMPOWERMENT FOR PRE-TEENS AND TEENS. DESCRIPTIONS OF THE COMMUNITY BENEFIT PROGRAMS THAT ADDRESS THESE SIGNIFICANT HEALTH NEEDS CAN BE FOUND IN PART VI. NO HOSPITAL CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. KAHI MOHALA IS COMMITTED TO SERVING THE COMMUNITY BY ADHERING TO ITS MISSION, USING ITS SKILLS AND CAPABILITIES, AND REMAINING A STRONG ORGANIZATION SO THAT IT CAN CONTINUE TO PROVIDE A WIDE RANGE OF COMMUNITY BENEFITS. THE HOSPITAL DOES NOT PLAN TO ADDRESS THE FOLLOWING SIGNIFICANT HEALTH NEEDS THAT WERE IDENTIFIED IN THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT: . ADDRESS FINANCIAL INSECURITY . WORK TOGETHER FOR EQUALITY AND JUSTICE . PREPARE FOR EMERGENCIES . BUILD GOOD FOOD SYSTEMS . RESTORE ENVIRONMENT AND SENSE OF PLACE . NURTURE COMMUNITY IDENTITY AND COHESIVENESS . SHIFT KUPUNA CARE AWAY FROM "SICK CARE" . STRENGTHEN TRUST IN HEALTHCARE AS A MENTAL AND BEHAVIORAL HEALTH FACILITY KAHI MOHALA DOES NOT HAVE THE RESOURCES AND/OR EXPERTISE TO RESPOND TO THESE COMMUNITY NEEDS AT THIS TIME.
SCHEDULE H, PART V, SECTION B, LINE 15EMETHOD FOR APPLYING FOR FINANCIAL ASSISTANCE-OTHER: PATIENTS MAY REQUEST ASSISTANCE WITH COMPLETING THE APPLICATION FOR FINANCIAL ASSISTANCE IN PERSON AT THE HOSPITAL, OVER THE PHONE, THROUGH THE MAIL, OR VIA THE SUTTER HEALTH WEBSITE.
SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, & 16CTHE FINANCIAL ASSISTANCE POLICY, APPLICATION FORM, AND PLAIN LANGUAGE SUMMARY ARE WIDELY AVAILABLE ON THE SUTTER HEALTH WEBSITE AT: HTTPS://WWW.SUTTERHEALTH.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE
SCHEDULE H, PART V, SECTION B, LINE 16JMEASURES USED TO PUBLICIZE THE FACILITY'S FINANCIAL ASSISTANCE POLICY: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE IN THE PRIMARY LANGUAGES OF THE HOSPITAL'S SERVICE AREA. DURING PREADMISSION OR REGISTRATION ALL PATIENTS WILL BE PROVIDED A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY AND ALSO INFORMATION REGARDING THE RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES. PATIENTS WHO MAY BE UNINSURED WILL BE ASSIGNED A FINANCIAL COUNSELOR WHO WILL VISIT WITH THE PATIENT IN PERSON AT THE HOSPITAL AND CAN PROVIDE ADDITIONAL INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY AND ASSIST WITH THE APPLICATION PROCESS. AT THE TIME OF DISCHARGE ALL PATIENTS WILL BE PROVIDED THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY. SUTTER HEALTH WILL PLACE AN ADVERTISEMENT REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AT THE ORGANIZATION IN THE PRINCIPAL NEWSPAPER IN THE COMMUNITY OR WHEN DOING SO IS NOT PRACTICAL SUTTER WILL ISSUE A PRESS RELEASE CONTAINING THE INFORMATION OR USE OTHER MEANS THAT WILL WIDELY PUBLICIZE THE AVAILABILITY OF THE POLICY. SUTTER HEALTH WILL WORK WITH AFFILIATED ORGANIZATIONS, PHYSICIANS, COMMUNITY CLINICS AND OTHER HEALTH CARE PROVIDERS TO NOTIFY MEMBERS OF THE COMMUNITY ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE.
SCHEDULE H, PART V, SECTION B, LINE 22DAMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS: THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY PROVIDES FOR FULL WRITE OFF OF ALL CHARGES FOR AN UNINSURED PATIENT WITH A FAMILY INCOME AT OR BELOW 400% OF THE MOST RECENT FEDERAL POVERTY LEVEL. IN ACCORDANCE WITH INTERNAL REVENUE CODE SECTION 1.501(R)-5, THIS ORGANIZATION ADOPTS THE PROSPECTIVE MEDICARE METHOD FOR AMOUNTS GENERALLY BILLED; HOWEVER, PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT FINANCIALLY RESPONSIBLE FOR MORE THAN THE AMOUNTS GENERALLY BILLED BECAUSE ELIGIBLE PATIENTS DO NOT PAY ANY AMOUNT.

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINES 3A AND 3CFINANCIAL ASSISTANCE ELIGIBILITY CRITERIA: FOR UNINSURED PATIENTS TO BE ELIGIBLE FOR FREE CARE THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINES (FPG) FOR FAMILY INCOMES THAT ARE AT OR BELOW 400% OF FPG. IN ADDITION, THE ORGANIZATION HAS A HIGH MEDICAL COST CHARITY CARE CATEGORY IN WHICH A WRITE OFF OF THE PATIENT RESPONSIBILITY FOR HOSPITAL SERVICES CAN OCCUR IF THE INSURED PATIENT HAS FAMILY INCOME AT OR BELOW 400% FPG AND EXPENSES INCURRED FOR THEMSELVES OR THEIR FAMILY EXCEED 10% OF THE PATIENT'S FAMILY INCOME.
SCHEDULE H, PART I, LINE 3BSUTTER HEALTH PACIFIC - KAHI MOHALA IS COMMITTED TO PROVIDING CHARITY CARE AND THEREFORE, PROVIDES FREE CARE AT HIGH PERCENTAGE OF FPG. THE ORGANIZATION DOES NOT PROVIDE DISCOUNTED CARE.
SCHEDULE H, PART I, LINE 6ASUTTER HEALTH, A RELATED ORGANIZATION, PREPARES A COMBINED COMMUNITY BENEFIT REPORT.
SCHEDULE H, PART I, LINE 7COSTING METHODOLOGY USED: COST TO CHARGE RATIO UTILIZING WORKSHEET 2 METHODOLOGY.
SCHEDULE H, PART IICOMMUNITY BUILDING ACTIVITIES: KAHI MOHALA FUNDS THE FOLLOWING PROGRAMS THAT HELP ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS AND IMPACT THE HEALTH AND WELL-BEING IN THE COMMUNITIES WE SERVE (ALSO KNOWN AS COMMUNITY-BUILDING ACTIVITIES). THESE PROGRAMS HELP SUPPORT COMMUNITY ASSETS BY OFFERING THE EXPERTISE AND RESOURCES OF SUTTER HEALTH. KAHI MOHALA WAS PART OF THE PACIFIC REGION BEHAVIORAL HEALTH ALLIANCE FOCUSED ON DEVELOPING EFFECTIVE BEHAVIORAL HEALTH PREVENTION STRATEGIES. KAHI MOHALA FOCUSED ON ENVIRONMENTAL IMPROVEMENTS THROUGH ITS KAHI MOHALA NEIGHBORHOOD LITTER/GRAFFITI REMOVAL PROGRAM. KAHI MOHALA SUPPORTED COMMUNITY HEALTH IMPROVEMENT ADVOCACY WITH SUPPORT OF LOCAL ORGANIZATIONS SUCH AS THE HEALTH CARE ASSOCIATION OF HAWAII, HAWAII PUBLIC HEALTH ASSOCIATION, AND THE STATE HEALTH PLANNING DEPARTMENT. KAHI MOHALA SUPPORTED THE PACIFIC REGION BEHAVIORAL HEALTH ALLIANCE AND THE ARMY ONCE SOURCE PROGRAM WHICH HAS CREATED STATE-LEVEL ALLIANCES TO RAISE AWARENESS, IMPROVE SERVICE DELIVERY AND GENERATE COMMUNITY SUPPORT FOR SERVICE MEMBERS AND THEIR FAMILIES. THE PROGRAM EDUCATES THE BEHAVIORAL HEALTH COMMUNITY ON MILITARY CULTURE AND BEST PRACTICES FOR ASSESSING AND TREATING BEHAVIORAL HEALTH ISSUES RESULTING FROM TRAUMAS OF WAR.
SCHEDULE H, PART III, LINE 4 - BAD DEBTAUDIT FOOTNOTE THE ORGANIZATION IS AN AFFILIATE OF SUTTER HEALTH WHICH UNDERWENT A SYSTEM-WIDE AUDIT. THE AUDIT REPORT DOES NOT INCLUDE A BAD DEBT EXPENSE FOOTNOTE. EFFECTIVE JANUARY 1, 2018, SUTTER ENTITIES IMPLEMENTED THE FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS UPDATE (ASU), REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606). THE ACCOUNTING CHANGE MODIFIED BAD DEBT REPORTING, AND AS A RESULT, BAD DEBT IS ONLY REPORTED IN LIMITED SITUATIONS.
SCHEDULE H, PART III, LINE 7MEDICARE COSTS: MEDICARE COST REPORTS THAT THE ORGANIZATION FILES DO NOT INCLUDE ALL OF THE COSTS REQUIRED TO TREAT MEDICARE PATIENTS.
SCHEDULE H, PART III, LINE 9BDEBT COLLECTION POLICY: COLLECTION PRACTICES ARE CONSISTENT FOR ALL PATIENTS AND COMPLY WITH APPLICABLE PROVISIONS OF FEDERAL AND CALIFORNIA LAW. DURING PREADMISSION OR REGISTRATION, THE HOSPITAL PROVIDES ALL PATIENTS WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE. AN UNINSURED PATIENT WHO INDICATES THE FINANCIAL INABILITY TO PAY A BILL IS EVALUATED FOR FINANCIAL ASSISTANCE. AT DISCHARGE PATIENTS WILL BE GIVEN AN APPLICATION WHICH WILL DOCUMENT THE PATIENT'S OVERALL FINANCIAL SITUATION. IF AN UNINSURED PATIENT DOES NOT COMPLETE THE APPLICATION FORM WITHIN 30 DAYS OF DELIVERY, THE HOSPITAL WILL NOTIFY THE PATIENT THAT THE APPLICATION HAS NOT BEEN RECEIVED AND WILL PROVIDE THE PATIENT AN ADDITIONAL 210 DAYS TO COMPLETE THE APPLICATION. IF A PATIENT HAS APPLIED FOR CHARITY CARE, HAS BEEN APPROVED TO RECEIVE CHARITY CARE, OR IS COOPERATING WITH THE HOSPITAL'S EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE HOSPITAL WILL NOT PURSUE COLLECTIONS.
SCHEDULE H, PART VI, LINE 2THE ORGANIZATION DOES NOT CONDUCT ANY ADDITIONAL COMMUNITY HEALTH CARE NEEDS ASSESSMENTS OUTSIDE OF THE 2019 - 2021 COMMUNITY HEALTH NEEDS ASSESSMENT REFERENCED.
SCHEDULE H, PART VI, LINE 3PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: SUTTER HOSPITALS FOLLOW A SUTTER HEALTH SYSTEM-WIDE FINANCIAL ASSISTANCE POLICY, WHICH INCLUDES THE FOLLOWING DETAILS OF HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE. LANGUAGES: THE POLICY SHALL BE AVAILABLE IN THE PRIMARY LANGUAGE(S) OF HOSPITAL'S SERVICE AREA. IN ADDITION, ALL NOTICES/COMMUNICATIONS PROVIDED IN THIS SECTION SHALL BE AVAILABLE IN PRIMARY LANGUAGE(S) OF HOSPITAL'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. INFORMATION PROVIDED TO PATIENTS DURING THE PROVISION OF HOSPITAL SERVICES: A. DURING PREADMISSION OR REGISTRATION (OR AS SOON THEREAFTER AS PRACTICABLE) HOSPITALS SHALL PROVIDE ALL PATIENTS WITH A COPY OF A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY AND IDENTIFY THE DEPARTMENT THAT PATIENTS CAN VISIT TO RECEIVE INFORMATION ABOUT, AND ASSISTANCE WITH APPLYING FOR, FINANCIAL ASSISTANCE. B. FINANCIAL ASSISTANCE COUNSELORS: PATIENTS WHO MAY BE UNINSURED PATIENTS SHALL BE ASSIGNED FINANCIAL COUNSELORS, WHO SHALL VISIT WITH THE PATIENTS IN PERSON AT THE HOSPITAL, PROVIDE PATIENTS A FINANCIAL ASSISTANCE APPLICATION, ASSIST WITH THE APPLICATION PROCESS, AND PROVIDE A CONTACT INFORMATION FOR THE PATIENT TO CALL FOR QUESTIONS. C. EMERGENCY SERVICES: IN THE CASE OF EMERGENCY SERVICES, HOSPITALS SHALL PROVIDE ALL PATIENTS A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY AS SOON AS PRACTICABLE AFTER STABILIZATION OF THE PATIENT'S EMERGENCY MEDICAL CONDITION OR UPON DISCHARGE. D. APPLICATIONS PROVIDED AT DISCHARGE: AT THE TIME OF DISCHARGE, HOSPITALS SHALL PROVIDE ALL PATIENTS WITH A COPY OF A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY. E. INFORMATION PROVIDE TO PATIENTS AT OTHER TIMES: 1. CONTACT INFORMATION WHICH INCLUDES A PHONE NUMBER AND HOSPITAL DEPARTMENT TO OBTAIN ADDITIONAL INFORMATION ABOUT FINANCIAL ASSISTANCE AND ASSISTANCE WITH THE APPLICATION PROCESS. 2. BILLING STATEMENTS: BILLING STATEMENTS PROVIDED TO PATIENTS SHALL INCLUDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY, A PHONE NUMBER FOR PATIENTS TO CALL WITH QUESTIONS ABOUT FINANCIAL ASSISTANCE, AND THE WEBSITE ADDRESS WHERE PATIENTS CAN OBTAIN ADDITIONAL INFORMATION ABOUT FINANCIAL ASSISTANCE INCLUDING THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY OF THE POLICY, AND THE APPLICATION FOR FINANCIAL ASSISTANCE. 3. UPON REQUEST: HOSPITALS SHALL PROVIDE PATIENTS WITH PAPER COPIES OF THE FINANCIAL ASSISTANCE POLICY, THE APPLICATION FOR FINANCIAL ASSISTANCE, AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY UPON REQUEST AND WITHOUT CHARGE. F. PUBLICITY OF FINANCIAL ASSISTANCE INFORMATION 1. PUBLIC POSTING: HOSPITALS SHALL POST COPIES OF THE FINANCIAL ASSISTANCE POLICY, THE APPLICATION FOR FINANCIAL ASSISTANCE, AND THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IN A PROMINENT LOCATION IN THE EMERGENCY ROOM, ADMISSIONS AREA, AND ANY OTHER LOCATION IN THE HOSPITAL WHERE THERE IS A HIGH VOLUME OF PATIENT TRAFFIC, INCLUDING BUT NOT LIMITED TO THE WAITING ROOMS, BILLING OFFICES, AND HOSPITAL OUTPATIENT SERVICE SETTINGS. THESE PUBLIC NOTICES SHALL INCLUDE INFORMATION ABOUT THE RIGHT TO REQUEST AN ESTIMATE OF FINANCIAL RESPONSIBILITY FOR SERVICES. 2. WEBSITE: THE FINANCIAL ASSISTANCE POLICY, APPLICATION FOR FINANCIAL ASSISTANCE AND PLAIN LANGUAGE SUMMARY SHALL BE AVAILABLE IN A PROMINENT PLACE ON THE SUTTER HEALTH WEBSITE (WWW.SUTTERHEALTH.ORG) AND ON EACH INDIVIDUAL HOSPITAL'S WEBSITE. PERSONS SEEKING INFORMATION ABOUT FINANCIAL ASSISTANCE SHALL NOT BE REQUIRED TO CREATE AN ACCOUNT OR PROVIDE ANY PERSONAL INFORMATION BEFORE RECEIVING INFORMATION ABOUT FINANCIAL ASSISTANCE. 3. MAIL: PATIENTS MAY REQUEST A COPY OF THE FINANCIAL ASSISTANCE POLICY, APPLICATION FOR FINANCIAL ASSISTANCE AND PLAIN LANGUAGE SUMMARY BE SENT BY MAIL, AT NO COST TO THE PATIENT. 4. ADVERTISEMENTS/PRESS RELEASES: AS NECESSARY AND ON AT LEAST AN ANNUAL BASIS, SUTTER HEALTH WILL PLACE AN ADVERTISEMENT REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AT HOSPITALS IN THE PRINCIPAL NEWSPAPER(S) IN THE COMMUNITIES SERVED BY SUTTER HEALTH, OR WHEN DOING SO IS NOT PRACTICAL, SUTTER WILL ISSUE A PRESS RELEASE CONTAINING THIS INFORMATION, OR USE OTHER MEANS THAT SUTTER HEALTH CONCLUDES WILL WIDELY PUBLICIZE THE AVAILABILITY OF THE POLICY TO AFFECTED PATIENTS IN OUR COMMUNITIES. 5. COMMUNITY AWARENESS: SUTTER HEALTH WILL WORK WITH AFFILIATED ORGANIZATIONS, PHYSICIANS, COMMUNITY CLINICS AND OTHER HEALTH CARE PROVIDERS TO NOTIFY MEMBERS OF THE COMMUNITY (ESPECIALLY THOSE WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE) ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE.
SCHEDULE H, PART VI, LINE 4NINETEEN HAWAII HOSPITALS, LOCATED ACROSS THE STATE, PARTICIPATED IN THE CHNA PROJECT. THE HOSPITAL SERVICE AREA IS THE WHOLE STATE OF HAWAII AND ASIA PACIFIC BUT IS PREDOMINANTLY DEFINED BY A GEOGRAPHICAL BOUNDARY OF THE HONOLULU COUNTY AS THE MAJORITY OF OUR PATIENTS SERVED COME FROM THE ISLAND OF OAHU. IN THE PAST, HAH PRODUCED FIVE SEPARATE, THOUGH SIMILAR, REPORTS: ONE STATEWIDE REPORT AND ONE PER COUNTY JURISDICTION. FOR THIS CHNA, HAH AGREED THAT ISLANDER INSTITUTE WOULD PROVIDE ONE COMPREHENSIVE REPORT TO SERVE ALL 19 FACILITIES. THE REASON FOR THIS DECISION MAY BE UNIQUE TO HAWAII. ALTHOUGH SOME FACILITIES SERVE RELATIVELY SMALL COMMUNITIES, AS ISLAND PEOPLE WHO SHARE A UNIQUE HISTORICAL, CULTURAL, SOCIAL, AND ECONOMIC CONTEXT, THE STORY OF HAWAII'S ENTIRE ARCHIPELAGO FORMS THE BACKDROP FOR EVERYONE'S COMMUNITY WORK. COMMON THEMES, CHALLENGES, AND ISSUES CUT ACROSS COMMUNITIES, AND THERE IS MUCH TO BE LEARNED FROM OUR SHARED EXPERIENCES AS PEOPLE OF HAWAII. AS SUCH, THE MAJORITY OF THIS CHNA IS WRITTEN FOR THE BENEFIT OF EVERY PARTICIPATING FACILITY, WITH THEMES AND FINDINGS RELEVANT TO ANY WORK IN HAWAII. AN IN-DEPTH VIEW OF THE DEMOGRAPHICS AND GEOGRAPHY OF THE SERVICE AREA IS AVAILABLE IN KAHI MOHALA'S CHNA AT HTTPS://WWW.SUTTERHEALTH.ORG/FOR-PATIENTS/COMMUNITY-HEALTH-NEEDS- ASSESSMENT
SCHEDULE H, PART VI, LINE 5PROMOTION OF COMMUNITY HEALTH: SUTTER HEALTH'S MISSION IS TO "ENHANCE THE WELL-BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE, THROUGH A NOT-FOR-PROFIT COMMITMENT TO COMPASSION AND EXCELLENCE IN HEALTH CARE SERVICES." SUTTER HEALTH'S MISSION REACHES BEYOND THE WALLS OF OUR HOSPITALS AND FACILITIES. OUR AFFILIATES FURTHER THEIR TAX-EXEMPT PURPOSE BY: - BUILDING RELATIONSHIPS OF TRUST BY WORKING COLLABORATIVELY WITH COMMUNITY GROUPS, SCHOOLS AND GOVERNMENT ORGANIZATIONS TO EFFECTIVELY LEVERAGE RESOURCES AND ADDRESS IDENTIFIED COMMUNITY NEEDS; - SUPPORTING NONPROFIT ORGANIZATIONS THAT ARE COMMITTED TO COMMUNITY HEALTH IMPROVEMENT THROUGH FINANCIAL INVESTMENTS, IN-KIND SERVICES AND EMPLOYEE VOLUNTEERISM; AND - PROVIDING GENEROUS CHARITY CARE POLICIES FOR OUR MOST VULNERABLE COMMUNITY MEMBERS. THE 2019 - 2021 IMPLEMENTATION STRATEGY FOR KAHI MOHALA DEFINES PROGRAMS THAT WILL ADDRESS IDENTIFIED PRIORITY HEALTH NEEDS AND IMPROVE THE OVERALL HEALTH OF THE COMMUNITY IT SERVES. THE FOLLOWING REPRESENTS COMMUNITY PROGRAMS THAT ARE BEING SUPPORTED BY KAHI BUT HAVE BEEN PUT ON HOLD DUE TO THE COVID-19 PANDEMIC. PROGRAMS WILL BE RESTARTED AND SUPPORTED ONCE THE PANDEMIC EMERGENCY HAS ENDED. KAHI SUPPORTED THE PACIFIC REGION BEHAVIORAL HEALTH ALLIANCE. ARMY ONESOURCE HAS CREATED THE STATE-LEVEL ALLIANCES TO RAISE AWARENESS, IMPROVE SERVICE DELIVERY AND GENERATE COMMUNITY SUPPORT FOR OUR SERVICE MEMBERS AND FAMILIES. THEY ALSO FOCUS ON EDUCATING THE BEHAVIORAL HEALTH COMMUNITY ON MILITARY CULTURE AND BEST PRACTICES FOR ASSESSING AND TREATING BEHAVIORAL HEALTH ISSUES RESULTING FROM THE TRAUMA OF WAR. KAHI ALSO SUPPORTED THE HAWAII LGBT LEGACY FOUNDATION BY PROVIDING A COMMUNITY BENEFIT SPONSORSHIP OF HONOLUL PRIDE AS WELL AS PARTICIPATING IN THE PRIDE EVENT. THE HAWAII LGBT LEGACY FOUNDATION IS COMMITTED TO A LEGACY OF HOPE, EQUALITY AND UNITY. THE MISSION IS TO SUPPORT, EMPOWER, EDUCATE, UNIFY, AND FACILITATE LGBT ORGANIZATIONS AND INDIVIDUALS THROUGHOUT HAWAII. KAHI SUPPORTED THE MENTAL HEALTH AMERICA OF HAWAII ORGANIZATION THROUGH A COMMUNITY BENEFIT SPONSORSHIP AS WELL AS PARTNERING WITH MENTAL HEALTH AMERICA FOR THE 2021 MENTAL HEALTH AWARENESS DAY. DUE TO COVID-19 THEY WERE UNABLE TO HOST THE DAY IN PERSON AS THEY HAVE IN YEARS PAST. THE CEO OF KAHI MOHALA WAS ABLE TO REACH OUT TO LEGISLATORS TO HIGHLIGHT MENTAL HEALTH AS AN IMPORTANT PUBLIC HEALTH ISSUE, RAISE AWARENESS OF CURRENT PREVENTION AND TREATMENT OPPORTUNITIES, THE ORGANIZATIONS DOING THE WORK AND HOW ELECTED OFFICIALS CAN PROMOTE MENTAL HEALTH IN HAWAII. KAHI HOSTED AND CO-SPONSORED WITH MENTAL HEALTH KOKUA COMMUNITY EDUCATION TRAININGS ON CAMPUS AND TROUGHOUT THE SERVICE AREA. TOPICS PROVIDED WERE SAFE TALK TRAINING, C-SSRS TRAINING, YOUTH MENTAL HEALTH FIRST AID, CBCT FOR PTSD. KAHI PROVIDED THE USE OF THEIR ROOMS/FACILITIES FOR SEVERAL COMMUNITY PROGRAMS INCLUDING THE 12-STEP RECOVERY PROGRAM THROUGH ALANON, NARCOTICS ANONYMOUS, AND CHILD & FAMILY SERVICES FOR DOMESTIC VIOLENCE PROGRAMS.
SCHEDULE H, PART VI, LINE 6SUTTER HEALTH IS THE NOT-FOR-PROFIT PARENT OF NOT-FOR-PROFIT AND FOR-PROFIT COMPANIES THAT TOGETHER FORM AN INTEGRATED HEALTHCARE SYSTEM LOCATED IN NORTHERN CALIFORNIA. THE SYSTEM IS COMMITTED TO HEALTH EQUITY, COMMUNITY PARTNERSHIPS AND INNOVATIVE, HIGH-QUALITY PATIENT CARE. OUR OVER 65,000 EMPLOYEES AND ASSOCIATED CLINICIANS SERVE MORE THAN 3 MILLION PATIENTS THROUGH OUR HOSPITALS, CLINICS AND HOME HEALTH SERVICES. LEARN MORE ABOUT HOW WE'RE TRANSFORMING HEALTHCARE AT SUTTERHEALTH.ORG AND VITALS.SUTTERHEALTH.ORG SUTTER HEALTH'S TOTAL INVESTMENT IN COMMUNITY BENEFIT IN 2021 WAS $872 MILLION. THIS AMOUNT INCLUDES TRADITIONAL CHARITY CARE AND UNREIMBURSED COSTS OF PROVIDING CARE TO MEDI-CAL PATIENTS. THIS AMOUNT ALSO INCLUDES INVESTMENTS IN COMMUNITY HEALTH PROGRAMS TO ADDRESS PRIORITIZED HEALTH NEEDS AS IDENTIFIED BY REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENTS. AS PART OF SUTTER HEALTH'S COMMITMENT TO FULFILL ITS NOT-FOR-PROFIT MISSION AND HELP SERVE SOME OF THE MOST VULNERABLE IN ITS COMMUNITIES, THE SUTTER HEALTH NETWORK HAS IMPLEMENTED CHARITY CARE POLICIES TO HELP PROVIDE ACCESS TO MEDICALLY NECESSARY CARE FOR ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. IN 2021, SUTTER HEALTH INVESTED $91 MILLION IN CHARITY CARE. OVERALL, SINCE THE IMPLEMENTATION OF THE AFFORDABLE CARE ACT, GREATER NUMBERS OF PREVIOUSLY UNINSURED PEOPLE NOW HAVE MORE ACCESS TO HEALTHCARE COVERAGE THROUGH THE MEDI-CAL AND MEDICARE PROGRAMS. THE PAYMENTS FOR PATIENTS WHO ARE COVERED BY MEDI-CAL AND MEDICARE DO NOT COVER THE FULL COSTS OF PROVIDING CARE. IN 2021, SUTTER HEALTH INVESTED $557 MILLION MORE THAN THE STATE PAID TO CARE FOR MEDICAL PATIENTS. THROUGH COMMUNITY BENEFIT INVESTMENTS, SUTTER HELPED LOCAL COMMUNITIES ACCESS PRIMARY, MENTAL HEALTH AND ADDICTION CARE, AND BASIC NEEDS SUCH AS HOUSING, JOBS AND FOOD. SEE MORE ABOUT HOW SUTTER HEALTH REINVESTS INTO THE COMMUNITY BY VISITING SUTTERPARTNERS.ORG.
SCHEDULE H, PART VI, LINE 7STATE FILING OF COMMUNITY BENEFIT REPORT: N/A

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JAMES E CONFORTI
President, SH Pacific$0$1,119,575$0$709,247$0$207,587$0$526,438$0$30,824$0$2,593,671$0$306,460
Rishi Sikka MD
President, SHS Ent.$0$764,249$0$512,704$0$175,398$0$172,338$0$33,628$0$1,658,317$0$248,574
Penny Westfall
SH VP, CLO, SH$0$9,958$0$138,902$0$629,914$0$606$0$1,206$0$780,586$0$0
Claudia Crist
CEO, Kahi$0$326,745$0$218,098$0$46,795$0$45,338$0$14,121$0$651,097$0$55,741
Kevin W Kuich MD
Chief Medical Officer$463,543$0$46,000$0$1,801$0$17,638$0$10,977$0$539,959$0$0$0
Steven Chaplin MD
Psychiatrist$308,455$0$25,000$0$222$0$17,638$0$7,287$0$358,602$0$0$0
Elena Sharipova MD
Psychiatrist$314,381$0$8,000$0$134$0$17,638$0$15,842$0$355,995$0$0$0
Ben Kirk
Sec, Deputy Gen Counsel - SAC$0$249,489$0$18,626$0$476$0$15,169$0$31,577$0$315,337$0$0
Quin Ogawa
CFO SHP$216,536$0$29,000$0$134$0$13,165$0$119$0$258,954$0$0$0
Maureen Kumar
Director - Human Resources$161,677$0$29,000$0$58$0$9,830$0$6,200$0$206,765$0$0$0
Michelle M Fernandez
Director, Patient Care$157,719$0$28,000$0$134$0$9,589$0$119$0$195,561$0$0$0
Eduardo Jones
Director of Behavioral Health$137,007$0$26,617$0$53$0$8,330$0$14,714$0$186,721$0$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PART I, LINE 3SUPPLEMENTAL COMPENSATION INFORMATION: THE CEO OF THIS ORGANIZATION IS AN EMPLOYEE OF SUTTER HEALTH, A RELATED TAX-EXEMPT ORGANIZATION. THE COMPENSATION COMMITTEE OF THE SUTTER HEALTH BOARD OF DIRECTORS RETAINS ULTIMATE DISCRETIONARY AUTHORITY OVER ALL ELEMENTS OF COMPENSATION TO ASSURE THAT ORGANIZATIONAL PURPOSES ARE APPROPRIATELY BEING SERVED. THE COMPENSATION COMMITTEE USES CREDIBLE INDEPENDENT DATA SOURCES AND MAINTAINS AN OBJECTIVE "ARM'S LENGTH" DECISION-MAKING PROCESS, ENSURING THE INTEGRITY OF SUTTER'S EXECUTIVE PROGRAMS AND CONSISTENCY WITH THE ORGANIZATION'S OVERALL MISSION. SEE SCHEDULE O NARRATIVE FOR PART VI, LINE 15 FOR A FULL DESCRIPTION OF THE COMPENSATION APPROVAL PROCESS COMPLETED BY SUTTER HEALTH.
SCHEDULE J, PART I, LINE 4ASEVERANCE PAYMENTS: PENNY WESTFALL RECEIVED SEVERANCE PAYMENTS OF $500,140.
SCHEDULE J, PART I, LINE 4BNONQUALIFIED RETIREMENT PLAN: THE PURPOSE OF THE NONQUALIFIED RETIREMENT PLAN IS TO PROVIDE SUTTER HEALTH EXECUTIVES WITH A COMPETITIVE RETIREMENT BENEFIT CONSISTENT WITH SUTTER HEALTH'S OVERALL COMPENSATION PHILOSOPHY FOR ALL EMPLOYEES. CONTRIBUTIONS ARE DESIGNED TAKING INTO CONSIDERATION LOST RETIREMENT BENEFITS THAT WOULD OTHERWISE BE OBTAINED THROUGH THE QUALIFIED PENSION PLAN. SUTTER'S PLANS ARE DESIGNED CONSISTENT WITH COMPETITIVE INDUSTRY PRACTICES. THE RETIREMENT PLAN FOR SUTTER HEALTH EMPLOYEES IS A COMBINATION OF 403(B) EMPLOYER MATCH CONTRIBUTIONS AND QUALIFIED PENSION PLAN BENEFITS. SUTTER HEALTH EXECUTIVES ARE GENERALLY INELIGIBLE FOR EMPLOYER MATCH CONTRIBUTIONS. TO ENSURE A COMPETITIVE RETIREMENT BENEFIT, SUTTER HEALTH MAKES AN ANNUAL CONTRIBUTION TO A NON-QUALIFIED 457(F) PLAN FOR ITS EXECUTIVES. THE FORMULA PROVIDES 6% TO 12%OF BASE SALARY PLUS ANNUAL INCENTIVE PLAN AWARD (COMMENSURATE WITH MANAGEMENT LEVEL). CONTRIBUTIONS ARE ALSO MADE FOR A SMALL GROUP OF SENIOR LEVEL EXECUTIVES WHOSE ESTIMATED RETIREMENT BENEFIT (SOCIAL SECURITY PLUS QUALIFIED PLAN BENEFITS PLUS 457(F) FALLS BELOW 50% - 65% OF FINAL 4-YEAR AVERAGE BASE SALARY WHEN RETIRING AT AGE 65 WITH 22.5 YEARS OF SERVICE. TARGET BENEFIT LEVELS ARE DISCOUNTED FOR YEARS OF SERVICE LESS THAN 22.5 AT AGE 65. UNLIKE SUTTER HEALTH'S QUALIFIED PENSION PLAN WHERE EMPLOYEE BENEFITS ARE GUARANTEED (I.E., A DEFINED BENEFIT), SUTTER'S NON-QUALIFIED PLAN BENEFITS ARE NOT GUARANTEED BY SUTTER HEALTH. INVESTMENT RISK IS BORNE BY PARTICIPANTS AND BENEFITS ARE NOT PROTECTED SHOULD SUTTER HEALTH BECOME INSOLVENT. THE FOLLOWING INDIVIDUALS RECEIVED 457(F) NON-QUALIFIED PAYMENTS DURING THE YEAR: PENNY WESTFALL - $117,086
SCHEDULE J, PART I, LINE 7NON-FIXED PAYMENTS: SPOT AWARDS ARE INFREQUENTLY USED TO REWARD EMPLOYEES. THERE ARE NO SPECIFIC GUIDELINES FOR THE AMOUNT OF THE SPOT AWARD, AVERAGE AMOUNT OF SPOT AWARDS TEND TO NOT EXCEED 5% TO 15% OF GROSS ANNUAL SALARY. ANNUAL INCENTIVE PLAN (AIP): THE PURPOSE OF THE PLAN IS TO FOCUS EXECUTIVES ON SPECIFIC, SHORTER-TERM GOALS THAT ARE CRITICAL TO THE ACHIEVEMENT OF AFFILIATE, OPERATING UNIT AND SYSTEM-WIDE OBJECTIVES THAT DRIVE OVERALL ORGANIZATION PERFORMANCE. LONG TERM PERFORMANCE PLANS: SUTTER HEALTH ALSO EMPLOYS LONG TERM PERFORMANCE PLANS WHICH ARE DESIGNED TO FOCUS ON LONGER TERM STRATEGIC OBJECTIVES OF THE ORGANIZATION. SUTTER'S LONG TERM PERFORMANCE PLAN APPROACH IS A COMBINATION OF BOTH LONGER TERM MEASURES OF ORGANIZATION SUCCESS AND KEY ORGANIZATION STRATEGIES WHICH REQUIRE THE COMBINED EFFORT OF ALL LEADERSHIP TO ACHIEVE SUCCESS. SUTTER USES A COMMON FATE APPROACH IN THAT ALL LONG TERM PERFORMANCE PLAN PARTICIPANTS ARE MEASURED AGAINST THE SAME, ORGANIZATION-WIDE CRITERIA VS. INDIVIDUAL EFFORTS. THIS FOSTERS A COMMON PURPOSE ACROSS LEADERSHIP AND A SHARED SENSE OF ACCOUNTABILITY FOR THE OVERALL SUCCESS OF SUTTER HEALTH. IN ALL CASES, THE COMPENSATION COMMITTEE OF THE BOARD DETERMINES ACHIEVEMENT OF ORGANIZATION GOALS AND MAKES FINAL AWARD DETERMINATION WHICH MAY RESULT IN A REDUCTION OF AWARD IF APPROPRIATE. ALL SENIOR EXECUTIVE AWARDS ARE REVIEWED FOR COMPENSATION REASONABLENESS AND APPROVED BY THE COMPENSATION COMMITTEE PRIOR TO PAYMENT.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART I, LINE 1 AND PART III, LINE 1MISSION STATEMENT: Kahi Mohala is dedicated to improving the quality of life and restoring hope for individuals and families affected by mental illness.
FORM 990, PART III, LINE 4APROGRAM SERVICE ACCOMPLISHMENTS: SUTTER HEALTH PACIFIC, A CALIFORNIA NOT-FOR-PROFIT PUBLIC BENEFIT CORPORATION, WAS ORGANIZED TO OPERATE AS KAHI MOHALA, AN 88 BED, FREESTANDING NOT-FOR-PROFIT PSYCHIATRIC HOSPITAL. KAHI MOHALA HAS BEEN OPERATIONAL SINCE 1983 AND IS SITUATED ON A 14.5-ACRE CAMPUS. THE HOSPITAL IS LICENSED BY THE STATE OF HAWAII AND IS ACCREDITED BY THE JOINT COMMISSION. THERE WERE 22,747 PATIENT DAYS IN 2021. KAHI MOHALA'S MISSION IS: "KAHI MOHALA IS DEDICATED TO IMPROVING THE QUALITY OF LIFE AND RESTORING HOPE FOR INDIVIDUALS AND FAMILIES AFFECTED BY MENTAL ILLNESS." TREATMENT PROGRAMS KAHI MOHALA IS DEDICATED NOT ONLY TO PSYCHIATRIC, EMOTIONAL AND BEHAVIORAL STABILIZATION, BUT ALSO TO RECOVERY THROUGH EMPOWERMENT. TEACHING INDIVIDUALS THE SKILLS TO SELF-MANAGE AND SELF-REGULATE TO THE FULLEST POSSIBLE EXTENT IS A FUNDAMENTAL GOAL WITHIN THE TREATMENT AND RECOVERY PROCESS. LEVELS OF CARE - ACUTE CHILD AND ADOLESCENT PROGRAMS INDIVIDUALS 17 YEARS OF AGE AND UNDER (18 YEARS OLD IF STILL ENROLLED IN SCHOOL) - RESIDENTIAL CHILD AND ADOLESCENT PROGRAMS INDIVIDUALS 17 YEARS OF AGE AND UNDER (18 YEARS OLD IF STILL ENROLLED IN SCHOOL) - ADOLESCENT PARTIAL HOSPITALIZATION PROGRAM (PHP) INDIVIDUALS 13 TO 17 YEARS OLD (18 YEARS OLD IF STILL ENROLLED IN SCHOOL) SPECIALIZED TREATMENT SERVICES - PSYCHIATRIC EVALUATION/TREATMENT AND MEDICATION MANAGEMENT - NURSING ASSESSMENT - PSYCHOLOGICAL TESTING - SUBSTANCE ABUSE/DUAL DIAGNOSIS SERVICES - EATING DISORDER SERVICES THERAPEUTIC SERVICES AVAILABLE - INDIVIDUAL, FAMILY AND GROUP THERAPY - EDUCATIONAL SERVICES - OCCUPATIONAL THERAPY - RECREATIONAL THERAPY - ART THERAPY - REALITY-ORIENTED PHYSICAL EXPERIENTIAL SERVICES (ROPES) THIS CORPORATION WAS FORMED FOR THE PURPOSES SET FORTH IN ITS ARTICLES OF INCORPORATION: A. TO ESTABLISH, EQUIP AND MAINTAIN ONE OR MORE NOT-FOR-PROFIT HOSPITALS, MEDICAL CENTERS, INSTITUTIONS OR OTHER PLACES FOR THE RECEPTION AND CARE OF THE SICK, INJURED AND DISABLED, WITH PERMANENT FACILITIES THAT INCLUDE INPATIENT BEDS AND MEDICAL SERVICES; TO PROVIDE DIAGNOSIS AND TREATMENT FOR PATIENTSTO PROVIDE ASSOCIATED SERVICES, OUTPATIENT CARE AND HOME CARE IN FURTHERANCE OF THIS CORPORATION'S CHARITABLE PURPOSES; B. TO PROMOTE AND CARRY ON EDUCATIONAL ACTIVITIES RELATED TO THE CARE OF THE SICK, INJURED AND DISABLED, OR TO THE PROMOTION OF HEALTH; C. TO PROMOTE AND CARRY OUT SCIENTIFIC RESEARCH RELATED TO THE CARE OF THE SICK, INJURED AND DISABLED; D. TO PROMOTE OR CARRY OUT SUCH OTHER ACTIVITIES AS MAY BE DEEMED ADVISABLE FOR THE BETTERMENT OF THE GENERAL HEALTH OF THE COMMUNITY SERVED; AND E. TO CONTRIBUTE TO THE GROWTH, DEVELOPMENT AND FINANCIAL STRENGTH OF SUTTER HEALTH SYSTEM. KAHI MOHALA - LIST OF COMMUNITY BENEFITS 2021: - TWELVE-STEP PROGRAMS (ALCOHOLICS ANONYMOUS, ALANON, NARCOTICS ANONYMOUS) PURPOSE: PEER-LED, SELF-HELP GROUPS OF PERSONS RECOVERING FORM ADDICTIONS, OR FAMILY MEMBERS OF PERSONS RECOVERING FROM ADDICTIONS. GOALS AND OBJECTIVES: TO GAIN SUPPORT AND EDUCATION IN A GROUP SETTING. - INTERNSHIP, RESIDENCY AND PRACTICUM PROGRAMS PURPOSE: TO PROVIDE A SUPERVISED CLINICAL PRACTICE SETTING FOR MEDICAL STUDENTS, SOCIAL WORKERS, NURSES, PSYCHOLOGISTS, SUBSTANCE ABUSE COUNSELORS AND OCCUPATIONAL THERAPISTS. GOALS AND OBJECTIVES: TO OBTAIN DIRECT PRACTICE EXPERIENCE IN THE STUDENT'S FIELD. - INFORMATION AND REFERRAL PURPOSE: TO PROVIDE TELEPHONE INFORMATION AND REFERRAL TO THE PUBLIC REGARDING MENTAL HEALTH AND CHEMICAL DEPENDENCY RESOURCES. GOAL: TO PROVIDE A FREE COMMUNITY RESOURCE. - MEMBERSHIPS ON COMMUNITY BOARDS AND COMMITTEES: GOODWILL INDUSTRIES, ROTARY, HEALTHCARE ASSOCIATION OF HAWAII (HAH), HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION (HFMA), CHAMBER OF COMMERCE, MENTAL HEALTH AMERICA OF HAWAII (MHA), NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI), HAWAII YOUTH SERVICES NETWORK (HYSN), INSTITUTE ON VIOLENCE, ABUSE AND TRAUMA (IVAT) CULTURAL COMMITTEE, PACIFIC REGION BEHAVIORAL HEALTH ALLIANCE PURPOSE: TO VOLUNTEER EXPERTISE ON VARIOUS COMMUNITY BOARDS AND COMMITTEES. GOALS AND OBJECTIVES: TO SUPPORT OUR COMMUNITY BY HELPING OTHERS MEET THE GOALS AND OBJECTIVES OF THE VARIOUS ORGANIZATIONS AND COMMITTEES. - COMMUNITY ROPES GROUPS PURPOSE: PROVIDE PROBLEM SOLVING, TEAM BUILDING, AND LEADERSHIP AWARENESS THROUGH THE USE OF GAMES AND ELEMENTS ON THE ROPES COURSE. GOALS AND OBJECTIVES: PROVIDE THE YOUTH/AT RISK YOUTH THE OPPORTUNITY TO EXPERIENCE TEAM BUILDING/PROBLEM SOLVING EXERCISES THROUGH THE USE OF OUR ROPES COURSE. - COMMUNITY EDUCATION SERIES - APPLIED SUICIDE INTERVENTION SKILLS TRAINING (ASIST) PURPOSE: PROVIDE TWO DAY WORKSHOP IN SUICIDE FIRST AID. GOALS AND OBJECTIVES: PROVIDES MEMBERS OF THE COMMUNITY A COURSE TO IDENTIFY THOSE WHO MAY BE AT RISK OF SUICIDE AND HOW TO CREATE A PLAN FOR THEIR IMMEDIATE SAFETY. - CHILD & FAMILY SERVICE PURPOSE: USE OF ROOM/FACILITIES. GOALS AND OBJECTIVES: TO PROVIDE A MEETING PLACE FOR THE DOMESTIC VIOLENCE PROGRAM. - CPR TRAINING PURPOSE: TO PROVIDE CPR TRAINING TO COMMUNITY. GOAL: TRAIN EWA BEACH COMMUNITY HOW TO PERFORM CPR. - HAWAII FOOD BANK CASH DONATION AND CANNED FOOD DRIVE PURPOSE: CASH DONATION & CANNED FOOD COLLECTION. GOALS AND OBJECTIVES: PROVIDE ASSISTANCE TO THE HUNGRY AND HOMELESS IN THE COMMUNITY. - NATIONAL ASSOCIATION ON MENTAL ILLNESS (NAMI) WALK PURPOSE: PARTICIPATION IN ANNUAL NAMI WALK. GOALS AND OBJECTIVES: TO RAISE MONEY AND AWARENESS OF MENTAL ILLNESS. - LITTER & GRAFFITI REMOVAL PURPOSE: TO REMOVE BLIGHT FROM NEIGHBORHOOD. GOAL: MAINTAIN LITTER AND TAG FREE ENVIRONMENT FOR AREA SURROUNDING KAHI MOHALA.
FORM 990, PART VI, LINE 1AGOVERNING BODY: THE AFFAIRS AND MANAGEMENT OF SUTTER HEALTH PACIFIC (SHP) ARE SUPERVISED BY THE EXECUTIVE COMMITTEE WHO HAS POWER TO TRANSACT ALL REGULAR BUSINESS OF SHP DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE CONSISTS OF THE CHAIR OF THE BOARD WHO SERVES AS CHAIR OF THE COMMITTEE, THE ADMINISTRATOR/CEO, AND AT LEAST ONE ADDITIONAL DIRECTOR.
FORM 990, PART VI, LINES 6 & 7ACLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS: THIS CORPORATION IS AN AFFILIATE OF SUTTER HEALTH, A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. SUTTER HEALTH IS THE SOLE MEMBER WITH THE RIGHT TO ELECT AT LEAST A MAJORITY OF THE MEMBERS OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, LINE 7BCLASSES OF PERSONS, DECISIONS REQUIRING APPROVAL AND THE NATURE OF THEIR TYPE OF VOTING RIGHTS: SUTTER HEALTH AS THE SOLE MEMBER OF THE ORGANIZATION IS ENTITLED TO EXERCISE FULLY ALL RIGHTS AND PRIVILEGES OF MEMBERS OF NONPROFIT CORPORATIONS UNDER THE CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION LAW, AND ALL OTHER APPLICABLE LAWS. THE MEMBER HAS THE RIGHTS AND POWERS TO APPOINT (AND REMOVE) MEMBERS OF THE CORPORATION'S BOARD OF DIRECTORS, SUBJECT TO THE PROVISIONS OF THE BYLAWS. IN ADDITION, THE MEMBER HAS THE RIGHT TO APPROVE THE FOLLOWING ACTIONS OF THE CORPORATION'S BOARD OF DIRECTORS: A. MERGER, CONSOLIDATION, REORGANIZATION, OR DISSOLUTION OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; B. AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; C. ADOPTION OF OPERATING BUDGETS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY, INCLUDING CONSOLIDATED OR COMBINED BUDGETS OF THE CORPORATION AND ALL SUBSIDIARY ORGANIZATIONS OF THE CORPORATION; D. ADOPTION OF CAPITAL BUDGETS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; E. AGGREGATE OPERATING OR CAPITAL EXPENDITURES ON AN ANNUAL BASIS THAT EXCEED APPROVED OPERATING OR CAPITAL BUDGETS BY A SPECIFIED DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE GENERAL MEMBER; F. LONG-TERM OR MATERIAL AGREEMENTS INCLUDING, BUT NOT LIMITED TO, BORROWINGS, EQUITY FINANCINGS, CAPITALIZED LEASES AND INSTALLMENT CONTRACTS; AND PURCHASE, SALE, LEASE, DISPOSITION, HYPOTHECATION, EXCHANGE, GIFT, PLEDGE, OR ENCUMBRANCE OF ANY ASSET, REAL OR PERSONAL, WITH A FAIR MARKET VALUE IN EXCESS OF A DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE DIRECTORS OF THE GENERAL MEMBER, WHICH SHALL NOT BE LESS THAN 10% OF THE TOTAL ANNUAL CAPITAL BUDGET OF THE CORPORATION; G. APPOINTMENT OF AN INDEPENDENT AUDITOR AND HIRING OF INDEPENDENT COUNSEL EXCEPT IN CONFLICT SITUATIONS BETWEEN THE GENERAL MEMBER AND THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; H. THE CREATION OR ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE ENTITY; I. CONTRACTING WITH AN UNRELATED THIRD PARTY FOR ALL OR SUBSTANTIALLY ALL OF THE MANAGEMENT OF THE ASSETS OR OPERATIONS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; J. APPROVAL OF MAJOR NEW PROGRAMS AND CLINICAL SERVICES OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY. THE GENERAL MEMBER SHALL FROM TIME TO TIME DEFINE THE TERM "MAJOR" IN THIS CONTEXT; K. APPROVAL OF STRATEGIC PLANS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; L. ADOPTION OF QUALITY ASSURANCE POLICIES NOT IN CONFORMITY WITH POLICIES ESTABLISHED BY THE GENERAL MEMBER; M. ANY TRANSACTION BETWEEN THE CORPORATION, A SUBSIDIARY OR AFFILIATE AND A DIRECTOR OF THE CORPORATION OR AN AFFILIATE OF SUCH DIRECTOR; N. ANY SELF-DEALING TRANSACTION BETWEEN A DIRECTOR OF THE CORPORATION AND THE CORPORATION OR A SUBSIDIARY OF THE CORPORATION; OR O. REHIRING, CONTRACTING WITH, OR OTHERWISE COMPENSATING A SUTTER HEALTH EXECUTIVE, OR ANY OFFICER OR MEMBER OF MANAGEMENT OF THE CORPORATION OR ANY AFFILIATED ENTITY AFTER THEIR EMPLOYMENT HAS ENDED. IN ADDITION, THE GENERAL MEMBER SHALL HAVE THE AUTHORITY (BY A VOTE OF NOT LESS THAN TWO-THIRDS (2/3) OF ITS BOARD), TO DECLARE A MAJOR ACTIVITY REQUIRING APPROVAL.
FORM 990, PART VI, LINE 11BPROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW FORM 990: SUTTER HEALTH HAS A CENTRALIZED TAX DEPARTMENT RESPONSIBLE FOR THE PREPARATION OF THE FORM 990. ANNUALLY THE TAX DEPARTMENT PROVIDES TRAINING AND EDUCATION TO AFFILIATE PERSONNEL WHO ASSIST THE TAX DEPARTMENT IN COLLECTING AND REVIEWING DATA TO BE REPORTED ON THE FORM 990. THE PREPARATION MATERIAL IS REVIEWED BY VARIOUS DEPARTMENTS INCLUDING TAX, FINANCE, LEGAL, AND HUMAN RESOURCES. A NATIONAL ACCOUNTING FIRM PREPARES AND/OR REVIEWS THE RETURN. A COMPLETED RETURN IS THEN REVIEWED BY THE TAX DEPARTMENT, THE AFFILIATE, AND THE CFO BEFORE THE RETURN IS FILED.
FORM 990, PART VI, LINE 12PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST: EMPLOYEES ARE EDUCATED ON THE CONFLICT OF INTEREST POLICY AND THE NEED TO MAKE DISCLOSURE AS PART OF ANNUAL COMPLIANCE EDUCATION. IN ADDITION, ANNUALLY A DISCLOSURE STATEMENT IS COMPLETED BY ALL DIRECTORS, OFFICERS AND KEY EMPLOYEES. ON THIS STATEMENT THE INDIVIDUAL WILL LIST A WIDE RANGE OF INFORMATION WHICH INCLUDES BUSINESS RELATIONSHIPS, EMPLOYMENT RELATIONSHIPS, PROPERTY INTERESTS, AND THOSE OF RELATED PARTIES. IF THERE IS A POTENTIAL CONFLICT OF INTEREST RELATED TO A PARTICULAR TRANSACTION, THE INTERESTED INDIVIDUAL MUST DISCLOSE THE EXISTENCE AND NATURE OF THE RELATIONSHIP. THE BOARD CHAIR MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE THE CONFLICT. THE BOARD MAY CONSULT WITH THE OFFICE OF THE GENERAL COUNSEL AS NECESSARY. UNTIL THE POTENTIAL CONFLICT IS RESOLVED, THE BOARD CHAIR (OR COMMITTEE CHAIR AS APPLICABLE) MAY REQUEST THE INDIVIDUAL TO NOT PARTICIPATE DURING RELATED PRESENTATIONS AND DISCUSSIONS. IN ALL CIRCUMSTANCES INVOLVING AN ACTUAL CONFLICT, THE INTERESTED INDIVIDUAL SHALL LEAVE THE ROOM PRIOR TO THE BOARD'S FINAL DISCUSSION AND VOTE.
FORM 990, PART VI, LINE 15PROCESS FOR DETERMINING COMPENSATION: THE COMPENSATION COMMITTEE OF THE SUTTER HEALTH BOARD OF DIRECTORS RETAINS ULTIMATE DISCRETIONARY AUTHORITY OVER ALL ELEMENTS OF COMPENSATION TO ASSURE THAT ORGANIZATIONAL PURPOSES ARE APPROPRIATELY BEING SERVED. THE COMPENSATION COMMITTEE USES CREDIBLE DATA SOURCES AND MAINTAINS AN OBJECTIVE "ARMS LENGTH" DECISION-MAKING PROCESS, ENSURING THE INTEGRITY OF SUTTER'S EXECUTIVE PROGRAMS AND CONSISTENCY WITH THE ORGANIZATION'S OVERALL MISSION. IN ORDER TO ENSURE EXTERNAL COMPETITIVENESS, NATIONAL, CALIFORNIA AND LOCAL MARKET AREA COMPENSATION DATA COMPARISONS ARE REVIEWED. COMPETITIVE ANALYSIS INCLUDES: (A) BASE SALARY, (B) TOTAL CASH (BASE SALARY + ANNUAL INCENTIVE), (C) TOTAL DIRECT CASH (BASE SALARY + ANNUAL INCENTIVE + LONG TERM INCENTIVE) AND (D) TOTAL REMUNERATION (BASE SALARY + ANNUAL INCENTIVE + BENEFITS AND LONG TERM INCENTIVE). THIS ANALYSIS INCLUDES COMPARABLE ORGANIZATIONS AND GEOGRAPHIC CONSIDERATIONS. FOR THE MOST SENIOR EXECUTIVE POSITIONS, NATIONAL COMPARISONS FOR ORGANIZATIONS SIMILAR IN SIZE, SCOPE AND COMPLEXITY AS SUTTER HEALTH ARE MOST APPROPRIATE SINCE IT IS A NATIONAL MARKETPLACE IN WHICH SUTTER COMPETES FOR EXECUTIVE TALENT. ON THE OTHER HAND, BECAUSE CALIFORNIA'S UNDERLYING COMPENSATION STRUCTURE IS HIGHER THAN NATIONAL DATA (ESPECIALLY IN THE BAY AREA), REGIONAL PAY ADJUSTMENTS MAY BE MADE. OFFICERS AND KEY EMPLOYEES OF THIS ORGANIZATION UNDERGO A REVIEW AND COMPENSATION COMMITTEE APPROVAL ANNUALLY, AND SUCH APPROVAL IS RECORDED IN THE MINUTES. THE 2021 EXECUTIVE COMPENSATION APPROVAL WAS COMPLETED IN FEBRUARY 2021.
FORM 990, PART VI, LINE 19AVAILABILITY OF GOVERNING DOCUMENTS, COI POLICY & FINANCIAL STATEMENTS: THE SUTTER HEALTH SYSTEM POSTS ITS CURRENT AND PAST AUDITED FINANCIAL STATEMENTS AT SUTTERHEALTH.ORG. OTHER DOCUMENTS ARE ALSO LOCATED AT THIS WEBSITE INCLUDING THE ANNUAL REPORT, MISSION STATEMENT, HISTORY, AND LINKS TO AFFILIATE WEBSITES. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME.
FORM 990, PART VII, SECTION ACOMPENSATION OF BOARD MEMBERS: THE FOLLOWING BOARD MEMBERS OF THE ORGANIZATION ARE FULL-TIME EMPLOYEES (40 HOURS PER WEEK) OF SUTTER HEALTH AND THEIR SUTTER HEALTH SALARIES ARE REPORTED HEREIN. THESE INDIVIDUALS RECEIVE NO COMPENSATION FOR THEIR SERVICE AS BOARD MEMBERS OF THIS ORGANIZATION. - JAMES E. CONFORTI - CLAUDIA CRIST - RISHI SIKKA, MD COMMON LAW EMPLOYEES: INDIVIDUALS LISTED AS OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION THAT ARE PAID FULLTIME BY A RELATED ORGANIZATION ARE COMMON LAW EMPLOYEES OF SUTTER HEALTH, A SEPARATE LEGAL ENTITY. IT IS THE INTENTION OF SUTTER HEALTH AND THE FILING ORGANIZATION TO MAKE INFORMATION ACCESSIBLE AND TRANSPARENT, REPORTING THOSE SUTTER HEALTH EMPLOYEES WHO HAVE OFFICER AND KEY EMPLOYEE RESPONSIBILITIES TO THE FILING ORGANIZATION.
FORM 990, PART XI, LINE 9OTHER CHANGES IN NET ASSETS: EQUITY TRANSFERS (NET): $ 8,139,298 -------------------- TOTAL $ 8,139,298

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (19 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
CALIFORNIA PACIFIC MEDICAL CTR FOUND
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833942728423FUNDRAISINGCA501(C)(3)7SUTTER BHYes (true)
EAST BAY PERINATAL CENTER
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833510172285HEALTHCARECA501(C)(3)3SUTTER BHYes (true)
MEMORIAL HOSPITAL FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833942290244FUNDRAISINGCA501(C)(3)12A - ISUTTER VHYes (true)
MILLS-PENINSULA HOSPITAL FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833237288765FUNDRAISINGCA501(C)(3)7SUTTER BHYes (true)
SAMUEL MERRITT UNIVERSITY
450 30TH STREET STE 2840OAKLANDCA94609942992642UNIVERSITYCA501(C)(3)2SUTTER EBHYes (true)
SUTTER AUBURN FAITH HOSPITAL FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833942594966FUNDRAISINGCA501(C)(3)7SUTTER VHYes (true)
SUTTER BAY HOSPITALS
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833940562680HOSPITALCA501(C)(3)3SUTTER HLTHYes (true)
SUTTER BAY MEDICAL FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833941156581HEALTHCARECA501(C)(3)3SUTTER HLTHYes (true)
SUTTER COAST HOSPITAL
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833942988520HOSPITALCA501(C)(3)3SUTTER HLTHYes (true)
SUTTER DAVIS HOSPITAL FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833680217870FUNDRAISINGCA501(C)(3)7SUTTER VHYes (true)
SUTTER HEALTH
2200 RIVER PLAZA DRIVESACRAMENTOCA95833942788907SUPPORTING ORCA501(C)(3)12C III-FINAfalse
SUTTER HEALTH PLAN
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833461183948HEALTH PLANCA501(C)(4)N/ASUTTER HLTHYes (true)
SUTTER INSURANCE SERVICES CORPORATION
745 FORT STREET SUITE 1100HONOLULUHI96813990289310INSURANCE SERHI501(C)(3)12C III-FISUTTER HLTHYes (true)
SUTTER MEDICAL CENTER FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833942788906FUNDRAISINGCA501(C)(3)7SUTTER VHYes (true)
SUTTER ROSEVILLE MEDICAL CTR FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833680040113FUNDRAISINGCA501(C)(3)7SUTTER VHYes (true)
SUTTER VALLEY HOSPITALS
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833941156621HOSPITALCA501(C)(3)3SUTTER HLTHYes (true)
SUTTER VALLEY MEDICAL FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833680273974HEALTHCARECA501(C)(3)3SUTTER HLTHYes (true)
TRACY HOSPITAL FOUNDATION
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833680318845FUNDRAISINGCA501(C)(3)12A - ISUTTER VHYes (true)
SUTTER VISITING NURSE ASSOC AND HOSPICE
C/O SH TAX 2200 RIVER PLAZA DRSACRAMENTOCA95833946068843HEALTHCARECA501(C)(3)10SUTTER HLTHYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (19 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxt
CALIFORNIA PACIFIC ADV IMAGING LLC
PO BOX 6102NOVATOCA94598562311840PATIENT CAREDENAN/A
SAN FRANCISCO ENDOSCOPY CENTER
2200 RIVER PLAZA DRIVESACRAMENTOCA95833912160588PATIENT CARECANAN/A
PRESIDIO SURGERY CENTER LLC
1635 DIVISADEROSAN FRANCISCOCA94115320144060PATIENT CARECANAN/A
SUTTER FAIRFIELD SURGERY CENTER LLC
2200 RIVER PLAZA DRIVESACRAMENTOCA95833300233892PATIENT CARECANAN/A
SUTTER AMADOR SURGERY CENTER LLC
2200 RIVER PLAZA DRIVESACRAMENTOCA95833461398093PATIENT CARECANAN/A
ROSEVILLE ENDOSCOPY CENTER
2200 RIVER PLAZA DRIVESACRAMENTOCA95833870710513PATIENT CARECANAN/A
STANISLAUS SURGICAL HOSPITAL LLC
1421 OAKDALE ROADMODESTOCA95355911754157PATIENT CARECANAN/A
MEMORIAL MEDICAL BUILDING 1
1800 COFFEE RD 76MODESTOCA95355770234236OFFICE RENTALCANAN/A
MAGNETIC IMAGING AFFILIATES LLC
2125 OAK GROVE ROADWALNUT CREEKCA94598473696091PATIENT CARECANAN/A
ASC OPERATORS - SANTA ROSA LLC
2200 RIVER PLAZA DRIVESACRAMENTOCA95833263386169CARE MANAGEMECANAN/A
ASC OPERATORS - SAN LUIS OBISPO LLC
2200 RIVER PLAZA DRIVESACRAMENTOCA95833272673776CARE MANAGEMECANAN/A
ICG CREDIT OPPORTUNITIES FUND LP
11111 SANTA MONICA BLVD SUITE 2100LOS ANGELESCA90025814220441INVESTMENTSCANAN/A
CARLSBAD SURGERY CENTER LLC
6121 PASEO DEL NORTE STE 100CARLSBADCA92011201413484PATIENT CARECANAN/A
COAST CTR FOR ORTHOPEDIC & ARTHROSCOPIC
3444 KEARNY VILLA ROADSAN DIEGOCA92123330839637PATIENT CARECANAN/A
OTAY LAKES SURGERY CENTER LLC
955 LANE AVE SUITE 100CHULA VISTACA91914200794766PATIENT CARECANAN/A
MADISON INTERNATIONAL GLOBAL
410 PARK AVENUENEW YORKNY10022981310251INVESTMENTSNYNAN/A
SURG CTR OF ABSMC
3875 TELEGRAPHOAKLANDCA94609470946086Patient CareCANAN/A
DIVISADERO HOLD LLC
1635 DIVISADEROSAN FRANCISCOCA94115320621050Outpatient suCANAN/A
PENINSULA ENDOSCOPY
2200 RIVER PLAZASACRAMENTOCA95833271905059PATIENT CARECANA

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndLegal Domicile Foreign CountryLegalDomicileForeignCountryCdAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmProvince Or StateForeignAddress/ProvinceOrStateNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCd
SUTTER HEALTH DEFERRED COMP PLANS' TRUST
2200 RIVER PLAZA DRIVESACRAMENTOCA95833276851989RABBI TRUSTCANATRUSTYes (true)
NORTHWOOD EUROPE TE FEEDER LP
1819 WAZEE ST 2ND FLOORDENVERCO90202981272216HOLDING COMPANYNAC CORPYes (true)CJ
LYXSOP SEGREGATED PORTFOLIO 1
INVESTMENTNAC CORPYes (true)CJPO BOX 10008 WILLOW HOUSECRICKET SQUAREGRAND CAYMANCJ
LYXSOP SEGREGATED PORTFOLIO 2
INVESTMENTNAC CORPYes (true)CJPO BOX 10008 WILLOW HOUSECRICKET SQUAREGRAND CAYMANCJ
AQR REAL RETURN OFFSHORE FUND LP
980700570INVESTMENTNAc corpYes (true)CJ89 NEXUS WAYCAMANA BAYGRAND CAYMANCJKY1-9009
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Sutter Insurance Services CorporationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypePTransactionTypeTxt
Involved$252,036InvolvedAmt
Method Of Amount DeterminationFMVMethodOfAmountDeterminationTxt