2019-05-09T13:58:41-05:00 2018-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2017-07-01 465322209 Port City Operating Company LLC % LARA CARTOSCELLI - FINANCE PORT 2099432000 3400 Data Drive Rancho Cordova CA 95670 NIKKI OCHOA CFO 2094676442 2019-05-09 true VALERIE J BALL P00178114 4159635100 162.135.0.56 94661320191295000002 2019-05-09 P 3BCB7B9832BA545B8252A1AE1478056F4F8D2764 2B5788CE322FF00EB493AD5B21DC7D604E87DE51 2017 2019-02-21 02:37:17Z KARL SILBERSTEIN 3400 Data Drive Rancho Cordova CA 95670 619435340 false X WWW.DIGNITYHEALTH.ORG X 2014 CA PORT CITY LLC IS COMMITTED TO FURTHERING THE HEALING MINISTRY OF JESUS THROUGH THE DELIVERY OF AFFORDABLE HEALTH CARE, ADVOCACY FOR THE POOR AND COMMUNITY PARTNERSHIPS. 7 3 0 364 417616 5349028 2202809 519814662 608441349 3933132 2868512 2632514 2720757 531729336 616233427 10173810 12721068 0 0 0 0 0 0 0 522500654 561057916 532674464 573778984 -945128 42454443 404879636 458215003 158979051 169655835 245900585 288559168 X PORT CITY LLC IS COMMITTED TO FURTHERING THE CHARITABLE AND COMMUNITY-BASED HEALTH CARE PURPOSES, MISSION, VISION AND CORE VALUES OF DIGNITY HEALTH AND KAISER FOUNDATION HOSPITALS BY PROMOTING HEALTH AND PROVIDING AND EXPANDING ACCESS TO HEALTH CARE SERVICES FOR A BROAD CROSS-SECTION OF THE INDIVIDUALS WHO RESIDE IN STOCKTON, CALIFORNIA AND THE SURROUNDING COMMUNITIES. false false 433617894 12721068 575708168 Effective June 1, 2016, Dignity Health assigned, transferred and otherwise conveyed all rights, title and interest in and to all assets and properties, and related liabilities, of St. Joseph's Medical Center (SJMC) to Port City Operating Company, LLC (Port City). In return, Dignity Health retained 80% ownership of Port City and Management rights to SJMC. Kaiser Foundation Hospitals bought in, for valued received, the remaining 20% ownership of Port City. St. Joseph's Medical Center, prior to June 1, 2016, was a wholly owned affiliate of Dignity Health; SJMC is now wholly owned by Port City, a 501(c)(3) tax exempt organization, which is an 80% affiliate of Dignity Health. SJMC continues to operate under the same (assigned) Medicare and Medi-Cal provider numbers, and is licensed at the same level with the State of California, serving the County of San Joaquin and outlying areas. SJMC is a 355-bed licensed acute care facility, providing general medical/ surgical care, obstetrics, Neonatal ICU, Emergency Services, Cancer Services, with specialities in Cardiac surgery and Cardiovascular care, Respiratory, and Orthopedics. There are numerous ancillary and outpatient support services. 21572307 0 22011849 Effective June 1, 2016, Dignity health assigned, transferred and otherwise conveyed all rights, title and interest in and to all assets and properties, and related liabilities of St. Joseph's Behavioral Health Center (BHC) to Port City Operating Company, LLC (Port City). In return, Dignity Health retained 80% ownership of Port City and Management rights to BHC. Kaiser Foundation Hospitals bought in, for valued received, the remaining 20% ownership of Port city. St. Joseph's Behavoiral Health Center, prior to June 1, 2016, was a wholly owned affiliate of Dignity Health. BHC is now wholly owned by Port City, a 501(c)(3) tax exempt organization, which is an 80% affiliate of Dignity Health. BHC continues to operate under the same (assigned) Medicare and Medi-Cal provider numbers, and is licensed at the same level with the State of California, serving the County of San Joaquin and outlying areas. BHC is a 35 bed Acute Psychiatric and Chemical Dependency hospital, providing both inpatient and outpatient services. 6455929 0 10303716 Effective June 1, 2016, Dignity Health assigned, transferred and otherwise conveyed all rights, title and interest in and to all assets and properties, and related liabilities of St. Joseph's Medical Center Home Health (SJHHA) to Port City Operating Company, LLC (Port City). In return, Dignity Health retained 80% ownership of Port City and Management rights to SJHHA. Kaiser Foundation Hospitals bought in, for value received, the remaining 20% ownership of Port City. SJHHA, prior to June 1, 2016 was a hospital based Home Health Agency (attached to SJMC), separately licensed, and therefore a wholly owned affiliate of Dignity Health. SJHHA continues to be attached to St. Joseph's Medical Center, which is wholly owned by Port City, thereby making SJHHA wholly owned by Port City. Port City is a 501(c)(3) tax exempt organization, which is an 80% affiliate of Dignity Health. SJHHA continues to operate under the same (assigned) Medicare and Medi-Cal provider numbers, and is licensed as a Hospital based Home Health Agency with the State of California. SJHHA provides skilled nursing care services, social services, occupational, physical, and speech Therapies, as well as home health aides. 461646130 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true true true false false false false false false false false false false false false false true true false false false true X 0 0 0 true true false false false false false false false false false X 7 3 true false false false true true true true true false false false true true true true true false false true true CA X LARA CARTOSCELLI - FINANCE 9166313337 10901 GOLD CENTER DRIVE STE 300 Rancho Cordova CA 95670 X Elise Dempsey Board Member 2.0 40.0 X 0 359514 77390 Tom Hanenburg Board Member 2.0 0.0 X 0 0 0 John Petersdorf Board Member 2.0 40.0 X 0 830452 127820 Jon VanBoening Board Member 2.0 40.0 X 0 1437307 185188 Debra Cunningham Vice-Chair 2.0 0.0 X X 0 0 0 Stephan Foerster Secretary 2.0 40.0 X X 0 402816 73718 Corwin Harper Secretary 2.0 0.0 X X 0 0 0 Karl Silberstein Chair 2.0 40.0 X X 0 1241480 155880 Doreen Hartmann CFO (THRU 11/2017) 40.0 0.0 X 0 361493 43740 Andrea N Ochoa Chief Financial Officer 40.0 0.0 X 0 182883 32549 Donald Wiley President and CEO 40.0 0.0 X 0 1285511 114167 0 6101456 810452 0 false true false 0 X 2121817 80992 16607 2202809 MEDICARE/MEDICAID PAYMENTS 900099 307614403 307614403 0 0 PATIENT NET OF CHARITY AND BAD DEBT 900099 298571405 298571405 0 0 MEDICAL OFFICE BUILDING 621300 593459 593459 0 0 PROGRAM RELATED RENTAL INCOME(NOT MOB) 900099 533417 533417 0 0 MANAGEMENT SERVICES 541610 241950 241950 0 0 886715 469099 417616 0 608441349 2374580 0 0 2374580 0 0 153092 153092 0 153092 153092 3695606 239 3201913 493693 239 493932 493932 0 0 0 0 0 0 0 0 0 CAFETERIA 722514 1348564 0 0 1348564 GIFT SHOP 453220 295788 0 0 295788 LIFELINE 900099 281275 0 0 281275 642038 0 0 642038 2567665 616233427 608023733 417616 5589269 X 12580529 12580529 140539 140539 0 0 0 0 0 0 0 0 0 678835 678835 118973 118973 42162 42162 0 46087 46087 389277196 301150776 88126420 0 1141008 60890 1080118 9830805 7519390 2311415 18178541 566068 17612473 0 5657468 5383923 273545 565452 120245 445207 0 153358 20422 132936 3904135 3904135 0 23536357 23536357 2788973 2788973 MEDICAL SUPPLIES 63062961 63044916 18045 0 MEDI-CAL PROVIDER FEE 38932014 38932014 0 0 DUES AND SUBSCRIPTIONS 869189 270201 598988 0 LICENSES AND TAXES 422657 191806 230851 0 1851745 1434946 416799 573778984 461646130 112132854 0 X 13894 13570 19390438 56758423 79164 92846 84207798 88033907 0 0 0 0 844097 2677948 4990186 5255601 90650041 97553058 393160494 209670237 186375369 183490257 8794666 14418835 0 0 2477102 2833819 365677 365677 6691204 6721062 404879636 458215003 55032077 68321073 0 0 2641808 2532179 0 0 0 0 0 0 4392917 4315002 0 0 96912249 94487581 158979051 169655835 X 245900585 288559168 0 0 0 0 245900585 288559168 404879636 458215003 X 42454443 260456 -56316 X X false true X true true true X false false false false false false false false true 42162 42162 false SCHEDULE C, PART II-B, LINE 1 LOBBYING EXPENDITURES PAID DIRECTLY BY THE FILING ORGANIZATION FOR ANNUAL MEMBERSHIP DUES: AMERICAN COLLEGE OF HEALTHCARE EXECUTIVES $ 7 ASSOCIATION OF NUTRITION & FOODSERVICE PROF $ 152 MEDICAL GROUP MANAGEMENT ASSOCIATION $ 105 AMERICAN COLLEGE OF PHYSICIANS $ 50 CALCPA $ 20 CA ASSOCIATION FOR HEALTH SERVICES AT HOME $ 121 LOBBYING EXPENDITURES PAID BY THE PARENT ORGANIZATION FOR ANNUAL MEMBERSHIP DUES WHERE EXPENSES ARE ALLOCATED TO THE HOSPITAL: 340 B HEALTH $ 222 CATHOLIC HEALTH ASSOCIATION $ 3,424 HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA $ 22,649 AMERICAN HOSPITAL ASSOCIATION $ 4,310 ALLIANCE OF CATHOLIC HEALTH $ 10,915 CALIFORNIA ASSOCIATION FOR HEALTH SERVICES $ 115 ELEVATING HOME $ 72 -------- TOTAL EXPENDITURES PAID TO ORGANIZATIONS $ 42,162 ======== 9036479 9036479 269806611 133932611 135874000 978840 677900 300940 107978628 73758541 34220087 5359936 1301185 4058751 183490257 0 DUE TO RELATED PARTIES 78511805 PENSION PAYABLE 9674546 ASSET RETIREMENT OBLIGATION LI 5415000 OTHER LONG-TERM LIABILITIES 886230 94487581 X PART X, LINE 2 - FN48(ASC 740) FOOTNOTE ST. JOSEPHS MEDICAL CENTER OF STOCKTON AND ST. JOSEPHS BEHAVIORAL HEALTH CENTER REVIEW ITS TAX QUARTERLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. true true X true X true X 500. true true true false true true 3771 4840805 202816 4637989 0.00790 62607 202311883 199992538 2319345 0.00400 4 8699 757 7942 66382 207161387 200196111 6965276 0.01190 3 7621 2366692 339851 2026841 0.00350 2 2435 3914906 137194 3777712 0.00650 280 11960 365 11595 284 437118 65508 371610 0.00060 1 7843 2713587 22082 2691505 0.00460 6 18463 9444263 565000 8879263 0.01520 6 84845 216605650 200761111 15844539 0.02710 2 8 526326 526326 0.00090 2 8 526326 526326 0.00090 false 3739352 125291090 143654020 -18362930 X true true ST JOSEPH'S SURGERY SURGERY CENTER 0.7996 0.1504 2 1 St Josephs Medical Center of Stockt 1800 N California St Stockton CA 95204 www.dignityhealth.org/stjosephs-stockton 030000284 X X X X 2 St Josephs Behavioral Health Center 2510 N California St Stockton CA 95204 www.dignityhealth.org/stjosephsbehaviora 030000367 X BEHAVIORAL HEALTH St Josephs Medical Center of Stockt 1 false false true X X X X X X X X X 15 true true true true X SEE SECTION C X SEE SECTION C X true 15 true SEE SECTION C false true X 200. 500. X X X X true true X X X X true X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X X X true X false X X X X true X false false St Josephs Behavioral Health Center 2 false false true X X X X X X X X X 15 true true true true X SEE SECTION C X SEE SECTION C X true 15 true SEE SECTION C false true X 200. 500. X X X X true true X X X X true X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X X X true X false X X X X true X false false SCHEDULE H, PART V SCHEDULE H, PART V, SECTION B, LINE 5 - CHNA INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY ST. JOSEPH'S MEDICAL CENTER OF STOCKTON ST. JOSEPH'S BEHAVIORAL HEALTH CENTER THE 2015 CHNA PROCESS INCLUDED SURVEYS OF 2,927 RESIDENTS, 34 INTERVIEWS WITH KEY INFORMANTS INCLUDING THE COUNTY PUBLIC HEALTH DEPARTMENT, AND 29 FOCUS GROUP DISCUSSIONS IN THE COMMUNITY, INCLUDING INPUT FROM PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY. RESIDENTS AND KEY STAKEHOLDERS PROVIDED VALUABLE INPUT ABOUT THE TOP HEALTH NEEDS IN THEIR COMMUNITIES. THE COMMUNITY SURVEY WAS ADMINISTERED TO COLLECT INFORMATION ABOUT A BROAD RANGE OF SOCIAL, ECONOMIC, ENVIRONMENTAL, BEHAVIORAL, AND CLINICAL CARE FACTORS THAT MAY ACT AS CONTRIBUTING DRIVERS OF HEALTH NEED. THE SURVEYS WERE CONDUCTED ON PAPER, ONLINE AND IN PERSON IN MULTIPLE LANGUAGES (ENGLISH, SPANISH, HMONG, CAMBODIAN). THIRTY-FOUR INTERVIEWS WERE CONDUCTED TO OBTAIN INFORMATION FROM KEY STAKEHOLDERS ABOUT A BROAD RANGE OF SOCIAL, ECONOMIC, ENVIRONMENTAL, BEHAVIORAL, AND CLINICAL CARE FACTORS. FOCUS GROUPS WERE CONDUCTED TO ENGAGE RESIDENTS IN CONVERSATION ABOUT STRENGTHS AND NEEDS IN THEIR COMMUNITIES. KEY INFORMANT INTERVIEWS WERE INTENDED TO GIVE A BROAD PERSPECTIVE ON COMMUNITY HEALTH STATUS ACROSS THE COUNTY, WHILE FOCUS GROUPS ADDRESSED NEIGHBORHOOD-SPECIFIC CONCERNS. INTERVIEW PARTICIPANTS AND FOCUS GROUP PARTICIPANT CHARACTERISTICS ARE DETAILED IN THE CHNA REPORT APPENDICES. SCHEDULE H, PART V, SECTION B, LINE 6A ST. JOSEPH'S MEDICAL CENTER OF STOCKTON, ST. JOSEPH'S BEHAVIORAL HEALTH CENTER, DAMERON HOSPITAL ASSOCIATION, KAISER PERMANENTE, SUTTER TRACY COMMUNITY HOSPITAL SCHEDULE H, PART V, SECTION B, LINE 6B COMMUNITY MEDICAL CENTERS, COMMUNITY PARTNERSHIP FOR FAMILIES, FIRST 5 SAN JOAQUIN, HEALTH NET, HEALTH PLAN OF SAN JOAQUIN, SAN JOAQUIN PUBLIC HEALTH SERVICES, AND 36 PUBLIC AND NON-PROFIT AGENCIES ON THE STEERING COMMITTEE SCHEDULE H, PART V, SECTION B, LINE 7A ST. JOSEPH'S MEDICAL CENTER OF STOCKTON HTTPS://WWW.DIGNITYHEALTH.ORG/CENTRAL-CALIFORNIA/LOCATIONS/STJOSEPHS-STOCK TON/ABOUT-US/COMMUNITY-PROGRAMS/COMMUNITY-HEALTH-NEEDS-ASSESMENT ST. JOSEPH'S BEHAVIORAL HEALTH CENTER HTTPS://WWW.DIGNITYHEALTH.ORG/CENTRAL-CALIFORNIA/LOCATIONS/STJOSEPHSBEHAVI ORAL/ABOUT-US/COMMUNITY-HEALTH SCHEDULE H, PART V, SECTION B, LINE 7B WWW.HEALTHIERSANJOAQUIN.ORG SCHEDULE H, PART V, SECTION B, LINE 10A THE FACILITIES IMPLEMENTATION STRATEGY DOCUMENTS CAN BE ACCESSED AT HTTPS://WWW.DIGNITYHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH/COMMUNITY-HEALTH-P ROGRAMS-AND-REPORTS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS IMPLEMENTATION STRATEGIES ARE ALSO ON THE FACILITIES' WEB SITE, AT THE SAME LOCATIONS AS THEIR CHNA REPORTS LISTED IN PART V, SECTION B, LINE 7A ABOVE. SCHEDULE H, PART V, SECTION B, LINE 11 ST. JOSEPH'S MEDICAL CENTER OF STOCKTON THE HOSPITAL WILL ADDRESS THE MAJORITY OF THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN ITS 2015 CHNA, EITHER THROUGH DIRECT PROGRAMMING, FINANCIAL SUPPORT FOR COMMUNITY PARTNERS, OR PARTICIPATION IN COMMUNITY COLLABORATIVE EFFORTS. THE HOSPITAL WILL BE ADDRESSING OBESITY/DIABETES, VIOLENCE AND INJURY, SUBSTANCE USE, ACCESS TO HOUSING, ACCESS TO CARE, MENTAL HEALTH, AND ORAL HEALTH. AS THESE ARE NEWLY IDENTIFIED PRIORITY HEALTH NEEDS, THE HOSPITAL WILL BE IDENTIFYING BEST PRACTICES, CURRENT GAPS, AND OPPORTUNITIES FOR INVOLVEMENT. THE HOSPITAL IS ADDRESSING THESE NEEDS IN NUMEROUS WAYS DESCRIBED IN DETAIL IN THE IMPLEMENTATION STRATEGY, WHICH IS WIDELY AVAILABLE TO THE PUBLIC ONLINE. PROGRAMS DELIVERED OR SUPPORTED INCLUDE: DIABETES EDUCATION PROGRAM (IN ENGLISH, SPANISH AND HMONG), CHRONIC DISEASE SELF-MANAGEMENT PROGRAM, FAITH COMMUNITY NURSE PROGRAM, COMMUNITY HEALTH CONNECTORS, HEALING SOUTH STOCKTON, FREQUENT USER INITIATIVE, PATIENT FINANCIAL ASSISTANCE, CAREVAN, DOBBINS PROGRAM FOR BREAST HEALTH SERVICES, ST. MARY'S DINING ROOM, FRIENDS OF SENIORS PROGRAM, HOMECOMING PROJECT, SPECIAL NEEDS CAREGIVER PROGRAM, HUMAN TRAFFICKING INITIATIVE, HOMELESS MEDICAL RESPITE CARE PROGRAM, EMERGENCY DEPARTMENT PATIENT NAVIGATOR PROGRAM, FRIENDS OF SENIORS, ST. RAPHAEL'S DENTAL CLINIC, SMART MOVES, AND THE DIGNITY HEALTH COMMUNITY GRANTS PROGRAM. THE ONLY HEALTH NEEDS THAT WILL NOT BE ADDRESSED BY THE HOSPITAL AT THIS TIME ARE EDUCATION, YOUTH DEVELOPMENT, ECONOMIC SECURITY, AND ASTHMA/AIR QUALITY. THE HOSPITAL HAS LIMITED RESOURCES TO ADDRESS EVERY IDENTIFIED NEED, AND SOME OF THESE NEEDS ARE OUTSIDE THE SCOPE OF THE HOSPITAL'S CORE CAPABILITY. ST. JOSEPH'S BEHAVIORAL HEALTH CENTER THE HOSPITAL INTENDS TO TAKE STEPS TO HELP ADDRESS MENTAL HEALTH-RELATED NEEDS IDENTIFIED IN THE CHNA. THE HOSPITAL WILL CONDUCT FREE BEHAVIORAL EVALUATIONS TO ASSESS PATIENT NEEDS AND RISKS AND TO PROVIDE REFERRALS 24-HOURS DAILY, 365 DAYS PER YEAR TO ANYONE WHO PRESENTS AT THE FACILITY OR AT COMMUNITY HOSPITAL EMERGENCY DEPARTMENTS. THESE SERVICES ARE PROVIDED REGARDLESS OF THE INDIVIDUAL'S ABILITY TO PAY OR ELIGIBILITY FOR CARE AT OUR FACILITY. THE HOSPITAL WILL SPONSOR SUPPORT GROUPS AND FREE AFTERCARE GROUPS THAT SUPPORT THOSE IN THE COMMUNITY LIVING WITH A NEW OR CONTINUING LIFE-AFFECTING DIAGNOSIS. THE HOSPITAL WILL PROVIDE GREYHOUND BUS AND YELLOW CAB TRANSPORTATION SERVICES TO DISCHARGED PATIENTS THAT LIVE OUTSIDE OF SAN JOAQUIN COUNTY. AS A HOSPITAL EXCLUSIVELY DELIVERING BEHAVIORAL HEALTH SERVICES, NEEDS IDENTIFIED IN THE CHNA BEYOND MENTAL HEALTH ARE NOT ONES THAT THE HOSPITAL IS ABLE TO ADDRESS. THESE INCLUDE: OBESITY/DIABETES, VIOLENCE AND INJURY, ACCESS TO HOUSING, ACCESS TO CARE, ORAL HEALTH, EDUCATION, YOUTH DEVELOPMENT, ECONOMIC SECURITY, AND ASTHMA/AIR QUALITY. OTHER HOSPITALS AND COMMUNITY SERVICE ORGANIZATIONS IN THE REGION ARE ADDRESSING THESE NEEDS. SCHEDULE H, PART V, SECTION B, LINE 16A, 16B AND 16C ST JOSEPH'S MEDICAL CENTER OF STOCKTON HTTP://WWW.DIGNITYHEALTH.ORG/STJOSEPHS-STOCKTON/PATIENTS-AND-VISITORS/PATI ENTS/BILLING-INFORMATION/PAYMENT-ASSISTANCE ST JOSEPH'S BEHAVIORAL HEALTH CENTER HTTP://WWW.DIGNITYHEALTH.ORG/STJOSEPHSBEHAVIORAL/PATIENTS-AND-VISITORS/PAT IENTS/BILLING-INFORMATION/PAYMENT-ASSISTANCE SCHEDULE H, PART V, SECTION B, LINE 16J ADDITIONAL MEASURES TAKEN TO PUBLICIZE THE HOSPITAL FACILITIES' FINANCIAL ASSISTANCE POLICY INCLUDE THE PROVISION OF BROCHURES EXPLAINING AVAILABLE GOVERNMENT SPONSORED PROGRAMS AND THE FINANCIAL ASSISTANCE POLICY, A COPY OF THE FINANCIAL ASSISTANCE APPLICATION, A TELEPHONE NUMBER FOR PATIENTS TO REQUEST FURTHER INFORMATION ABOUT THE PROGRAM, AVAILABLITY OF INFORMATION IN LANGUAGES OTHER THAN ENGLISH, CONTACT INFORMATION FOR FINANCIAL COUNSELORS OR OTHER REPRESENTATIVES WHO CAN PROVIDE INFORMATION, THE FACILITIES' WEBSITE ALSO CONTAINS THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY OF THE POLICY, APPLICATION, BILLING AND COLLECTION POLICY, A DESCRIPTION OF THE AMOUNT GENERALLY BILLED AND A LISTING OF PROVIDERS AT EACH FACILITY THAT ARE COVERED AND NOT COVERED BY THE FINANCIAL ASSISTANCE POLICY. CONTACT INFORMATION CAN ALSO BE FOUND ON EACH FACILITIES' WEB PAGE. 1 St Joseph's Surgery Center LP 1800 N California Street Ste 1 STockton CA 95204 surgery center PART I, LINE 7 PORT CITY OPERATING COMPANY, LLC, DBA ST. JOSEPH'S MEDICAL CENTER OF STOCKTON (SJMC) AND ST. JOSEPH'S BEHAVORIAL HEALTH CENTER (BHC) FOLLOWS THE METHOD USED BY DIGNITY HEALTH. FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, SJMC AND BHC USES A COST ACCOUNTING SYSTEM THAT COMBINES RELATIVE VALUE UNITS (RVU) AND COST TO CHARGE RATIOS (CCR) TO ALLOCATE COSTS TO THE PATIENT LEVEL. THE COST ACCOUNTING SYSTEM ALGORITHM ALLOCATES TOTAL OPERATING EXPENSES TO THE PROCEDURE CHARGE CODE LEVEL BASED UPON AN RVU FOR PROCEDURES THAT HAVE BEEN STUDIED AND ASSIGNED AN RVU, OR BASED UPON A CCR FOR UNSTUDIED PROCEDURES THAT DO NOT HAVE AN RVU ASSIGNED. WHEN A CCR IS USED, THE SYSTEM CALCULATES THAT CCR ON A DEPARTMENTAL SPECIFIC BASIS AT EACH INDIVIDUAL FACILITY WHERE THE SERVICES WERE PROVIDED. THE CALCULATION IS SIMILAR TO THE WORKSHEET 2 OF SCHEDULE H, RATIO OF PATIENT CARE COST TO CHARGES, EXCEPT IT IS CALCULATED ON A DEPARTMENTAL SPECIFIC BASIS, NOT IN THE AGGREGATE. THE ALLOCATED PROCEDURE CHARGE CODE LEVEL COSTS ARE THEN ROLLED UP TO THE PATIENT LEVEL BASED UPON THE BILLED PROCEDURE CHARGE CODES ASSOCIATED WITH THOSE SERVICES PROVIDED TO EACH SPECIFIC PATIENT. THIS IS DONE FOR ALL PATIENT SEGMENTS INCLUDING INPATIENT, OUTPATIENT, EMERGENCY DEPARTMENT, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED AND SELF-PAY. THE COST ACCOUNTING SYSTEM IS UTILIZED TO DETERMINE THE UNREIMBURSED COST OF MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS. THE COST OF CHARITY CARE IS CALCULATED BY APPLYING THE CCR DERIVED FROM THE COST ACCOUNTING SYSTEM ON A PER FACILITY BASIS, TO THE CHARGES INCURRED ON PATIENTS THAT QUALIFY FOR CHARITY CARE AT THE RESPECTIVE FACILITY. THE ACTUAL COST IS REPORTED FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS AND CASH AND IN-KIND DONATIONS. PART I, LINE 7, COLUMN (F) BEGINNING IN 2009, THE STATE OF CALIFORNIA ESTABLISHED PROVIDER FEE PROGRAMS. THESE PROGRAMS ARE FUNDED BY QUALITY ASSURANCE FEES PAID BY PARTICIPATING HOSPITALS AND MATCHING FEDERAL FUNDS. PORT CITY'S HOSPITAL FACILTIES RECOGNIZED QUALITY ASSURANCE FEES DURING THE YEAR OF $38.93 MILLION WHICH ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE RELATED TO UNREIMBURSED MEDICAID (PART I, LINE 7B, COLUMN C), AND RECOGNIZED FEE-FOR-SERVICE SUPPLEMENTAL PAYMENTS OF $93.56 MILLION DURING THE YEAR REFLECTED UNDER THE MEDICAID PROGRAM AS DIRECT OFFSETTING REVENUE (PART I, LINE 7B, COLUMN D). THIS NET REDUCTION IN THE COST OF THE MEDICAID PROGRAM IS DRIVING THE DECREASE IN THE OVERALL COST OF COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSES WHEN COMPARED TO PRIOR YEARS. THE CALIFORNIA HOSPITAL ASSOCIATION CREATED A PRIVATE PROGRAM, THE CALIFORNIA HEALTH FOUNDATION AND TRUST ("CHFT"), ESTABLISHED FOR SEVERAL PURPOSES, INCLUDING AGGREGATING AND DISTRIBUTING FINANCIAL RESOURCES TO SUPPORT CHARITABLE ACTIVITIES AT VARIOUS HOSPITALS AND HEALTH SYSTEMS IN CALIFORNIA. DURING THE YEAR, PORT CITY RECORDED A PLEDGE TO A GRANT FUND ESTABLISHED BY CHFT IN THE AMOUNT $1.92 MILLION. THE GRANT IS REPORTED UNDER OTHER BENEFITS (PART I, LINE 7I, COLUMN C), AS CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. PART II - COMMUNITY BUILDING ACTIVITIES WORKFORCE DEVELOPMENT - IN AN EFFORT TO MEET THE PHYSICIAN SHORTAGE IN THE STOCKTON SERVICE AREA, ST. JOSEPH'S MEDICAL CENTER ENCOURAGES PHYSICIANS TO RELOCATE AND/OR SET UP PRACTICE TO MEET THE HEALTHCARE NEEDS. RECRUITMENT AND LOAN FORGIVENESS ARE OFFERED TO PHYSICIANS WHO RELOCATE IN TO THE STOCKTON SERVICE AREA. THE NUMBER OF PRACTITIONERS WILL BE REDUCED DUE THE RETIREMENT OR DEPARTURE OF PRACTITIONERS PRESENTLY IN THE STOCKTON SERVICE AREA WITHIN THE NEXT THREE TO FIVE YEAR PERIOD, WHICH IS COUPLED WITH AN ANTICIPATED INCREASE IN THE POPULATION, WILL RESULT IN A DEFICIENCY IN THE POPULATION TO PRACTITIONER RATIO IN THE AREA. PART III, LINE 2 THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE CCR (SEE ABOVE) TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER FINANCIAL ASSISTANCE, AND ARE OTHERWISE UNINSURED. ANY PORTION OF A PATIENT BILL REMAINING AFTER APPLYING FINANCIAL, UNINSURED OR OTHER DISCOUNTS OR PAYMENTS RECEIVED ON THE ACCOUNT THAT ARE ULTIMATELY DETERMINED TO BE UNCOLLECTIBLE ARE WRITTEN OFF TO BAD DEBT. PORT CITY PROVIDES FREE OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS THAT FALL INTO THREE CATEGORIES; UNDER 200%, 201%-350% OR 351%-500% OF THE FEDERAL POVERTY LEVEL. PORT CITY ALSO PROVIDES PATIENTS OPTIONS FOR PROMPT PAY DISCOUNTS AND INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS RECEIVE AN AUTOMATIC UNINSURED DISCOUNT OF 30%. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3 PORT CITY MAKES EVERY EFFORT IN DETERMINING IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. PORT CITY FOLLOWS DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY. DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. DIGNITY HEALTH ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF AN UNINSURED PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL UNINSURED PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT NO SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE WERE REPORTED AS BAD DEBT. AS SUCH, DIGNITY HEALTH DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE. PART III, LINE 4 THE FOLLOWING IS AN EXCERPT FROM DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS' CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2018, RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCES FOR CHARITY AND DOUBTFUL ACCOUNTS: PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE ARE REPORTED AT THE NET REALIZABLE AMOUNT FROM PATIENTS, THIRD-PARTY PAYERS, AND OTHERS FOR SERVICES RENDERED. PORT CITY MANAGES ITS COLLECTION RISK BY REGULARLY REVIEWING ITS ACCOUNTS AND CONTRACTS AND BY PROVIDING APPROPRIATE ALLOWANCES. RESERVES FOR CHARITY AND UNCOLLECTIBLE AMOUNTS HAVE BEEN ESTABLISHED AND ARE NETTED AGAINST PATIENT ACCOUNTS RECEIVABLE IN THE CONSOLIDATED BALANCE SHEET. PART III, LINE 8 PORT CITY PREPARES MEDICARE COST REPORTS IN A MANNER THAT COMPLIES WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1, 2150FF AND PRM 15-2, 1000FF. AS SUCH, THE FOLLOWING LANGUAGE PER THE PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR TO BE CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. DIGNITY HEALTH AND ITS SUBORDINATES, INCLUDING PORT CITY, BELIEVES THAT THE ENTIRE MEDICARE SHORTFALL OF $1.2 BILLION, AS REPORTED BELOW IN PART VI, LINE 6, CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY HOSPITAL FACILITIES IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. THIS SHORTFALL INCLUDES $18.4 MILLION REPORTED ON PART III, SECTION B, LINE 7, PRIMARILY FOR FEE FOR SERVICE MEDICARE PATIENTS, AS WELL AS THE UNREIMBURSED PORTION OF MEDICARE MANAGED CARE AND MEDICARE CAPITATED PROGRAMS FOR PORT CITY. LINE III, LINE 9b PORT CITY ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. PORT CITY ALSO FOLLOWS DIGNITY HEALTH'S BILLING AND COLLECTION POLICY. DIGNITY HEALTH'S COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHOM THE ORGANIZATION KNOWS QUALIFY FOR CHARITY CARE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE HOSPITAL FACILITIES OR THE BILLING COMPANY RETAINED BY DIGNITY HEALTH IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED FINANCIAL ASSISTANCE OR FOR ASSISTANCE UNDER DIGNITY HEALTH'S FINANCIAL ASISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, PORT CITY WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. LEGAL ACTION WILL NOT BE PURSUED TO COLLECT DEBTS FROM PATIENTS WHO HAVE QUALIFIED FOR CHARITY OR ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DEBT. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY DIGNITY HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNTS TO A COLLECTION AGENCY, PORT CITY REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT. PART VI, LINE 2 - NEEDS ASSESSMENT IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT COMPLETED IN COLLABORATION WITH OTHER HOSPITALS, LOCAL PUBLIC HEALTH AND COMMUNITY PARTNERS IN THE HEALTHIER COMMUNITIES COALITION, ST. JOSEPH'S ASSESSES LOCAL NEEDS CONTINUOUSLY THROUGH ONGOING ENGAGEMENT IN THE HEALTHIER COMMUNITY COALITION AND A WIDE RANGE OF OTHER COMMUNITY ORGANIZATIONS, WORK GROUPS AND PROJECTS WITH PARTNERS. MANY OF THESE SPECIFIC ENGAGEMENTS ARE DESCRIBED IN SCHEDULE H, PART VI, LINE 5 BELOW. THE HOSPITALS CREATE AND MAKE WIDELY AVAILABLE TO THE PUBLIC ANNUAL COMMUNITY BENEFIT REPORTS THAT SUMMARIZE IDENTIFIED HEALTH NEEDS, UPDATE COMMUNITY DEMOGRAPHIC INFORMATION, AND REPORT ON RECENT AND PLANNED COMMUNITY HEALTH PROGRAMS, INCLUDING GOALS, OBJECTIVES AND MEASURABLE RESULTS. THE HOSPITALS UTILIZE DIGNITY HEALTH'S COMMUNITY NEED INDEX (CNI), WHICH PROVIDES AN AGGREGATE SCORE OF THE SOCIOECONOMIC BARRIERS THAT PUT RESIDENTS AT GREATER RISK OF NEEDING HEALTH SERVICES. CRERATED WITH TRUVEN HEALTH ANALYTICS, THE CNI AGGREGATES NINE INDICATORS INTO FIVE SOCIOECONOMIC FACTORS KNOWN TO CONTRIBUTE TO HEALTH DISPARITY. THE FIVE INCLUDE INCOME, CULTURE/LANGUAGE, EDUCATION, HOUSING STATUS, AND INSURANCE COVERAGE. THE INDEX IS CALCULATED ANNUALLY FOR EVERY ZIP CODE IN THE UNITED STATES. RESIDENTS OF COMMUNITIES WITH THE HIGHEST CNI SCORES WERE SHOWN TO BE TWICE AS LIKELY TO EXPERIENCE PREVENTABLE HOSPITALIZATION FOR MANAGABLE CONDITIONS AS COMMUNITIES WITH THE LOWEST CNI SCORES. THE CNI PROVIDES COMPELLING EVIDENCE FOR ADDRESSING SOCIOECONOMIC BARRIERS WHEN CONSIDERING HEALTH POLICY AND LOCAL HEALTH PLANNING. THE TOOL HIGHLIGHTS HEALTH CARE DISPARITIES AND ENABLES HEALTH CARE PROVIDERS, POLICYMAKERS, AND OTHERS TO TARGET RESOURCES WHERE THEY ARE MOST NEEDED. ADDITIONAL INFORMATION ABOUT THE CNI IS ACCESSIBLE AT HTTPS://WWW.DIGNITYHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH/COMMUNITY-HEALTH-P ROGRAMS-AND-REPORTS PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE COMMUNICATION OF THE FINANCIAL ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC: INFORMATION ABOUT PORT CITY'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS THE PORT CITY'S FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES PORT CITY'S FACILITIES SERVE. THE SIGNAGE INCLUDES NOTIFICATION THAT ALL UNINSURED PATIENTS RECEIVE AN UNINSURED DISCOUNT OF 30%, AND THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION OR WITH PROMPT PAYMENT. FINANCIAL ASSISTANCE INFORMATION, GOVERNMENT PROGRAM RESOURCE INFORMATION, TOOLS TO ASSIST PATIENTS IN FINDING HEALTH COVERAGE, ANSWERS TO FREQUENTLY ASKED BILLING QUESTIONS, AND OTHER SUCH INFORMATION CAN ALSO BE FOUND ON THE HOSPITAL'S WEBSITE AT HTTP://WWW.DIGNITYHEALTH.ORG/STJOSEPHS-STOCKTON/PATIENTS-AND-VISITORS/PATI ENTS/BILLING-INFORMATION AND HTTPS://WWW.DIGNITYHEALTH.ORG/STJOSEPHSBEHAVIORAL/PATIENTS-AND-VISITORS/PA TIENTS/BILLING-INFORMATION AT THE POINT OF REGISTRATION, BROCHURES ARE MADE AVAILABLE TO ALL PATIENTS EXPLAINING THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND THE AVAILABILITY OF GOVERNMENT SPONSORED PROGRAMS. COPIES OF THE FINANCIAL ASSISTANCE APPLICATION ARE MADE AVAILABLE TO ALL UNINSURED PATIENTS IN ADDITION TO THE BROCHURE UPON ADMISSION TO THE FACILITY. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO UNINSURED PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED, A STATEMENT INFORMING PATIENTS WITHOUT INSURANCE COVERAGE THAT THEY MAY BE ELIGIBLE FOR A GOVERNMENT SPONSORED PROGRAM OR FACILITY FUNDED FINANCIAL ASSISTANCE, INSTRUCTIONS ON HOW TO APPLY FOR A GOVERNMENT PROGRAM OR FINANCIAL ASSISTANCE AND THE PROVISION OF SUCH APPLICATIONS. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF PORT CITY REQUIRE ALL INITIAL STATEMENTS TO UNINSURED PATIENTS TO INCLUDE VERBIAGE INFORMING PATIENTS OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND A COPY OF THE FINANCIAL ASSISTANCE APPLICATION. ALSO, ANY MEMBER OF THE DIGNITY HEALTH FACILITY STAFF OR MEDICAL STAFF MAY MAKE REFERRALS OF PATIENTS FOR FINANCIAL ASSISTANCE. THE PATIENT, A FAMILY MEMBER, A CLOSE FRIEND OR AN ASSOCIATE OF THE PATIENT MAY ALSO MAKE A REQUEST FOR FINANCIAL ASSISTANCE. PART VI, LINE 4 - COMMUNITY INFORMATION THE PRIMARY SERVICE AREA OF ST. JOSEPH'S MEDICAL CENTER IS THE CITY OF STOCKTON, WITH A SECONDARY SERVICE AREA OF SAN JOAQUIN COUNTY. MANY OF THE COMMUNITIES SERVED BY THE HOSPITAL ARE DESIGNATED AS MEDICALLY UNDERSERVED AREAS AND THE MIGRANT FARM WORKERS SERVED BY THE HOSPITAL ARE DESIGNATED AS A MEDICALLY UNDERSERVED POPULATION. TOTAL POPULATION: 379,203 RACE/ETHNICITY: WHITE - NON-HISPANIC 22.9%; BLACK/AFRICAN AMERICAN - NON-HISPANIC 9.4%; HISPANIC OR LATINO 45.4%; ASIAN/PACIFIC ISLANDER 18.0%; ALL OTHERS 4.3% MEDIAN INCOME: $48,498 UNEMPLOYMENT: 9.1% NO HIGH SCHOOL DIPLOMA: 26.3% MEDICAID: 37.6% UNINSURED: 10.0% OTHER AREA HOSPITALS: 7 THE PRIMARY SERVICE AREA OF ST. JOSEPH'S MEDICAL BEHAVIORAL HEALTH CENTER IS THE CITY OF STOCKTON, WITH A SECONDARY SERVICE AREA OF SAN JOAQUIN COUNTY. MANY OF THE COMMUNITIES SERVED BY THE HOSPITAL ARE DESIGNATED AS MEDICALLY UNDERSERVED AREAS AND THE MIGRANT FARM WORKERS SERVED BY THE HOSPITAL ARE DESIGNATED AS A MEDICALLY UNDERSERVED POPULATION. TOTAL POPULATION: 648,110 RACE/ETHNICITY: WHITE - NON-HISPANIC 32.9%; BLACK/AFRICAN AMERICAN - NON-HISPANIC 6.6%; HISPANIC OR LATINO 42.9%; ASIAN/PACIFIC ISLANDER 13.5%; ALL OTHERS 4.1% MEDIAN INCOME: $54,606 UNEMPLOYMENT: 8.4% NO HIGH SCHOOL DIPLOMA: 23.0% MEDICAID: 32.5% UNINSURED: 8.1% OTHER AREA HOSPITALS: 7 PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH PORT CITY OPERATING COMPANY LLC BOARD OF MANAGERS IS RESPONSIBLE FOR ENSURING THAT COMMUNITY HEALTH IS ONE OF THE MAJOR GOALS IN THE STRATEGIC PLANNING PROCESSS. THE BOARD OF MANAGERS IS A GROUP OF BUSINESS HEALTH EXECUTIVES WHO PROVIDE A BROAD SPECTRUM OF PERSPECTIVES ON PLANS PRESENTED FOR THEIR APPROVAL. ST. JOSEPH'S MEDICAL CENTER AND ST. JOSEPH'S BEHAVIORAL HEALTH CENTER (A DBA OF PORT CITY OPERATING COMPANY LLC) PRESIDENT IS COMMITTED TO THE COMMUNITY BENEFIT PROCESS AND ACCOUNTABLE TO DIGNITY HEALTH SYSTEM LEADERSHIP. ST. JOSEPH'S MEDICAL CENTER AND ST. JOSEPH'S BEHAVIORAL HEALTH CENTER SERVE AN IMPORTANT ROLE IN IMPROVING THE HEALTH OF THE COMMUNITY THROUGH WORKING COLLABORATIVELY WITH COMMUNITY PARTNERS, PROVIDING LEADERERSHIP AND ADVOCACY, CAREFULLY MANAGING RESOURCES, ASSISTING WITH LOCAL CAPACITY BUILDING AND PARTICIPATING IN COMMUNITY-WIDE HEALTH PLANNING. THE LEADERSHIP ROLE IS ESPECIALLY IMPORTANT IN SAN JOAQUIN COUNTY WHERE INDIVIDUAL AND COMMUNITY RESOURCES ARE VERY LIMITED. THE HEALTHIER COMMUNITY COALITION IS A CONSORTIUM OF ALL THE LOCAL HOSPITALS, THE MEDI-CAL MANAGED CARE PLANS, THE COUNTY PUBLIC HEALTH DEPARTMENT, AND NUMEROUS COMMUNITY BASED ORGANIZATIONS. THE COALITION HAS SHARED GOVERNANCE BY ALL MEMBERS, THE CHAIR POSITION ROTATES ANNUALLY, AND ST. JOSEPH'S MEDICAL CENTER SERVES AS THE FIRST FISCAL SPONSOR. THE HEALTHIER COMMUNITY COALITION PROVIDES CONTINUOUS INPUT ON THE COMMUNITY BENEFIT WORK TO THE MANAGEMENT TEAM OF ST. JOSEPH'S MEDICAL CENTER. LEADERS FROM ST. JOSEPH'S SERVE AS BOARD MEMBERS OF NUMEROUS COMMUNITY ORGANIZATIONS AND COLLABORATIVES, INCLUDING THE CALIFORNIA HEALTH CARE FACILITY ADVISORY COMMITTEE FOR THE DEPARTMENT OF CORRECTIONS, ST. MARY'S DINING ROOM, AND COMMUNITY MEDICAL CENTERS (FQHC). THE HOSPITALS HAVE DEDICATED LEADERSHIP AND A COMMUNITY HEALTH DEPARTMENT WORKING CLOSELY WITH OTHER HEALTHCARE PROVIDERS, COMMUNITY BASED ORGANIZATIONS, AND INDIVIDUALS TO DEVELOP AND SHARE RESOURCES. THE DIRECTOR OF COMMUNITY HEALTH LEADS THE DEVELOPMENT OF COMMUNITY-WIDE INITIATIVES TO ADDRESS THE PRIORITY HEALTH NEEDS FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE HOSPITALS ARE ALSO A MEMBER OF THE HOMELESS MEDICAL RECUPERATIVE CARE HEALTHCARE ADVISORY GROUP, THE HOMELESS TASK FORCES, REINVENT SOUTH STOCKTON, SAN JOAQUIN HOMELESS TASK FORCE AND THE SAN JOAQUIN HUMAN TRAFFICKING TASK FORCE. THE HOSPITALS ARE ALSO A PARTNER IN THE DEVELOPMENT OF THE COMMUNITY HEALTH CONNECTOR PROGRAM, WHICH IS A JOINT EFFORT OF THE LOCAL HOSPITALS, COUNTY PUBLIC HEALTH DEPARTMENT AND COMMUNITY PARTNERS. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM PORT CITY IS 80% OWNED BY DIGNTY HEALTH AND THEREFORE AFFILIATED WITH ALL ENTITIES WITHIN DIGNITY HEALTH. AFFILIATES OF DIGNITY HEALTH ALSO PROMOTE THE HEALTH OF ADDITIONAL COMMUNITIES IN BAKERSFIELD, SACRAMENTO, SAN BERNARDINO, SAN FRANCISCO, SAN ANDREAS, AND GRASS VALLEY/NEVADA CITY, CALIFORNIA. THESE AFFILIATES FOLLOW PRACTICES SIMILAR TO THOSE NOTED ABOVE IN DETERMINING THE UNMET HEALTHCARE NEEDS OF THEIR COMMUNITIES. TOTAL UNSPONSORED COMMUNITY BENEFIT EXPENSE FOR DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS FOR THE YEAR ENDED JUNE 30, 2018, IS AS FOLLOWS: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 85,916 108,592,000 0.8% Unpaid Costs of Medicaid/Medi-Cal 1,739,745 555,935,000 4.1% Other Means-tested Programs 13,398 13,971,000 0.1% Community Services: Community Health Services 317,655 23,099,000 0.2% Health Professions Education 14 209,000 0.0% Subsidized Health Services 26,310 3,432,000 0.0% Donations 100,355 39,204,000 0.3% Community Building Activities 2,657 4,468,000 0.0% Community Benefit Operations 1,446 9,166,000 0.1% Total Community Services for the poor 448,437 79,578,000 0.6% Total Benefits for the Poor 2,287,496 758,076,000 5.6% Benefits for the Broader Community: Community Services: Community Health Services 235,185 12,634,000 0.1% Health Professions Education 18,906 98,392,000 0.7% Subsidized Health Services 418 631,000 0.0% Research 284 10,954,000 0.1% Donations 32,055 3,204,000 0.1% Community Building Activities 13,295 3,702,000 0.0% Community Benefit Operations 4,836 1,028,000 0.0% Total Benefits for the Broader Community 304,979 130,545,000 0.9% Total Community Benefits 2,592,475 888,621,000 6.5% Unpaid Costs of Medicare 1,412,924 1,213,419,000 8.9% Total Community Benefits including Unpaid Cost of Medicare 4,005,399 2,102,040,000 15.4% true Dignity Health Medical Foundation 3400 DATA DRIVE RANCHO CORDOVA CA 95670 680220314 501(c)(3) 9524496 N/A N/A Medical Fnd Support St Joseph's Foundation of San Joaquin 1800 N California Street Stockton CA 95204 510432777 501(c)(3) 889025 N/A N/A Foundation Support California Health Foundation and Trust 1215 K STREET SUITE 800 SACRAMENTO CA 95814 941498697 501(c)(3) 1917589 N/A N/A Community Health Community Medical Center Inc 7210 MURRAY DRIVE STOCKTON CA 952103339 942437106 501(c)(3) 10000 N/A N/A Community Health Catholic Charities of The Diocese of Stockton 1106 N EL DORADO St STOCKTON CA 95202 941629114 501(c)(3) 77220 N/A N/A Community Health St Mary's Dining Room 545 W SONORA ST STOCKTON CA 95203 942687280 501(c)(3) 67888 7047 Book Food Community Health HOSPICE OF SAN JOAQUIN 3888 PACIFIC AVE STOCKTON CA 952041953 942777980 501(c)(3) 6000 N/A N/A Community Health READY TO WORK 119 EAST WEBER AVENUE STOCKTON CA 95202 814884512 501(c)(3) 25000 N/A N/A Community Health Delta College Foundation 5151 Pacific Ave STOCKTON CA 95207 237367633 501(c)(3) 5750 N/A N/A Community Health 9 PROVISION OF FOOD/CLOTHING/OTHER 2695 0 124099 BOOK FOOD/CLOTHING PROVISION OF Pharmaceuticals 9 0 3721 BOOK Pharmaceuticals PROVISION OF MEDICAL SUPPLIES TO PATIENTS 63 0 12719 BOOK MEDICAL SUPPLIES/EQU SCHEDULE I, PART I, LINE 2 Donations are provided to the community to further the mission of the Medical Center and support various community programs. St. Josephs Medical Center provides donations to support community programs that meet specific criteria through its Community Health Department and also donates directly to various community events and programs through the Marketing and Business Development Departments. false true false false false false false false false Elise Dempsey Board Member 0 242319 0 101436 0 15759 0 35667 0 41723 0 436904 0 0 John Petersdorf Board Member 0 399551 0 425219 0 5682 0 73438 0 54382 0 958272 0 0 Jon VanBoening Board Member 0 594532 0 608434 0 234341 0 103196 0 81992 0 1622495 0 181650 Stephan Foerster Secretary 0 309424 0 91537 0 1855 0 39943 0 33775 0 476534 0 0 Karl Silberstein Chair 0 606222 0 608712 0 26546 0 104372 0 51508 0 1397360 0 Doreen Hartmann CFO (THRU 11/2017) 0 243089 0 61163 0 57241 0 32136 0 11604 0 405233 0 0 Andrea N Ochoa Chief Financial Officer 0 156066 0 25752 0 1065 0 19894 0 12655 0 215432 0 0 Donald Wiley President and CEO 0 434456 0 312207 0 538848 0 67652 0 46515 0 1399678 0 515242 PART I, LINE 3 ALTHOUGH THE ORGANIZATION DOES NOT EMPLOY PERSONNEL, THE ORGANIZATION RELIED ON A RELATED ORGANIZATION, DIGNITY HEALTH, THAT USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART I, LINE 3, TO ESTABLISH THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A FOR ADDITIONAL INFORMATION. PART I, LINE 4A CERTAIN OFFICERS PARTICIPATE IN A SEVERANCE PLAN THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 1 TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE PLAN. NO PAYMENTS PURSUANT TO THE PLAN ARRANGEMENT OCCURRED DURING 2017. PART I, LINE 4B CERTAIN OFFICERS PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN LIMITED TO PARTICIPANTS IN THE DIGNITY HEALTH RETIREMENT PLAN WHOSE BENEFITS ARE AFFECTED BY THE LIMITATIONS IMPOSED BY SECTIONS 401(A)(17) AND 415 OF THE INTERNAL REVENUE CODE. BENEFIT SERVICE UNDER THIS PLAN WAS FROZEN AS OF JANUARY 1,2008. NO PAYMENTS PURSUANT TO THE PLAN OCCURRED DURING 2017. CERTAIN OFFICERS ARE ELIGIBLE TO PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN LIMITED TO PARTICIPANTS IN THE DIGNITY HEALTH RETIREMENT PLAN WHOSE BENEFITS ARE AFFECTED BY THE LIMITATIONS IMPOSED BY SECTIONS 401(A)(17) AND 415 OF THE INTERNAL REVENUE CODE. BENEFIT SERVICE UNDER THIS PLAN WAS FROZEN AS OF JANUARY 1, 2008. NO PAYMENTS PURSUANT TO THE PLAN OCCURRED DURING 2017. DIGNITY HEALTH'S KEY EMPLOYEES AND CERTAIN OFFICERS AND HIGHLY COMPENSATED EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN NON-QUALIFIED 457(F) PLANS THAT ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE, AS REQUIRED BY THE IRS. THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR EXECUTIVES HIRED PRIOR TO JUNE 30, 2006. THE BENEFIT IS INTENDED TO BRIDGE THE DIFFERENCE, IF ANY, BETWEEN THE BENEFIT PROVIDED UNDER THE DIGNITY HEALTH EXCESS BENEFIT PLAN HAD BENEFIT SERVICE NOT BEEN FROZEN AT JANUARY 1, 2008, AND THE BENEFITS PROVIDED FROM ALL OTHER QUALIFIED AND NON-QUALIFIED PLANS. BENEFITS VEST UNDER THIS 457(F) PLAN AT THE LATER OF THE DATE THE PARTICIPANT ATTAINS AGE 62 OR IS CREDITED WITH 15 YEARS OF SERVICE. THE 2010 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR CERTAIN OFFICERS AND KEY EMPLOYEES, PRIMARILY THOSE WHO ARE NOT ELIGIBLE TO PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN OR THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN DESCRIBED ABOVE. THIS BENEFIT PROVIDES AN ANNUAL ACCRUAL OF 10% OF TOTAL COMPENSATION AND IS PAYABLE ANNUALLY ON JULY 1 ONCE VESTED, WHICH IS AGE 62 WITH 5 YEARS OF SERVICE; THE PLAN ALSO ALLOWS FOR SPECIAL AWARDS. PAYMENTS PURSUANT TO THE PLAN ARRANGEMENTS FOR ONE BOARD MEMBER AND ONE OFFICER OCCURRED DURING 2017 INCLUDE J. VANBOENING; $181,650, AND D. WILEY; $187,924. CERTAIN LISTED PERSONS PARTICIPATE IN THE DIGNITY HEALTH KEY EMPLOYEE SHARE OPTION PLAN (KEYSOP), WHICH WAS FROZEN IN MAY 2002. THE KEYSOP PROGRAM WAS ESTABLISHED IN 2001 WITH THE PURPOSE OF PROVIDING INCOME DEFERRAL OPPORTUNITIES TO EMPLOYEES ELIGIBLE FOR THE COMPANY'S KEY EMPLOYEE RETENTION PROGRAM. PAYMENT PURSUANT TO THE PLAN ARRANGEMENTS FOR BOARD MEMBER OCCURRED DURING 2017 INCLUDE D. WILEY; $327,318. COMPENSATION AMOUNTS FOR THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS DISCUSSED ABOVE ARE REPORTED AS DEFERRED COMPENSATION IN THE YEAR ACCRUED (SCHEDULE J, PART II, COLUMN C) AND ARE REFLECTED AGAIN AS REPORTABLE COMPENSATION IN THE YEAR PAID (SCHEDULE J, PART II, COLUMN B(III)). PART III SUPPLEMENTAL DISCLOSURES THE ORGANIZATION'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES DIGNITY HEALTH SERVES, PROMOTING PATIENT AND EMPLOYEE SATISFACTION, AND ENSURING FINANCIAL STABILITY. A SUBSTANTIAL PORTION OF EXECUTIVE COMPENSATION IS PERFORMANCE BASED AND IS LINKED TO ORGANIZATIONAL GOALS APPROVED IN ADVANCE BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND DIGNITY HEALTH'S COMMITMENT TO SERVING THE POOR AND DISENFRANCHISED IN THE COMMUNITIES IT SERVES. TOTAL COMPENSATION, WHICH INCLUDES BASE SALARY, ANNUAL AND LONG-TERM INCENTIVE COMPENSATION, IS ESTABLISHED TO APPROXIMATE THE PREVAILING MARKET CONDITIONS FOR EXECUTIVES OF COMPANIES OF SIMILAR SIZE, REVENUES AND COMPLEXITY. PAYMENTS PURSUANT TO A LONG-TERM FINANCIAL PERFORMANCE GOAL WERE PAID IN CALENDAR YEAR 2017. FORM 990, PART I, LINE 7B PART I, LINE 7B INCLUDES SECTION 512(A)(7) QUALIFIED TRANSPORTATION FRINGE BENEFIT AMOUNTS THAT ARE NOT REVENUE AND THEREFORE NOT REPORTED ON FORM 990. FORM 990, PART V THROUGH PART XII FORM 990, PART V, LINE 2A THE ORGANIZATION DOES NOT HAVE EMPLOYEES. THE ORGANIZATION UTILIZES THE EMPLOYEES OF DIGNITY HEALTH PER THE EMPLOYEE LEASE AGREEMENT. THE SALARIES OF THESE EMPLOYEES ARE INCLUDED ON DIGNITY HEALTH'S FORM W-3 AND FEDERAL EMPLOYMENT TAX RETURNS. FORM 990, PART VI, SECTION A, LINE 2 DONALD WILEY, ANDREA N OCHOA - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 PORT CITY IS 80% OWNED BY DIGNITY HEALTH AND 20% BY KFH, BOTH 501(C)(3) EXEMPT ORGANIZATIONS. DIGNITY HEALTH HOLDS THE MANAGEMENT AGREEMENT WITH PORT CITY, LLC. FORM 990, PART VI, SECTION A, LINE 7A DIGNITY HEALTH AND KFH, KNOWN AS THE COMPANY MEMBERS, APPOINT A BOARD OF MANAGERS. FORM 990, PART VI, SECTION A, LINE 7B RESERVED RIGHTS OF THE COMPANY MEMBERS INCLUDE: SELL, LEASE, EXCHANGE OR OTHERWISE DISPOSE OF ALL, OR SUBSTANTIALLY ALL, OF THE ORGANIZATION'S PROPERTY, WITH OR WITHOUT THE GOODWILL, OUTSIDE OF THE ORDINARY COURSE OF THE ORGANIZATION'S ACTIVITIES, APPROVE A MERGER OR CONVERSION, UNDERTAKE ANY OTHER ACT OUTSIDE OF THE ORDINARY COURSE OF THE ORGANIZATION'S ACTIVITIES, AND AMEND THE ORGANIZATION'S AGREEMENT. FORM 990, PART VI, SECTION B, LINE 11A THE PORT CITY OPERATING COMPANY LLC CFO REVIEWED THE FORM 990. IN ADDITION, THE DIGNITY HEALTH CORPORATE TAX DEPARTMENT WORKED CLOSELY WITH AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN. DUE TO TIMING, THE FORM 990 WILL BE REVIEWED BY THE BOARD OF MANAGERS AND/OR SUBCOMMITTEE OF THE BOARD OF MANAGERS SUBSEQUENT TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12A DIGNITY HEALTH EMPLOYEES HAVE ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. DIGNITY HEALTH IS CHARGED WITH MONITORING PROPOSED OR ONGOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. PURSUANT TO THESE POLICIES, THE EVP/GENERAL COUNSEL IS DESIGNATED AS THE ORGANIZATION'S FILING OFFICER AND RESPONSIBLE FOR COLLECTING, REVIEWING AND VALIDATING ANNUAL DISCLOSURES OF ALL COVERED PERSONS INCLUDING THE MEMBERS OF DIGNITY HEALTH'S GOVERNING BODIES INCLUDING ITS BOARD OF DIRECTORS AND BOARD COMMITTEES, AS WELL AS DIGNITY HEALTH'S OFFICERS AND EXECUTIVE LEADERS, KEY EMPLOYEES, MANAGEMENT PERSONNEL AT THE VICE PRESIDENT LEVEL AND ABOVE, AND ANY OTHER PERSONNEL DESIGNATED BY THE FILING OFFICER (COVERED PERSONS). ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS ARISING FROM THE BUSINESS, OWNERSHIP, FINANCIAL AND PERSONAL INTERESTS HELD BY SUCH COVERED PERSONS OR THEIR FAMILY MEMBERS. COVERED PERSONS ARE REQUIRED TO DISCLOSE TO THEIR SUPERVISORS AND TO RELEVANT DECISION MAKERS ANY INTEREST THAT MAY PRESENT A CONFLICT OF INTEREST, OR THE APPEARANCE OF A CONFLICT OF INTEREST. SUCH DISCLOSURE IS REQUIRED ON A TRANSACTIONAL BASIS AT THE TIME SUCH CONFLICTS ARISE, WHEN AN INDIVIDUAL BECOMES A COVERED PERSON (E.G. UPON HIRING OR UPON PROMOTION), AND ANNUALLY THEREAFTER. AS PART OF THE ANNUAL DISCLOSURE SURVEY CONDUCTED PURSUANT TO THE COI POLICIES, EACH COVERED PERSON IS REQUIRED TO CERTIFY THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE COI POLICY OR COI POLICIES APPLICABLE TO HIS/HER POSITION; (2) HAS READ THE COI POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE COI POLICIES, INCLUDING COMPLETING THE CONFLICTS OF INTEREST DISCLOSURE SURVEY AS REQUIRED BY THE COI POLICIES. USING THE INFORMATION FROM THE ANNUAL DISCLOSURE SURVEY, THE FILING OFFICER PREPARES ANNUAL REPORTS OF REPORTED CONFLICTS OF INTEREST AND DISTRIBUTES THOSE REPORTS TO THE GOVERNING BODY CHAIRS, INCLUDING THE CHAIR OF THE BOARD OF DIRECTORS AND THE CHAIR OF DIGNITY HEALTH BOARD COMMITTEES, AS WELL AS TO KEY LEADERS OF THE ORGANIZATION TO ENABLE THE RESPONSIBLE INDIVIDUALS TO MONITOR AND MANAGE DISCLOSED CONFLICTS OF INTEREST AND ASSURE DECISIONS ARE MADE IN THE ORGANIZATION'S BEST INTERESTS. THE PROCEDURES FOR ADDRESSING A CONFLICT OF INTEREST RELATED TO A PROPOSED TRANSACTION IN THE CASE OF GOVERNING BODIES INCLUDE, BUT ARE NOT LIMITED TO: (1) THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST IS FULLY DISCLOSED TO THE APPLICABLE GOVERNING BODY AND ANY OTHER RELEVANT DECISION-MAKERS; (2) THE INTERESTED PERSON RESPONDS TO FACTUAL QUESTIONS RELATED TO THE SUBSTANCE OF THE TRANSACTION OR ARRANGEMENT BEING CONSIDERED, AFTER WHICH HE/SHE SHALL LEAVE THE MEETING; (3) THE INTERESTED PERSON MAY BE EXCLUDED FROM THE DISCUSSION AND MUST BE EXCUSED FROM THE MEETING PRIOR TO AND DURING THE APPROVAL OF SUCH TRANSACTION; (4) IF WARRANTED, ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED, AND COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED; (5) THE TRANSACTION OR ACTION IS APPROVED BY A MAJORITY OF DISINTERESTED MEMBERS OF THE GOVERNING BODIES, CONSISTENT WITH ANY REQUIREMENTS OF BYLAWS AND COI POLICIES; AND (6) ANY CONFLICTING ISSUES ARISING DURING THE COURSE OF A GOVERNING BODY MEETING WHICH CANNOT BE RESOLVED MAY BE REFERRED TO AN INDEPENDENT COMMITTEE OF THE APPLICABLE GOVERNING BODY. THERE ARE SIMILAR CONFLICTS OF INTEREST PROVISIONS UNDER DIGNITY HEALTH'S STANDARDS OF CONDUCT, WHICH ARE APPLICABLE TO ALL EMPLOYEES AND WHICH ARE ADMINISTERED BY THE VP/CORPORATE COMPLIANCE OFFICER WHO HAS REPORTING RESPONSIBILITY TO THE PRESIDENT/CEO AS WELL AS TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S PERSONNEL IS COMPENSATED BY DIGNITY HEALTH. FOR 2017 COMPENSATION, DIGNITY HEALTH'S HUMAN RESOURCES AND COMPENSATION COMMITTEE APPROVES, CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR OFFICERS AND KEY EMPLOYEES. THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ALSO ENGAGES OUTSIDE LEGAL COUNSEL AS NECESSARY AND QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALISTS (INDEPENDENT EXPERTS) TO REVIEW, ANALYZE AND PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGES OF OFFICERS AND KEY EXECUTIVES. APPROPRIATE COMPARABLE DATA IS OBTAINED FROM THE INDEPENDENT EXPERTS, (E.G., TOTAL ECONOMIC BENEFITS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR SIMILAR JOB RESPONSIBILITIES). KEY DELIBERATIONS OF THE COMMITTEE ARE DOCUMENTED IN MEETING MINUTES WHICH ARE APPROVED AT THE NEXT COMMITTEE MEETING AND PROVIDED TO THE BOARD OF DIRECTORS. THE DOCUMENTATION OF THE DELIBERATIONS INCLUDES (A) THE TERMS OF THE TRANSACTION APPROVED AND THE DATE APPROVED; (B) THE MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING DISCUSSION OF THE APPROVED TRANSACTION AND THOSE WHO VOTED ON IT; AND (C) THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE COMMITTEE AND HOW THE DATA WAS OBTAINED. FORM 990, PART VI, SECTION C, LINE 19 FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A J PETERSDORF, J VANBOENING, S FOERSTER, K SILBERSTEIN RECEIVED COMPENSATION FOR SERVICES PROVIDED TO A RELATED ORGANIZATION, DIGNITY HEALTH. D HARTMANN (FORMER CFO ), A N OCHOA (CURRENT CFO) AND D WILEY ARE EMPLOYEES OF DIGNITY HEALTH BUT PROVIDES SERVICES AS OFFICERS TO PORT CITY. FORM 990, PART XI, LINE 9 NET ASSET ALLOCATION BETWEEN DIGNITY HEALTH 80% AND KAISER 20% OWNERSHIP INTEREST FOR LEGAL SERVICES; $(26,316) SAN JOAQUIN QUALITY CARE NETWORK INITIAL FUNDING; $(30,000) FORM 990, PART XII, LINE 3B THE ORGANIZATION'S FEDERAL AWARDS WERE INCLUDED IN DIGNITY HEALTH'S CONSOLIDATED OMB CIRCULAR A-133 AUDITED SCHEDULE OF FEDERAL EXPENDITURES. SAFE HARBOR ELECTION DISCLOSURE TANGIBLE PROPERTY REGULATION STATEMENT SECTION 1.263(A)-1(F) DE MINIMIS SAFE HARBOR ELECTION TAXPAYER IS MAKING THE DE MINIMIS SAFE HARBOR ELECTION UNDER TREASURY REGULATION 1.263(A)-1(F) FOR ALL ELIGIBLE AMOUNTS PAID OR INCURRED DURING THE TAXABLE YEAR. FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATIVE SVCS TOTAL FEES:XXX-XX-XXXX FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL FEES TOTAL FEES:21960872 FORM 990 PART IX LINE 11G DESCRIPTION:REVENUE CYCLE SERVICES TOTAL FEES:12159179 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE/REPAIRS TOTAL FEES:7657519 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES-CONSULTING TOTAL FEES:2397631 FORM 990 PART IX LINE 11G DESCRIPTION:OPTUM 360 INCENTIVES TOTAL FEES:2161240 FORM 990 PART IX LINE 11G DESCRIPTION:JANITORIAL/WASTE MGMT/STORAGE TOTAL FEES:827125 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:2384617 DIGNITY HEALTH 185 BERRY STREET SUITE 300 SAN FRANCISCO CA 94107 941196203 HOSPITAL CA 501(C)(3) 3 NA false Kaiser Foundation Hospitals ONE KAISER PLAZA 15L OAKLAND CA 94612 941105628 HOSPITAL CA 501(C)(3) 3 NA false ST JOSEPH'S FOUNDATION OF SAN JOAQUIN 1800 N California Street STOCKTON CA 95204 510432777 FNDRAISE FND CA 501(C)(3) 12 Type 1 DIGNITY HLTH false St Joseph's Surgery Center LP 15305 Dallas Parkway Suite 1600 LB ADDISON TX 75001 201019390 SURGERY CA PORT CITY Related 1799994 3326938 false 0 true 0.79962 true true true false true false false false false true false false true false true true true true true SCHEDULE R, PART V, LINE 2 COLUMN (C) PART V, LINE 1A - PORT CITY OPERATING COMPANY LLC LEASES EQUIPMENT TO A JOINT VENTURE. AMOUNT REPORTED AS TRANSACTION TYPE "A" REPRESENT THE AMOUNTS CHARGED FOR SUCH AGREEMENTS. SUCH CHARGES REPRESENT FAIR MARKET VALUE OF THE AMOUNTS CHARGED UNDER THESE AGREEMENTS.