2019-05-13T11:27:01-05:00 2018-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2017-07-01 680127677 Mark Twain Medical Center % LARA CARTOSCELLI ACCOUNTING MARK 2097543521 185 BERRY STREET SUITE 300 SAN FRANCISCO CA 94107 DAVID YEAGER CFO 6613274647 2019-05-13 true VALERIE J BALL P00178114 4159635100 162.135.0.56 94661320191335000001 2019-05-13 P AD538940DC5A4E8C7023F4289E6268AD8315BFF9 2B5788CE322FF00EB493AD5B21DC7D604E87DE51 2017 2019-02-21 02:37:17Z DAVID YEAGER CFO 768 MOUNTAIN RANCH ROAD SAN ANDREAS CA 95249 70915069 false X www.marktwainmedicalcenter.org X 1987 CA To continuously improve the health status of our community. of our community. 7 6 362 23 0 15262 9965 239735 58834010 66253752 896574 587435 269487 288826 60010036 67369748 374755 510380 0 0 34895666 34519535 0 0 0 29389697 33916576 64660118 68946491 -4650082 -1576743 45185982 38023384 11544541 5918718 33641441 32104666 TO CONTINUOUSLY IMPROVE THE HEALTH STATUS OF OUR COMMUNITY. false false 54804947 510380 66253752 THE HOSPITAL PROVIDES ROUTINE PATIENT CARE IN PRIVATE AND SEMI-PRIVATE ROOMS AS WELL AS VARIOUS INPATIENT AND OUTPATIENT ANCILLARY SERVICES SUCH AS X-RAY, LAB, EMERGENCY ROOM, ETC. DURING THE FISCAL YEAR 2018, 873 PATIENTS WERE ADMITTED TO THE FACILITY AND 73,846 OUTPATIENT VISITS WERE RECORDED INCLUDING VISITS AT OUR 5 RURAL HEALTH CLINICS. 54804947 true true false true false false false false false false true true true false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true false false false true 79 0 true 362 true false false false false false false false false false false X 7 6 false false false false true true true true true false false false true true true true true false false false CA X LARA CARTOSCELLI ACCOUNTING 9166313337 10901 GOLD CENTER DRIVE 3RD FLOOR RANCHO CORDOVA CA 95670 X Sean Anderson MD Ex-officio Board Member 2.0 0.0 X 0 0 0 Susan Atkinson Ex-officio Board Member 4.0 0.0 X 0 0 0 Charles Kassis Board Member 4.0 40.0 X 0 561217 102030 Andrew McCoy MD Ex-officio Board Member 40.0 0.0 X 0 0 0 Lin Reed Ex-officio Board Member 4.0 0.0 X 0 0 0 Randall Ross Board Member 4.0 0.0 X 0 0 0 William Griffin MD Chairman 4.0 0.0 X X 0 0 0 David Woodhams DDS Treasurer 4.0 0.0 X X 0 0 0 Robert Diehl President & CEO 40.0 0.0 X 0 340433 87004 Chris L Roberts VP & CFO 40.0 0.0 X 192691 0 50232 Katherine McCoy VP & CNE 40.0 0.0 X 176661 0 29378 Lonnie Smith MD CMO 40.0 0.0 X 322780 0 32033 John D Anderson MD Physician 40.0 0.0 X 225823 0 32470 Mark W Faryan DO CT Technologist 40.0 0.0 X 221631 0 67172 Richard Gonzales MD Family Practice Physician 40.0 0.0 X 228721 0 54677 Jill Ortiz Director of Pharmacy 40.0 0.0 X 209237 0 64755 Mohamad A Parsa MD Physician 40.0 0.0 X 323984 0 61011 Robert Allen Former Key Employee 0.0 40.0 X 0 413965 62541 Katherine A Medeiros Former Officer 0.0 40.0 X 0 566678 94570 1901528 1882293 737873 94 true true false Inpatient Service of CA Inc 7032 Collection Ctr Dr CHICAGO IL 60693 medical services 1213728 Rodger Orman MD Inc PO Box 2189 MURPHYS CA 95247 medical services 816000 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 Medical Services 684344 CRAIG H LOVETT MD INC PO BOX 610 ALTAVILLE CA 95221 medical services 634346 ELISABETH SIEGLER MD A PC 585 STANISLAUS AVE ANGELS CAMP CA 95222 medical services 577984 19 19889 219846 239735 PATIENT NET OF CHARITY AND BAD DEBT 900099 35734997 35734997 MEDICARE/MEDICAID PAYMENTS 900099 30313259 30313259 CASE MANAGEMENT 900099 106927 106927 QUALITY IMPROVEMENT INCENTIVE 900099 41725 41725 BLOODWORK FEES 900099 29869 29869 26975 26975 66253752 136066 136066 0 0 0 0 0 3996690 3545321 451369 451369 451369 0 0 0 0 0 0 0 0 0 CAFETERIA 561000 155436 155436 TENANT SERVICES 561110 114680 114680 A/R FINANCE CHARGE 900099 7603 7603 11107 11107 288826 67369748 66253752 876261 X 510380 510380 0 0 0 818027 743186 74841 0 0 24046558 22122005 1924553 0 1466413 1349102 117311 0 6468449 4786763 1681686 0 1720088 1599682 120406 0 0 412853 0 412853 0 13430 0 13430 0 5235 0 5235 0 0 49914 0 49914 0 15555837 9934676 5621161 0 572614 6065 566549 0 1303537 780406 523131 0 2407639 144611 2263028 0 0 1798356 1474642 323714 0 66589 31128 35461 0 0 65644 53147 12497 0 59377 59377 0 0 0 3161405 3060414 100991 0 533583 533583 0 0 MEDICAL SUPPLIES 7557693 7557693 0 0 RECRUITING 133152 0 133152 0 DUES & SUBSCRIPTIONS 99358 13219 86139 0 LICENSES & TAXES 91322 44868 46454 0 29038 29038 68946491 54804947 14141544 0 X 2813 2800 634591 3446878 0 0 9143129 8250248 0 0 0 0 227227 99384 1112434 1100747 2688548 3792118 43802708 31043543 13545861 12759165 5855405 3430144 8722948 2275810 2779096 2423799 0 0 473930 442291 45185982 38023384 9981102 4984424 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1563439 934294 11544541 5918718 X 30862345 29680867 2779096 2423799 0 0 33641441 32104666 45185982 38023384 X -1576743 395265 -355297 X X false true X true true true X false false false false false false false false true 5235 5235 false PART II - B, Line 1i LOBBYING EXPENDITURES PAID BY THE PARENT ORGANIZATION FOR ANNUAL MEMBERSHIP DUES AND OTHER LOBBYING ACTIVITIES WHERE EXPENSES ARE ALLOCATED TO THE HOSPITAL: AMERICAN HOSPITAL ASSOCIATION $ 1,048 CHA/HASC/HOSPITAL COUNCIL $ 3,638 CATHOLIC HEALTH ASSOCIATION $ 495 340B HEALTH $ 54 -------- TOTAL $ 5,235 ======== 18815260 12393092 6422168 3261390 3084464 176926 18473876 14772615 3701261 3252182 793372 2458810 12759165 POOLED INVESTMENTS 2275810 F 2275810 INVSTMNT IN UNCONSOLIDATED FND 2423799 F 2423799 0 DUE TO RELATED PARTIES 685939 PENSION PAYABLE 72214 OTHER NON-CURRENT LIABILITIES 176141 934294 X Schedule D, Part X, Line 2 - FIN 48 (ASC 740) FOOTNOTE DIGNITY HEALTH REVIEWS ITS TAX POSITIONS 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 false true true 54 87871 87871 0.00130 25146 17975299 14302056 3673243 0.05330 9 16902 14954 1948 25209 18080072 14317010 3763062 0.05460 5 278 250990 250990 0.00360 5 2 250020 250020 0.00360 10 280 501010 501010 0.00720 10 25489 18581082 14317010 4264072 0.06180 true 1088875 0 15931795 23719168 -7787373 X true true 1 1 Mark Twain Medical Center 768 Mountain Ranch Road San Andreas CA 95249 dignityhealth.org/marktwainmedical/ 030000058 X X X X Mark Twain Medical Center 1 false false true X X X X X X X X X 16 true false false true X SEE SECTION C X true 16 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, SECTION B, LINE 5 CHNA INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS RECENTLY CONDUCTED IN FISCAL YEAR 2017, AS REQUIRED BY STATE LAW (SB 697) AND THE AFFORDABLE CARE ACT. IT WAS A COLLABORATIVE EFFORT WITH INPUT FROM THE MARK TWAIN MEDICAL CENTER COMMUNITY BOARD OF DIRECTORS, THE CALAVERAS COUNTY DEPARTMENT OF PUBLIC HEALTH, PRACTICING PHYSICIANS, THE CALAVERAS COUNTY UNIFIED SCHOOL DISTRICT, RESOURCE CONNECTION FOOD BANK, AND FIRST 5 CALAVERAS. MTMC WORKED TO COLLECT THE PRIMARY AND SECONDARY DATA REQUIREMENTS OF THE CHNA WITH APPLIED SURVEY RESEARCH (ASR), A NONPROFIT SOCIAL RESEARCH FIRM. THE CHNA DATA COLLECTION PROCESS TOOK PLACE OVER TWO MONTHS AND CULMINATED IN A REPORT WRITTEN FOR MTMC IN JUNE OF 2017. THE CHNA USED THREE STRATEGIES FOR COLLECTING COMMUNITY INPUT: KEY INFORMANT INTERVIEWS WITH HEALTH EXPERTS, A COMMUNITY SUMMIT WITH A SELECTION OF COMMUNITY PARTNERS AND LOCAL EXPERTS, AND A SURVEY OF MARK TWAIN MEDICAL CENTER STAFF. ASR CONDUCTED PRIMARY RESEARCH VIA KEY INFORMANT INTERVIEWS WITH FOUR CALAVERAS COUNTY EXPERTS FROM VARIOUS ORGANIZATIONS, INCLUDING THE COUNTY HEALTH OFFICER AND THE DIRECTOR OF PUBLIC HEALTH NURSING. INFORMANTS WERE ASKED TO IDENTIFY THE TOP NEEDS OF THEIR CONSTITUENCIES, HOW ACCESS TO HEALTHCARE HAS CHANGED IN THE POST-AFFORDABLE CARE ACT ENVIRONMENT, THE IMPACT OF THE PHYSICAL ENVIRONMENT ON HEALTH, AND THE EFFECT OF THE USE OF NEW TECHNOLOGIES FOR HEALTH-RELATED ACTIVITIES. IN APRIL 2017, MTMC SURVEYED STAFF AND STAKEHOLDERS (35 HOSPITAL EMPLOYEES AND 12 COMMUNITY STAKEHOLDERS) REGARDING THE PRIORITIZED HEALTH NEEDS. FOR THE FOUR IDENTIFIED NEEDS, THE SURVEY ASKED HOW THEIR WORK WAS IMPACTED, WHAT CURRENT EFFORTS THEY WERE INVOLVED IN TO ADDRESS THOSE NEEDS, AND IF THEY HAD SUGGESTIONS FOR STRATEGIES THAT THE HOSPITAL COULD IMPLEMENT, EITHER ALONE OR IN COLLABORATION WITH OTHER STAKEHOLDERS. THE SURVEY ALSO ASKED RESPONDENTS TO IDENTIFY ANY OTHER HIGH-PRIORITY NEEDS THAT HAD NOT YET BEEN DISCUSSED. SCHEDULE H, PART V, SECTION B, LINE 7A HTTP://WWW.DIGNITYHEALTH.ORG/MARKTWAINMEDICAL/COMMUNITY-BENEFITS SCHEDULE H, PART V, SECTION B, LINE 10A DIGNITY HEALTH HOSPITAL FACILITY 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 EACH HOSPITAL FACILITY'S 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 MARK TWAIN MEDICAL CENTER TOOK SEVERAL ACTIONS TO HELP ADDRESS IDENTIFIED 2017 CHNA NEEDS. SIGNIFICANT HEALTH NEEDS INCLUDE: MENTAL HEALTH, ACCESS TO PRIMARY AND SPECIALTY CARE, CHRONIC DISEASE MANAGEMENT, AND MATERNAL AND CHILD HEALTH. MENTAL HEALTH: THE HOSPITAL GRANTED FUNDS TO THE CALAVERAS YOUTH HEALTH INITIATIVE THAT INCLUDED HEALTHY STRESS MANAGEMENT, COPING SKILLS, BUILDING SELF-ESTEEM AND HEALTHY RELATIONSHIPS, AND YOGA. THE HOSPITAL DELIVERED TELEHEALTH PSYCHIATRIC CARE TO AID IN STABILITZATION, PRESCRIPTIONS, AND TREATMENT RECOMMENDATIONS. MTMC CONTINUED ITS ACTIVE PARTICIPATION IN THE PROFESSIONAL MENTAL HEALTH COUNTY-WIDE TASK FORCE TO DEVELOP BEST PRACTICES WITH LOCAL RESOURCES. ACCESS TO PRIMARY AND SPECIALTY CARE: MTMC EMPLOYED A GRANT-FUNDED PATIENT NAVIGATOR IN THE EMERGENCY DEPARTMENT TO WORK WITH PATIENTS COVERED BY CALIFORNIA HEALTH AND WELLNESS, AS WELL AS WITH OTHER PATIENTS TO HELP ARRANGE PRIMARY CARE PROVIDERS AND OTHER LINKAGES TO POST-ACUTE SERVICES. THE HOSPITAL OPERATES SPECIALTY CARE CENTERS: IN ANGELS CAMP FOR ORTHOPEDICS AND IN SAN ANDREAS FOR CANCER AND INFUSION THERAPY, AND SURGICAL SPECIALTY CARE. MTMC OPERATES FIVE PRIMARY CARE CLINICS IN ARNOLD, ANGELS CAMP, COPPEROPOLIS, SAN ANDREAS, AND VALLEY SPRINGS. THESE OFFER IMMEDIATE CARE, PRIMARY CARE, BEHAVIORAL HEALTH, OCCUPATIONAL HEALTH, PEDIATRICS, GENERAL X-RAY, LABORATORY DRAWS AND HEALTH EDUCATION. THE HOSPITAL RUNS AND PARTICIPATES IN COMMUNITY HEALTH FAIRS DELIVERING CHOLESTEROL SCREENING, BLOOD PRESSURE CHECKS, BONE DENSITY STUDIES, AND HEALTH EDUCATION. THE HOSPITAL MAINTAINS AN ACTIVE PROVIDER RECRUITMENT EFFORT, WHICH IS CRITICAL IN MTMC'S LOW-POPULATION RURAL COMMUNITY. AS A PART OF THE DIGNITY HEALTH SYSTEM, SPECIALISTS CAN AT TIMES BE SECURED FROM MORE URBAN AREAS IN THE REGION. CHRONIC DISEASE MANAGEMENT: TO ADDRESS TWO OF THE MORE PREVALENT CHRONIC HEALTH NEEDS OF THE COMMUNITY, MTMC CONTINUED TO FOCUS ON PROVIDING EDUCATION AND INSTRUCTION IN SECONDARY PREVENTION AND SELF-MANAGEMENT FOR CONGESTIVE HEART FAILURE/CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND FOR DIABETES. THESE PROGRAMS ARE DELIVERED AT NO OR NOMINAL COST TO COMMUNITY RESIDENTS WHO HAVE COMPLETED AN ACUTE CARE EPISODE AND WISH TO MAINTAIN AND IMPROVE THEIR HEALTH GAINS. PROGRAMS ARE LED BY TRAINED CLINICIANS AND HEALTH EDUCATORS. THE GOAL OF THESE PROGRAMS IS TO IMPROVE QUALITY OF LIFE FOR PARTICIPANTS BY INCREASING THEIR SELF-EFFICACY AND AVOIDING UNNECESSARY ACUTE CARE. MATERNAL AND CHILD HEALTH: THE HOSPITAL IS UNABLE TO DIRECTLY ADDRESS THIS CHNA NEED, DUE IN PART TO THE PHYSICIAN AND HEALTH PROFESSIONALS SHORTAGE IN THE SERVICE AREA. AT THIS TIME, PATIENTS ARE REFERRED OUTSIDE THE COUNTY TO ACCESS OBSTETRICAL AND GYNECOLOGICAL SERVICES. CHILD HEALTH WAS ADDRESSED IN PART THROUGH GRANT SUPPORT FOR THE CALAVERAS YOUTH HEALTH INITIATIVE TARGETED AT MENTAL, EMOTIONAL AND PHYSICIAL HEALTH OF THE COMMUNITY'S YOUNG PEOPLE. OTHER ORGANIZATONS IN THE COMMUNITY, INCLUDING THE SCHOOL DISTRICT, OFFER PROGRAMS AND SERVICES TO ADDRESS CHILDHOOD HEALTH MORE DIRECTLY. SCHEDULE H, PART V, SECTION B, LINES 16A THROUGH 16C HTTPS://WWW.DIGNITYHEALTH.ORG/CENTRAL-CALIFORNIA/LOCATIONS/MARKTWAINMEDICA L/PATIENTS-AND-VISITORS/PATIENTS/BILLING-INFORMATION/FINANCIAL-ASSISTANCE SCHEDULE H, PART V, SECTION B, LINE 16J ADDITIONAL MEASURES TAKEN TO PUBLICIZE DIGNITY HEALTH'S 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 FACILITY'S WEB SITE 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 FINANICAL ASSISTANCE POLICY. CONTACT INFORMATION CAN ALSO BE FOUND ON EACH FACILITY'S WEB PAGE. THE POLICY'S PLAIN LANGUAGE SUMMARY IS INCLUDED IN THE HOSPITAL'S ANNUAL COMMUNITY BENEFIT REPORT, WHICH IS WIDELY AVAILABLE TO THE PUBLIC ONLINE. 5 Valley Springs Family Medical Center 1919 VISTA DEL LAGO DRIVE VALLEY SPRINGS CA 95252 OUTPATIENT CLINIC Angels Camp Familly Medical Center 222 SOUTH MAIN STREET ANGELS CAMP CA 95222 OUTPATIENT CLINIC Arnold Family Medical Center 2182 Highway 4 Arnold CA 95223 Outpatient Clinic San Andreas Clinic 704 Mt Ranch Road Suite 103 San Andreas CA 95249 Outpatient Clinic Copperopolis Family Medical Center 3505 Spangler Lane Suite 400 Copperopolis CA 95228 Outpatient Clinic SCHEDULE H, PART I, LINE 7 MARK TWAIN MEDICAL CENTER (MTMC) FOLLOWS THE METHOD USED BY DIGNITY HEALTH. FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, MTMC 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. SCHEDULE H, 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. MTMC RECOGNIZED FEE-FOR-SERVICE SUPPLEMENTAL PAYMENTS OF $5.31 MILLION DURING THE YEAR REFLECTED UNDER THE MEDICAID PROGRAM AS DIRECT OFFSETTING REVENUE (PART I, LINE 7B, COLUMN D). SCHEDULE H, PART I, LINE 7I INCLUDED IN CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT IS $0.19 MILLION TO A FUND ESTABLISHED BY THE CALIFORNIA HEALTH FOUNDATION AND TRUST ("CHFT") FOR SEVERAL PURPOSES, INCLUDING AGGREGATING AND DISTRIBUTING FINANCIAL RESOURCES TO SUPPORT CHARITABLE ACTIVITIES AT VARIOUS HOSPITALS AND HEALTH SYSTEMS IN CALIFORNIA, CONSISTENT WITH CHFT'S MISSION OF SUPPORTING HEALTH CARE, ACCESS TO HEALTH CARE, RESEARCH AND EDUCATION. Schedule H, Part II - Community Building Activities THE HOSPITAL DID NOT REPORT EXPENSES ASSOCIATED WITH COMMUNITY BUILDING PROGRAM ACTIVITIES IN FY18. SCHEDULE H, 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. MTMC 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. MTMC 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. SCHEDULE H, PART III, LINE 3 MTMC MAKES EVERY EFFORT IN DETERMINING IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. MTMC 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, URGENT CARE CENTERS, 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. SCHEDULE H, 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. MTMC 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. SCHEDULE H, PART III, LINE 8 MTMC PREPARES MEDICARE COST REPORTS IN A MANNER THAT COMPORTS 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 SUBORDINATE CORPORATIONS BELIEVE 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 MTMC 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 $7.8 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 MTMC. SCHEDULE H, PART III, LINE 9B MTMC ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. MTMC ALSO FOLLOWS DIGNITY HEALTH'S COLLECTION POLICY. DIGNITY HEALTH'S BILLING AND 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 MTMC OR 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, MTMC 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 MTMC. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, MTMC REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT. Schedule H, Part VI, Line 2 - Needs Assessment HOSPITAL LEADERSHIP OVERSEES COMMUNITY BENEFIT ACTIVITIES FOR THE HOSPITAL AS IT STRIVES TO MEET THE HEALTH AND WELLNESS NEEDS OF THE LOCAL COMMUNITY. MEMBERS OF MARK TWAIN'S SENIOR AND MIDDLE MANAGEMENT TEAM SERVE THE COMMUNITY ON A VARIETY OF COMMUNITY-BASED NOT-FOR-PROFIT BOARDS, OTHER SERVICE CLUBS, LOCAL CHURCHES AND CHAMBER OF COMMERCE, AND PROVIDE INSIGHT INTO THE UNIQUE NEEDS OF THE COMMUNITY THAT MAY NOT BE APPARENT IN SECONDARY DATA. MTMC BOARD OF DIRECTORS, MANY OF WHOM ARE RECOGNIZED COMMUNITY LEADERS, ALSO REPRESENTED THE MEDICAL COMMUNITY. AS REPRESENTATIVES OF THE COMMUNITY, THESE LEADERS AND BOARD MEMBERS PROVIDED INSIGHT INTO NEEDS THROUGH DISCUSSION AT MEETINGS. THE HOSPITAL HAS CLOSE WORKING RELATIONSHIPS WITH THE MARK TWAIN HEALTH CARE DISTRICT, THE COUNTY HEALTH AND HUMAN SERVICES AGENCY, THE PUBLIC SCHOOLS AND OTHERS THROUGHOUT THE YEAR. THESE RELATIONSHIPS ENSURE FREQUENT DIALOGUE ABOUT A WIDE RANGE OF COMMUNITY HEALTH NEEDS. Schedule H, Part VI, Line 3 - Patient Education of Eligibility for ASSISTANCE COMMUNICATION OF THE FINANCIAL ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC: INFORMATION ABOUT PATIENT FINANCIAL ASSISTANCE IS AVAILABLE AT MTMC AND ALL OF ITS COMMUNITY LOCATIONS AND WEBSITES, INCLUDING A CONTACT NUMBER FOR PATIENTS TO CALL FOR INFORMATION AND ASSISTANCE. THE INFORMATION IS DISSEMINATED BY MTMC BY VARIOUS MEANS TO INCLUDE NOTICES ON PATIENT BILLS, BROCHURES AT ALL REGISTRATION DESKS AND IN ALL WAITING ROOMS, AND NOTICES POSTED IN THE EMERGENCY DEPARTMENT. SUCH INFORMATION IS PROVIDED IN ENGLISH AND SPANISH. AT THE POINT OF REGISTRATION, ALL PATIENTS RECEIVE BROCHURES EXPLAINING THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND THE AVAILABILITY OF GOVERNMENT SPONSORED PROGRAMS. UNINSURED PATIENTS RECEIVE COPIES OF THE FINANCIAL ASSISTANCE AND MEDICAID APPLICATIONS 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 THEY MAY BE ELIGIBLE FOR A GOVERNMENT SPONSORED PROGRAM OR FACILITY FUNDED FINANCIAL ASSISTANCE, INSTRUCTIONS ON HOW TO APPLY FOR A GOVERNMENT PROGRAM OR CHARITY CARE AND THE PROVISION OF SUCH APPLICATIONS. ANY MEMBER OF MTMC STAFF OR MEDICAL STAFF MAY REFER A PATIENT 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. Schedule H, Part VI, Line 4 - Community Information THE HOSPITAL SERVES CALAVERAS COUNTY, APPROXIMATELY 130 MILES EAST OF SAN FRANCISCO, 60 MILES SOUTHEAST OF SACRAMENTO, AND 50 MILES EAST OF STOCKTON. THE RURAL COUNTY'S GEOGRAPHY BEGINS NEAR SEA-LEVEL IN THE WEST AND CULMINATES NEAR 8,200 FEET IN THE EASTERN PART OF THE COUNTY, IN THE SIERRA NEVADA RANGE. CALAVERAS COUNTY IS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AND PORTIONS OF THE COUNTY ARE MEDICALLY UNDERSERVED AREAS (MUA). BESIDES MARK TWAIN MEDICAL CENTER, ITS FIVE AMBULATORY CARE ENTERS AND FOUR SPECIALTY CARE CENTERS, THE FOLLOWING FACILITIES AND RESOURCES ARE AVAILABLE: CONVALESCENT HOSPITAL, ASSISTED LIVING, COMMUNITY CLINICS, CHILDREN SERVICES, HOME HEALTH CARE, HOSPICE, MENTAL HEALTH, DRUG & ALCOHOL ABUSE SERVICES, SUPPORT GROUPS & SERVICES, AND TRANSPORTATION. THE COUNTY HAS A RELATIVELY MATURE POPULATION WITH A HIGHER PROPORTION OF PERSONS AGED 65 YEARS AND OVER (26.9%) COMPARED TO CALIFORNIA (13.9%), AND A HIGHER PROPORTION OF MILITARY VETERANS (10%) COMPARED TO CALIFORNIA (4%) TOTAL POPULATION: 44,987 RACE/ETHNICITY: WHITE - NON-HISPANIC 80.6%; BLACK/AFRICAN AMERICAN - NON-HISPANIC 0.9%; HISPANIC OR LATINO 12.2%; ASIAN/PACIFIC ISLANDER 1.7%; ALL OTHERS 4.6% MEDIAN INCOME: $58,605 UNEMPLOYMENT: 5.9% NO HIGH SCHOOL DIPLOMA: 8.3% MEDICAID: 23.3% UNINSURED: 7.6% OTHER AREA HOSPITALS: 0 Schedule H, Part VI, Line 5 - Promotion of Community Health HOSPITAL LEADERSHIP OVERSEES COMMUNITY BENEFIT ACTIVITIES FOR THE HOSPITAL AS IT MEETS THE HEALTH AND WELLNESS NEEDS OF THE LOCAL COMMUNITY. SEVERAL MEMBERS OF MARK TWAIN MEDICAL CENTER'S MANAGEMENT TEAM SERVE THE COMMUNITY ON A VARIETY OF COMMUNITY BASED NOT FOR PROFIT BOARDS. THE HOSPITAL IS GOVERNED BY A BOARD OF TRUSTEES, THE MAJORITY OF WHOM RESIDE WITHIN ITS PRIMARY SERVICE AREA AND WHO ARE NOT EMPLOYEES, CONTRACTORS OR FAMILY MEMBERS THEREOF. IN THE RURAL ENVIRONMENT OF OUR COMMUNITY, SMALL BUSINESS, AGENCIES AND THE HOSPITAL PARTNER TO PROVIDE VARIOUS EVENTS THROUGHOUT THE YEAR THAT ARE FOCUSED ON PROMOTING THE HEALTH OF THE COMMUNITY, ENHANCING QUALITY OF LIFE FOR THE RESIDENTS AND SHOWCASING THE UNIQUE HISTORY AND NATURAL WONDERS OF OUR ENVIRONMENT. BASED ON THE PRIORITIZED HEALTH NEED OF THE COMMUNITY, A SPECIFIC FOCUS HAS BEEN ON WOMEN'S HEALTH ISSUES AND PRIMARY CARE AND PREVENTION. MARK TWAIN MEDICAL CENTER PUBLISHED A COMMUNITY RESOURCES BROCHURE FOR RESIDENTS. THE ORGANIZATIONS IN THIS BROCHURE WORK WITH US TO PROVIDE COMMUNITY RESOURCES THAT CAN MAKE A DIFFERENCE. IN ADDITION, MANY EMPLOYEES HAVE LINKAGES TO VARIOUS SERVICE ORGANIZATIONS THROUGHOUT THE COMMUNITIES. COMMUNITY INVOLVEMENT IS EVIDENCED BY PARTICIPATION OF LOCAL BUSINESS AND COMMUNITY LEADERS IN THE HOSPITAL'S GOVERNING BOARDS, FINANCE COMMITTEE, ETHICS COMMITTEE AND OUR PATIENT ADVISORY COMMITTEE. MTMC EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN AND OUTSIDE ITS COMMUNITY WHO REQUEST SAID PRIVILEGES. ALL SURPLUS FUNDS GENERATED BY MTMC ARE REINVESTED BACK INTO THE ORGANIZATION TO IMPROVE PATIENT CARE AND PROVIDE HEALTH CARE SERVICES TO ITS COMMUNITY. Schedule H, Part VI, Line 6 - Affiliated Health Care System MTMC IS AFFILIATED WITH DIGNITY HEALTH. AFFILIATES OF DIGNITY HEALTH ALSO PROMOTE THE HEALTH OF ADDITIONAL COMMUNITIES IN BAKERSFIELD, 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 Mark Twain Medical Center Foundation 768 Mountain Ranch Road San Andreas CA 95249 680023507 501(c)(3) 289154 N/A N/A Foundation Support California Health Foundation and Trust 1215 K Street Suite 800 Sacramento CA 95814 941498697 501(c)(3) 186172 N/A N/A Community Health Resource Connection Food Bank PO Box 919 San Andreas CA 95249 942705790 501(C)(3) 0 5768 book food COMMUNITY health 3 0 PART I, LINE 1 AS A 501(C)(3) ORGANIZATION, WE PROVIDE ASSISTANCE TO VARIOUS CHARITABLE ORGANIZATIONS TO PROMOTE MTMC'S MISSION. A DESIGNATED COMMITTEE CONSISTING PRIMARILY OF THE EXECUTIVE TEAM ESTABLISHES AND EVALUATES PRIORITIES AND ALLOCATION OF FUNDS WITH EMPHASIS ON PROMOTION OF HEALTHY COMMUNITIES AND COMMUNITY COLLABORATION. WE DO NOT MONITOR AND REPORT PROGRAM OUTCOMES. SPENDING IS TRACKED ON AN ONGOING BASIS TO ENSURE THAT IT IS GENERALLY WITHIN THE BUDGETED AMOUNT. false true false false false false false false false Charles Kassis Board Member 0 336421 0 210712 0 14084 0 51446 0 50584 0 663247 0 0 Robert Diehl President & CEO 0 257894 0 71716 0 10823 0 32681 0 54323 0 427437 0 0 Chris L Roberts VP & CFO 190920 0 375 0 1396 0 21343 0 28899 0 242933 0 0 0 Katherine McCoy VP & CNE 170976 0 375 0 5310 0 13537 0 15841 0 206039 0 0 0 Lonnie Smith MD CMO 301437 0 275 0 21068 0 25654 0 6379 0 354813 0 0 0 John D Anderson MD Physician 224972 0 0 0 851 0 17775 0 14695 0 258293 0 0 0 Mark W Faryan DO CT Technologist 217220 0 0 0 4411 0 24286 0 42886 0 288803 0 0 0 Richard Gonzales MD Family Practice Physician 227813 0 0 0 908 0 17999 0 36678 0 283398 0 0 0 Jill Ortiz Director of Pharmacy 195632 0 592 0 13013 0 22135 0 42620 0 273992 0 0 0 Mohamad A Parsa MD Physician 323495 0 0 0 489 0 33656 0 27355 0 384995 0 0 0 Robert Allen Former Key Employee 0 323892 0 89314 0 759 0 41499 0 21042 0 476506 0 0 Katherine A Medeiros Former Officer 0 303377 0 239260 0 24041 0 51126 0 43444 0 661248 0 0 PART I, LINE 3 Although the organization employs 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 THE ORGANIZATION'S KEY EMPLOYEES AND ITS HIGHEST COMPENSATED EMPLOYEES PARTICIPATE IN A SEVERANCE PLAN THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 6 MONTHS 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 WERE MADE UNDER THIS PLAN DURING 2017. PART I, LINE 4b CERTAIN LISTED PERSONS 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. NO PAYMENTS WERE MADE UNDER THIS PLAN DURING 2017. 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 II - 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 DIGNITY HEALTH 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 IT 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 THE ORGANIZATION'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, PARTS I, VI, VII and XII FORM 990, PART I, LINE 7A PART I, LINE 7A INCLUDES SECTION 512(A)(7) QUALIFIED TRANSPORTATION FRINGE BENEFIT AMOUNTS THAT ARE NOT REVENUE AND THEREFORE NOT REPORTED ON FORM 990. FORM 990, PART VI, SECTION A, LINE 6 THE MARK TWAIN MEDICAL CENTER IS JOINTLY OWNED BY DIGNITY HEALTH, A 501(C)(3) EXEMPT ORGANIZATION AND MARK TWAIN HEALTHCARE DISTRICT (THE DISTRICT). FORM 990, PART VI, SECTION A, LINE 7A DIGNITY HEALTH AND THE DISTRICT, AS THE CORPORATE MEMBERS, RATIFY THE SELECTION OF MEMBERS AND APPROVE NEW BOARD MEMBERS OF THE ORGANIZATION. EACH OWNER DESIGNATES TWO BOARD MEMBERS, AND EACH PAIR OF DESIGNATED BOARD MEMBERS SELECTS A COUNTY RESIDENT; THESE SIX SELECT THE SEVENTH VOTING MEMBER, WHO MUST ALSO BE A COUNTY RESIDENT. THE EIGHTH VOTING MEMBER IS ELECTED AND IS THE CHIEF OF STAFF OF MARK TWAIN MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B RESERVED RIGHTS OF THE CORPORATE MEMBERS (DIGNITY HEALTH AND THE DISTRICT) INCLUDE ADOPTION OF MISSION AND PHILOSOPHY STATEMENTS, AMENDMENT OR RESTATEMENT OF ARTICLES OF INCORPORATION AND BYLAWS, DISSOLUTION OF THE CORPORATION, ACQUISITION OF ANOTHER CORPORATION, CREATION OF A NEW SUBSIDIARY, MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION, PARTICIPATION AS A GENERAL OR LIMITED PARTNER IN ANY VENTURE, INCURRING LONG-TERM INDEBTEDNESS IN EXCESS OF NORMAL OPERATING REQUIREMENTS, RATIFICATION OF BOARD MEMBER APPOINTMENTS AND DISMISSALS, SELECTION AND REMOVAL OF INDEPENDENT AUDITORS, AND TRANSACTIONS OUTSIDE THE ORDINARY COURSE OF BUSINESS. FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT PRESENTED THE DRAFT OF THE FORM 990 TO THE BOARD BEFORE FILING THE FORM WITH THE INTERNAL REVENUE SERVICE. THE BOARD'S REVIEW INCLUDED ALL INFORMATION REPORTED ON THE FORM 990 WITH THE EXCEPTION OF INDIVIDUALS' COMPENSATION AMOUNTS REPORTED WHICH WERE DIRECTLY REVIEWED BY THE VICE PRESIDENT OF HUMAN RESOURCES. IN THE PROCESS OF ITS PREPARATION, THE FORM 990 WAS REVIEWED AT VARIOUS LEVELS OF FINANCE AND ACCOUNTING (REGIONAL DIGNITY HEALTH MANAGEMENT AND CORPORATE TAX DEPARTMENT), AS WELL AS REVIEWED BY MARK TWAIN'S FINANCE MANAGER AND CFO (WHO SIGNS THE FORM) AND BY AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. THE ORGANIZATION'S BOARD 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 15A ALTHOUGH THE ORGANIZATION EMPLOYS PERSONNEL, THE TOP MANAGEMENT OFFICIAL 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 B, LINE 15B THE HOSPITAL 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 CHIEF FINANCIAL OFFICER'S COMPENSATION. COMPENSATION OF OTHER HIGHLY PAID KEY EMPLOYEES IS BASED ON A COMPREHENSIVE EVALUATION FOCUSING ON ALL ASPECTS OF THE INCUMBENT'S ASSIGNED DUTIES AND ASSESSED PERFORMANCE IN CARRYING OUT THE PHILOSOPHY AND MISSION OF MTMC. ADDITIONALLY, COMPARATIVE DATA AND MARKET SURVEYS REGARDING COMPENSATION IN THE SURROUNDING MARKETPLACE ARE CONSIDERED. 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 C. KASSISR. DIEHL'S COMPENSATION ARE FOR EMPLOYMENT SERVICES PROVIDED TO THE RELATED ORGANIZATION. FORM 990, PART XI, LINE 9 INTEREST IN NET ASSETS OF UNCONSOLIDATED FOUNDATION; $(355,297) 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. FORM 990 PART IX LINE 11G DESCRIPTION:REVENUE CYCLE SERVICES TOTAL FEES:400652 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN/MEDICAL SERVICES TOTAL FEES:8563389 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATIVE SERVICES TOTAL FEES:4100496 FORM 990 PART IX LINE 11G DESCRIPTION:BUILDING SERVICES TOTAL FEES:1835539 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL SERVICES TOTAL FEES:443398 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:212363 Dignity Health 185 Berry Street San Francisco CA 94107 941196203 Hospital CA 501(c)(3) 3 NA false false false false false true false false false false false true false true true false true false true true NONE