2016-05-06T14:16:36-05:00 2015-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2014-07-01 941439787 Sierra Nevada Memorial - Miners Hospital Inc % LARA HARROWFINANCE DEPT SIER 5302746099 185 BERRY STREET SUITE 300 SAN FRANCISCO CA 94107 CAROLYN CANADY CFO 5302746099 2016-05-06 true VALERIE J BALL P00178114 4159635100 2016-05-06 2014 2016-08-17 19:52:53Z Carolyn Canady 155 Glasson Way Grass Valley CA 95945 207672864 false X www.SNMH.Org X 1934 CA TO CONTRIBUTE TO THE WELLNESS OF OUR COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER. 10 7 928 93 8111 -1602 1075455 1003110 132763933 148797515 15441807 7492224 630723 641210 149911918 157934059 6000503 5422875 0 0 84288028 90326370 0 0 0 47262916 61100968 137551447 156850213 12360471 1083846 247735568 251963383 29653296 33385953 218082272 218577430 X TO CONTRIBUTE TO THE WELLNESS OF OUR COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER,COLLABORATING WITH OTHERS IN THE COMMUNITY TO IMPROVE QUALITY OF LIFE. false false 133611315 5422875 148793688 SIERRA NEVADA MEMORIAL HOSPITAL'S MISSION IS TO CONTRIBUTE TO THE WELLNESS OF OUR COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER, COLLABORATING WITH OTHERS IN THE COMMUNITY TO IMPROVE THE QUALITY OF LIFE. THE HOSPITAL OFFERS A WIDE RANGE OF SERVICES AND SPECIALTIES TO ACCOMMODATE THE GROWING NEEDS OF WESTERN NEVADA COUNTY. AS THE SOLE ACUTE CARE PROVIDER IN OUR SERVICE AREA, SIERRA NEVADA MEMORIAL HOSPITAL TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. SIERRA NEVADA MEMORIAL HOSPITAL IS LICENSED WITH 104 ACUTE BEDS, SPECIALIZING IN ORTHOPEDICS, ONCOLOGY AND GENERAL MEDICAL SERVICE. SERVICES PROVIDED IN FISCAL YEAR 2015 INCLUDED 149,389 OUTPATIENT VISITS, 33,978 EMERGENCY VISITS, AND 2,440 INPATIENT AND OUTPATIENT SURGERIES. SIERRA NEVADA MEMORIAL HOSPITAL'S LIST OF INPATIENT, OUTPATIENT AND SUPPORT SERVICES IS QUITE EXHAUSTIVE. INPATIENT SERVICES INCLUDE ACUTE MEDICAL/SURGICAL CARE; INTENSIVE CARE; PHARMACY; ORTHOPEDIC AND GENERAL SURGERY; AND WOMEN & INFANT CARE UNIT. OUTPATIENT SERVICES: AMBULATORY TREATMENT CENTER; CARDIAC REHABILITATION; CARDIOPULMONARY; DIAGNOSTIC IMAGING; LABORATORY; OUTPATIENT SURGERY CENTER; NUEROLOGICAL REHABILITATION SERVICES; WOUND CARE CENTER; AMBULANCE; CANCER CENTER; AND EMERGENCY SERVICES. 133611315 true true false true false false false false false true true true false false true true false true false false false false false false false false true true true false true true true false false false false false false false false false false false false false false true false false false true 123 0 true 928 true true true false false false false false false false false false X 10 7 false false false false true true true true true false false false true true true true true false false true true CA X LARA HARROWFINANCE DEPT 9168512104 3400 DATA DRIVE Rancho Cordova CA 95670 X Tom Walker Brown Board Member (thru 1/5/15) 2.0 0.0 X 0 0 0 Andrew Chang MD Board Member (thru 12/31/14) 2.0 0.0 X 0 0 0 Dale Creighton Board Member 2.0 0.0 X 0 0 0 Stacy Fore DDS Board Member 2.0 0.0 X 0 0 0 Kathryn Rappath Board Member 2.0 0.0 X 0 0 0 Scott Robertson Board Member 2.0 0.0 X 0 0 0 Kevin Vaziri Board Member 2.0 40.0 X 0 540435 81039 Alan Wong Board Member 2.0 0.0 X 18000 0 0 Katherine A Medeiros CEO/ Service Area Leader 40.0 0.0 X X 0 472879 75478 Edward Sylvester Board Secretary 2.0 0.0 X X 0 0 0 Michele White Board Vice Chair 2.0 0.0 X X 0 0 0 Sarah Woerner MD Board Chair (thru 6/30/15) 2.0 0.0 X X 30650 0 0 Carolyn Canady CFO/Board Treasurer 40.0 0.0 X 215437 0 26387 Brian Evans VP, CMO 40.0 0.0 X 249308 0 49397 Jill McWilliams VP/CNE 40.0 0.0 X 205961 0 35590 Debbie L Plass VP Operations 40.0 0.0 X 162693 0 31725 Timothy Stephens VP Ancillary Services 40.0 0.0 X 156234 0 36561 Gregory T Smith Registered Nurse 40.0 0.0 X 243177 0 47202 Jonathan D Stone Director of Pharmacy 40.0 0.0 X 189795 0 32249 William S Swindling Pharmacist 40.0 0.0 X 164782 0 12495 Tzvetan I Tzvetanov Physicist 40.0 0.0 X 263633 0 21057 Gail A Van Vleck Charge Nurse IP/OP Surgery 40.0 0.0 X 175007 0 33086 2074677 1013314 482266 220 false true false COGENT HEALTHCARE OF CA PO BOX 645037 CINCINNATI OH 452645037 Medical Services 1324808 SIERRA NEVADA ANESTHESIA 970 E MAIN ST SUITE 100 GRASS VALLEY CA 95945 Medical Services 1201626 DELPHI OF TEAM HEALTH PO BOX 634850 CINCINNATI OH 45263 Medical Services 791938 ALLIEDBARTON SECURITY SERVICES LLC 161 WASHINGTON ST SUITE 600 CONSHOHOCKEN PA 19428 Security Services 480674 SWOPE MEDICAL GROUP INC PO BOX 1886 NEVADA CITY CA 95959 Medical Services 214134 12 X 928661 41872 32577 1003110 PATIENT NET OF CHARITY & BAD DEBT 900099 71912750 71912750 MEDICARE/MEDICAID PAYMENTS 900099 75117979 75117979 MEANINGFUL USE INCENTIVES (EHR) 900099 707773 707773 MEDICAL OFFICE BLDG 621300 136370 136370 GS HIO MAINTENANCE 900099 355284 355284 567359 563532 3827 148797515 2577912 0 0 2577912 0 0 1165 0 1165 0 1165 1165 54649961 2904 49738553 0 4911408 2904 4914312 4914312 0 1016 252 764 764 0 GIFT SHOPS 453220 142710 0 142710 CAFETERIA/CATERING 722320 174106 4284 169822 FINANCE CHARGES 900099 77667 77667 244798 244798 639281 157934059 148793688 8111 8129150 X 5418875 5418875 4000 4000 0 0 1134539 1052924 81615 0 66854228 62849171 4005057 4510039 4256977 253062 13120929 12400963 719966 4706635 4442542 264093 0 89799 89799 35637 35637 50994 50994 0 768301 768301 24536912 18695450 5841462 340920 17627 323293 3238680 2297475 941205 10001388 630760 9370628 0 1639894 1588864 51030 218117 159940 58177 0 79830 35746 44084 733252 733252 0 5040600 5016717 23883 803850 803850 MEDICAL SUPPLIES 12757847 12754721 3126 0 DUES & SUBSCRIPTIONS 195500 28236 167264 0 LICENSES & TAXES 103840 62623 41217 0 BAD DEBT 16706 0 16706 0 448901 360602 88299 156850213 133611315 23238898 0 X 6175 6388 4707840 2264536 0 0 22592217 28887452 0 0 0 0 149618 473610 1825906 1940027 2572252 5766887 123037358 81157831 38054473 41879527 118899478 111818708 52246405 53246572 6681204 5679676 0 0 0 0 247735568 251963383 12436128 15705874 0 0 211023 266436 4334365 4334365 0 0 0 0 0 413203 0 0 12671780 12666075 29653296 33385953 X 213306085 214817106 3408509 2392646 1367678 1367678 218082272 218577430 247735568 251963383 X 1083846 312127 -900815 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 50994 50994 false PART II-B, LINE 1 SCHEDULE C, PART II-B, LINE 1 LOBBYING EXPENDITURES PAID DIRECTLY BY THE FILING ORGANIZATION FOR ANNUAL MEMBERSHIP DUES: AMERICAN COLLEGE OF HEALTHCARE $3 WOUND OSTOMY AND CONTINENCE NURSES SOCIETY $1 ASTRO $186 LOBBYING EXPENDITURES PAID BY THE PARENT ORGANIZATION FOR ANNUAL MEMBERSHIP DUES WHERE EXPENSES ARE ALLOCATED TO THE HOSPITAL: CATHOLIC HEALTH ASSOCIATION $692 AMERICAN HOSPITAL ASSOCIATION $2,544 HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA $8,503 CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME $38 VISITING NURSE ASSOCIATION OF AMERICA $149 CALIFORNIA HOSPITAL ASSOCIATION $38,878 TOTAL EXPENDITURES PAID TO ORGANIZATIONS $50,994 2296400 0 66097 2362497 1367108 570 928722 2296400 1351797 15311 0 1367108 1599745 61959 -309907 1351797 2423093 57110 350442 1230900 1599745 0.00000 0.60000 0.40000 false true true 1140153 1140153 63225301 41234065 21991236 289591 289591 0 46072409 36773231 9299178 12309904 2860944 9448960 41879527 POOLED INVESTMENTS 53246572 F 53246572 0 DUE TO RELATED PARTIES 9782946 PENSION PAYABLE 2883129 12666075 X Sch D, PART V, LINE 4 The endowment funds are intended to be used to support Alzheimer's research, the Cancer Center, the Cardiac program and other hospital program needs. Sch D, PART X, LINE 2 DIGNITY HEALTH REVIEWS ITS TAX POSITIONS ANNUALLY 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 5281 2213911 0 2213911 0.01410 33081 33619742 34020664 -400922 0.00260 28 85834 35734 50100 0.00030 38390 35919487 34056398 1863089 0.01180 23 12083 426177 720 425457 0.00270 2 26 49951 0 49951 0.00030 7 663 1251307 0 1251307 0.00800 32 12772 1727435 720 1726715 0.01100 32 51162 37646922 34057118 3589804 0.02280 2 25 56293 0 56293 0.00040 2 25 56293 0 56293 0.00040 true 2655624 0 39834468 62332851 -22498383 X true true GRASS VALLEY OP SURG AMBULATORY SURGERY CENTER 0.22800 0.00000 0.31590 1 1 Sierra Nevada Memorial-Miners Hospita 155 Glasson Way Grass Valley CA 95945 www.SNMH.org 230000152 X X X Sierra Nevada Memorial-Minors Hosp 1 false false true X X X X X X X X X 13 true true false true X SEE SECTION C X www.healthylivingmap.com X true 13 true SEE SECTION C false false true X 200. 500. X X X X true true X X X X true X www.snmh.org X X X X X true X false X X X X true X false false SCH H, PART V SCHEDULE H, PART V, SECTION B, LINE 5 THE JUNE 2013 CHNA WAS GUIDED BY AN OBJECTIVE THAT FOCUSED ON IDENTIFYING COMMUNITIES, AND SPECIFIC GROUPS WITHIN THESE COMMUNITIES, EXPERIENCING HEALTH DISPARITIES. ANOTHER OBJECTIVE WAS TO IDENTIFY CONTRIBUTING FACTORS THAT CREATE BOTH BARRIERS AND OPPORTUNITIES FOR SPECIFIC POPULATIONS TO LIVE HEALTHIER LIVES. PRIMARY QUALITATIVE DATA WAS OBTAINED FROM INTERVIEWS WITH HOSPITAL CLINICAL AND COMMUNITY BENEFIT STAFF MEMBERS, AND KEY INFORMANTS INCLUDING: NEVADA COUNTY AND SURROUNDING COUNTY PUBLIC HEALTH AGENCIES, MINERS COMMUNITY CLINIC, COMMUNITY RECOVERY SERVICES, AND THE NEVADA CITY UNIFIED SCHOOL DISTRICT. A FOCUS GROUP CONSISTING OF 12 COMMUNITY MEMBERS WAS CONDUCTED WITH AREA RESIDENTS, AND PHONE INTERVIEWS AND WEBSITE ANALYSES WERE CONDUCTED TO ASSESS COMMUNITY HEALTH ASSETS. SECONDARY QUANTITATIVE DATA WAS COLLECTED ON HEALTH, DEMOGRAPHIC, BEHAVIORAL, AND ENVIRONMENTAL FACTORS. COUNTY, STATE, AND HEALTHY PEOPLE 2020 TARGETS (WHEN AVAILABLE) WERE USED AS BENCHMARKS TO DETERMINE SEVERITY OF HEALTH ISSUES. SCHEDULE H, PART V, SECTION B, LINE 6A MERCY HOSPITAL OF FOLSOM, MERCY GENERAL HOSPITAL, METHODIST HOSPITAL OF SACRAMENTO, MERCY SAN JUAN MEDICAL CENTER, WOODLAND MEMORIAL HOSPITAL, UC DAVIS MEDICAL CENTER, KAISER PERMANENTE, SUTTER MEDICAL CENTER SCHEDULE H, PART V, SECTION B, LINE 7A HTTP://WWW.DIGNITYHEALTH.ORG/SACRAMENTO/HOSPITALS/SIERRA-NEVADA-MEMORIAL-H OSPITAL/ABOUT-US/SERVING-THE-COMMUNITY SCHEDULE H, PART V, SECTION B, LINE 10A http://www.dignityhealth.org/cm/media/documents/Sierra-Nevada-Memorial-Hos pital-IS.pdf SCHEDULE H, PART V, SECTION B, LINE 11 SIERRA NEVADA MEMORIAL HOSPITAL IDENTIFIED AS PRIORITY HEALTH NEEDS IN THE CHNA INCLUDE: 1. LACK OF ACCESS TO PRIMARY CARE AND PREVENTIVE SERVICES; 2. LACK OF INTEGRATION OF BEHAVIORAL HEALTH AND PRIMARY CARE; 3. TRANSPORTATION ISSUES AND LIMITATIONS; 4. LIMITED ACCESS TO HEALTHY FOODS, FOOD SECURITY; 5. LACK OF ACCESS TO SPECIALTY CARE; 6. LACK OF DENTAL CARE; 7. LACK OF ACCESS TO MENTAL HEALTH SERVICES; 8. ELIGIBILITY REQUIREMENTS FOR MEDI-CAL AND OTHER SOCIAL SERVICES; 9. LACK OF ACCESS TO OUTDOOR AND RECREATIONAL ACTIVITIES; 10. LACK OF ACCESS TO PHYSICAL THERAPY. LACK OF ACCESS TO PRIMARY CARE: THE HOSPITAL SUPPORTS THIS CENTER'S CURRENT EFFORTS TO SERVE AS A PRIMARY HEALTH CARE HOME TO THE UNDERSERVED. TO PROVIDE MUCH NEEDED SPACE (ONE CONTRIBUTOR TO POOR ACCESS IDENTIFIED THROUGH QUALITATIVE DATA IN THE CHNA) THE HOSPITAL HAS ENABLED THE CLINIC TO UTILIZE HOSPITAL-OWNED FACILITIES IN GRASS VALLEY FOR ADDITIONAL CAPACITY AT A REDUCED RATE. LACK OF ACCESS TO PREVENTATIVE SERVICES: THE HOSPITAL IS ONE OF THE FEW PROVIDERS IN THE REGION ADDRESSING THE NEED FOR HEALTH EDUCATION THAT FOCUSES ON DISEASE PREVENTION AND MANAGEMENT OF CHRONIC DISEASE. THROUGH THE HOSPITAL'S WELLNESS EDUCATION DEPARTMENT, THOUSANDS OF RESIDENTS HAVE BEEN SERVED OVER THE PAST 15 YEARS, RECEIVING THE NECESSARY RESOURCES AND SKILLS TO CONTROL HEALTH CONDITIONS AND LEAD HEALTHIER LIVES. DIABETES: TAKE CONTROL! IS AN ACTIVE AND GROWING PROGRAM FOCUSED ON EDUCATION AND NUTRITION COUNSELING TO ENABLE RESIDENTS TO BETTER MANAGE THIS CHRONIC CONDITION, STAY HEALTHY, AND AVOID HOSPITALIZATIONS FOR UNCONTROLLED SYMPTOMS. BETTER BREATHER AND PULMONARY REHABILITATION, AND SMOKING CESSATION CLASSES ARE ALSO OFFERED, RESPONDING TO THE CHRONIC DISEASES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ASTHMA, WHICH WAS ALSO SHOWN TO BE PREVALENT IN THE CHNA. BUILDING CAPACITY FOR PREVENTATIVE SERVICES: COLLABORATIVE EFFORTS ARE UNDERWAY BY THE HOSPITAL WITH WESTERN SIERRA MEDICAL CLINIC TO INCREASE ACCESS TO PREVENTATIVE SERVICES. THE HOSPITAL IS TRAINING KEY MEMBERS OF THE CLINIC'S STAFF TO BE ABLE TO PROVIDE EDUCATION AND TO FACILITATE CHRONIC DISEASE SELF MANAGEMENT CLASSES, EXTENDING THE REACH OF THESE PROGRAMS IN THE REGION, AND IN PARTICULAR TO COMMUNITIES OF CONCERN. LACK OF MENTAL HEALTH SERVICES AND SUBSTANCE ABUSE TREATMENT: SIERRA NEVADA MEMORIAL HOSPITAL RECOGNIZES THE MAJOR GAP IN SERVICES FOR MENTAL HEALTH CARE, AND THE HIGH SUBSTANCE ABUSE PROBLEM IN THE REGION, AND IS RESPONDING THROUGH COLLABORATIVE MEASURES THAT BUILD CAPACITY IN THE COMMUNITY FOR SERVICES ADDRESSING THESE NEEDS. LACK OF ACCESS TO SPECIALTY CARE: THE HOSPITAL CONTINUES TO GROW ITS NURSE NAVIGATOR AND PEER SUPPORT PROGRAMS WITHIN ITS EXISTING SERVICE LINES, PARTICULARLY FOR STROKE VICTIMS. STROKE, SPECIFICALLY AMONG THE LARGE ELDERLY MALE POPULATION IN THE REGION, WAS IDENTIFIED AS A HIGH-RISK HEALTH ISSUE IN THE CHNA. THE HOSPITAL IS ALSO DEVELOPING A LUNG CANCER SCREENING PROGRAM TO RESPOND TO THE GROWING PREVALENCE OF LUNG CANCER, WHICH WAS INDICATED IN THE CHNA AS AN INCREASING CONCERN. UNINTENTIONAL INJURY. FALLS PREVENTION CLASSES ARE OFFERED, AND THE HOSPITAL IS INVOLVED IN THE FALLS PREVENTION COALITION OF NEVADA COUNTY, AN ORGANIZATION DEDICATED TO REDUCING THE RISK OF FALLS THROUGH EDUCATION. ELIGIBILITY REQUIREMENTS FOR MEDI-CAL AND OTHER SOCIAL SERVICES: SIERRA NEVADA MEMORIAL HOSPITAL'S ACTIVE ENROLLMENT ASSISTANCE PROGRAM IS DIRECTLY ALIGNED WITH THIS CHNA PRIORITY. THE PROGRAM IDENTIFIES PATIENTS WITHOUT INSURANCE AND NAVIGATES THEM THROUGH THE COMPLICATED AND OFTEN CONFUSING ENROLLMENT PROCESS. THE NEEDS OF NEVADA COUNTY ARE MONUMENTAL, AND AS THE SOLE HOSPITAL SERVING THIS EXPANSIVE RURAL REGION, SIERRA NEVADA MEMORIAL HOSPITAL, AS A RURAL COMMUNITY HOSPITAL, DOES NOT HAVE THE RESOURCES AVAILABLE TO DEVELOP AND/OR DUPLICATE INITIATIVES TO MEET EVERY PRIORITY NEED IDENTIFIED, WHICH MAKES COLLABORATION WITH COMMUNITY ASSETS CRITICAL. THE COUNTY PUBLIC HEALTH DEPARTMENT AND OTHER COMMUNITY-BASED NONPROFIT ORGANIZATIONS FOR INSTANCE, ARE PROVIDING MENTAL HEALTH SERVICES. COMMUNITY RECOVERY RESOURCES DIRECTLY RESPONDS TO THE ISSUE OF SUBSTANCE ABUSE, AND IN FACT, IS BUILDING A NEW INPATIENT TREATMENT FACILITY. THE CITY OF GRASS VALLEY AND NEVADA CITY OFFER WEEKLY FARMERS MARKETS, MAKING FRESH FOODS AVAILABLE AT AN AFFORDABLE COST TO RESIDENTS. SCHEDULE H, PART V, SECTION B, LINE 16B http://www.dignityhealth.org/sacramento/hospitals/sierra-nevada-memorial-h ospital/patients-and-visitors/patients/billing-information/payment-assista nce SCHEDULE H, PART V, SECTION B, LINE 16I ADDITIONAL MEASURES TAKEN TO PUBLICIZE SNMH'S FINANCIAL ASSISTANCE POLICY INCLUDE THE PROVISION OF BROCHURES EXPLAINING AVAILABLE GOVERNMENT SPONSORED PROGRAMS, A COPY OF THE CHARITY CARE 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, AND THE FACILITY'S WEBPAGE ADDRESS WHERE ADDITIONAL INFORMATION AND APPLICATIONS CAN BE ACCESSED. SCHEDULE H, PART V, SECTION B, LINE 22D PATIENTS WHO ARE APPLYING FOR DISCOUNTS UNDER THE DISCOUNT PROVISION POLICY WHOSE HOUSEHOLD INCOME IS AT OR BELOW 350% OF THE FPL ARE ELIGIBLE TO RECEIVE SERVICES AT THE HIGHEST AVERAGE PAYMENT RATE THE HOSPITAL WOULD RECEIVE FOR PROVIDING SERVICES FROM MEDICARE, MEDICAID, OR ANY OTHER GOVERNMENT SPONSORED HEALTH PROGRAM OR HEALTH BENEFIT IN WHICH THE HOSPITAL PARTICIPATES. PATIENTS WHOSE INCOME IS ABOVE 350% BUT NOT MORE THAN 500% OF THE FPL ARE ELIGIBLE TO RECEIVE SERVICES AT 135% OF THE HIGHEST AVERAGE PAYMENT RATE THE HOSPITAL WOULD RECEIVE FOR PROVIDING SERVICES TO PATIENTS COVERED BY MEDICARE, MEDICAID, OR ANY OTHER GOVERNMENT-SPONSORED HEALTH PROGRAM OF HEALTH BENEFITS IN WHICH THE HOSPITAL PARTICIPATES. 1 GRASS VALLEY SURGERY CENTER 408 Sierra College Drive GRASS VALLEY CA 95945 OUTPATIENT SURGERY CENTER SCH H, Part I, Lines 7 & 7B, column (f) Line 7, column (f) THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) IS $16,706 AND HAS BEEN SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN COLUMN (F). Line 7B, 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. SIERRA NEVADA MEMORIAL HOSPITAL RECOGNIZED FEE-FOR-SERVICE SUPPLEMENTAL PAYMENTS OF $14.6 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, SIERRA NEVADA MEMORIAL HOSPITAL RECORDED A PLEDGE TO A GRANT FUND ESTABLISHED BY CHFT IN THE AMOUNT $0.6 MILLION. THE GRANT IS REPORTED UNDER OTHER BENEFITS (PART I, LINE 7I, COLUMN C), AS CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. SCH H, PART I, LINE 7 FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, SNMMH 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 HOSPITAL 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, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH AND CASH AND IN-KIND DONATIONS. SCH H, PART II - COMMUNITY BUILDING ACTIVITIES ADVOCACY TO IMPROVE THE HEALTH STATUS OF THE UNDERSERVED AND THE QUALITY OF LIFE FOR RESIDENTS IN NEVADA COUNTY IS A PRIORITY. SIERRA NEVADA MEMORIAL HOSPITAL IS INVOLVED IN VARIOUS ORGANIZATIONS TO REPRESENT THE NEEDS OF THE UNDERSERVED, DEVELOP INITIATIVES FOR HEALTHIER COMMUNITIES, AND ENHANCE THE OVERALL ECONOMY OF THE COMMUNITY. SIGNIFICANT VOLUNTEER TIME IS SPENT SERVING THE COMMUNITY IN THIS CAPACITY ON THE BOARDS OF ORGANIZATIONS THAT INCLUDE: -MINERS/WESTERN SIERRA CLINIC -GRASS VALLEY CHAMBER OF COMMERCE -COMMUNITY RECOVERY RESOURCES -ROTARY OF GRASS VALLEY -ROTARY OF NEVADA COUNTY SOUTH -THE FRIENDSHIP CLUB -ELDERCARE PROVIDERS -ECONOMIC RESOURCE COUNCIL THE HOSPITAL ALSO PARTICIPATES IN FUNDRAISING EVENTS TO SUPPORT MEANINGFUL HEALTH IMPROVEMENT PROGRAMS AND SERVICES BY COMMUNITY BASED NONPROFIT ORGANIZATIONS. SCH H, PART III 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. AS NOTED IN PART I, LINE 3B, SNMMH 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. SNMMH 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 25% FOR PATIENTS SEEN. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. SCHEDULE H, PART III, LINE 3 SNMMH MAKES EVERY EFFORT IN DETERMINING IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. SNMMH FOLLOWS DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY. THIS 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 A PATIENT MAY QUALIFY FOR FINANCIAL ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL 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, SNMH DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL 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, 2015, 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 PAYORS, AND OTHERS FOR SERVICES RENDERED. SNMMH 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 SNMMH 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 BELIEVES THAT THE ENTIRE MEDICARE SHORTFALL OF $756 MILLION, 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 DIGNITY HEALTH HOSPITALS 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 $22.5 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 SNMMH. SCHEDULE H, PART III, LINE 9B SNMMH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. SNMMH'S COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE SNMMH OR BILLING COMPANY RETAINED BY SNMMH 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 SNMMH'S FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, SNMMH 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 HOSPITAL PATIENT FINANCIAL ASSISTANCE DEPARTMENT. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, SNMMH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT. Sch H, Part VI, Line 2 - Needs Assessment THE HOSPITAL IS ADDRESSING PRIORITY NEEDS IDENTIFIED IN THE NEEDS ASSESSMENT, FOCUSING ON ACCESS TO CARE AS A PRIORITY NEED AND BY IMPLEMENTING A CHRONIC DISEASE SELF-MANAGEMENT PROGRAM. NEEDS ARE ALSO ASSESSED EACH YEAR WORKING WITH COMMUNITY ORGANIZATIONS DURING OUR COMMUNITY GRANTS PROGRAM. SIERRA NEVADA MEMORIAL HOSPITAL ENGAGED VALLEY VISION, INC. TO CONDUCT AN ASSESSMENT OF THE HEALTH NEEDS OF THE RESIDENTS LIVING IN THE SERVICE AREA. THE ASSESSMENT WAS CONDUCTED FROM EARLY 2012 THOURGH FEBRUARY 2013 USING A MIXED METHOD DATA COLLECTION APPROACH THAT INCLUDED PRIMARY DATA SUCH AS KEY INFORMANT INTERVIEWS, COMMUNITY FOCUS GROUPS, AND COMMUNITY ASSET ASSESSMENTS. SECONDARY DATA INCLUDED HEALTH OUTCOMES, DEMOGRAPHIC DATA, BEHAVIORAL DATA AND ENVIRONMENTAL DATA. SNMMH LEADERSHIP REVIEWED AND COMPARED THE FINDINGS OF THE ASSESSMENT WITH COMMUNITY BENEFIT PROGRAMS AND SERVICES CURRENTLY BEING OFFERED BY THE HOSPITAL AND DETERMINED SNMMH IS RESPONDING TO A NUMBER OF PRIORITY NEEDS. SNMMH LEADERSHIP HAS CONTRUCTED AN ACTION PLAN AND IS WORKING WITH COMMUNITY PARTNERS TO FURTHER ADDRESS THE NEEDS INDENTIFIED IN THE ASSESSMENT. Sch 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 AVAILABLE FROM SNMMH, INCLUDING A CONTACT NUMBER, IS DISSEMINATED BY THE HOSPITAL BY VARIOUS MEANS, INCLUDING THE PUBLICATION OF NOTICES IN PATIENT BILLS AND BY POSTING NOTICES IN THE EMERGENCY AND ADMITTING DEPARTMENTS, CENTRAL LOBBIES, AND WAITING ROOMS. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN BY THE POPULATIONS SERVED BY THE HOSPITAL. IN ADDITION, PAYMENT DISCUSSIONS ARE HELD WITH PATIENTS AT THE TIME OF REGISTRATION AND AGAIN WHEN DISCHARGED. THE PATIENT IS GIVEN A BROCHURE AT THESE TIMES. FINANCIAL ADVISORS ARE ALSO AVAILABLE DURING THE PATIENT'S VISIT. 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 FINANCIAL ASSISTANCE AND THE PROVISION OF SUCH APPLICATIONS. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF THE HOSPITAL REQUIRE ALL INITIAL STATEMENTS TO UNINSURED PATIENTS INCLUDE VERBIAGE INFORMING PATIENTS OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND A COPY OF THE FINANCIAL ASSISTANCE APPLICATION. ANY MEMBER OF SNMMH'S STAFF OR MEDICAL STAFF MAY MAKE REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE. THE PATIENT OR A FAMILY MEMBER, A CLOSE FRIEND OR ASSOCIATE OF THE PATIENT MAY ALSO MAKE A REQUEST FOR FINANCIAL ASSISTANCE. Sch H, Part VI Line 4: - Community Information PRIMARY SERVICE AREA: SIERRA NEVADA MEMORIAL HOSPITAL IS IN NEVADA COUNTY ENCOMPASSING THREE ZIP CODES IN THE COMMUNITIES OF GRASS VALLEY, PENN VALLEY AND NEVADA CITY. POPULATION: POPULATION WITHIN SIERRA NEVADA MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA IS 99,000; A LARGE PERCENTAGE WHO ARE RETIRED. WITHIN THE HOSPITAL'S PRIMARY SERVICE AREA, PEOPLE BETWEEN THE AGES OF 35 AND 64 MAKE UP THE LARGEST PERCENTAGE OF THE POPULATION (44.4%). OVER 16% OF THE POPULATION IS BETWEEN 18 AND 34 YEARS OF AGE. CHILDREN AGE 17 AND YOUNGER MAKE UP 18.8% OF THE POPULATION, AND SENIORS 65 YEARS AND OLDER ACCOUNT FOR NEARLY 20.6% OF THE POPULATION. GROWTH IN THE SENIOR POPULATION IS ANTICIPATED IN THE FUTURE. OVER HALF OF THE POPULATION IS FEMALE. ETHNICITY: THE MAJORITY OF THE POPULATION IN SIERRA NEVADA MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA IS CAUCASIAN (87.7%). SOME GROWTH IS EXPECTED IN THE HISPANIC COMMUNITY. IN THE 2009 OSHPD DATA, 9% OF ITS RESIDENTS LIVE BELOW THE POVERTY LINE. 19.71% RECEIVE MEDICARE, 10.95% RECEIVE MEDICAL, 16.71% ARE UNINSURED AND 52.62% ARE SELF-PAID (12.97% RISK AND 39.64% NON-RISK). SIERRA NEVADA MEMORIAL HOSPITAL IS THE COMMUNITY'S SOLE HEALTHCARE PROVIDER. THE NEAREST HOSPITAL IS SUTTER AUBURN FAITH WHICH IS 22 MILES AWAY. PRIMARY CARE AND MENTAL HEALTH SERVICES HAVE BEEN FEDERALLY DESIGNATED AS MEDICALLY UNDERSERVED AREAS. Sch H, Part VI, Line 5 - Promotion of Community Health SIERRA NEVADA MEMORIAL HOSPITAL OFFERS MEDICAL STAFF PRIVILEGES TO ANY QUALIFYING PHYSICIANS. THE HOSPITAL'S COMMUNITY BOARD SERVES IN AN OVERSIGHT ROLE TO ENSURE THAT COMMUNITY BENEFIT PRACTICES AND PROGRAMS ARE ALIGNED WITH AND SUPPORT THE MISSION, POLICY AND PRIORITIES OF THE REGION AND THE ORGANIZATION. THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY RESIDES IN THE PRIMARY SERVICE AREA AND IS NOT EMPLOYED BY NOR CONTRACTED WITH THE ORGANIZATION. SNMMH UTILIZES A COMMUNITY NEEDS ASSESSMENT PROCESS THAT RESULTS IN A DOCUMENT DESCRIBING THE HEALTH CARE NEEDS OF THE SURROUNDING POPULATION. IN ADDITION A COMPANION DOCUMENT LISTING COMMUNITY HEALTH ASSETS IS PREPARED AND THEN COMPARED TO THE NEEDS ASSESSMENT. UNMET NEEDS ARE IDENTIFIED AND USED IN PLANNING FOR PHYSICIAN RECRUITMENT, ADDING NEW SERVICES AND PROGRAMS, AND OFFERING COMMUNITY EDUCATION. SIERRA NEVADA MEMORIAL HOSPITAL SPECIFICALLY SPONSORS AND TAKES AN ACTIVE ROLE IN PROGRAMS THAT ADDRESS PRIORITIES WITHIN ITS SERVICE AREA SUCH AS: - CHAMP (CONGESTIVE HEART ACTIVE MANAGEMENT PROGRAM) THAT PROVIDES A VITAL MEDICAL LINK TO HEART FAILURE PATIENTS WHEN THEY LEAVE THE HOSPITAL TO IMPROVE THEIR UNDERSTANDING AND ABILITY TO MANAGE THIS CHRONIC DISEASE, AND REDUCE THEIR RISK OF READMISSION. -FREE OR DISCOUNTED CARDIAC REHAB PROGRAMS TO THOSE WHO ARE UNABLE TO PAY AS A COMPLEMENTARY PROGRAM TO CHAMP. - WELLNESS EDUCATION PROGRAM THAT OFFERS A WIDE VARIETY OF FREE OR DISCOUNTED CLASSES ADDRESSING HEALTH ISSUES INCLUDING DIABETES, CHRONIC DISEASE SELF-MANAGEMENT, SMOKING CESSATION, AGING, HEALTHY COOKING, AND PRENATAL CARE. - FREE NUTRITIONAL COUNSELING BY A REGISTERED DIETICIAN FOR THOSE THAT ARE UNINSURED OR CAN'T AFFORD TO PAY. - FREE OR LOW COST LAB TESTING FOR ALL IN THE COMMUNITY, WITH AN EMPHASIS ON POOR AND VULNERABLE. - ASSISTANCE TO ALZHEIMER'S PATIENTS AND THEIR CAREGIVERS/FAMILIES BY THE HOSPITAL'S HOME CARE DEPARTMENT. - CANCER SCREENINGS AND CANCER SUPPORT GROUPS. - TRAUMATIC BRAIN INJURY, STROKE AND OTHER SUPPORT GROUPS. - EDUCATIONAL TRAINING FOR THOSE ENTERING THE PROFESSIONAL AND MEDICAL HEALTH FIELD. SIERRA NEVADA MEMORIAL HOSPITAL ALSO PROVIDES ASSISTANCE TO UNINSURED PATIENTS FOR ENROLLMENT IN GOVERNMENT SPONSORED HEALTH INSURANCE PROGRAMS, AND FREE TRANSPORTATION TO THOSE IN NEED. Sch H, Part VI, Line 6 - Affiliated Health Care System SNMMH is affiliated with Dignity Health. Affiliates of Dignity Health 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, 2015, is as follows: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 155,869 144,043,000 1.2% Unpaid Costs of Medicaid/Medi-Cal 1,529,842 582,988,000 4.9% Other Means-tested Programs 269,823 9,201,000 0.1% Community Services: Community Health Services 376,686 41,756,000 0.3% Health Professions Education 79 3,000 0.0% Subsidized Health Services 96,294 24,872,000 0.2% Donations 123,504 36,533,000 0.3% Community Building Activities 7,795 1,818,000 0.0% Community Benefit Operations 143 7,124,000 0.1% Total Community Services for the poor 604,501 112,106,000 0.9% Total Benefits for the Poor 2,560,035 848,338,000 7.1% Benefits for the Broader Community: Community Services: Community Health Services 278,419 12,046,000 0.1% Health Professions Education 27,306 67,915,000 0.6% Subsidized Health Services 3,641 1,441,000 0.0% Research 14,806 10,910,000 0.1% Donations 31,341 8,662,000 0.1% Community Building Activities 7,583 3,822,000 0.0% Community Benefit Operations 31 1,333,000 0.0% Total Benefits for the Broader Community 363,127 106,129,000 0.9% Total Community Benefits 2,923,162 954,467,000 8.0% Unpaid Costs of Medicare 1,042,065 756,109,000 6.3% Total Community Benefits including Cost of Medicare 3,965,227 1,710,576,000 14.3% true California Health Foundation and Trust 1215 K Street Suite 800 Sacramento CA 95814 941498697 501(c)(3) 563051 0 N/A N/A Community Health Sierra Nevada Hospital Foundation 140 Litton Drive Grass Valley CA 95945 680005939 501(c)(3) 591058 N/A N/A Foundation Support Dignity Health Medical Foundation 3400 Data Drive Rancho Cordova CA 95670 680220314 501(c)(3) 4257508 N/A N/A Medical Fnd Support 3 0 Part I, line 2 The organization's CFO reviews financial information monthly and approves the grant payment based on that review. The grants to the foundation are based on actual expenses, not to exceed the approved budget. false true false false false false false false false Kevin Vaziri Board Member 0 325589 0 204626 0 10220 0 44385 0 36654 0 621474 0 0 Katherine A Medeiros CEO/ Service Area Leader 0 290607 0 167652 0 14620 0 39560 0 35918 0 548357 0 0 Carolyn Canady CFO/Board Treasurer 188302 0 27135 0 0 0 14945 0 11442 0 241824 0 0 0 Brian Evans VP, CMO 226083 0 22116 0 1109 0 17126 0 32271 0 298705 0 0 0 Jill McWilliams VP/CNE 180243 0 25718 0 0 0 14211 0 21379 0 241551 0 0 0 Debbie L Plass VP Operations 142215 0 20478 0 0 0 11390 0 20335 0 194418 0 0 0 Timothy Stephens VP Ancillary Services 108612 0 19657 0 27965 0 8988 0 27573 0 192795 0 0 0 Gregory T Smith Registered Nurse 233509 0 375 0 9293 0 16698 0 30504 0 290379 0 0 0 Jonathan D Stone Director of Pharmacy 171404 0 18391 0 0 0 13127 0 19122 0 222044 0 0 0 William S Swindling Pharmacist 161466 0 3316 0 0 0 11370 0 1125 0 177277 0 0 0 Tzvetan I Tzvetanov Physicist 254870 0 8751 0 12 0 18362 0 2695 0 284690 0 0 0 Gail A Van Vleck Charge Nurse IP/OP Surgery 174632 0 375 0 0 0 12248 0 20838 0 208093 0 0 0 PART I, LINE 3 SCHEDULE J, 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 SERVICE AREA LEADER'S COMPENSATION. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A FOR ADDITIONAL INFORMATION PART I, LINE 4a SCHEDULE J, PART I, LINE 4A THE ORGANIZATION'S KEY EMPLOYEES, CERTAIN OFFICERS AND HIGHLY COMPENSATED EMPLOYEES PARTICIPATE IN A SEVERANCE PLAN THAT PROVIDES MARKET-STANDARD COMPENSATION PAYMENTS OF UP TO 6 MONTHS 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 2014. PART I, LINE 4b CERTAIN LISTED PERSONS are eligible to participate in one of two 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 2014. 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 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. A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521598225 13033FTN0 2004-05-19 150000000 BOND A: CUSIP 13033FTN0-SEE PRT VI false false true B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033FYE4 2005-11-10 200000000 BOND B: CUSIP 13033FYE4-SEE PRT VI false false true A 0 0 2000000 0 0 0 0 0 0 2000000 0 0 2005 false false true true B 0 0 2334365 0 0 0 0 0 0 2334365 0 0 2008 false false true true A false true true true true true 0.00100 0.00300 0.00400 false false 0.00000 false true B false true true true true true 0.00100 0.00300 0.00400 false false 0.00000 false true A false false false true true false 0 false 0 true true B false false false true true false 0 false 0 true true A true B true BOND A: CUSIP 13033FTN0 PART I, COLUMN (C) THE CHFFA 2004 SERIES J BONDS WERE EXCHANGED IN NOVEMBER 2009 FOR THE CHFFA 2009 SERIES H BONDS IN AN EXCHANGE PURSUANT TO NOTICE 2008-41 THAT WAS NOT TREATED AS A NEW ISSUANCE FOR PURPOSES OF SECTIONS 103 AND 141-150 OF THE INTERNAL REVENUE CODE. PART I, COLUMN (E) THE DIFFERENCE BETWEEN THE ISSUE PRICE IN PART I, COLUMN (E) AND PART II, LINE 3 IS PRIMARILY A RESULT OF THE fact that the COMPOSITE BOND ISSUE WAS A POOLED FINANCING ISSUE. THE FULL ISSUE PRICE OF WHICH IS SHOWN IN PART I, COLUMN (E). IN COMPARISON, THE AMOUNT OF PROCEEDS SHOWN IN PART II, LINE 3 REFLECTS ONLY THE PORTION OF THE BOND ISSUE BORROWED BY SIERRA NEVADA HOSPITAL AND CURRENTLY OUTSTANDING. A SMALL PART OF THE DIFFERENCE BETWEEN THE ISSUE PRICE AND PROCEEDS IS DUE TO INVESTMENT EARNINGS. PART I, COLUMN (F) FINANCE ACQUISITION OF MEDICAL EQUIPMENT AND CONSTRUCTION AND RENOVATION OF HOSPITAL FACILITIES. PART II, LINE 3 IN MAY 2013, ALL OF THE LOANS ORIGINATED WITH PROCEEDS OF THE BONDS MATURED AND WERE REPAID TO THE ISSUER. OF SUCH REPAYMENTS, SIERRA NEVADA MEMORIAL HOSPITAL BORROWED THE SUM OF $2,000,000 TO FINANCE THE CONSTRUCTION/RENOVATION OF FACILITIES AND THE ACQUISITION OF MEDICAL EQUIPMENT AT VARIOUS HOSPITALS. ALTHOUGH THE FACILITIES ORIGINALLY FINANCED WITH PROCEEDS OF THE BONDS WERE SUBSTANTIALLY COMPLETED IN THE YEAR INDICATED, REPAYMENTS OF THE LOANS ORIGINATED WITH PROCEEDS OF THE BONDS WERE AND/OR WILL BE RECYCLED INTO NEWLY ORIGINATED LOANS CONTINGENT ON DEMAND BY PARTICULAR BORROWERS AT THE TIME OF A LOAN REPAYMENT. COMPLETION DATES OF PROJECTS FINANCED OR TO BE FINANCED WITH SUCH RECYCLED AMOUNTS ARE NOT INDICATED. PART IV, LINE 2C THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 6/30/2015. BOND B: CUSIP 13033FYE4 PART I, COLUMN (E) THE DIFFERENCE BETWEEN THE ISSUE PRICE IN PART I, COLUMN (E) AND PART II, LINE 3 IS PRIMARILY A RESULT OF THE fact that the COMPOSITE BOND ISSUE WAS A POOLED FINANCING ISSUE. THE FULL ISSUE PRICE OF WHICH IS SHOWN IN PART I, COLUMN (E). IN COMPARISON, THE AMOUNT OF PROCEEDS SHOWN IN PART II, LINE 3 REFLECTS ONLY THE PORTION OF THE BOND ISSUE BORROWED BY SIERRA NEVADA HOSPITAL AND CURRENTLY OUTSTANDING. A SMALL PART OF THE DIFFERENCE BETWEEN THE ISSUE PRICE AND PROCEEDS IS DUE TO INVESTMENT EARNINGS. PART I, COLUMN (F) FINANCE ACQUISITION OF MEDICAL EQUIPMENT AND CONSTRUCTION AND RENOVATION OF HOSPITAL FACILITIES. PART IV, LINE 2C THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFOMED ON 1/28/2014. FORM 990, PART VI, VII, XI and XII FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SOLE CORPORATE MEMBER, DIGNITY HEALTH, A 501(C)(3) EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER CAN ELECT ONE MEMBER AND APPOINT TWO OTHER MEMBERS IF NOMINATED BY THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B RESERVED RIGHTS OF THE CORPORATE MEMBER 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 THE ORGANIZATION'S CFO REVIEWED THE FORM 990. IN ADDITION, IN THE PROCESS OF PREPARATION, THE FORM 990 WAS REVIEWED BY FINANCE AND ACCOUNTING (REGIONAL DIGNITY HEALTH MANAGEMENT AND CORPORATE TAX DEPARTMENT), WHICH WORKED CLOSELY WITH AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN. DUE TO TIMING, THE FORM 990 WILL BE SHARED WITH THE ORGANIZATION'S BOARD SUBSEQUENT TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. Under such policies, the EVP/General Counsel is responsible for collecting, reviewing and validating annual disclosures of all covered persons (i.e., Board and Board Committee members, officers and executive leadership, key employees, management personnel at the vice president level and above, and any other personnel at his or her discretion). All covered persons are required to disclose real or potential conflicts arising from the business, financial and personal interests held by such covered persons or their family members. Covered persons are required to disclose to their superiors and to relevant decision makers any interest that may present a conflict, 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, and annually thereafter. Each covered person is required to certify at least annually that he/she: (1) has received a copy of the policy applicable to his/her position; (2) has read the policy and understands said policy; and (3) agrees to comply with all requirements of the policy, including completing the conflicts of interest disclosure statement as required by the policy. The President/CEO and EVP/General Counsel prepare annual reports of reported conflicts of interest, which are provided to the Board of Directors, Committee Chairs, and key leaders of the organization to enable 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 include, but are not limited to, the following: (1) the conflicting interest is fully disclosed to the Board of Directors; (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 is excluded from the discussion and 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 persons, consistent with any requirements of bylaws or policies; and (6) any conflicting issues arising during the course of a board meeting which cannot be resolved may be referred to an independent committee of the Board of Directors. There are similar conflicts of interest provisions under the 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 SERVICE AREA LEADER IS COMPENSATED BY DIGNITY HEALTH. FOR 2014, 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 COMPENSATION OF OTHER OFFICERS AND 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 SNMMH. 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 AND CONFLICT OF INTEREST POLICY BE MADE AVAILABLE FOR PUBLIC INSPECTION. FORM 990 AND THE COPY OF AUDITED FINANCIAL STATEMENTS ATTACHED TO IT ARE MADE AVAILABLE UPON REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE ALSO AVAILABLE ON OUR WEBSITE. FORM 990, PART XI, LINE 9 EARNINGS FROM EXEMPT CORPORATION; 65,051 INTEREST IN NET ASSETS OF AN UNCONSOLIDATED FOUNDATION; (1,015,866) REFUND OF PRIOR YEAR GRANT EXPENSE; 50,000 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:MEDICAL SERVICES TOTAL FEES:7610357 FORM 990 PART IX LINE 11G DESCRIPTION:REVENUE CYCLE SERVICES TOTAL FEES:5998077 FORM 990 PART IX LINE 11G DESCRIPTION:INTERCOMPANY ASSESSMENT TOTAL FEES:4151431 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER TOTAL FEES:6777047 Sierra Nevada Memorial Hospital Fdtn 140 Litton Drive Grass Valley CA 95945 680005939 Fundraising CA 501(c)(3) 11;type 3 NA false Dignity Health 185 Berry Street San Francisco CA 94107 941196203 Hospital CA 501(c)(3) 3 NA false false true true false false false false false false false false true false false true false false true NA