2016-05-04T11:21:16-05:00 2014-12-31 910189318 Moss Adams LLP 3121 W March Ln Ste 200 Stockton CA 952192367 990 2014-01-01 941201197 Dameron Hospital Association DAME 2099445550 525 West Acacia Street Stockton CA 95203 Lorraine Auerbach President/CEO 2099445550 2016-05-04 1 Tracy S Paglia P00366884 2099556100 2016-05-04 2014 2016-08-17 19:52:53Z Lorraine Auerbach 525 West Acacia Street Stockton CA 95203 206362682 0 X www.dameronhospital.org X 1912 CA We support physicians and our employees in providing quality care in a safe, caring environment. 8 6 1130 60 126053 0 135000 260 189459429 184625035 803207 219715 77152 175722 190474788 185020732 0 0 0 0 92388352 87162772 0 0 0 110738792 97861095 203127144 185023867 -12652356 -3135 152203396 154281475 28691272 29560088 123512124 124721387 X We support physicians and our employees in providing quality care in a safe, caring environment. 0 0 169087248 0 184595880 Dameron Hospital Association is a non-profit facility providing a full emergency and acute care.Dameron exists solely to serve the healthcare needs of the surrounding communities, providing advanced technology and state-of-the-art diagnostic and therapeudic equipment, as well as facilities for inpatient, outpatient and occupational patient care.Hospital services include cardiology, orthopedics, neonatology, bariatrics, emergency/urgent care, imaging services, occupational health care.Beginning with its founder, Dameron Hospital has continued an uncompromised approach to patient care and health care attitudes believing not only in serving the community but being a part of it. The hospital offers outreach and scholarship programs through young scrubs and preceptor programs for young nurses.The mission is to support the physicians and employees in providing quality patient care in a safe and caring environment. The vision is to be the hospital that physicians prefer, patients request and employees choose. 169087248 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 114 0 1 1130 1 1 1 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X Lorraine Travis-Brown 2099445550 525 W Acacia St Stockton CA 95203 Lorraine Auerbach President/CEO 40.00 X X 932294 0 10303 William Trezza Chairman of the Board 10.00 X X 0 0 0 Dan Dixon Secretary/Treasurer 10.00 X X 0 0 0 Philip Ruhl Director 10.00 X 24000 0 0 Robert Lawrence Director 10.00 X 0 0 0 Brian Martucci Director 10.00 X 0 0 0 Hon Ron A Northup Director 10.00 X 0 0 0 Gary Giannini Director 10.00 X 0 0 0 Elizabeth Propp VP of Finance, CFO 40.00 X 393239 0 6840 Michael Glasberg VP of Operations, COO 40.00 X 350313 0 5459 Janine Hawkins VP of Patient Care Services, CNO 40.00 X 347356 0 24117 David Kerrins VP of Information Services, CIO 40.00 X 278255 0 10335 Bradley Reinke VP of Medical Affairs, CMO 40.00 X 259600 0 0 William Chase Director of Finance (Through 4/2014) 40.00 X 282863 0 5499 Chad Davis RN Manager - Surgery 40.00 X 229257 0 12999 Terrance Thomas Registered Nurse 40.00 X 218566 0 17219 Shawn Fillon Registered Nurse 40.00 X 202147 0 11844 Maria Villarreal Assistant Nurse Manager 40.00 X 188375 0 16646 Christopher Arismendi Former CEO (Through 10/2012) 0.00 X 300000 0 0 Cyrus Dah Former CFO (Through 12/2012) 0.00 X 162500 0 0 Nicholas Arismendi Former COO (Through 7/2013) 0.00 X 243750 0 0 4412515 0 121261 280 1 1 0 CPS LLC P O Box 638316 Cincinnati OH 45263 Pharmacy Services 4995754 Sound Physicians P O Box 742936 Los Angeles CA 90074 Hospitalist Services 2085332 Emerald Health Services 1801 W Olympic Blvd File 1471 Pasadena CA 91199 Registry Nurse Staffing 1483573 Rehab Practice Management 9364 Ansley Avenue Brentwood TN 37027 Rehabilitation Services 1148427 Dialysis & Pheresis Technologies P O Box 692312 Stockton CA 95269 Renal Dialysis Services 787784 23 260 260 Patient Service Rev. 621110 102439693 102439693 Medical/Medicare Pymts 621110 58540234 58540234 Hospital Fee 621110 22069064 22069064 Cafeteria 722210 941510 941510 Rebates/Refunds 621110 174643 174643 459891 459891 184625035 1310779 1310779 141974 106495 35479 35479 35479 18232142 1200 19324406 0 -1092264 1200 -1091064 -1091064 1878920 1911049 -32129 -29155 -2974 Income from K-1 541900 129027 129027 Other Income 900099 43345 43345 172372 185020732 184595880 126053 298539 X 2642111 50173 2591938 706250 706250 59595196 57608640 1986556 2116372 1996026 120346 16443475 15392200 1051275 5659368 5322689 336679 3249772 2325039 924733 1505623 1505623 293466 293466 103533 103533 46890 46890 23723148 19607078 4116070 29304698 28805875 498823 8408090 8408090 1624547 1504584 119963 107813 35300 72513 143775 112952 30823 86892 86892 7970383 7970383 1224066 1224066 Medi-cal Hospital Fee E 14549983 14549983 Bad Debts Provision 5273025 5273025 Dues & Subscriptions 241519 38319 203200 3872 3872 185023867 169087248 15936619 0 4400 3901 3119095 1573755 30328979 33783195 894878 689212 3315455 3184513 3302000 2222653 180118001 121871228 58376820 58246773 40114742 35234701 5142421 5244467 7604606 14098305 152203396 154281475 15890532 17309013 203503 0 2424854 1961338 10172383 10289737 28691272 29560088 X 123174007 124382218 338117 339169 123512124 124721387 152203396 154281475 -3135 1212398 0 X 0 1 X 1 0 X 1 103533 103533 0 Part II-B, Line 1: DUES PAID TO CALIFORNIA HOSPITAL ASSOCIATION ARE CONSIDERED TO BE FOR LOBBYING ACTIVITIES. 4268040 4268040 1995756 79840272 47321647 34514381 1560764 999365 561399 84944337 70118833 14825504 7508832 3431383 4077449 58246773 Other Receivables 2078161 Cost Report Settlement Receivable 10816108 Deferred Compensation Fund 898314 Accrued Interest on Investments -49488 Due from Medical Group 355210 14098305 Risk Management Programs 7700447 Retiree Medical Liability 2589290 10289737 182921491 1212397 2012149 3224546 179696945 46890 5276897 5323787 185020732 181712229 2012149 2012149 179700080 46890 5276897 5323787 185023867 Part XI, Line 2d - Other Adjustments: Pharmacy Expenses netted against revenue on F/S 1,911,049. Rental Prop Depreciation netted against revenue on 990 101,100. Part XI, Line 4b - Other Adjustments: Provision for Bad Debts netted against revenue on F/S 5,273,025. Foundation Expenses netted against revenue on F/S 3,872. Part XII, Line 2d - Other Adjustments: Pharmacy Expenses netted against revenue on F/S 1,911,049. Rental Prop Depreciation netted against revenue on 990 101,100. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts netted against revenue on F/S 5,273,025. Foundation Expenses netted against revenue on F/S 3,872. 1 1 1 X 350.000000000000 1 X 1 1 0 1 1 1148943 1148943 0.00620 50836262 25938996 24897266 0.13460 51985205 25938996 26046209 0.14080 190204 190204 0.00100 11724 11724 0.00010 149440 149440 0.00080 351368 351368 0.00190 52336573 25938996 26397577 0.14270 4 62510 62510 0.00030 1 2000 2000 0.00000 1 25000 25000 0.00010 3 30415 30415 0.00020 2 70279 70279 0.00040 3 161164 161164 0.00090 14 351368 351368 0.00190 1 5273025 527303 47602700 55939233 -8336533 X 1 1 1 1 Dameron Hospital Association 525 West Acacia Street Stockton CA 95203 www.dameronhospital.org 030000024 X X X Dameron Hospital Association 1 0 0 1 X X X X X X 13 1 1 0 1 X www.dameronhospital.org X www.healthiersanjoaquin.org 1 13 1 www.dameronhospital.org 0 0 1 X 350.000000000000 350.000000000000 X 1 1 X X 1 X www.dameronhospital.org X www.dameronhospital.org X X 1 0 X X 1 X 0 0 Dameron Hospital Association Part V, Section B, Line 5: A community-based participatory research orientation was used to conduct the assessment, which included both primary and secondary data. Primary data collection included input from more than 180 members of the hospital service area (HSA), expert interviews with 45 key informants, and focus group interviews with 137 community members. Further input was gathered at meetings of the healthier community coalition and the annual community health forum, held in November 2012. In addition, a community health assets survey collected basic information for more than 300 assets in the greater San Joaquin County area.Secondary data included health outcome data, socio-demographic data, and behavioral and environmental data at the zip code or census tract level. Health outcome data included emergency department (ED) visits, hospitalization, and mortality rates related to heart disease, diabetes, stroke, hypertension, chronic obstructive pulmonary disease, asthma, and safety and mental health conditions. Socio-demographic data included race and ethnicity, poverty (female-headed households, families with children, people over 65 years of age), educational attainment, health insurance status, and housing arrangement (own or rent). Behavioral and environmental data such as crime rates, access to parks, availability of healthy food, and leading causes of death helped describe the general living conditions in the HSA. Dameron Hospital Association Part V, Section B, Line 6a: - St. Joseph's Medical Center- Lodi Memorial Hospital- Sutter Tracy Community Hospital- Kaiser Permanente Dameron Hospital Association Part V, Section B, Line 11: Working with other participants of the SJC2HAC Health Needs Assessment, Dameron concentrated on thethree primary health needs among the seven identified which most closely aligned with its mission and organizational capabilities. Dameron Hospital community benefit personnel then developed an implementation plan to address these needs. Although strategies to address the remaining four identified health needs were not included in the plan, Dameron will address these as secondary priorities through other hospital programs and activities. Dameron Hospital Association Part V, Section B, Line 13h: UNINSURED DISCOUNT. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Dameron Hospital Association Part V, Section B, line 16a website: www.dameronhospital.org Dameron Hospital Association Part V, Section B, line 16c website: www.dameronhospital.org Part I, Line 7: The Bad Debt expense included on Form 990, Part IX, Line 25(A), but subtracted for purposes of calculating the percentage in this column is $5,273,025. Part II, Community Building Activities: * Community support- Dameron Hospital contributes to increasing health literacy by providing educational materials with pictorial and plain language information at all of our Community events and Health fairs.- "Books for Babies" is supported by our Volunteers who are associated with Tau Chapter of Delta Kappa Gamma (UOP Educators sorority). On a monthly basis,books are assembled both in English and Spanish. and a plentiful supply for all new mothers is available on the Mother Baby Unit. This service is associated with San Joaquin County Healthier Community Coalition, which focuses on increasing reading literacy in our community. Dameron Hospital supplies the books necessary to maintain this important program.- Free Interpreter Services for patients and their designated support person- Taxi/bus transportation to and from the Hospital/Clinic, if needed.* Leadership development and training for community membersLeadership Stockton is a program designed to inspire a new generation of men and women to assume leadership roles in the community. The nine-month program challenges and prepares individuals from diverse backgrounds to become influential in the region's future. To develop educated and motivated community leader participants are exposed to civic, civil, education, healthcare and non-profit entities. Participants heard from area healthcare leaders about the current and future state of healthcare. Michael Glasberg, Dameron Hospital's Chief Operating Officer and Vice-President of Operations, presented on behalf of Dameron Hospital. The roundtable discussion enabled participants to learn about hospital and healthcare facilities located throughout Greater Stockton community. A question and answer period concluded the forum.* Coalition buildingDameron Hospital is an active participant in the San Joaquin County Healthier Community Coalition. The purposes of the Coalition are: a) to provide leadership in the development and coordination of health status improvement efforts in San Joaquin County; b) to provide a forum for health services stakeholders to share ideas and information about projects and seek collaborative partners; and c) to work collaboratively and encourage the efforts of other collaborative attempting to respond to community health issues and problems. Currently we are collaborating on creating a 211 all inclusive help for all referral services. Dameron staff have co-chaired this Coalition and have participated in key leadership roles since 2011.*Community health improvement advocacyDameron has provided TB testing to Fire Department personnel, and has offered flu shot clinics in the community. In addition, Dameron's Linacia pharmacy has provided pharmaceuticals at no cost to a number of indigent patients.* Workforce developmentDecision Medicine is a two-week program, sponsored by San Joaquin Medical Society, is designed to introduce high school students to the field of medicine through personal mentoring opportunities and site visits with behind-the-scenes access to some of our regional hospitals, clinics and public health centers. Decision Medicine 2014 took place at various locations in Northern California, including hospitals, various clinics and inside actual private offices of participating physicians in San Joaquin County. Decision Medicine 2014 at Dameron Hospital was a full eight-hour day including student interactive tours into the Core Laboratory, the Pathology Laboratory, American Medical Response ambulance tour, and a tour of the Hospital Data Center; didactic lectures on Basic Hematology & Comparative Cellular Morphology and Forensic Pathology; and hands-on laboratory exercises for Phlebotomy, Blood Specimen Preparation, Blood Smear Technique, Differential Staining Technique, Blood Smear Examination by Light Microscopy, and Blood Typing. In addition, students were provided an individual Complete Blood Analysis (CBC), a preliminary ABO blood group determination, historical information about Dameron Hospital and career information in pathology and laboratory medicine. Twenty-seven students were hosted at Dameron Hospital which included lunch and refreshments throughout the day. The Director of Risk Management coordinates this Program for Dameron Hospital which includes a Board Member, the Chief Information Officer, a Hospital Administrator, the Laboratory Medical Director, the Laboratory Manager, several Clinical Laboratory Scientists, the Patient Relations Coordinator, and the Employee Relations Coordinator. Also, Dameron Hospital entered into an agreement whereby the Hospital has extended an income guarantee to a physician in exchange for the doctor providing services in the Hospital's service area. Payments under the guarantee began being forgiven in August of 2012 and continued over 24 months. The payments forgiven in 2014 amounted to $59,765.* Other community building activityDameron Hospital is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide Continuing Medical Education for physicians. Classes are offered at noon on Fridays (excluding Holidays and the months of July and August) in the hospital's Annex building. The classes are open to all physicians throughout the community. Dameron provided 25 continuing medical education classes throughout 2014 and will continue to provide Continuing Medical Education Classes in 2015. A total of 786 medical professionals attended the classes in 2014; and 140 other healthcare professionals. Dameron Hospital also provides staff, volunteer time, and meeting room space for community programs and organizations throughout San Joaquin County:- NICU and Bariatric support groups- US Coast Guard Coalition- Healthier Community Coalition- Alpha Phi Chapter of Chi Eta Phi Nursing Society - Health and Wellness Family Festival at Lodi Lake- ACNL- Flu Shot Clinics- Narcotic Anonymous- TB tests Stockton Fire Dept.- AAUW (Am Assoc of University Women)- Champions for Change: Network for a Healthy California- Lamaze Prepared Childbirth- Chi Eta Phi Sorority Meeting - The Record's Literacy and Book Fair - Family Fun Day in the Park - Healthy Highway- Healthy Lifestyles - No. California Stroke Coord. Meeting - California Emergency HAM volunteers- NICU Support Group- Decision Medicine- Bariatric Support Group- Breastfeeding Coalition- California Society for Healthcare Engineering Part III, Line 4: The organization determines the amount that could be attributable to patients who likely would qualify for financial assistance under the hospital's financial assistance policy based upon a query of the collections system (Golden State Collections) - 10% of estimated bad debt expense.Any discounts and/or payments applied to a patient's account are not reversed before writing the account off to bad debt. In other words, the net balance of the account is what's written off.Bad debt expense is not included as a community benefit in the hospital's community benefit report.Bad Debt expense footnote - See audited financial statements, page 5, footnote 1, Patient accounts receivable and Allowance for uncollectible accounts sections. Part III, Line 8: If Medicare does not reimburse our costs for patient care, the excess of cost over reimbursement should be considered a benefit to the community we serve.Medicare uses the Medicare cost report program in computing the cost in providing medical care services for Medicare beneficiaries. The Medicare cost report calculates routine costs using per diem methodolgy and the ancillary cost is calculated using cost to charge ratios. Part III, Line 9b: The account automatically sets a follow-up date for the collector to work. When the collector works the account, the collector determines the collectibility of the account. This can be determined through contact with the patient, patient's personal financial statement, employment status, CBI credit reports, property listings, skip tracing, etc. Part VI, Line 2: Dameron Hospital is a member of the San Joaquin County Community Health Assessment Collaborative (SJC2HAC), which is responsible for producing and releasing, every three years, the Healthier San Joaquin County Community Assessment. Federal and state laws require that not-for-profit hospitals conduct a Community Health Needs Assessment (CHNA) every three years. Based on the results of this assessment, an implementation Plan is developed detailing how the community needs will be addressed. This plan is submitted annually to both the California Office of Statewide Health Planning and Development (OSHPD) and the Internal Revenue Service. In accordance with these legislative requirements, Dameron Hospital, in collaboration with other members of The (SJC2HAC) conducted an assessment of the community they serve, which encompasses all of San Joaquin County. The CHNA was conducted over eight-months and was led by Valley Vision, Inc., a non-profit community consulting organization dedicated to improving the quality of life for residents across Northern California. The most recent SJC2HAC assessment was released in March 2013. The assessment is used to: inform and engage local stakeholders and community members, promote collaborative efforts based on data, solicit community input and obtain group consensus in order to improve the health of our community. Part VI, Line 3: Dameron Hospital encourages its uninsured and partially insured patients to apply for financial assistance programs. A financial counselor is available on site to assist patients through the process of determining programs for which they may qualify. Signage in English and Spanish is posted in the hospital registration areas to provide patients with financial assistance program information. The financial counselor provides assistance with programs such as MediCal, Victims of Crime, Hospital Uninsured Discount, Hospital Charity and County MIAP, etc. Part VI, Line 4: San Joaquin County is one of the original counties of California, created in 1850 and is located in the Central Valley of Northern California; home to approximately 700,000 residents. The County seat is Stockton, the largest incorporated city in the county and is home to almost half of the county's residents. San Joaquin has a rich agricultural presence and is known for its asparagus, strawberries, almonds, cherries, and other abundant crops. The racial and ethnic makeup of county residents includes Whites (68.7%), African American (8.2%), and Native American 2.0%), Asian (15.5%), Pacific Islander (0.7%), and two or more races (4.9%). Hispanic or Latino origin includes (39.4%). According to the US Census (2011), almost 40% of all county residents speak a language other than English at home, and nearly one in four over the age of 25 does not have a high school diploma. San Joaquin County offers its residents affordable housing, abundant recreational facilities, excellent educational opportunities, and diverse cultural resources. As the northernmost county in the Central Valley, San Joaquin County includes the cities of Stockton, Lathrop, Lodi, Manteca, Ripon, Tracy, and Escalon, as well as numerous planned communities, census-designated areas, small towns and unincorporated areas. The U.S Census Bureau anticipates that San Joaquin County's population will reach 789,000 by 2020. Population change by ethnicity will also affect San Joaquin County; the largest increase over the next thirty years will come from an estimated 104.6% increase in the Hispanic/Latino population and the white population will decrease by 8.7%. This represents a significant shift in San Joaquin County demographics. In 2013, unemployment for the county was 14.4% compared to the state rate of 10.1%. San Joaquin County earned a nation-wide reputation for its high number of home foreclosures; in 2013, 22% of all homes were in some stage of foreclosure compared to the state rate of 14% and national rate of 12%. According to the U.S. Department of Urban Housing and Development (HUD), San Joaquin County's median household income has increased 39% over the last decade, reaching $63,100 in 2010; despite this increase, the County's median household income was lower than the median household income in the United States ($64,000), and in California ($71,000). It is important to note that a greater percentage of the San Joaquin County population lives below federal poverty levels compared to the rest of the state of California. HUD projected that San Joaquin County's 2012 median household income was $66,300. The 2010 Census showed that people aged 60 and older now make up 15% of the population. The 2010 Census also shows people under the age of 20 has decreased to 32.9%. The percentage of the youth population ages 6-17 are projected to remain nearly constant from 2010 to 2020, while the percentage for those ages 0-5 are projected to increase.10 Adults aged 19 and older will increase by 31% by the year 2040. These trends show that San Joaquin County's population is slowly aging. Part VI, Line 5: In addition to the medical services and programs we offer, Dameron Hospital also offers the following community benefits and outreach services:- Classroom use for community education and support groups- A program for adults to volunteer their time in a health care environment- Sponsorship of health-related community events and activities- Donations of materials, equipment and supplies to community groups- Employee volunteer time- Transportation- Continuing medical education for community physicians- Community education classes- Diabetic outpatient education program- Unreimbursed Medi-Cal, Medicare, and charity care- Uninsured patient discount- Participation in a program exposing high school students to health care careers to encourage youth to give back to the community and consider a career in medicine (Decision Medicine)- Free wireless internet access- Workforce development- Hospitalist program for inpatients admitted through Dameron Hospital Emergency Room who do not have a primary care physician- Health professional education- Management staff participation in local leadership programs- An online health center- Management participation in local school mentoring programs- Physician recruitment in a medical shortage area- Staff participation in conducting community health needs assessments- Multilingual education classes- Junior volunteers- A variety of support groups- Providing a clinical setting for undergraduate/vocational training to students enrolled in an outside organization- Notary Services- Interpreter Services for patients and their support person- Taxi Transportation for patients as needed Part VI, Line 6: (not part of affiliated healthcare system) Part VI, Line 7, Reports Filed With States CA X X X X X 1 1 0 0 0 0 0 1 0 Lorraine Auerbach President/CEO 697853 0 234441 0 0 0 0 0 10303 0 942597 0 0 0 Elizabeth Propp VP of Finance, CFO 299837 0 93402 0 0 0 0 0 6840 0 400079 0 0 0 Michael Glasberg VP of Operations, COO 308079 0 42234 0 0 0 0 0 5459 0 355772 0 0 0 Janine Hawkins VP of Patient Care Services, CNO 297356 0 0 0 50000 0 13825 0 10292 0 371473 0 50000 0 David Kerrins VP of Information Services, CIO 237844 0 40411 0 0 0 0 0 10335 0 288590 0 0 0 Bradley Reinke VP of Medical Affairs, CMO 259600 0 0 0 0 0 0 0 0 0 259600 0 0 0 William Chase Director of Finance (Through 4/2014) 132863 0 0 0 150000 0 2618 0 2881 0 288362 0 150000 0 Chad Davis RN Manager - Surgery 229257 0 0 0 0 0 7512 0 5487 0 242256 0 0 0 Terrance Thomas Registered Nurse 218566 0 0 0 0 0 7810 0 9409 0 235785 0 0 0 Shawn Fillon Registered Nurse 202147 0 0 0 0 0 6229 0 5615 0 213991 0 0 0 Maria Villarreal Assistant Nurse Manager 188375 0 0 0 0 0 7593 0 9053 0 205021 0 0 0 Christopher Arismendi Former CEO (Through 10/2012) 0 0 0 0 300000 0 0 0 0 0 300000 0 0 0 Cyrus Dah Former CFO (Through 12/2012) 0 0 0 0 162500 0 0 0 0 0 162500 0 0 0 Nicholas Arismendi Former COO (Through 7/2013) 0 0 0 0 243750 0 0 0 0 0 243750 0 0 0 Part I, Lines 4a-b Dr. Christopher Arismendi terminated as CEO/President on 10/31/12. His severance agreement is for a total of $1,200,000 over 4 years, and during 2014 a total of $300,000 was paid to him. Cyrus Dah terminated as CFO on 12/31/12. His severance agreement is for a total of $325,000 over 2 years, and during 2014 a total of $162,500 was paid to him. Nicholas Arismendi terminated as COO on 7/8/2013. His severance agreement is for a total of $375,000 over 18 months, and during 2014 a total of $243,750 was paid to him. William Chase terminated as Controller on 3/19/14. His severance agreement is for a total of $230,000 over 18 months, and as of 12/31/14 no severance payments had yet been made to him. The 457(f) plan was open to highly compensated executive or managerial personnel determined to be eligible by the plan committee. During 2014 there were two remaining participants, one of whom (William Chase) terminated early in the year. The plan indicates that participants may defer up to 100% of their compensation under the plan. Amounts reported in Part II, Column (B)(III) are distributions of prior year 457(f) contributions. Part I, Line 7 Executive Incentive Compensation is set based on meeting a specific set of metrics established annually by the CEO and Executive Team and approved by the Board. Metrics generally include quality, finance, patient safety, patient experience, employee engagement and meaningful use goals. Each year, the Board appoints an Executive Compensation Committee to 1) review and approve an Annual Executive Compensation Plan; 2) to evaluate Executive performance against established goals as well as overall executive performance; and 3) to set the overall Executive Compensation Plan for the following year. The CEO provides recommendations concerning the performance and compensation of the Executives for Board approval. The Executive Compensation Committee and Chairman of the Board evaluate the CEO and approve the CEO's compensation. The Annual Executive Compensation Plan is developed and presented to the Board by an independent healthcare compensation expert who also advises and guides the board as to market and other factors affecting executive and CEO compensation. This includes but is not limited to base compensation, the Executive Incentive program and recommended performance and market compensation adjustments. Form 990, Part VI, Section B, line 11 Form 990 is reviewed by the CFO, Director of Finance, and Accounting Supervisor. The return is provided to the board for review prior to filing. Form 990, Part VI, Section B, line 12c Each individual Fiduciary must execute a Conflicts of Interest Disclosure Statement and Questionnaire at least annually and must promptly report all facts regarding any new transaction that might create a Conflict of Interest as soon as they become aware of any such transaction. It is each Fiduciary's duty to make a full disclosure as provided herein of all material facts regarding any possible conflict of interest, to describe the situation or transaction, and to disclose the details of the employee, medical staff officer, or Related Party's interest in the situation or transaction. All Fiduciaries shall report all possible conflict of interest to the Chief Executive Officer, or his designee. The Chief Executive Officer, or designee, shall conduct such review as appropriate, and refer such information to the Governance Committee of the Hospital. The Governance Committee shall review such conflicts and disclosures and, at least annually, shall report any material conflicts to the Board, along with recommendations, if any, with respect to such persons or conflicts. The Board or Governance Committee may consult with legal counsel and such other authorities as may be desired, and may request any additional information deemed relevant, including the source and amount of any income or financial interest or other economic benefit to be derived by such person from the situation or transaction. It is the policy of the Board of Directors that the existence of ANY interest shall be disclosed before any transaction is consummated. Each Fiduciary has a continuing responsibility to scrutinize any transaction in which the Fiduciary or a Related Party is directly or indirectly interested for potential conflict of interest and to make a full disclosure as provided herein. The Chief Executive Officer, the Governance Committee or the Board of Directors shall as provided herein then determine whether a Conflict of Interest exists and shall take the appropriate action. All decisions regarding conflicts of interest rest in the sole discretion of the Board of Directors in the exercise of its ultimate judgment of the best interests of the Hospital. Form 990, Part VI, Section B, line 15 In 2013 the organization established an executive compensation committee, which sets the policy each year and creates the compensation document. An outside independent consultant, Romanoff & Associates, provides salary ranges and market value used in setting compensation. Form 990, Part VI, Section C, line 19 Financial statements are made available upon request. Governing documents and conflict of interest policy are not available to the public to view. Form 990, Part IX, line 11g Nurse Registry: Program service expenses 3,101,550. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,101,550. Other Contracted Services: Program service expenses 1,721,500. Management and general expenses 365,075. Fundraising expenses 0. Total expenses 2,086,575. Physicians Fees: Program service expenses 2,883,332. Management and general expenses 5,850. Fundraising expenses 0. Total expenses 2,889,182. Other Professional Fees: Program service expenses 88,239. Management and general expenses 102,616. Fundraising expenses 0. Total expenses 190,855. Pharmacy and Laboratory Outsourcing: Program service expenses 4,790,916. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,790,916. Maintenance: Program service expenses 1,977,897. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,977,897. Medical records & Transcription services: Program service expenses 0. Management and general expenses 1,875,920. Fundraising expenses 0. Total expenses 1,875,920. Dialysis services: Program service expenses 763,625. Management and general expenses 0. Fundraising expenses 0. Total expenses 763,625. Collection services: Program service expenses 577,046. Management and general expenses 0. Fundraising expenses 0. Total expenses 577,046. Contract negotiation assistance: Program service expenses 862,721. Management and general expenses 0. Fundraising expenses 0. Total expenses 862,721. Other Purchased Services: Program service expenses 2,840,252. Management and general expenses 1,766,609. Fundraising expenses 0. Total expenses 4,606,861.