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SIERRA NEVADA MEMORIAL-MINERS HOSPITAL: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
SIERRA NEVADA MEMORIAL-MINERS HOSPITAL (EIN 94-1439787)
Tax period
2013-07-01 to 2014-06-30
Filed
2015-05-04
IRS object ID
201521249349301517
Schema version
2013v4.0
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-05-04T17:09:22-05:00ReturnTs
Tax Period End2014-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line155 SECOND STREET SUITE 1400AddressLine1
CitySAN FRANCISCOCity
StateCAState
ZIP Code94105ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN941439787EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Sierra Nevada Memorial - Miners Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of% LARA HARROWFINANCE DEPARTMEInCareOfNm
Business Name ControlSIERBusinessNameControlTxt
Phone5302746099PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1029AddressLine1
Address Line2155 Glasson Way SuiteAddressLine2
CityGrass ValleyCity
StateCAState
ZIP Code95945ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCAROLYN CANADYPersonNm
Person TitleCFOPersonTitleTxt
Phone5302746099PhoneNum
Signature2015-05-01SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonVALERIE J BALLPreparerPersonNm
PTINP00178114PTIN
Phone5302746099PhoneNum
Preparation2015-05-01PreparationDt
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerCarolyn CanadyPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1155 Glasson WayAddressLine1
CityGrass ValleyCity
StateCAState
ZIP Code95945ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$230,872,894GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.SNMH.OrgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1934FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionTO CONTRIBUTE TO THE WELLNESS OF OUR COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee925TotalEmployeeCnt
Total Volunteers94TotalVolunteersCnt
Total Gross UBI$7,704TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$5,130NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$988,108PYContributionsGrantsAmt
CY Contributions Grants$1,075,455CYContributionsGrantsAmt
PY Program Service Revenue$129,715,107PYProgramServiceRevenueAmt
CY Program Service Revenue$132,763,933CYProgramServiceRevenueAmt
PY Investment Income$12,016,659PYInvestmentIncomeAmt
CY Investment Income$15,441,807CYInvestmentIncomeAmt
PY Other Revenue$592,310PYOtherRevenueAmt
CY Other Revenue$630,723CYOtherRevenueAmt
PY Total Revenue$143,312,184PYTotalRevenueAmt
CY Total Revenue$149,911,918CYTotalRevenueAmt
PY Grants And Similar Paid$3,445,724PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$6,000,503CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$87,920,275PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$84,288,028CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$42,509,156PYOtherExpensesAmt
CY Other Expenses$47,262,916CYOtherExpensesAmt
PY Total Expenses$133,875,155PYTotalExpensesAmt
CY Total Expenses$137,551,447CYTotalExpensesAmt
PY Revenues Less Expenses$9,437,029PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$12,360,471CYRevenuesLessExpensesAmt
Total Assets BOY$229,146,734TotalAssetsBOYAmt
Total Assets EOY$247,735,568TotalAssetsEOYAmt
Total Liabilities BOY$32,142,728TotalLiabilitiesBOYAmt
Total Liabilities EOY$29,653,296TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$197,004,006NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$218,082,272NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO 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.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$116,647,658ExpenseAmt
Grant$6,000,503GrantAmt
Revenue$132,762,890RevenueAmt
DescSIERRA 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 2014 INCLUDED 142,917 OUTPATIENT VISITS, 31,128 EMERGENCY VISITS, AND 2,501 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.Desc
Total Program Service Expenses$116,647,658TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsYes (true)InvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document120IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee925EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (true)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonLARA HARROWFINANCE DEPARTMEPersonNm
Phone9168512104PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13400 DATA DRIVEAddressLine1
CityRancho CordovaCity
StateCAState
ZIP Code95670ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
Tom Walker Brown
Board Member2.00.0Yes (X)$0$0$0
Andrew Chang MD
Board Member2.00.0Yes (X)$0$0$0
Dale Creighton
Board Member2.00.0Yes (X)$0$0$0
Stacy Fore DDS
Board Member2.00.0Yes (X)$0$0$0
Leo Granucci
Board Member2.00.0Yes (X)$0$3,750$0
Kevin Vaziri
Board Member2.040.0Yes (X)$0$571,263$75,093
Don Coots
Board Chair (thru 6/30/14)2.00.0Yes (X)$0$0$0Yes (X)
Katherine A Medeiros
CEO/ Service Area Leader40.00.0Yes (X)$0$499,599$69,681Yes (X)
Edward Sylvester
Board Secretary2.00.0Yes (X)$0$0$0Yes (X)
Michele White
Board Vice Chair2.00.0Yes (X)$0$0$0Yes (X)
Sarah Woerner MD
Board Chair (start 6/30/14)2.00.0Yes (X)$20,800$3,750$0Yes (X)
Carolyn Canady
CFO/Board Treasurer40.00.0$223,584$0$33,662Yes (X)
Joseph Britton MD
VPMA (thru 9/3/13)40.00.0$235,352$0$35,756Yes (X)
Jill McWilliams
VP/CNE40.00.0$165,249$0$26,087Yes (X)
Timothy Stephens
VP Ancillary Services40.00.0$167,292$0$45,605Yes (X)
Debbie L Plass
VP Strategy and Business Dev40.00.0$166,972$0$18,792Yes (X)
GREGORY T SMITH
Registered Nurse40.00.0$222,158$0$43,620Yes (X)
JONATHAN D STONE
Director of Pharmacy40.00.0$191,599$0$37,661Yes (X)
TZVETAN I TZVETANOV
Physicist40.00.0$252,146$0$34,789Yes (X)
Gail A Van Vleck
Charge Nurse IP/OP Surgery40.00.0$198,735$0$28,687Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,843,887TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,078,362TotReportableCompRltdOrgAmt
Total Other Compensation$449,433TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K209IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
COGENT HEALTHCARE OF CA
PO BOX 645037CINCINNATIOH452645037Medical Services$1,296,683
SIERRA NEVADA ANESTHESIA
970 E MAIN ST SUITE 100GRASS VALLEYCA95945Medical Services$1,227,970
DELPHI OF TEAM HEALTH
PO BOX 634850CINCINNATIOH45263Medical Services$807,479
EXECUTIVE HEALTH RESOURCES INC
PO BOX 822688PHILADELPHIAPA191822688Medical Services$290,895
HEALTH INFORMATION TECHNOLOGY CARE
775 BAYWOOD DR STE 314PETALUMACA94954Consulting Services$225,876
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K13CntrctRcvdGreaterThan100KCnt
Info In Schedule O Part VIIIYes (X)InfoInScheduleOPartVIIIInd
Related Organizations$988,415RelatedOrganizationsAmt
Government Grants$13,517GovernmentGrantsAmt
All Other Contributions$73,523AllOtherContributionsAmt
Total Contributions$1,075,455TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT REV/CHARITY CARE900099$68,260,803$68,260,803
MEDICARE/MEDICAID PAYMENTS900099$62,074,104$62,074,104
EHR900099$1,296,992$1,296,992
MED OFFICE BLDG621300$297,535$297,535
GS HIO MAINTENANCE900099$284,167$284,167

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$550,332TotalRevenueColumnAmt
Related Or Exempt Func Income$549,289RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$1,043UnrelatedBusinessRevenueAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$132,763,933TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,093,494TotalRevenueColumnAmt
Exclusion$3,093,494ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

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

Royalties Revenue RoyaltiesRevenueGrp

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

Rental Income Or Loss RentalIncomeOrLossGrp

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

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

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

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$93,281,344SecuritiesAmt
Other$27,945OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$80,960,976SecuritiesAmt
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$12,320,368SecuritiesAmt
Other$27,945OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,348,313TotalRevenueColumnAmt
Exclusion$12,348,313ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$1,282GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,282TotalRevenueColumnAmt
Exclusion$1,282ExclusionAmt

Net Income Or Loss NetIncomeOrLossGrp

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

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
GIFT SHOPS453220$141,801$141,801
CAFETERIA/CATERING722320$173,928$167,267$6,661
FINANCE CHARGES900099$100,113$100,113

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$213,599TotalRevenueColumnAmt
Exclusion$213,599ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$629,441OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$149,911,918TotalRevenueColumnAmt
Related Or Exempt Func Income$132,762,890RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$7,704UnrelatedBusinessRevenueAmt
Exclusion$16,065,869ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$5,993,003TotalAmt
Program Services$5,993,003ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$7,500TotalAmt
Program Services$7,500ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,010,541TotalAmt
Program Services$910,127ProgramServicesAmt
Management And General$100,414ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$60,150,299TotalAmt
Program Services$54,759,115ProgramServicesAmt
Management And General$5,391,184ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$3,841,089TotalAmt
Program Services$3,462,711ProgramServicesAmt
Management And General$378,378ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$14,772,149TotalAmt
Program Services$11,096,903ProgramServicesAmt
Management And General$3,675,246ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$4,513,950TotalAmt
Program Services$4,465,703ProgramServicesAmt
Management And General$48,247ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$90,156TotalAmt
Management And General$90,156ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$39,318TotalAmt
Management And General$39,318ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$192,557TotalAmt
Program Services$55ProgramServicesAmt
Management And General$192,502ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$911,237TotalAmt
Management And General$911,237ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$18,868,031TotalAmt
Program Services$12,963,713ProgramServicesAmt
Management And General$5,904,318ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$246,864TotalAmt
Program Services$3,252ProgramServicesAmt
Management And General$243,612ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$2,439,475TotalAmt
Program Services$1,441,617ProgramServicesAmt
Management And General$997,858ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$3,294,235TotalAmt
Program Services$727,066ProgramServicesAmt
Management And General$2,567,169ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,560,401TotalAmt
Program Services$1,517,869ProgramServicesAmt
Management And General$42,532ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$205,549TotalAmt
Program Services$144,293ProgramServicesAmt
Management And General$61,256ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$49,426TotalAmt
Program Services$36,617ProgramServicesAmt
Management And General$12,809ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$785,432TotalAmt
Program Services$785,430ProgramServicesAmt
Management And General$2ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$4,819,306TotalAmt
Program Services$4,803,810ProgramServicesAmt
Management And General$15,496ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,428,278TotalAmt
Program Services$1,428,278ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
MEDICAL SUPPLIES$11,730,723$11,730,296$427$0
DUES & SUBSCRIPTIONS$144,121$22,784$121,337$0
LICENSES & TAXES$136,975$93,305$43,670$0
RECRUITING$7,457$0$7,457$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$313,375TotalAmt
Program Services$254,211ProgramServicesAmt
Management And General$59,164ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$137,551,447TotalAmt
Program Services$116,647,658ProgramServicesAmt
Management And General$20,903,789ManagementAndGeneralAmt
Fundraising$0FundraisingAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XYes (X)InfoInScheduleOPartXInd

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$6,175BOYAmt
EOY$6,175EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$716,659BOYAmt
EOY$4,707,840EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

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

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$19,185,915BOYAmt
EOY$22,592,217EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

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

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

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

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$127,312BOYAmt
EOY$149,618EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,708,909BOYAmt
EOY$1,825,906EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$4,330,144BOYAmt
EOY$2,572,252EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$113,935,557LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$75,881,084LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$35,779,230BOYAmt
EOY$38,054,473EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$124,507,521BOYAmt
EOY$118,899,478EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$36,351,482BOYAmt
EOY$52,246,405EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$6,433,387BOYAmt
EOY$6,681,204EOYAmt

Intangible Assets IntangibleAssetsGrp

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

Other Assets Total OtherAssetsTotalGrp

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

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$229,146,734BOYAmt
EOY$247,735,568EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$13,729,458BOYAmt
EOY$12,436,128EOYAmt

Grants Payable GrantsPayableGrp

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

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$165,215BOYAmt
EOY$211,023EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,334,365BOYAmt
EOY$4,334,365EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

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

Loans From Officers Directors LoansFromOfficersDirectorsGrp

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

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

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

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

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

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$13,913,690BOYAmt
EOY$12,671,780EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$32,142,728BOYAmt
EOY$29,653,296EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$192,857,954BOYAmt
EOY$213,306,085EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,778,944BOYAmt
EOY$3,408,509EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,367,108BOYAmt
EOY$1,367,678EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$197,004,006BOYAmt
EOY$218,082,272EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$229,146,734BOYAmt
EOY$247,735,568EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$12,360,471ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$8,089,994NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$627,801OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$192,557OtherActivitiesAmt
Total Lobbying Expenditures$192,557TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1FormAndLineReferenceDesc
ExplanationLOBBYING EXPENDITURES PAID DIRECTLY BY THE FILING ORGANIZATION FOR ANNUAL MEMBERSHIP DUES: AMERICAN COLLEGE OF HEALTHCARE $3 ASET - The Neurodiagnostic Society $53 American Association of Cardiovascular and Pulmanary $2 LOBBYING EXPENDITURES PAID BY THE PARENT ORGANIZATION FOR ANNUAL MEMBERSHIP DUES WHERE EXPENSES ARE ALLOCATED TO THE HOSPITAL: CATHOLIC HEALTH ASSOCIATION $772 AMERICAN HOSPITAL ASSOCIATION $1,778 CALIFORNIA HOSPITALS COMMITTEE ON ISSUES $181,394 NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE $152 HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA $8,371 CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME $32 TOTAL EXPENDITURES PAID TO ORGANIZATIONS $192,557ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,367,108BeginningYearBalanceAmt
Contributions$570ContributionsAmt
Investment Earnings Or Losses$928,722InvestmentEarningsOrLossesAmt
End Year Balance$2,296,400EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,351,797BeginningYearBalanceAmt
Contributions$15,311ContributionsAmt
End Year Balance$1,367,108EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,599,745BeginningYearBalanceAmt
Contributions$61,959ContributionsAmt
Investment Earnings Or Losses-$309,907InvestmentEarningsOrLossesAmt
End Year Balance$1,351,797EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,423,093BeginningYearBalanceAmt
Contributions$57,110ContributionsAmt
Investment Earnings Or Losses$350,442InvestmentEarningsOrLossesAmt
Other Expenditures$1,230,900OtherExpendituresAmt
End Year Balance$1,599,745EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,178,093BeginningYearBalanceAmt
Contributions$1,252,000ContributionsAmt
Investment Earnings Or Losses-$7,000InvestmentEarningsOrLossesAmt
End Year Balance$2,423,093EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.60000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.40000TermEndowmentBalanceEOYPct
Endowments Held Related OrgYes (true)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (true)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,140,153OtherCostOrOtherBasisAmt
Book Value$1,140,153BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$61,735,282OtherCostOrOtherBasisAmt
Depreciation$39,378,261DepreciationAmt
Book Value$22,357,021BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$289,591OtherCostOrOtherBasisAmt
Depreciation$275,895DepreciationAmt
Book Value$13,697BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$42,285,918OtherCostOrOtherBasisAmt
Depreciation$33,439,830DepreciationAmt
Book Value$8,846,088BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$8,484,613OtherCostOrOtherBasisAmt
Depreciation$2,787,098DepreciationAmt
Book Value$5,697,514BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$38,054,473TotalBookValueLandBuildingsAmt
Financial DerivativesFinancialDerivativesGrp
Closely Held Equity InterestsCloselyHeldEquityInterestsGrp

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescPOOLED INVESTMENTSDesc
Book Value$52,246,405BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$52,246,405TotalBookValueSecuritiesAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
DUE TO RELATED PARTIES$9,964,688
PENSION PAYABLE$2,707,092
FieldValueIRS element (for citing)
Total Liability$12,671,780TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Sch D, PART V, LINE 4The 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 2DIGNITY 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.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other500.DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served4976PersonsServedCnt
Total Community Benefit Expns$1,884,731TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,884,731NetCommunityBenefitExpnsAmt
Total Expense0.01370TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Persons Served25404PersonsServedCnt
Total Community Benefit Expns$21,003,147TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$17,177,136DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,826,011NetCommunityBenefitExpnsAmt
Total Expense0.02780TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Persons Served3301PersonsServedCnt
Total Community Benefit Expns$3,313,645TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,487,643DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,826,002NetCommunityBenefitExpnsAmt
Total Expense0.01330TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Persons Served33681PersonsServedCnt
Total Community Benefit Expns$26,201,523TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$18,664,779DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,536,744NetCommunityBenefitExpnsAmt
Total Expense0.05480TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs25ActivitiesOrProgramsCnt
Persons Served11267PersonsServedCnt
Total Community Benefit Expns$370,224TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$370,224NetCommunityBenefitExpnsAmt
Total Expense0.00270TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Activities Or Programs9ActivitiesOrProgramsCnt
Persons Served1144PersonsServedCnt
Total Community Benefit Expns$1,034,132TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,034,132NetCommunityBenefitExpnsAmt
Total Expense0.00750TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs34ActivitiesOrProgramsCnt
Persons Served12411PersonsServedCnt
Total Community Benefit Expns$1,404,356TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,404,356NetCommunityBenefitExpnsAmt
Total Expense0.01020TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs34ActivitiesOrProgramsCnt
Persons Served46092PersonsServedCnt
Total Community Benefit Expns$27,605,879TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$18,664,779DirectOffsettingRevenueAmt
Net Community Benefit Expns$8,941,100NetCommunityBenefitExpnsAmt
Total Expense0.06500TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served22PersonsServedCnt
Total Community Benefit Expns$29,632TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$29,632NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served22PersonsServedCnt
Total Community Benefit Expns$29,632TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$29,632NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$1,395,640BadDebtExpenseAmt
Reimbursed By Medicare$37,983,907ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$44,703,528CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$6,719,621MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

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

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

FieldValueIRS element (for citing)
Business Name Line1GRASS VALLEY OP SURGBusinessNameLine1
FieldValueIRS element (for citing)
Primary ActivitiesAMBULATORY SURGERY CENTERPrimaryActivitiesTxt
Org Profit Or Ownership0.22800OrgProfitOrOwnershipPct
Physicians Profit Or Ownership0.31590PhysiciansProfitOrOwnershipPct
FieldValueIRS element (for citing)
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Sierra Nevada Memorial-Miners HospitaBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1155 Glasson WayAddressLine1
CityGrass ValleyCity
StateCAState
ZIP Code95945ZIPCode
FieldValueIRS element (for citing)
Website Addresswww.SNMH.orgWebsiteAddressTxt
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Sierra Nevada Memorial-Minors HospBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE PART V, SECTION COwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLSEE PART V, SECTION COtherWebsiteURLTxt
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
Exec Implementation StrategyYes (X)ExecImplementationStrategyInd
Develop Community Wide PlanYes (X)DevelopCommunityWidePlanInd
Exec Community Wide PlanYes (X)ExecCommunityWidePlanInd
Include Operational PlanYes (X)IncludeOperationalPlanInd
Adopt BudgetYes (X)AdoptBudgetInd
Prioritize Health NeedsYes (X)PrioritizeHealthNeedsInd
Prioritize ServicesYes (X)PrioritizeServicesInd
All Needs AddressedfalseAllNeedsAddressedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (true)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (true)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care500.FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (true)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
Asset LevelYes (X)AssetLevelInd
Medical IndigencyYes (X)MedicalIndigencyInd
Insurance StatusYes (X)InsuranceStatusInd
Uninsured DiscountYes (X)UninsuredDiscountInd
Medicaid MedicareYes (X)MedicaidMedicareInd
State RegulationYes (X)StateRegulationInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
Posted On WebsiteYes (X)PostedOnWebsiteInd
Attached To InvoiceYes (X)AttachedToInvoiceInd
Available On RequestYes (X)AvailableOnRequestInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSECTIONS B AND CFormAndLineReferenceDesc
ExplanationLINE 3 SIERRA NEVADA MEMORIAL HOSPITAL COMPLETED ITS MOST RECENT CHNA IN THE SPRING OF 2013, IN PARTNERSHIP WITH THE NONPROFIT RESEARCH ORGANIZATION VALLEY VISION, REGIONAL HEALTH SYSTEMS, PUBLIC HEALTH EXPERTS, SIERRA HEALTH FOUNDATION, AND CALIFORNIA STATE UNIVERSITY, SACRAMENTO. THE PROCESS ENGAGED MULTIPLE COMMUNITY STAKEHOLDERS OVER A NINE-MONTH PERIOD THAT IN ADDITION TO RESIDENTS, INCLUDED SCHOOL DISTRICT OFFICIALS, PHYSICIANS, AND LEADERS OF COMMUNITY HEALTH AND SOCIAL SERVICE ORGANIZATIONS. THE ASSESSMENT USED A MIXED METHODS RESEARCH APPROACH. PRIMARY QUALITATIVE DATA WAS OBTAINED FROM INTERVIEWS WITH HOSPITAL CLINICAL AND COMMUNITY BENEFIT STAFF MEMBERS AND KEY INFORMANTS (AREA HEALTH AND COMMUNITY EXPERTS). 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. LINE 5A http://www.snmh.org/Who_We_Are/Serving_the_Community/index.htm LINE 5B www.healthylivingmap.com LINE 7 THE HOSPITAL RESPONDS TO PRIORITY HEALTH NEEDS IN MANY WAYS, AND IN TIMES THAT ARE CRITICAL FOR PATIENTS IN CRISIS. IN ADDITION TO CHARITY CARE, INDIGENT CARE, AND UN-FUNDED CARE FOR MEDI-CAL PATIENTS, A SIGNIFICANT NUMBER OF PROGRAMS AND SERVICES OFFERED ADDRESS THE PRIORITY NEEDS IDENTIFIED IN THE 2013 CHNA. THE NEEDS OF NEVADA COUNTY ARE MONUMENTAL, AND AS THE SOLE HOSPITAL SERVING THIS EXPANSIVE RURAL REGION, SIERRA NEVADA MEMORIAL 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. LINE 14G ALL LANGUAGE REGARDING THE POLICY IS COMMUNICATED TO PATIENTS VIA THE METHODS OUTLINED BELOW. 1. SIGNAGE IN ALL ADMITTING AREAS; 2. AT THE POINT OF REGISTRATION, ALL PATIENTS RECEIVE BROCHURES EXPLAINING THE FACILITY'S CHARITY CARE PROGRAM AND THE AVAILABILITY OF GOVERNMENT SPONSORED PROGRAMS; 3. ALL INITIAL STATEMENTS TO UNINSURED PATIENTS INCLUDES VERBIAGE INFORMING PATIENTS OF THE FACILITY'S CHARITY CARE PROGRAM AND A COPY OF THE CHARITY CARE APPLICATION. A TELEPHONE NUMBER IS PROVIDED FOR PATIENTS TO REQUEST FURTHER INFORMATION ABOUT THE PROGRAM AND ASSISTANCE IS AVAILABLE IN LANGUAGES OTHER THAN ENGLISH; 4. INFORMATION ABOUT THE FACILITY'S CHARITY CARE PROGRAM, ACCESS TO THE APPLICATION, AND CONTACT INFORMATION IS AVAILABLE ON THE FACILITY'S WEBPAGE. LINE 20D PATIENTS WHO ARE APPLYING FOR DISCOUNTS UNDER THE DISCOUNT PROVISION OF HOSPITAL FAIR PRICING ACT - CALIFORNIA HEALTH AND SAFETY CODE 127400 WHOSE HOUSEHOLD INCOME IS AT OR BELOW 350% OF THE FPL ARE ELIGIBLE TO RECEIVE SERVICES AT THE HIGHEST AVERAGE RATE THE HOSPITAL WOULD RECEIVE FOR PROVIDING SERVICES FROM MEDICARE, MEDICAID, OR ANY OTHER GOVERNMENT-SPONSORED HEALTH PROGRAM OF HEALTH BENEFIT IN WHICH THE HOSPITAL PARTICIPATES, WHICHEVER IS GREATER.ExplanationTxt
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GRASS VALLEY SURGERY CENTERBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1408 Sierra College DriveAddressLine1
CityGRASS VALLEYCity
StateCAState
ZIP Code95945ZIPCode
FieldValueIRS element (for citing)
FacilityOUTPATIENT SURGERY CENTERFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCH H, Part I, Line 7, column (f)The amount of bad debt expense included on Form 990, Part IX, line 25, column (A) is ($30,513) and has been subtracted for purposes of calculating the percentages in column (f).
SCH H, PART I, LINE 7For 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 I, 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 $3.8 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 $0.3 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 II - COMMUNITY BUILDING ACTIVITIESAdvocacy 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 IIILINE 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, DISCOUNTS FOR THE MEDICALLY INDIGENT, 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. LINE 3 SNMMH MAKES EVERY EFFORT IN DETERMINING IF A PATIENT QUALIFIES FOR CHARITY CARE 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 PAYMENT 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 PAYMENT ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE. 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, 2014, 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. 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 $674.3 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 $6.7 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. 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 Patient Payment 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. SNMMH does not impose wage garnishments or liens on primary residences. 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. 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 AssessmentTHE 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 ASSISTANCECommunication 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 InformationPrimary 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 HealthSierra 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 SystemSNMMH 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, 2014, is as follows: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 118,274 175,717,000 1.7% Unpaid Costs of Medicaid/Medi-Cal 1,182,999 864,074,000 8.3% Other Means-tested Programs 269,323 51,389,000 0.5% Community Services: Community Health Services 434,278 39,122,000 0.4% Health Professions Education 54 24,000 0.0% Subsidized Health Services 108,604 27,467,000 0.3% Donations 128,428 19,579,000 0.2% Community Building Activities 4,623 1,508,000 0.0% Community Benefit Operations 2,886 6,793,000 0.1% Total Community Services for the poor 678,873 94,493,000 1.0% Total Benefits for the Poor 2,249,469 1,185,673,000 11.5% Benefits for the Broader Community: Community Services: Community Health Services 297,849 13,162,000 0.1% Health Professions Education 37,567 63,515,000 0.6% Subsidized Health Services 3,990 771,000 0.0% Research 408 23,158,000 0.2% Donations 31,034 9,080,000 0.1% Community Building Activities 7,068 3,716,000 0.0% Community Benefit Operations 21 1,110,000 0.0% Total Benefits for the Broader Community 377,937 114,512,000 1.1% Total Community Benefits 2,627,406 1,300,185,000 12.6% Unpaid Costs of Medicare 1,032,864 674,324,000 6.5% Total Community Benefits including Cost of Medicare 3,660,270 1,974,509,000 19.1%

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (4 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtNon Cash AssistanceNonCashAssistanceAmtValuation Method UsedValuationMethodUsedDescNon Cash AssistanceNonCashAssistanceDescPurpose Of GrantPurposeOfGrantTxt
Dignity Health Medical Foundation
3400 Data DriveRancho CordovaCA95670680220314501(c)(3)$5,091,533$0N/AN/AMedical Fnd Support
Sierra Nevada Hospital Foundation
140 Litton DriveGrass ValleyCA95945680005939501(c)(3)$545,042$0N/AN/AFoundation Support
California Health Foundation and Trust
1215 K Str Ste 800SacramentoCA95814941498697501(c)(3)$262,866$0N/AN/ACommunity Health
Western Sierra Medical Clinic Inc
1345 Whispering Pines LaneGrass ValleyCA95945942279011501(c)3)$90,000$0n/anaCommunity Health
FieldValueIRS element (for citing)
Total501c3 Org4Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeSCHOLARSHIPSGrantTypeTxt
Recipient9RecipientCnt
Cash Grant$7,500CashGrantAmt
Non Cash Assistance$0NonCashAssistanceAmt
Valuation Method UsedN/AValuationMethodUsedDesc
Non Cash AssistanceN/ANonCashAssistanceDesc

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, line 2FormAndLineReferenceDesc
ExplanationThe 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.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (11 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Kevin Vaziri
Board Member$0$316,667$0$244,735$0$9,861$0$40,802$0$34,291$0$646,356$0$0
Katherine A Medeiros
CEO/ Service Area Leader$0$283,576$0$199,920$0$16,103$0$36,290$0$33,391$0$569,280$0$0
Carolyn Canady
CFO/Board Treasurer$183,839$0$38,861$0$884$0$24,746$0$8,916$0$257,246$0$0$0
Joseph Britton MD
VPMA (thru 9/3/13)$174,290$0$52,816$0$8,246$0$13,399$0$22,357$0$271,108$0$0$0
Jill McWilliams
VP/CNE$165,004$0$0$0$245$0$9,780$0$16,307$0$191,336$0$0$0
Timothy Stephens
VP Ancillary Services$136,190$0$28,069$0$3,033$0$18,122$0$27,483$0$212,897$0$0$0
Debbie L Plass
VP Strategy and Business Dev$137,532$0$29,440$0$0$0$17,700$0$1,092$0$185,764$0$0$0
GREGORY T SMITH
Registered Nurse$213,596$0$300$0$8,262$0$16,137$0$27,483$0$265,778$0$0$0
JONATHAN D STONE
Director of Pharmacy$165,162$0$26,437$0$0$0$21,157$0$16,504$0$229,260$0$0$0
TZVETAN I TZVETANOV
Physicist$238,730$0$13,416$0$0$0$34,614$0$175$0$286,935$0$0$0
Gail A Van Vleck
Charge Nurse IP/OP Surgery$198,435$0$300$0$0$0$12,183$0$16,504$0$227,422$0$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3ALTHOUGH 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 4aTHE 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 2013.
PART I, LINE 4bCERTAIN LISTED PERSONS are eligible to participate in one of two DIGNITY HEALTH 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. No benefit will vest under this 457(f) plan before the attainment of age 62 or the completion of 15 years of service. The 2010 Executive Deferred Compensation Plan is for certain officers and key employees 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. NO PAYMENTS WERE MADE UNDER THIS PLAN DURING 2013. CERTAIN LISTED PERSONS PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN LIMITED TO PARTICIPANTS IN THE DIGNITY HEALTH RETIREMENT PLAN WHOSE BENEFITS ARE AFFECTED BY THE LIMITATIONS IMPOSED BY SECTIONS 401(A)(17) AND 415 OF THE INTERNAL REVENUE CODE. BENEFIT SERVICE UNDER THIS PLAN WAS FROZEN AS OF JANUARY 1, 2008. NO PAYMENTS WERE MADE TO ANY LISTED PERSONS DURING 2013 PURSUANT TO THIS PLAN. VESTED AMOUNTS, IF ANY, FOR THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS DISCUSSED ABOVE ARE REPORTED AS DEFERRED COMPENSATION IN THE YEAR VESTING OCCURS (SCHEDULE J, PART II, COLUMN C) AND ARE REFLECTED AGAIN AS W-2 REPORTABLE COMPENSATION IN THE YEAR PAID (SCHEDULE J, PART II, COLUMN B(III)).
PART II - SUPPLEMENTAL DISCLOSURESTHE ORGANIZATION'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE THE ORGANIZATION 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 THE ORGANIZATION SERVES, PROMOTING 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 COMPENSATION AND BENEFITS 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 AND REVENUE.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITHY
A52159822513033FTN02004-05-19$150,000,000BOND A: CUSIP 13033FTN0-SEE PRT VIfalsefalseYes (true)
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITHY
B52164382813033FYE42005-11-10$200,000,000BOND B: CUSIP 13033FYE4-SEE PRT VIfalsefalseYes (true)

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtBond DefeasedBondDefeasedAmtTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtCapitalized InterestCapitalizedInterestAmtRefunding EscrowRefundingEscrowAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCredit EnhancementCreditEnhancementAmtWorking Capital ExpendituresWorkingCapitalExpendituresAmtCapital ExpendituresCapitalExpendituresAmtOther Spent ProceedsOtherSpentProceedsAmtUnspentUnspentAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$0$0$2,000,000$0$0$0$0$0$0$2,000,000$0$02005falsefalseYes (true)Yes (true)
B$0$0$2,334,365$0$0$0$0$0$0$2,334,365$0$02008falsefalseYes (true)Yes (true)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndEngage Bond Counsel ContractsEngageBondCounselContractsIndAny Research AgreementsAnyResearchAgreementsIndEngage Bond Counsel ResearchEngageBondCounselResearchIndPrivate Bus Use By OthersPrivateBusUseByOthersPctPrivate Bus Concerning UBIPrivateBusConcerningUBIPctTotal Private Business UseTotalPrivateBusinessUsePctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndChange In Use Bond Financed PropChangeInUseBondFinancedPropPctRemedial Action TakenRemedialActionTakenIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
AfalseYes (true)Yes (true)Yes (true)Yes (true)Yes (true)0.022000.001000.02300falsefalse0.00000falseYes (true)
BfalseYes (true)Yes (true)Yes (true)Yes (true)Yes (true)0.000000.000000.00000falsefalse0.00000falseYes (true)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndBusiness Name Line1GICProviderName/BusinessNameLine1Gross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
0
AfalsefalsefalseYes (true)Yes (true)falsefalse0Yes (true)Yes (true)
0
BfalsefalsefalseYes (true)Yes (true)falsefalse0Yes (true)Yes (true)

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (true)
BYes (true)

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
BOND A: CUSIP 13033FTN0PART 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 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 6/30/2014.
BOND B: CUSIP 13033FYE4PART 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 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.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, VII, XI and XIIFORM 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 DIRECTOR LEVEL AND ABOVE, AND ANY OTHER PERSONNEL AT HIS OR HER DISCRETION). THE ORGANIZATION'S BOARD IS CHARGED WITH MONITORING PROPOSED OR ONGOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE REAL OR POTENTIAL CONFLICTS ARISING FROM 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 ANY 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; (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 PERSON WITH THE CONFLICT OF INTEREST 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, AND 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 ALSO CONFLICTS OF INTEREST PROVISIONS UNDER THE STANDARDS OF CONDUCT APPLICABLE TO ALL EMPLOYEES, AND WHICH ARE ADMINISTERED BY THE CHIEF COMPLIANCE OFFICER WHO HAS REPORTING RESPONSIBILITY TO THE AUDIT & COMPLIANCE COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15A ALTHOUGH THE ORGANIZATION EMPLOYS PERSONNEL, THE SERVICE AREA LEADER IS COMPENSATED BY DIGNITY HEALTH. FOR 2013, DIGNITY HEALTH'S COMPENSATION AND BENEFITS DEPARTMENT CONDUCTED AN ANNUAL REVIEW AND ANALYSIS TO PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGE OF THE SERVICE AREA LEADER. APPROPRIATE COMPARABILITY DATA FOR SIMILAR JOBS IN PEER COMPANIES (BOTH TAXABLE AND TAX-EXEMPT) WAS OBTAINED FROM INDEPENDENT THIRD-PARTY SURVEY SOURCES. 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 VII, SECTION A SNMMH DOES NOT COMPENSATE DIRECTOR, DR SARAH WOERNER,FOR HER SERVICES AS A BOARD MEMBER. HOWEVER, SHE RECEIVED A stipend for services as a non-director member of a Dignity Health Board committee PAID BY THE RELATED ORGANIZATION. ALL OTHER COMPENSATION AND BENEFITS REPORTED FOR DIRECTORS REPRESENT COMPENSATION AS MEDICAL DIRECTOR OF SNMMH OR FOR PAYMENT OF EMERGENCY ON-CALL MEDICAL SERVICES. FORM 990, PART XI, LINE 9 EARNINGS FROM EXEMPT CORPORATION; (2,334) INTEREST IN NET ASSETS OF AN UNCONSOLIDATED FOUNDATION; 630,135 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 11GDESCRIPTION:MEDICAL FEES TOTAL FEES:6396193
FORM 990 PART IX LINE 11GDESCRIPTION:INTERCOMPANY ADMIN SERVICES TOTAL FEES:5934106
FORM 990 PART IX LINE 11GDESCRIPTION:ADMINISTRATIVE SERVICES TOTAL FEES:2080190
FORM 990 PART IX LINE 11GDESCRIPTION:MAINTENANCE/ REPAIRS TOTAL FEES:2070479
FORM 990 PART IX LINE 11GDESCRIPTION:PROFESSIONAL CONSULTING TOTAL FEES:542474
FORM 990 PART IX LINE 11GDESCRIPTION:LAUNDRY & LINEN SERVICES TOTAL FEES:351760
FORM 990 PART IX LINE 11GDESCRIPTION:STORAGE & SHREDDING SERVICES TOTAL FEES:211392
FORM 990 PART IX LINE 11GDESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:1281437

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrganizationControlledOrganizationInd
Sierra Nevada Memorial Hospital Fdtn
140 Litton DriveGrass ValleyCA95945680005939FundraisingCA501(c)(3)11;type 3NAfalse
Dignity Health
185 Berry StreetSan FranciscoCA94107941196203HospitalCA501(c)(3)3NAfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (true)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1