2014-05-02T19:00:40-05:00 2013-06-30 135565207 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2012-07-01 941439787 SIERRA NEVADA MEMORIAL - MINERS HOSPITAL INC SIER 5302746099 PO Box 1029 Grass Valley CA 95945 CAROLYN CANADY 2014-04-29 true VALERIE J BALL P00178114 4159635100 2012 2015-11-30 17:44:51Z CAROLYN CANADY 155 GLASSON WAY GRASS VALLEY CA 95945 198850824 false X WWW.SNMH.ORG X 1934 CA TO CONTRIBUTE TO THE WELLNESS OF OUR COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER. 11 7 905 97 8928 -6055 1016949 988108 136997377 129715107 10700707 12016659 750151 592310 149465184 143312184 4379122 3445724 0 0 84946565 87920275 0 0 0 49108550 42509156 138434237 133875155 11030947 9437029 216587487 229146734 36897615 32142728 179689872 197004006 TO CONTRIBUTE TO THE WELLNESS OF OUR COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER. false false 120102518 3445724 129712374 SIERRA NEVADA MEMORIAL HOSPITAL'S MISSION IS TO CONTRIBUTE TO THE WELLNESS OF OUR COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER, COLLABORATING WITH OTHERS IN THE COMMUNITY TO IMPROVE THE QUALITY OF LIFE. THE HOSPITAL OFFERS A WIDE RANGE OF SERVICES AND SPECIALTIES TO ACCOMMODATE THE GROWING NEEDS OF WESTERN NEVADA COUNTY. AS THE SOLE ACUTE CARE PROVIDER IN OUR SERVICE AREA, SIERRA NEVADA MEMORIAL HOSPITAL TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. SIERRA NEVADA MEMORIAL HOSPITAL IS LICENSED WITH 104 ACUTE BEDS AND 17 SKILLED NURSING FACILITY BEDS AND SERVICE PATIENTS AS FOLLOWS: OUTPATIENT VISITS OF 148,044; EMERGENCY VISITS OF 31,310; AND INPATIENT AND OUTPATIENT OPERATING ROOM CASES OF 2,456. SIERRA NEVADA MEMORIAL HOSPITAL'S LIST OF INPATIENT, OUTPATIENT AND SUPPORT SERVICES IS QUITE EXHAUSTIVE, INCLUDING: INPATIENT SERVICES: ACUTE MEDICAL/SURGICAL CARE; INTENSIVE CARE; PHARMACY; SURGERY; TRANSITIONAL CARE UNIT AND WOMEN & INFANT CARE UNIT. OUTPATIENT SERVICES: AMBULATORY TREATMENT CENTER; CARDIAC REHABILITATION; CARDIOPULMONARY; DIAGNOSTIC IMAGING; LABORATORY; OUTPATIENT SURGERY CENTER; REHABILITATION SERVICES; WOUND CARE CENTER; AMBULANCE; CANCER CENTER; AND EMERGENCY. 120102518 true true false true false false false false true true true false false true true false true false false false false false false false false true true true false true true true false false false false false false false false false false false false false false true false false false false true 138 0 true 905 true true true false false false false false false false false false X 11 7 false false false false true true true true true false false false true true true true true false false true true CA X LARA HARROW 9168512104 FINANCE DEPT 3400 DATA DRIVE RANCHO CORDOVA CA 95670 X DON COOTS 2.00 0 X X 0 0 0 EDWARD SYLVESTER 2.00 0 X X 0 0 0 GERALD ANGOVE 2.00 0 X X 0 0 0 KATHERINE A MEDEIROS 40.00 0.00 X X 0 406854 72309 MICHELE WHITE 2.00 0 X X 0 0 0 ANDREW CHANG MD 2.00 0 X 0 0 0 DALE CREIGHTON 2.00 0 X 0 0 0 DAVID CAMPBELL MD 2.00 0 X 14400 0 0 KEVIN VAZIRI 2.00 20.00 X 0 483550 70518 LEO GRANUCCI 2.00 0 X 0 0 0 SARAH WOERNER MD 2.00 0 X 20800 0 0 STACY FORE DDS 2.00 0 X 0 0 0 CAROLYN CANADY 40.00 0 X 220016 0 33446 JOSEPH BRITTON MD 40.00 0 X 294083 0 48788 DEBBIE L PLASS 40.00 0 X 164295 0 12535 GREGORY T SMITH 40.00 0 X 171924 0 42002 JONATHAN D STONE 40.00 0 X 187233 0 44994 JOSEPH G STEHMEYER 40.00 0 X 172157 0 43363 TZVETAN I TZVETANOV 40.00 0 X 262825 0 34771 1507733 890404 402726 201 false true false DELPHI OF TEAM HEALTH PO BOX 634850 CINCINNATI OH 45263 MEDICAL SERVICES 226829 LEADER INDUSTRIES 10941 WEAVER AVE SOUTH EL MONTE CA 91733 CONTRACTOR 145599 THOMAS M BOYLE MD 123 MARGARET LN STE B2 GRASS VALLEY CA 95945 PHYSICIAN SERVICES 132700 LEON LEONARD MD 280 SIERRA COLLEGE DR SUITE 125 GRASS VALLEY CA 95945 PHYSICIAN SERVICES 107200 4 870052 25437 92619 988108 PATIENT REV NET OF CHARITY CARE & BAD DEBT 900099 63659292 63659292 MEDICARE/MEDICAID PAYMENTS 900099 62772852 62772852 MEANINGFUL USE INCENTIVES (EHR) 900099 2105351 2105351 MEDICAL OFFICE BUILDING 621300 285849 285849 MANAGEMENT SERVICES 541610 72517 72517 819246 816513 2733 0 129715107 3815913 3815913 0 0 0 0 0 63739386 55538640 8200746 0 8200746 8200746 0 0 0 CAFETERIA/CATERING 722320 208659 6107 202552 GIFT SHOPS 453220 174531 174531 FINANCE CHARGES 900099 83080 83080 126040 0 88 125952 592310 143312184 129712374 8928 12602773 3441203 3441203 4521 4521 0 0 742549 685041 57508 22400 22400 62626630 57464640 5161990 4587553 4168312 419241 15227861 13824313 1403548 4713282 4278982 434300 0 80737 80737 41513 41513 10873 11 10862 0 875032 875032 14276528 10371149 3905379 0 231015 38851 192164 3428402 3062248 366154 2178738 2107344 71394 0 1761408 1511729 249679 177565 131086 46479 0 43821 29946 13875 841586 841418 168 0 4831332 4742515 88817 1020000 1020000 MEDICAL SUPPLIES 11850836 11828032 22804 LICENSES AND TAXES 125408 69787 55621 FOOD EXPENSE 390266 387734 2532 DUES & SUBSCRIPTIONS 199951 40941 159010 144145 30316 113829 0 133875155 120102518 13772636 0 0 6275 6175 3859975 716659 15570591 19185915 0 0 107021 127312 1519551 1708909 7341692 4330144 107904423 72125193 36887167 35779230 115498042 124507521 29915226 36351482 5870261 6433387 11686 0 216587487 229146734 18876828 13729458 160303 165215 4000000 4334365 0 13860484 13913690 36897615 32142728 X 176010847 192857954 2327228 2778944 1351797 1367108 179689872 197004006 216587487 229146734 X 9437029 7366019 468942 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 10873 10873 false Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 LOBBYING EXPENDITURES PAID DIRECTLY BY THE FILING ORGANIZATION FOR ANNUAL MEMBERSHIP DUES: AMERICAN COLLEGE OF HEALTHCARE $3 AMERICAN SOCIETY OF ASET $11 SOCIETY FOR HUMAN RESOURCES $13 LOBBYING EXPENDITURES PAID BY THE PARENT ORGANIZATION FOR ANNUAL MEMBERSHIP DUES WHERE EXPENSES ARE ALLOCATED TO THE HOSPITAL: CATHOLIC HEALTH ASSOCIATION $723 NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE $136 HOSPITAL ASSOCIATION OF S. CALIFORNIA $7,724 AMERICAN HOSPITAL ASSOCIATION $1,809 CALIFORNIA ASSOCIATION FOR HEALTH SERVICES AT HOME $40 VISITING NURSE ASSOCIATION OF AMERICA $414 TOTAL EXPENDITURES PAID TO ORGANIZATIONS $10,873 1351797 15311 1367108 1599744 61959 -309906 1351797 2423093 57110 350441 1230900 1599744 1178093 1252000 -7000 2423093 1130227 47866 1178093 1.00000 false true true 1140153 1140153 61393568 37712132 23681436 3764816 2960545 804271 41110620 31452516 9658104 495266 495266 35779230 0 0 POOLED INVESTMENTS 36351482 F 36351482 0 DUE TO RELATED PARTIES 10593640 PENSION PAYABLE 3320050 13913690 X Intended uses of endowment funds Schedule D, Part V, Line 4 THE ENDOWMENT FUNDS ARE INTENDED TO BE USED TO SUPPORT ALZHEIMER'S RESEARCH, THE CANCER CENTER, THE CARDIAC PROGRAM AND OTHER HOSPITAL PROGRAM NEEDS. FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 DIGNITY HEALTH REVIEWS ITS TAX POSITIONS ANNUALLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. true true X true X true X 5 true true false true true 0 3485 1399740 0 1399740 0.01050 0 20588 17446054 18161511 -715457 0.00000 0 6151 5487105 2872363 2614742 0.01950 0 30224 24332899 21033874 3299025 0.03000 22 5141 183720 0 183720 0.00140 1 4 1012 0 1012 0.00000 0 0.00000 0 0.00000 10 867 1243601 0 1243601 0.00930 33 6012 1428333 0 1428333 0.01070 33 36236 25761232 21033874 4727358 0.04070 0 0.00000 0 0.00000 2 27 113 0 113 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 2 27 113 0 113 0.00000 true 2912152 0 37021760 47077340 -10055580 X true true GRASS VALLEY OP SURG AMBULATORY SURGERY CENTER 0.228 0.3159 1 1 SIERRA NEVADA MEMORIAL MINER'S HOSPITAL

155 GLASSON WAY GRASS VALLEY CA 95945

HTTP://WWW.SNMH.ORG X X X SIERRA NEVADA MEMORIAL MINER'S HOSPITAL 1 true X X X X X X X X X 13 true true true X X X X X X X X X X false false true true 200 true 500 true X X X X X X X true true X X X X true false X X X X true X false false 1 GRASS VALLEY SURGERY CENTER

408 SIERRA COLLEGE DRIVE GRASS VALLEY CA 95945

OUTPATIENT SURGERY CENTER Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, SNMMH USES A COST ACCOUNTING SYSTEM THAT COMBINES RELATIVE VALUE UNITS (RVU) AND COST TO CHARGE RATIOS (CCR) TO ALLOCATE COSTS TO THE PATIENT LEVEL. THE COST ACCOUNTING SYSTEM ALGORITHM ALLOCATES TOTAL OPERATING EXPENSES TO THE PROCEDURE CHARGE CODE LEVEL BASED UPON AN RVU FOR PROCEDURES THAT HAVE BEEN STUDIED AND ASSIGNED AN RVU, OR BASED UPON A CCR FOR UNSTUDIED PROCEDURES THAT DO NOT HAVE AN RVU ASSIGNED. WHEN A CCR IS USED, THE SYSTEM CALCULATES THAT CCR ON A DEPARTMENTAL SPECIFIC BASIS AT EACH INDIVIDUAL HOSPITAL WHERE THE SERVICES WERE PROVIDED. THE CALCULATION IS SIMILAR TO THE WORKSHEET 2 OF SCHEDULE H, RATIO OF PATIENT CARE COST TO CHARGES, EXCEPT IT IS CALCULATED ON A DEPARTMENTAL SPECIFIC BASIS, NOT IN THE AGGREGATE. THE ALLOCATED PROCEDURE CHARGE CODE LEVEL COSTS ARE THEN ROLLED UP TO THE PATIENT LEVEL BASED UPON THE BILLED PROCEDURE CHARGE CODES ASSOCIATED WITH THOSE SERVICES PROVIDED TO EACH SPECIFIC PATIENT. THIS IS DONE FOR ALL PATIENT SEGMENTS INCLUDING INPATIENT, OUTPATIENT, EMERGENCY DEPARTMENT, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED AND SELF PAY. THE COST ACCOUNTING SYSTEM IS UTILIZED TO DETERMINE THE UNREIMBURSED COST OF MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS. THE COST OF CHARITY CARE IS CALCULATED BY APPLYING THE CCR DERIVED FROM THE COST ACCOUNTING SYSTEM ON A PER FACILITY BASIS, TO THE CHARGES INCURRED ON PATIENTS THAT QUALIFY FOR CHARITY CARE AT THE RESPECTIVE FACILITY. THE ACTUAL COST IS REPORTED FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH AND CASH AND IN-KIND DONATIONS. SCH H, PART I, LINE 7B, COLUMN (F) SCHEDULE H, PART I, LINE 7B 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 $6.9 MILLION DURING THE YEAR REFLECTED UNDER THE MEDICAID PROGRAM AS DIRECT OFFSETTING REVENUE (PART I, LINE 7B, COLUMN D). THIS NET REDUCTION IN THE COST OF THE MEDICAID PROGRAM IS DRIVING THE DECREASE IN THE OVERALL COST OF COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSES WHEN COMPARED TO PRIOR YEARS. THE CALIFORNIA HOSPITAL ASSOCIATION CREATED A PRIVATE PROGRAM, THE CALIFORNIA HEALTH FOUNDATION AND TRUST ("CHFT"), ESTABLISHED FOR SEVERAL PURPOSES, INCLUDING AGGREGATING AND DISTRIBUTING FINANCIAL RESOURCES TO SUPPORT CHARITABLE ACTIVITIES AT VARIOUS HOSPITALS AND HEALTH SYSTEMS IN CALIFORNIA. DURING THE YEAR, SIERRA NEVADA MEMORIAL HOSPITAL RECORDED A PLEDGE TO A GRANT FUND ESTABLISHED BY CHFT IN THE AMOUNT $0.6 MILLION. THE GRANT IS REPORTED UNDER OTHER BENEFITS (PART I, LINE 7I, COLUMN C), AS CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 0 Community Building Activities Schedule H, Part II ADVOCACY TO IMPROVE THE HEALTH STATUS OF THE UNDERSERVED AND THE QUALITY OF LIFE FOR RESIDENTS IN NEVADA COUNTY IS A PRIORITY. SIERRA NEVADA MEMORIAL HOSPITAL IS INVOLVED IN VARIOUS ORGANIZATIONS TO REPRESENT THE NEEDS OF THE UNDERSERVED, DEVELOP INITIATIVES FOR HEALTHIER COMMUNITIES, AND ENHANCE THE OVERALL ECONOMY OF THE COMMUNITY. SIGNIFICANT VOLUNTEER TIME IS SPENT SERVING THE COMMUNITY IN THIS CAPACITY ON THE BOARDS OF ORGANIZATIONS THAT INCLUDE: -MINERS/WESTERN SIERRA CLINIC -GRASS VALLEY CHAMBER OF COMMERCE -COMMUNITY RECOVERY RESOURCES -ROTARY OF GRASS VALLEY -ROTARY OF NEVADA COUNTY SOUTH -THE FRIENDSHIP CLUB -ELDERCARE PROVIDERS -ECONOMIC RESOURCE COUNCIL THE HOSPITAL ALSO PARTICIPATES IN FUNDRAISING EVENTS TO SUPPORT MEANINGFUL HEALTH IMPROVEMENT PROGRAMS AND SERVICES BY COMMUNITY BASED NONPROFIT ORGANIZATIONS. Bad debt expense - methodology used to estimate amount Schedule H, Part III, Line 2 THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE CCR (SEE ABOVE) TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER FINANCIAL ASSISTANCE, AND ARE OTHERWISE UNINSURED. ANY PORTION OF A PATIENT BILL REMAINING AFTER APPLYING FINANCIAL, UNINSURED OR OTHER DISCOUNTS OR PAYMENTS RECEIVED ON THE ACCOUNT THAT ARE ULTIMATELY DETERMINED TO BE UNCOLLECTIBLE ARE WRITTEN OFF TO BAD DEBT. AS NOTED IN PART I, LINE 3B, SNMMH PROVIDES FREE OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS AT OR BELOW 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 AT CALIFORNIA FACILITIES. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. Bad debt expense - methodology used to estimate amount as community benefit Schedule H, Part III, 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 AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS FINANCIAL ASSISTANCE AS SOON AS ELIGIBILITY IS KNOWN. SNMMH ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF A PATIENT MAY QUALIFY FOR FINANCIAL ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE FINANCIAL ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIO-ECONOMIC 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 CHARITY ARE REPORTED AS BAD DEBT. AS SUCH, SNMMH DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 THE FOLLOWING IS AN EXCERPT FROM DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS' CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2013, 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. Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 SNMMH PREPARES MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1, §2150FF AND PRM 15-2, §1000FF. AS SUCH, THE FOLLOWING LANGUAGE PER THE PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR TO BE CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. DIGNITY HEALTH BELIEVES THAT THE ENTIRE MEDICARE SHORTFALL OF $603.9 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 $10.0 MILLION REPORTED ON PART III, SECTION B, LINE 8, PRIMARILY FOR FEE FOR SERVICE MEDICARE PATIENTS, AS WELL AS THE UNREIMBURSED PORTION OF MEDICARE MANAGED CARE AND MEDICARE CAPITATED PROGRAMS FOR SNMMH. Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b SNMMH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. SNMMH'S COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE SNMMH OR BILLING COMPANY RETAINED BY SNMMH IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED FINANCIAL ASSISTANCE OR FOR ASSISTANCE UNDER SNMMH'S 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. Community Served by Needs Assessment Schedule H, Part V Section B, Line 3 (1) SIERRA NEVADA MEMORIAL MINER'S HOSPITAL - KEY INFORMANTS ARE HEALTH AND COMMUNITY EXPERTS FAMILIAR WITH POPULATIONS AND GEOGRAPHIC AREAS RESIDING WITHIN THE SIERRA NEVADA MEMORIAL MINERS HOSPITAL'S SERVICE AREA. TO GAIN A DEEPER UNDERSTANDING OF THE HEALTH ISSUES PERTAINING TO CHRONIC DISEASE AND POPULATIONS LIVING IN MORE VULNERABLE COMMUNITIES, THIRTY-SEVEN KEY INFORMANTS PARTICIPATED IN THE CHNA PROCESS. INTERVIEWS WERE CONDUCTED WITH THESE INFORMANTS USING A THEORETICALLY GROUNDED INTERVIEW GUIDE. EACH INTERVIEW WAS RECORDED AND CONTENT ANALYSIS WAS CONDUCTED TO IDENTIFY KEY THEMES AND IMPORTANT POINTS PERTAINING TO EACH HSA GEOGRAPHIC AREA. FINDINGS FROM THESE INTERVIEWS WERE ALSO USED TO HELP IDENTIFY COMMUNITIES MOST APPROPRIATE FOR FOCUS GROUPS. MEMBERS OF THE COMMUNITY REPRESENTING SUBGROUPS, DEFINED AS GROUPS WITH UNIQUE ATTRIBUTES (RACE AND ETHNICITY, AGE, SEX, CULTURE, LIFESTYLE, OR RESIDENTS OF A PARTICULAR AREA OF THE HSA), WERE RECRUITED TO PARTICIPATE IN A FOCUS GROUP. A STANDARD PROTOCOL WAS USED FOR THE FOCUS GROUP TO UNDERSTAND THE EXPERIENCES OF THESE COMMUNITY MEMBERS AS THEY RELATE TO HEALTH DISPARITIES AND CHRONIC DISEASE. IN ALL, A TOTAL OF TEN FOCUS GROUPS WITH 124 PEOPLE WERE CONDUCTED. CONTENT ANALYSIS WAS PERFORMED ON THE FOCUS GROUP INTERVIEW NOTES TO IDENTIFY SALIENT HEALTH ISSUES AFFECTING THESE COMMUNITY RESIDENTS. ; Other Hospital Facilities included in Needs Assessment Schedule H, Part V Section B, Line 4 (1) SIERRA NEVADA MEMORIAL MINER'S HOSPITAL - MERCY HOSPITAL OF FOLSOM, MERCY SAN JUAN MEDICAL CENTER, MERCY GENERAL HOSPITAL, METHODIST HOSPITAL OF SACRAMENTO, SIERRA NEVADA MEMORIAL HOSPITAL, WOODLAND HEALTHCARE, UC DAVIS MEDICAL CENTER, KAISER PERMANENTE, SUTTER MEDICAL CENTER.; SCH H, PART V, SECT B, LINE 5A SCHEDULE H, PART V, SECTION B, LINE 5A HTTP://WWW.DIGNITYHEALTH.ORG/WHO_WE_ARE/COMMUNITY_HEALTH/235026 Needs not addressed in Needs Assessment Schedule H, Part V Section B, Line 7 (1) SIERRA NEVADA MEMORIAL MINER'S HOSPITAL - 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.; Other ways hospital publicized Financial Assistance Policy Schedule H, Part V Section B, Line 14g (1) SIERRA NEVADA MEMORIAL MINER'S HOSPITAL - 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. ; Means used to determine amounts billed Schedule H, Part V Section B, Line 20d (1) SIERRA NEVADA MEMORIAL MINER'S HOSPITAL - 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. ; Needs assessment. Schedule H, Part VI, Line 2 THE HOSPITAL IS ADDRESSING PRIORITY NEEDS IDENTIFIED IN THE NEEDS ASSESSMENT, FOCUSING ON ACCESS TO CARE AS A PRIORITY NEED AND BY IMPLEMENTING A CHRONIC DISEASE SELF-MANAGEMENT PROGRAM. NEEDS ARE ALSO ASSESSED EACH YEAR WORKING WITH COMMUNITY ORGANIZATIONS DURING OUR COMMUNITY GRANTS PROGRAM. SIERRA NEVADA MEMORIAL HOSPITAL ENGAGED VALLEY VISION, INC. TO CONDUCT AN ASSESSMENT OF THE HEALTH NEEDS OF THE RESIDENTS LIVING IN THE SERVICE AREA. THE ASSESSMENT WAS CONDUCTED FROM EARLY 2012 THOURGH FEBRUARY 2013 USING A MIXED METHOD DATA COLLECTION APPROACH THAT INCLUDED PRIMARY DATA SUCH AS KEY INFORMANT INTERVIEWS, COMMUNITY FOCUS GROUPS, AND COMMUNITY ASSET ASSESSMENTS. SECONDARY DATA INCLUDED HEALTH OUTCOMES, DEMOGRAPHIC DATA, BEHAVIORAL DATA AND ENVIRONMENTAL DATA. SNMMH LEADERSHIP REVIEWED AND COMPARED THE FINDINGS OF THE ASSESSMENT WITH COMMUNITY BENEFIT PROGRAMS AND SERVICES CURRENTLY BEING OFFERED BY THE HOSPITAL AND DETERMINED SNMMH IS RESPONDING TO A NUMBER OF PRIORITY NEEDS. SNMMH LEADERSHIP HAS CONTRUCTEDD AN ACTION PLAN AND IS WORKING WITH COMMUNITY PARTNERS TO FURTHER ADDRESS THE NEEDS INDENTIFIED IN THE ASSESSMENT. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 COMMUNICATION OF THE FINANCIAL ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC: INFORMATION ABOUT PATIENT FINANCIAL ASSISTANCE AVAILABLE FROM SNMMH, INCLUDING A CONTACT NUMBER, IS DISSEMINATED BY THE HOSPITAL BY VARIOUS MEANS, INCLUDING THE PUBLICATION OF NOTICES IN PATIENT BILLS AND BY POSTING NOTICES IN THE EMERGENCY AND ADMITTING DEPARTMENTS, CENTRAL LOBBIES, AND WAITING ROOMS. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN BY THE POPULATIONS SERVED BY THE HOSPITAL. IN ADDITION, PAYMENT DISCUSSIONS ARE HELD WITH PATIENTS AT THE TIME OF REGISTRATION AND AGAIN WHEN DISCHARGED. THE PATIENT IS GIVEN A BROCHURE AT THESE TIMES. FINANCIAL ADVISORS ARE ALSO AVAILABLE DURING THE PATIENT'S VISIT. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO UNINSURED PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED, A STATEMENT INFORMING PATIENTS WITHOUT INSURANCE COVERAGE THEY MAY BE ELIGIBLE FOR A GOVERNMENT SPONSORED PROGRAM OR FACILITY FUNDED FINANCIAL ASSISTANCE, INSTRUCTIONS ON HOW TO APPLY FOR A GOVERNMENT PROGRAM OR FINANCIAL ASSISTANCE AND THE PROVISION OF SUCH APPLICATIONS. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF THE HOSPITAL REQUIRE ALL INITIAL STATEMENTS TO UNINSURED PATIENTS INCLUDE VERBIAGE INFORMING PATIENTS OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND A COPY OF THE FINANCIAL ASSISTANCE APPLICATION. ANY MEMBER OF SNMMH'S STAFF OR MEDICAL STAFF MAY MAKE REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE. THE PATIENT OR A FAMILY MEMBER, A CLOSE FRIEND OR ASSOCIATE OF THE PATIENT MAY ALSO MAKE A REQUEST FOR FINANCIAL ASSISTANCE. Community information. Schedule H, Part VI, Line 4 PRIMARY SERVICE AREA: SIERRA NEVADA MEMORIAL HOSPITAL IS IN NEVADA COUNTY ENCOMPASSING THREE ZIP CODES IN THE COMMUNITIES OF GRASS VALLEY, PENN VALLEY AND NEVADA CITY. POPULATION: POPULATION WITHIN SIERRA NEVADA MEMORIAL HOSPITAL'S PRIMARY SERVICE AREA IS 75,194; 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 (87.0%). SOME GROWTH IS EXPECTED IN THE HISPANIC COMMUNITY. IN THE 2009 OSHPD DATA, 9% OF ITS RESIDENTS LIVE BELOW THE POVERTY LINE. 21.93% RECEIVE MEDICARE, 10.52% RECEIVE MEDICAL, 16.72% ARE UNINSURED AND 50.83% HAVE SOME FORM OF COMMERCIAL INSURANCE. 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. Promotion of community health Schedule H, Part VI, Line 5 SIERRA NEVADA MEMORIAL HOSPITAL OFFERS MEDICAL STAFF PRIVILEGES TO ANY QUALIFYING PHYSICIANS. THE HOSPITAL'S COMMUNITY BOARD SERVES IN AN OVERSIGHT ROLE TO ENSURE THAT COMMUNITY BENEFIT PRACTICES AND PROGRAMS ARE ALIGNED WITH AND SUPPORT THE MISSION, POLICY AND PRIORITIES OF THE REGION AND THE ORGANIZATION. THE MAJORITY OF THE ORGANIZATION'S GOVERNING BODY RESIDES IN THE PRIMARY SERVICE AREA AND IS NOT EMPLOYED BY NOR CONTRACTED WITH THE ORGANIZATION. SNMMH UTILIZES A COMMUNITY NEEDS ASSESSMENT PROCESS THAT RESULTS IN A DOCUMENT DESCRIBING THE HEALTH CARE NEEDS OF THE SURROUNDING POPULATION. IN ADDITION A COMPANION DOCUMENT LISTING COMMUNITY HEALTH ASSETS IS PREPARED AND THEN COMPARED TO THE NEEDS ASSESSMENT. UNMET NEEDS ARE IDENTIFIED AND USED IN PLANNING FOR PHYSICIAN RECRUITMENT, ADDING NEW SERVICES AND PROGRAMS, AND OFFERING COMMUNITY EDUCATION. SIERRA NEVADA MEMORIAL HOSPITAL SPECIFICALLY SPONSORS AND TAKES AN ACTIVE ROLE IN PROGRAMS THAT ADDRESS PRIORITIES WITHIN ITS SERVICE AREA SUCH AS: - CHAMP (CONGESTIVE HEART ACTIVE MANAGEMENT PROGRAM) THAT PROVIDES A VITAL MEDICAL LINK TO HEART FAILURE PATIENTS WHEN THEY LEAVE THE HOSPITAL TO IMPROVE THEIR UNDERSTANDING AND ABILITY TO MANAGE THIS CHRONIC DISEASE, AND REDUCE THEIR RISK OF READMISSION. -FREE OR DISCOUNTED CARDIAC REHAB PROGRAMS TO THOSE WHO ARE UNABLE TO PAY AS A COMPLEMENTARY PROGRAM TO CHAMP. - WELLNESS EDUCATION PROGRAM THAT OFFERS A WIDE VARIETY OF FREE OR DISCOUNTED CLASSES ADDRESSING HEALTH ISSUES INCLUDING DIABETES, CHRONIC DISEASE SELF-MANAGEMENT, SMOKING CESSATION, AGING, HEALTHY COOKING, AND PRENATAL CARE. - FREE NUTRITIONAL COUNSELING BY A REGISTERED DIETICIAN FOR THOSE THAT ARE UNINSURED OR CAN'T AFFORD TO PAY. - FREE OR LOW COST LAB TESTING FOR ALL IN THE COMMUNITY, WITH AN EMPHASIS ON POOR AND VULNERABLE. - ASSISTANCE TO ALZHEIMER'S PATIENTS AND THEIR CAREGIVERS/FAMILIES BY THE HOSPITAL'S HOME CARE DEPARTMENT. - CANCER SCREENINGS AND CANCER SUPPORT GROUPS. - TRAUMATIC BRAIN INJURY, STROKE AND OTHER SUPPORT GROUPS. - EDUCATIONAL TRAINING FOR THOSE ENTERING THE PROFESSIONAL AND MEDICAL HEALTH FIELD. SIERRA NEVADA MEMORIAL HOSPITAL ALSO PROVIDES ASSISTANCE TO UNINSURED PATIENTS FOR ENROLLMENT IN GOVERNMENT SPONSORED HEALTH INSURANCE PROGRAMS, AND FREE TRANSPORTATION TO THOSE IN NEED. Affiliated health care system Schedule H, Part VI, Line 6 SNMMH IS AFFILIATED WITH DIGNITY HEALTH. AFFILIATES OF DIGNITY HEALTH PROMOTE THE HEALTH OF ADDITIONAL COMMUNITIES IN BAKERSFIELD, SAN BERNARDINO, SAN FRANCISCO, SAN ANDREAS, AND GRASS VALLEY/NEVADA CITY, CALIFORNIA. THESE AFFILIATES FOLLOW PRACTICES SIMILAR TO THOSE NOTED ABOVE IN DETERMINING THE UNMET HEALTHCARE NEEDS OF THEIR COMMUNITIES. TOTAL UNSPONSORED COMMUNITY BENEFIT EXPENSE FOR DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS FOR THE YEAR ENDED JUNE 30, 2013, IS AS FOLLOWS: THE FOLLOWING INFORMATION REPRESENTS PERSON SERVED, NET COMMUNITY BENEFIT EXPENSE, AND THE PERCENT OF TOTAL EXPENSES. BENEFITS FOR THE POOR: TRADITIONAL CHARITY CARE 120,470; 198,395,000; 2.0% UNPAID COSTS OF MEDICAID/MEDI-CAL 1,136,319; 538,029,000; 5.3% OTHER MEANS-TESTED PROGRAMS 300,240; 75,758,000; 0.7% COMMUNITY SERVICES: COMMUNITY HEALTH SERVICES 449,578; 53,933,000; 0.5% HEALTH PROFESSIONS EDUCATION 69; 30,000; 0.0% SUBSIDIZED HEALTH SERVICES 193,609; 38,432,000; 0.4% DONATIONS 144,076; 29,562,000; 0.3% COMMUNITY BUILDING ACTIVITIES 9,025; 1,862,000; 0.0% COMMUNITY BENEFIT OPERATIONS 2,445; 8,124,000; 0.1% TOTAL COMMUNITY SERVICES FOR THE POOR 798,802; 131,943,000; 1.3% TOTAL BENEFITS FOR THE POOR 2,355,831; 944,125,000; 9.3% BENEFITS FOR THE BROADER COMMUNITY: COMMUNITY SERVICES: COMMUNITY HEALTH SERVICES 560,690; 15,733,000; 0.2% HEALTH PROFESSIONS EDUCATION 40,924; 55,898,000; 0.6% SUBSIDIZED HEALTH SERVICES 4,517; 1,238,000; 0.0% RESEARCH 7,207; 28,631,000; 0.3% DONATIONS 82,520; 9,385,000; 0.1% COMMUNITY BUILDING ACTIVITIES 13,019; 2,723,000; 0.0% COMMUNITY BENEFIT OPERATIONS 66; 1,233,000; 0.0% TOTAL BENEFITS FOR THE BROADER COMMUNITY 708,943; 114,841,000; 1.1% TOTAL COMMUNITY BENEFITS 3,064,774; 1,058,966,000; 10.5% UNPAID COSTS OF MEDICARE 1,269,112; 603,955,000; 6.0% TOTAL COMMUNITY BENEFITS INCLUDING COST OF MEDICARE 4,333,886; 1,662,921,000; 16.4% State filing of community benefit report Schedule H, Part VI, Line 7 CA true DIGNITY HEALTH MEDICAL FOUNDATION 3400 DATA DRIVE RANCHO CORDOVA CA 95670 680220314 501(C)(3) 2332677 0 N/A N/A MEDICAL FND SUPPORT SIERRA NEVADA HOSPITAL FOUNDATION 140 LITTON DRIVE GRASS VALLEY CA 95945 680005939 501(C)(3) 540766 0 N/A N/A FOUNDATION SUPPORT CALIFORNIA HEALTH FOUNDATION AND TRUST 1215 K ST SUITE 800 SACRAMENTO CA 95814 941498697 501(C)(3) 563977 0 N/A N/A SERVICE FOR THE POOR 3 0 Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 THE ORGANIZATION'S CFO REVIEWS FINANCIAL INFORMATION MONTHLY AND APPROVES THE GRANT PAYMENT BASED ON THAT REVIEW. THE GRANTS TO THE FOUNDATION ARE BASED ON ACTUAL EXPENSES, NOT TO EXCEED THE APPROVED BUDGET. true true false false false false false false false CAROLYN CANADY 183355 0 36661 0 0 0 23653 0 9793 0 253462 0 0 0 DEBBIE L PLASS 136360 0 27935 0 0 0 11511 0 1024 0 176830 0 0 0 GREGORY T SMITH 170407 0 275 0 1242 0 12035 0 29967 0 213925 0 0 0 JONATHAN D STONE 162958 0 24275 0 0 0 21789 0 23205 0 232227 0 0 0 JOSEPH BRITTON MD 250016 0 44067 0 0 0 18821 0 29967 0 342871 0 0 0 JOSEPH G STEHMEYER 171882 0 275 0 0 0 13396 0 29967 0 215520 0 0 0 KATHERINE A MEDEIROS 0 282348 0 111024 0 13482 0 32773 0 39536 0 479164 0 0 KEVIN VAZIRI 0 313960 0 160002 0 9588 0 37895 0 32624 0 554068 0 0 TZVETAN I TZVETANOV 251103 0 11722 0 0 0 34609 0 162 0 297596 0 0 0 Arrangement used to establish the top management official's compensation Schedule J, Part I, Line 3 ALTHOUGH THE ORGANIZATION EMPLOYS PERSONNEL, THE ORGANIZATION RELIED ON A RELATED ORGANIZATION, DIGNITY HEALTH, THAT USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART I, LINE 3, TO ESTABLISH THE ORGANIZATION'S SERVICE AREA LEADER'S COMPENSATION. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A FOR ADDITIONAL INFORMATION. Severance or change-of-control payment Schedule J, Part I, Line 4a THE ORGANIZATION'S KEY EMPLOYEES, CERTAIN OFFICERS AND HIGHLY COMPENSATED EMPLOYEES PARTICIPATE IN A SEVERANCE PLAN THAT PROVIDES MARKET-STANDARD COMPENSATION PAYMENTS OF UP TO 6 MONTHS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE PLAN. PAYMENTS PURSUANT TO THE PLAN ARRANGEMENT FOR ONE KEY EMPLOYEE OCCURRED DURING 2012; M. GISH $95,000. Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b DIGNITY HEALTH'S KEY EMPLOYEES AND CERTAIN OFFICERS AND HIGHLY COMPENSATED EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN THE 2007 DIGNITY HEALTH EXECUTIVE DEFERRED COMPENSATION PLAN THAT IS 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. NO PAYMENTS WERE MADE UNDER THIS PLAN DURING 2012. CERTAIN OFFICERS AND KEY EMPLOYEES 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 2012 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 DISCLOSURES SCHEDULE J, PART II THE 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. A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521598225 13033FTN0 2004-05-19 150000000 SEE PART VI: BOND A CUSIP 13033FTN0 false false true B CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033FYE4 2005-11-10 200000000 SEE PART VI: BOND B CUSIP 13033FYE4 false false true A 0 0 2000000 0 0 0 0 0 0 2000000 0 0 2005 false false true true B 0 0 2334365 0 0 0 0 0 0 2334365 0 0 2008 false false true true A false true true true true true 0.0136 0.0003 0.0139 false false 0 false true B false true true true true true 0.0000 0.0000 0.0000 false false 0 false true A false false false true true false 0 false false false 0 false true true B false false false true true false 0 false false false 0 false true true A true B true ISSUER NAME: CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY: No Rebate Due. Schedule K, Part IV, Line 2c THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 7/1/2013. ISSUER NAME: CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY: No Rebate Due. Schedule K, Part IV, Line 2c THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 1/28/2010. BOND A - CUSIP 13033FTN0 SCHEDULE K, PART VI PART I(E) AND PART II, LINE 3 THE DIFFERENCE BETWEEN THE ISSUE PRICE IN PART I, COLUMN (E) AND PART II, LINE 3 IS PRIMARILY A RESULT OF THE FACT THAT THE BOND ISSUE WAS A POOLED FINANCING ISSUE. THE FULL ISSUE PRICE OF WHICH IS SHOWN ON PART I, COLUMN (E) IN COMPARISON TO THE AMOUNT OF PROCEEDS SHOWN ON PART II, LINE 3 REFLECTS ONLY THE PORTION OF THE BOND ISSUE BORROWED BY THIS 501(C)(3) CORPORATION AND CURRENTLY OUTSTANDING. A SMALL PART OF THE DIFFERENCE BETWEEN THE ISSUE PRICE AND PROCEEDS IS DUE TO INVESTMENT EARNINGS.. PART II, LINE 3 ALTHOUGH THE FACILITIES ORIGINALLY FINANCED WITH PROCEEDS OF THE BONDS WERE SUBSTANTIALLY COMPLETED IN THE YEAR INDICATED, REPAYMENTS OF THE LOANS ORIGINATED WITH PROCEEDS OF THE BONDS WERE AND/OR WILL BE RECYCLED INTO NEWLY ORIGINATED LOANS CONTINGENT ON DEMAND BY PARTICULAR BORROWERS AT THE TIME OF A LOAN REPAYMENT. COMPLETION DATES OF PROJECTS FINANCED OR TO BE FINANCED WITH SUCH RECYCLED AMOUNTS ARE NOT INDICATED. BOND B - CUSIP 13033FYE4 SCHEDULE K, PART VI PART I(E) AND PART II, LINE 3 THE DIFFERENCE BETWEEN THE ISSUE PRICE IN PART I, COLUMN (E) AND PART II, LINE 3 IS PRIMARILY A RESULT OF THE FACT THAT THE BOND ISSUE WAS A POOLED FINANCING ISSUE. THE FULL ISSUE PRICE OF WHICH IS SHOWN ON PART I, COLUMN (E) IN COMPARISON TO THE AMOUNT OF PROCEEDS SHOWN ON PART II, LINE 3 REFLECTS ONLY THE PORTION OF THE BOND ISSUE BORROWED BY THIS 501(C)(3) CORPORATION AND CURRENTLY OUTSTANDING. A SMALL PART OF THE DIFFERENCE BETWEEN THE ISSUE PRICE AND PROCEEDS IS DUE TO INVESTMENT EARNINGS. PART II, LINE 3 ALTHOUGH THE FACILITIES ORIGINALLY FINANCED WITH PROCEEDS OF THE BONDS WERE SUBSTANTIALLY COMPLETED IN THE YEAR INDICATED, REPAYMENTS OF THE LOANS ORIGINATED WITH PROCEEDS OF THE BONDS WERE AND/OR WILL BE RECYCLED INTO NEWLY ORIGINATED LOANS CONTINGENT ON DEMAND BY PARTICULAR BORROWERS AT THE TIME OF A LOAN REPAYMENT. COMPLETION DATES OF PROJECTS FINANCED OR TO BE FINANCED WITH SUCH RECYCLED AMOUNTS ARE NOT INDICATED. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 THE ORGANIZATION HAS A SOLE CORPORATE MEMBER, DIGNITY HEALTH, A 501(C)(3) EXEMPT ORGANIZATION. Members or stockholders electing members of governing body 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. Decisions requiring approval by members or stockholders 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. Review of form 990 by governing body 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. Conflict of interest policy 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 FORM 990, PART VI, LINE 15A ALTHOUGH THE ORGANIZATION EMPLOYS PERSONNEL, THE SERVICE AREA LEADER IS COMPENSATED BY DIGNITY HEALTH. FOR 2012, 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 FORM 990, PART VI, 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. Governing documents, conflict of interest policy and financial statements available to the public 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. PART VII, SECTION A FORM 990, PART VII, SECTION A SNMMH DOES NOT COMPENSATE DIRECTORS, DRS SARAH WOERNER AND DAVID CAMPBELL, FOR THEIR SERVICES AS A BOARD MEMBER. ALL COMPENSATION AND BENEFITS REPORTED FOR DIRECTORS REPRESENT COMPENSATION AS MEDICAL DIRECTOR OF SNMMH OR FOR PAYMENT OF EMERGENCY ON-CALL MEDICAL SERVICES. Other Expenses Form 990, Part IX, Line 11g MEDICAL FEES - TOTAL EXPENSE: 5289555, PROGRAM SERVICE EXPENSE: 5181085, MANAGEMENT AND GENERAL EXPENSES: 108470, FUNDRAISING EXPENSES: ; PROFESSIONAL CONSULTING - TOTAL EXPENSE: 646534, PROGRAM SERVICE EXPENSE: 403071, MANAGEMENT AND GENERAL EXPENSES: 243463, FUNDRAISING EXPENSES: ; INTERCOMPANY ADMINISTRATIVE SERVICES - TOTAL EXPENSE: 2425283, PROGRAM SERVICE EXPENSE: , MANAGEMENT AND GENERAL EXPENSES: 2425283, FUNDRAISING EXPENSES: ; LAUNDRY/LINEN SERVICES - TOTAL EXPENSE: 383114, PROGRAM SERVICE EXPENSE: 382533, MANAGEMENT AND GENERAL EXPENSES: 581, FUNDRAISING EXPENSES: ; MAINTENANCE CONTRACTS - TOTAL EXPENSE: 2143098, PROGRAM SERVICE EXPENSE: 2089280, MANAGEMENT AND GENERAL EXPENSES: 53818, FUNDRAISING EXPENSES: ; OTHER PURCHASED SERVICES - TOTAL EXPENSE: 3388944, PROGRAM SERVICE EXPENSE: 2315180, MANAGEMENT AND GENERAL EXPENSES: 1073764, FUNDRAISING EXPENSES: ; Other changes in net assets or fund balances Form 990 , Part XI, Line 9 EARNINGS FROM EXEMPT CORPORATION - 1915; INTEREST IN NET ASSETS OF AN UNCONSOLIDATED FOUNDATION - 467027; FORM 990, PART XII, LINE 3B 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. SIERRA NEVADA MEMORIAL HOSPITAL FDTN PO BOX 1810 GRASS VALLEY CA 95945 FUNDRAISING CA 501(C)(3) 11 - Type III - FI NA false DIGNITY HEALTH 185 BERRY STREET SAN FRANCISCO CA 94107 HOSPITAL CA 501(C)(3) 3 NA false false true true false false false false false false false false false true false false true false false true