2014-05-14T12:27:53-05:00 2013-06-30 990 2012-07-01 941437713 SAINT AGNES MEDICAL CENTER SAIN 5594503559 1303 EAST HERNDON AVENUE FRESNO CA 93720 CHRISTINE SARRICO 5594503559 2014-05-14 2012 2015-11-30 17:44:51Z NANCY HOLLINGSWORTH 1303 EAST HERNDON AVENUE FRESNO CA 93720 504818629 0 0928 X WWW.SAMC.COM X 1958 CA HEALTH CARE SERVICES 15 12 3152 730 307564 105856 1591907 1685757 425832685 478881589 8158357 14372014 6526536 8779231 442109485 503718591 188333 171004 0 0 206610616 203458729 0 0 939047 217723022 281061192 424521971 484690925 17587514 19027666 616991699 632110844 153298785 145081948 463692914 487028896 HEALTH CARE SERVICES 0 0 403238392 171004 485061183 SAINT AGNES MEDICAL CENTER (THE HOSPITAL), A CALIFORNIA NOT-FOR-PROFIT CORPORATION, OWNS AND OPERATES AN ACUTE-CARE HOSPITAL IN FRESNO, CALIFORNIA. THE HOSPITAL PROVIDES HEALTH SERVICES TO INDIVIDUALS WHO RESIDE PRIMARILY IN THE LOCAL GEOGRAPHIC REGION. THE HOSPITAL IS A MEMBER OF TRINITY HEALTH, AN INDIANA NOT-FOR-PROFIT CORPORATION, SPONSORED BY CATHOLIC HEALTH MINISTRIES, A PUBLIC JURIDIC PERSON OF THE HOLY ROMAN CATHOLIC CHURCH. FOR MORE INFORMATION ABOUT SERVICES PROVIDED,SEE SAINT AGNES MEDICAL CENTER'S WEBSITE AT WWW.SAMC.COM MISSIONTHE MISSION STATEMENT OF THE HOSPITAL IS AS FOLLOWS:WE, CHE TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES. 403238392 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 1 1 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 1 575 1 1 3152 1 1 1 0 0 0 0 1 1 0 0 0 0 X 15 12 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 CA X STEPHEN KALOMIRIS CONTROLLER & CAO 5594503559 1111 E SPRUCE AVENUE FRESNO CA 93720 MICHAEL MARTINEZ 2.00 X X 0 0 0 A THOMAS FERDINANDI JR 2.00 X X 0 0 0 PHILLIP SANCHEZ 2.00 X X 0 0 0 NANCY HOLLINGSWORTH 50.00 X X 0 620246 119950 DEBRA CANALES 2.00 X 0 852044 102033 SR MARY CORITA HEID RSM 2.00 X 0 0 0 CAROLYN DRAKE MD 2.00 X 0 0 0 LEE JAY KOLLIGIAN ESQ 2.00 X 0 0 0 DIANNE NURY 2.00 X 0 0 0 WILLIAM OWEN MD 2.00 X 0 0 0 WILLIAM HADCOCK MD 2.00 X 46849 0 0 DEBORAH IKEDA 2.00 X 0 0 0 NEIL KOENIG PHD 2.00 X 0 0 0 SR KATHLEEN MORONEY CSC 2.00 X 0 0 0 CRAIG SALADINO 2.00 X 0 0 0 MIKE TOLLADAY 2.00 X 0 0 0 CHRISTINE SARRICO 50.00 X 0 368287 61516 VREELAND JONES ESQ 50.00 X 0 227738 31942 MARK BATEMAN 50.00 X 54000 310387 27365 PHILLIP ROBINSON TATUM LLC 50.00 X 89005 0 0 JOSEPH SWEDISH 2.00 53.00 X 0 3233500 601476 KEDRICK ADKINS 2.00 53.00 X 0 1821619 126167 J RICHARD O'CONNELL 2.00 53.00 X 0 1036410 130423 STEPHEN SOLDO MD 50.00 X 0 492301 39900 STACY VAILLANCOURT 50.00 X 0 301449 31573 DEBBIE CHAPPELL 50.00 X 174288 0 47198 DEBRA PASLEY RN 50.00 X 0 196005 17350 TINA DEMARCO 50.00 X 0 486000 12500 GERALD MARGOSIAN 50.00 X 284353 0 65257 PATRICIA HARGER 50.00 X 0 254380 38130 KEVIN KOZUKI 50.00 X 210261 0 19331 TY DUONG 50.00 X 204782 0 19893 THOMAS ANDERSON 0.00 50.00 X 0 549162 46429 JARELL E WILLIAMSON ESQ 50.00 X 0 164758 23672 MICHAEL MURPHY 0.00 X 0 180882 16630 TONI KAZARIAN 50.00 X 173846 0 84744 MARYANN STATBILE INTER HLTH INV 0.00 X 120151 0 0 1357535 11095168 1663479 446 1 1 1 STANFORD HOSPITAL AND CLINICS 300 PASTEUR DR FALK BLDG MC STANFORD CA 94305 MEDICAL PROFESSIONAL SERVICES 3449246 SEALSBIEHLE GENERAL CONTRACTORS 9410 W PLACER AVE VISALIA CA 93291 CONSTRUCTION SERVICES 2036538 ANGELICA CORPORATION 1105 LAKEWOOD PARKWAY STE 210 ALPHARETTA GA 30009 LAUNDRY SERVICES 1795655 DAVITA DIALYSIS GHENT PO BOX 403008 ATLANTA GA 30384 DIALYSIS SERVICES 1605124 CROSS COUNTRY STAFFING 6551 PARK OF COMMERCE BLVD BOCA RATON FL 33487 TEMPORARY MEDICAL STAFFING SERVICES 1519499 72 454285 3200 10625 1217647 175650 1685757 ACUTE INPATIENT SVCS 900099 334940737 334940737 ACUTE OUTPATIENT SVCS 900099 143940852 143767860 172992 478881589 9100326 9100326 744355 291589 452766 452766 452766 5667290 62845 0 458447 5667290 -395602 5271688 5271688 87626 454285 296428 -208802 -208802 74727 53574 21153 21153 MEDICARE/MEDICAID HIT 900099 4395418 4395418 OTHER REVENUE 900099 2091740 1957168 134572 CAFETERIA REVENUE 900099 2026956 2026956 8514114 503718591 485061183 307564 16664087 122207 122207 48797 48797 3461536 3461536 552059 103727 448332 167618454 157514564 9571129 532761 12113151 11433247 641240 38664 7017326 6607077 387915 22334 12696203 11237507 1420667 38029 497485 468479 29006 372318 372318 24122519 21616995 2480067 25457 718657 13321 696456 8880 4954940 3737783 1172150 45007 19067924 399121 18668353 450 7335321 6936319 392933 6069 476207 324339 124697 27171 3929661 3929661 26899149 9420135 17470353 8661 2577672 2577672 MEDICAL SUPPLIES 64511461 64511461 HOSPITAL PROVIDER TAX 61201633 61201633 BAD DEBT 30817487 30817487 UBI TAXES 79984 79984 33498774 12794532 20518678 185564 484690925 403238392 80513486 939047 2268472 19914230 275757 267271 2140659 2074375 60250038 69100636 400000 1203567 6708665 6289051 1065633 1159239 505761758 303241941 210044664 202519817 125140440 162077758 183209387 142132830 25487984 25372070 616991699 632110844 39525795 38047095 445471 266986 516579 113327519 106251288 153298785 145081948 X 449482300 471993049 3636591 3682154 10574023 11353693 463692914 487028896 616991699 632110844 X 19027666 7471389 -3163073 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 63727 1 0 0 0 63727 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: SAINT AGNES MEDICAL CENTER HAS HAD DIRECT CONTACT WITH AND SENT MAILINGS TO LEGISLATORS DURING THE YEAR. THIS CONTACT INCLUDED DISCUSSIONS OF HEALTH CARE AND MEDICARE ISSUES. SAINT AGNES MEDICAL CENTER HAS ALSO MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED SAINT AGNES MEDICAL CENTER WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. SAINT AGNES MEDICAL CENTER MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 13673937 38630 1184274 14896841 13948318 80410 -354791 13673937 11889721 30096 2028501 13948318 11022433 19842 902081 54635 11889721 13058503 403895 -2439965 11022433 0.23780 0.76220 0 0 1369459 5093934 6463393 293795787 142880865 150914922 3947874 2247751 1700123 198349195 158113325 40235870 3205509 3205509 202519817 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 43510050 F EQUITY METHOD INVESTMENTS 52212060 C HEDGE FUNDS 46410720 F 142132830 INTERCOMPANY ACCOUNTS PAYABLE 1900279 ASSET RETIREMENT OBLIGATION (FIN 47) 1491955 INTERCOMPANY NOTES PAYABLE 102280073 OTHER LONG-TERM LIABILITIES 578981 106251288 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: SAINT AGNES MEDICAL CENTER HAS ENDOWMENT FUNDS (BOARD DESIGNATED AND PERMANENTLY RESTRICTED) WHERE THE GOAL IS TO BUILD THE OVERALL ENDOWMENT FUNDS TO $25 MILLION. UPON REACHING THIS GOAL, INVESTMENT INCOME FROM THE FUNDS WILL BE USED BY SAINT AGNES MEDICAL CENTER TO PURCHASE EQUIPMENT AND TO OFFSET OPERATING EXPENDITURES. PRIOR TO REACHING THE $25 MILLION GOAL, AN ANNUAL DISTRIBUTION EQUAL TO THE LESSER OF 50% OF THE ANNUAL INVESTMENT INCOME OR 5% OF THE ENDOWMENT FUND BALANCE WILL BE DISTRIBUTED TO SAINT AGNES MEDICAL CENTER. AS OF JUNE 30,2013, THE BOARD DESIGNATED ENDOWMENT FUND WAS $3.6 MILLION AND THE PERMANENTLY RESTRICTED ENDOWMENT FUND WAS $10.8 MILLION. SAINT AGNES MEDICAL CENTER HAS ANOTHER PERMANENTLY RESTRICTED ENDOWMENT FUND, THE INCOME FROM WHICH IS USED FOR NURSING EDUCATION. AS OF JUNE 30, 2013, THIS PERMANENTLY RESTRICTED ENDOWMENT FUND WAS $491,000. FASHION SHOW 152453 119226 33227 0 0 8982 17726 15271 28858 DINNER & GOLF 150330 120258 30072 0 0 44503 31095 11155 17682 3 239128 214801 24327 0 0 1896 34400 13201 71659 541911 454285 87626 55381 83221 39627 118199 296428 -208802 74727 1500 48614 3460 1 0.10000 74727 1500 48614 3460 53574 21153 CA 0 ORGANIZATION IS EXEMPT AND DOES NOT REQUIRE A LICENSE. 0 0 0 1.00000 MARISELA ROMO 1111 E SPRUCE AVENUE FRESNO CA 93720 0 TERI AMERINE 1195 THE GAMING ACTIVITIES AT SAINT AGNES MEDICAL CENTER PRIMARILY RELATE TO RAFFLE TICKET SALES AT FUNDRAISING EVENTS. TERI AMERINE, VP - FOUNDATION, MANAGES THE OVERALL GAMING ACTIVITIES INCLUDING THE RECORDKEEPING, HIRING AND FIRING OF WORKERS, AND MAKING THE BANK DEPOSITS FOR THE GAMING ACTIVITIES. TERI AMERINE'S COMPENSATION ALLOCATED TO GAMING ACTIVITIES IS APPROXIMATELY $1,195. X 0 1 1 X 1 X 1 X 1 1 1 0 1 1 1 8131 8345214 8345214 0.01840 1 46383 138398505 121238499 17160006 0.03780 0 2 54514 146743719 121238499 25505220 0.05620 8 7072 881602 881602 0.00190 1 122207 122207 0.00030 9 7072 1003809 1003809 0.00220 11 61586 147747528 121238499 26509029 0.05840 1 40681 540051 540051 0.00120 1 40681 540051 540051 0.00120 0 7197863 3030300 156853032 168594124 -11741092 X 1 1 1 1 SAINT AGNES MEDICAL CENTER

1303 E HERNDON AVE FRESNO CA 93720

WWW.SAMC.COM X X X SAINT AGNES MEDICAL CENTER 1 1 X X X X X X X X X 12 1 1 1 X X X X X 0 0 1 1 200.000000000000 1 350.000000000000 1 X X X X X X 1 1 X X X 1 0 X X X X 1 X 0 0 7 SAINT AGNES PEACHWOOD LABORATORY

275 W HERNDON AVE CLOVIS CA 93612

LAB SAINT AGNES NORTHWEST LABORATORY

4770 W HERNDON AVE FRESNO CA 93722

LAB SAINT AGNES LAB AT KEISHO PLAZA

568 E HERNDON AVE FRESNO CA 93720

LAB SAINT AGNES CENTRAL FRESNO LABORATORY

1300 N FRESNO ST FRESNO CA 93703

LAB (CLOSED 3/13) SAINT AGNES OAKHURST LABORATORY

40232 JUNCTION DRIVE OAKHURST CA 93644

LAB (CLOSED 2/13) THE HOLY CROSS CLINIC AT POVERELLO HOUSE

412 F STREET FRESNO CA 93720

MEDICAL/DENTAL FOR THE INDIGENT HOLY CROSS CENTER FOR WOMEN

421 F STREET FRESNO CA 93720

DAYTIME SHELTER FOR WOMEN AND CHILDREN PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS. PART I, LINE 6A: SAINT AGNES MEDICAL CENTER REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH IN ITS ANNUAL REPORT, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, SAINT AGNES MEDICAL CENTER INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, L7 COL(F): THE FOLLOWING NUMBER, $30,817,487, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART II: COMMUNITY BUILDING ACTIVITIES - SAINT AGNES MEDICAL CENTER ENGAGES IN A WIDE RANGE OF COMMUNITY BUILDING ACTIVITIES. A SAMPLING IS INCLUDED HERE. ESTABLISHED IN 1984 BY SAINT AGNES MEDICAL CENTER AND THE SISTERS OF THE HOLY CROSS, SAINT AGNES HOLY CROSS CENTER FOR WOMEN (HCCW) SERVES AS A DAYTIME REFUGE FOR POOR AND HOMELESS WOMEN AND THEIR CHILDREN. AN AVERAGE OF 129 WOMEN AND 20 CHILDREN VISIT THE CENTER EACH DAY FOR A NAP, A WARM MEAL, TO BATHE, WASH THEIR CLOTHES OR SIMPLY WATCH TELEVISION. LOCATED ACROSS THE STREET FROM POVERELLO HOUSE IN DOWNTOWN FRESNO, HOLY CROSS CENTER FOR WOMEN IS EASILY ACCESSIBLE TO THOSE IN NEED. IT PROVIDES WOMEN OF ALL AGES AND THEIR CHILDREN A PEACEFUL RESPITE FROM THE COLD REALITIES OF THE STREETS. THEY CAN ALSO TAKE ADVANTAGE OF COUNSELING, REFERRAL SERVICES, EDUCATIONAL AND SKILLS TRAINING, AND RECREATIONAL ACTIVITIES.THOSE WHO COME TO THE CENTER ARE PREDOMINANTLY YOUNG, MINORITY, IMPOVERISHED WOMEN WITH CHILDREN WHOSE LIVES ARE CHALLENGED BY UNEMPLOYMENT, POVERTY, ADDICTION, RACISM, FEAR, LACK OF EDUCATION, LOW SELF-ESTEEM AND HOMELESSNESS. SOME COME BACK DAY AFTER DAY; OTHERS COME TO FILL A TEMPORARY NEED. ON A MONTHLY BASIS, HCCW PROVIDES:- GENTLY USED CLOTHING TO MORE THAN 403 INDIVIDUALS AND FAMILIES - WARM SHOWERS TO 774 HOMELESS WOMEN - WASHERS AND DRYERS TO ACCOMMODATE 455 LOADS OF LAUNDRY IN ADDITION TO REFUGE AND REST, HCCW PROVIDES WOMEN WITH OPPORTUNITIES TO LEARN NECESSARY SKILLS THAT ENABLE THEM TO BECOME SELF-SUFFICIENT SO THEY MAY EVENTUALLY BREAK THE CYCLE THEY ARE IN. THIS INCLUDES:- ENGLISH AS A SECOND LANGUAGE CLASSES- SELF-ESTEEM AND PARENTING CLASSES- SEWING INSTRUCTION- ARTS AND CRAFTS- PRAYER GROUPS- PSYCHOLOGIST COUNSELINGTHANKS TO THE COMMUNITY VOLUNTEERS WHO DONATE THEIR TIME TO LEAD THESE CLASSES AND ACTIVITIES, AND THE SUPPORTIVE STAFF AT HCCW, MANY CLIENTS HAVE SUCCESSFULLY TURNED THEIR LIVES AROUND AND BECOME PRODUCTIVE, CONTRIBUTING MEMBERS OF THE COMMUNITY.THE POVERELLO HOUSE, LOCATED ACROSS THE STREET FROM HOLY CROSS CENTER FOR WOMEN, PROVIDES FREE MEALS TO HUNDREDS OF HOMELESS INDIVIDUALS AND LOW-INCOME FAMILIES EVERY DAY. BESIDES NEEDING FOOD AND CLOTHING, MANY VISITORS LACK BASIC MEDICAL CARE. TO ADDRESS THIS NEED, THE SISTERS OF THE HOLY CROSS AND SAINT AGNES MEDICAL CENTER ESTABLISHED THE HOLY CROSS CLINIC AT POVERELLO HOUSE IN 1982. SAINT AGNES STAFF AND MEDICAL PROFESSIONAL VOLUNTEERS - INCLUDING SPECIALISTS, DENTISTS, NURSES, AND OTHER PARAMEDICAL PERSONNEL - PROVIDE FREE BASIC MEDICAL AND DENTAL CARE TO OUR VALLEY'S GROWING NUMBERS OF UNINSURED AND UNDERINSURED. LAST YEAR ALONE, HOLY CROSS CLINIC RECEIVED 4,284 VISITS FOR MEDICAL SERVICES AND 585 VISITS FOR DENTAL CARE. THE VALUE OF DONATED SERVICES TOTALED MORE THAN $512,491. HEALTH EDUCATION IS ALSO PROVIDED BY THE CLINIC TO TEACH INDIVIDUALS WHO SUFFER FROM CHRONIC CONDITIONS LIKE DIABETES AND ASTHMA HOW TO MANAGE THEIR DISEASE, PREVENT COMPLICATIONS AND EXPERIENCE A HEALTHIER, MORE PRODUCTIVE LIFESTYLE. FURTHER, THE CLINIC COLLABORATES WITH NUMEROUS COMMUNITY GROUPS AND SERVICE PROVIDERS TO REACH OUT TO THOSE CLIENTS WHO - IN ADDITION TO MEDICAL OR DENTAL SERVICES - MAY NEED HELP FINDING SHELTER OR OTHER SUPPORT SERVICES. PART III, LINE 4: SAINT AGNES MEDICAL CENTER IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 17 OF THOSE STATEMENTS: "THE CORPORATION RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THE CORPORATION DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY AT THAT TIME. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION ESTABLISHES AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THIS ALLOWANCE IS ESTABLISHED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY MINISTRY ORGANIZATION AND FOR EACH TYPE OF PAYOR. A SIGNIFICANT PORTION OF THE CORPORATION'S PROVISION FOR DOUBTFUL ACCOUNTS RELATES TO SELF-PAY PATIENTS, AS WELL AS CO-PAYMENTS AND DEDUCTIBLES OWED TO THE CORPORATION BY PATIENTS WITH INSURANCE."PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - BAD DEBT EXPENSE REPORTED ON LINE 2 IS SHOWN AT COST AND WAS CALCULATED USING A COST TO CHARGE RATIO METHODOLOGY. ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS.PART III, LINE 3: SAINT AGNES MEDICAL CENTER USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR CHARITY: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FY13 WAS THE FIRST YEAR SAINT AGNES MEDICAL CENTER UTILIZED THE PREDICTIVE MODEL WITH RESULTS USED FOR ANALYSIS ONLY. STARTING IN FY14, SAINT AGNES MEDICAL CENTER IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. PART III, LINE 8: SAINT AGNES MEDICAL CENTER DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CHA RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTHCARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S COLLECTION POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS. SAINT AGNES MEDICAL CENTER PART V, SECTION B, LINE 3: IN ADDITION TO PRIMARY DATA SOURCES, A STRONG EMPHASIS WAS PLACED ON CONDUCTING FOCUS GROUPS AND INTERVIEWS OF KEY STAKEHOLDERS IN EACH COUNTY. A TOTAL OF 14 FOCUS GROUPS WERE CONDUCTED. IN ADDITION, EIGHT FACILITY CEOS OR SENIOR EXECUTIVES WERE INTERVIEWED BY PHONE OR IN PERSON AS WERE ALL FOUR COUNTY PUBLIC HEALTH DIRECTORS. TO ENSURE THAT THE FOCUS GROUP PROCESS COULD ALSO ACCOMMODATE INDIVIDUALS UNABLE TO TRAVEL TO THE MEETINGS OR PARTICIPATE IN PERSON (SUCH AS THOSE IN RURAL AREAS OR FRONTLINE HEALTHCARE STAFF WHO WOULD NOT BE ABLE TO BE RELEASED FROM THEIR WORK IN ORDER TO ATTEND THE FOCUS GROUPS), AN ONLINE SURVEY VERSION OF THE FOCUS GROUP QUESTIONS WAS CREATED TO SOLICIT INPUT.THE WORK OF GATHERING THE FOCUS GROUP DATA AND INTERVIEWS INVOLVED SECURING MEETING DATES AND SITES NEAR EACH OF THE PARTICIPATING FACILITIES IN EACH COUNTY. MEMBERS OF THE WORKING COMMITTEE IDENTIFIED KEY STAKEHOLDERS IN THEIR RESPECTIVE COMMUNITIES AND CONSULTANTS REACHED OUT BY EMAIL TO INVITE THEM TO A COMMUNITY FOCUS GROUP. A TOTAL OF 230 INDIVIDUALS WERE INVITED BY CONSULTANTS TO ATTEND THE COMMUNITY FOCUS GROUPS. HOSPITAL STAFF WERE ALSO IDENTIFIED BY THE COMMITTEE MEMBERS AND THEY WERE INVITED TO THEIR OWN FOCUS GROUP SESSIONS. SAINT AGNES MEDICAL CENTER PART V, SECTION B, LINE 4: THE HOSPITAL'S CHNA WAS CONDUCTED IN COLLABORATION WITH:1. ADVENTIST HEALTH/ADVENTIST MEDICAL CENTER - HANFORD2. ADVENTIST MEDICAL CENTER - REEDLEY3. CLOVIS COMMUNITY MEDICAL CENTER4. COALINGA REGIONAL MEDICAL CENTER5. CORCORAN DISTRICT HOSPITAL6. COMMUNITY REGIONAL MEDICAL CENTER (INCLUDES COMMUNITYBEHAVIORAL HEALTH CENTER)7. CHILDREN'S HOSPITAL CENTRAL CALIFORNIA8. FRESNO HEART & SURGICAL HOSPITAL9. KAISER PERMANENTE FRESNO MEDICAL CENTER10. KAWEAH DELTA HEALTH CARE DISTRICT11. MADERA COMMUNITY HOSPITAL12. SAN JOAQUIN VALLEY REHABILITATION HOSPITAL13. SIERRA VIEW DISTRICT HOSPITAL14. TULARE REGIONAL MEDICAL CENTER SAINT AGNES MEDICAL CENTER PART V, SECTION B, LINE 5C: LINE 5A: HTTP://WWW.SAMC.COM/DOCUMENTS/COMMUNITY%20BENEFITS/FINAL_CHNA_2013.PDF SAINT AGNES MEDICAL CENTER PART V, SECTION B, LINE 7: OF THE FOUR MAJOR NEEDS IDENTIFIED IN THE CHNA, THE ONE AREA WHICH WE HAVE NOT TAKEN DIRECT ACTION TO ADDRESS IS PHYSICAL ACTIVITY/OVERWEIGHT/OBESITY. GIVEN THE REGIONAL APPROACH TO OUR PLAN, RECOGNITION WAS MADE THAT EACH OF THE PARTNER HOSPITALS HAVE LIMITED FINANCIAL RESOURCES AND THEREFORE MUST WORK TOGETHER TO ACHIEVE GREATER COLLABORATION. SOME OF THE STEPS IDENTIFIED TO MEET THIS COLLABORATION INCLUDED:LINK DIABETES PATIENTS TO EFFECTIVE COMMUNITY-BASED PROGRAMS WHERE ONGOING SUPPORT, EDUCATION AND NEW HEALTHY BEHAVIORS ARE INCORPORATED INTO BROAD LIFESTYLE CHANGES; ENCOURAGE ACCESS TO NUTRITIOUS FOODS IN SCHOOLS, WORKPLACES AND OUR OWN FACILITIES; PROMOTE SAFE PLACES TO WALK AND EXERCISE IN REGIONAL PLANS WHEN OPPORTUNITIES ARISE ENCOURAGE EXERCISE AND FITNESS ACTIVITIES AMONG OUR OWN FACILITY STAFF. IN ADDITION, A NUMBER OF EFFORTS TO REDUCE OBESITY IN THE REGION HAVE ALREADY SURFACED IN OUR COMMUNITIES. FOR EXAMPLE, IN FRESNO COUNTY, THE DEPARTMENT OF PUBLIC HEALTH HAS ALREADY INITIATED THE HEALTHY EATING ACTIVE LIVING BLUEPRINT WHICH REFLECTS A COMPREHENSIVE, FIVE-YEAR STRATEGY TO REDUCE OBESITY AND RELATED CHRONIC DISEASE. SIMILARLY, ONE OF FRESNO'S MOST ACTIVE NONPROFITS, FRESNO METRO MINISTRY, IS LEADING THE CENTRAL CALIFORNIA REGIONAL OBESITY PREVENTION PROGRAM (CCROPP). IT ADVOCATES FOR SAFE PLACES TO PLAY AND EXERCISE, HEALTHY FOOD CHOICES, AND OPTIONS FOR IMPROVING PHYSICAL FITNESS. OUR EFFORTS SHOULD LINK TO AND BUILD ON THESE EFFORTS RATHER THAN TO DUPLICATE EFFORTS AT ADDITIONAL EXPENSE. SAINT AGNES MEDICAL CENTER PART V, SECTION B, LINE 12H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. SAINT AGNES MEDICAL CENTER PART V, SECTION B, LINE 14G: BROCHURES ARE AVAILABLE AND/OR SIGNS ARE POSTED AT THE DESKS OF FACILITY FINANCIAL ADVOCATES AND CASHIER, AS WELL AS IN THE PATIENT WAITING AREAS FOR EMERGENCY ROOM, REGISTRATION, OUTPATIENT DEPARTMENT, LABORATORY, SURGERY, SECOND FLOOR MAIN, AND FIRST FLOOR WEST/ENDOSCOPY.THE POLICY AND FORMS AVAILABLE FROM THE FINANCIAL ADVOCATE OFFICE, REGISTRATION, EMERGENCY DEPARTMENT, AND REGIONAL SHARED SERVICES CENTER.INFORMATION ABOUT FINANCIAL ASSISTANCE IS PROVIDED DURING ENCOUNTERS WITH FINANCIAL ADVOCATES AND UPON REQUEST TO CUSTOMER SERVICE REPRESENTATIVES AT THE REGIONAL SHARED SERVICES CENTER AND THE BILLING COMPANY, AND ON OUR WEBSITE: HTTP://WWW.SAMC.COM/FINANCIAL-SUPPORT. BILLING STATEMENTS REFERENCE THE AVAILABILITY OF THE POLICY FOR THOSE WHO ARE UNABLE TO PAY. SAINT AGNES MEDICAL CENTER PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 201% AND 350% OF THE FPG RECEIVE A WRITE OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE COMMERCIAL CONTRACTUAL ADJUSTMENT FOR ALL COMMERCIAL PAYERS. PART VI, LINE 2: NEEDS ASSESSMENT - SAINT AGNES MEDICAL CENTER ASSESSES THE HEALTH STATUS OF ITS COMMUNITY IN THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED, IN THE ASSESSMENT OF THE COMMUNITY. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - SAINT AGNES MEDICAL CENTER IS COMMITTED TO:- PROVIDING ACCESS TO QUALITY HEALTH CARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR ALL THOSE WE SERVE, PARTICULARLY OUR COMMUNITY'S POOR AND UNDERSERVED; - CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY; - ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE SERVICES/CARE PROVIDED;- BALANCING NEEDED PATIENT FINANCIAL ASSISTANCE WITH THE ORGANIZATION'S BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE. IN ACCORDANCE WITH AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, SAINT AGNES MEDICAL CENTER HAS ADOPTED THESE PRINCIPLES FOR HANDLING PATIENT BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS: - PROACTIVELY COMMUNICATE WITH PATIENTS REGARDING THEIR HOSPITAL BILLS;- MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS;- OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS;- IMPLEMENT CONSISTENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS; - IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PAYMENT OBLIGATIONS.SAINT AGNES MEDICAL CENTER PROACTIVELY COMMUNICATES WITH PATIENTS REGARDING THEIR PAYMENT OBLIGATIONS AND OFFERS FINANCIAL COUNSELING TO HELP PATIENTS UNDERSTAND THEIR HOSPITAL BILLS AND FINANCIAL OBLIGATIONS, AS WELL AS ADDRESS ANY FINANCIAL QUESTIONS OR CONCERNS THEY MAY HAVE. DURING THE PRE-REGISTRATION AND ADMITTING PROCESS, AND/OR THROUGH COMMUNICATION WITH PATIENTS SEEKING FINANCIAL ASSISTANCE, SAINT AGNES MEDICAL CENTER PROVIDES PATIENTS WITH INFORMATION ABOUT HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SPECIFIC SERVICES.THE SAINT AGNES MEDICAL CENTER REGISTRARS GIVE FINANCIAL ASSISTANCE APPLICATIONS TO EVERY PATIENT WHO EXPRESSES A FINANCIAL CONCERN AND THEN REFER THE PATIENT TO A HOSPITAL FINANCIAL COUNSELOR FOR FURTHER ASSISTANCE. THE HOSPITAL ALSO CONTRACTS WITH AN ELIGIBILITY VENDOR WHO ASSISTS PATIENTS WITH THEIR MEDICAID APPLICATIONS AND ELIGIBILITY. THE VENDOR HELPS PATIENTS GATHER THE APPROPRIATE DOCUMENTS REQUIRED TO APPLY FOR MEDI-CAL OR MEDICARE DISABILITY; TRANSLATES AS NEEDED; AND PROVIDES TRANSPORTATION TO THE LOCAL WELFARE OFFICE, IF REQUIRED.FINANCIAL COUNSELORS HELP PATIENTS OBTAIN AND PAY FOR NEEDED HEALTH CARE SERVICES BY IDENTIFYING AND HELPING THEM APPLY FOR THOSE PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY. SAINT AGNES MEDICAL CENTER ALSO ASSISTS PATIENTS BY PAYING THEIR COBRA BENEFITS SO THAT THE PATIENT WILL HAVE HEALTH CARE COVERAGE WHILE OBTAINING SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE.SAINT AGNES MEDICAL CENTER ALSO OFFERS FINANCIAL ASSISTANCE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE, BUT WHO HAVE LIMITED MEANS. DETAILS AND CONTACT INFORMATION FOR OBTAINING FINANCIAL ASSISTANCE IS MADE AVAILABLE AT ALL REGISTRATION SITES ON AND OFF CAMPUS. THIS INCLUDES A COMPREHENSIVE FINANCIAL ASSISTANCE PROGRAM BROCHURE GIVEN TO PATIENTS. INFORMATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM IS ALSO NOTED IN THE CONDITIONS OF ADMISSION AND ON THE PATIENT BILL. IT IS ALSO MADE AVAILABLE IN THE SAINT AGNES MEDICAL CENTER PATIENT FINANCIAL SERVICES OFFICE. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO THE PUBLIC, PHYSICIANS, FRESNO METRO MINISTRIES, HOLY CROSS CENTER FOR WOMEN AND HOLY CROSS CLINIC AT POVERELLO HOUSE. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE AS PART OF THE ADMISSION PACKET, ON THE PUBLIC SAINT AGNES MEDICAL CENTER WEB SITE, AND AT EACH REGISTRATION AREA. IN ADDITION TO ENGLISH, THIS INFORMATION IS AVAILABLE IN SPANISH AND HMONG.SAINT AGNES MEDICAL CENTER HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND FINANCIAL SUPPORT OF PATIENTS AND PATIENT PAYMENT OBLIGATIONS. THE MEDICAL CENTER MAKES EVERY EFFORT TO ADHERE TO THE POLICY AS PART OF ITS COMMITMENT TO ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. TO ENSURE THAT ALL PATIENTS ARE TREATED WITH DIGNITY AND RESPECT, REGARDLESS OF THEIR INSURANCE STATUS OR ABILITY TO PAY FOR SERVICES, SAINT AGNES MEDICAL CENTER EDUCATES ITS EMPLOYEES - PARTICULARLY THOSE WORKING IN FINANCIAL ASSISTANCE, REGISTRATION, AND BILLING AND COLLECTION - ABOUT ITS FINANCIAL POLICY. SAINT AGNES MEDICAL CENTER ALSO INCLUDES THE VENDOR AND COLLECTION AGENCIES IN THIS EDUCATION. PART VI, LINE 4: COMMUNITY INFORMATION - SAINT AGNES MEDICAL CENTER'S PRIMARY SERVICE AREA INCLUDES THE MAJORITY OF FRESNO AND PORTIONS OF MADERA COUNTIES. THE REMAINDER OF FRESNO AND MADERA COUNTIES COMPRISES THE SECONDARY SERVICE AREA. COMBINED, SAINT AGNES MEDICAL CENTER'S SERVICE AREA ENCOMPASSES A POPULATION IN EXCESS OF 1 MILLION.DESPITE A NATIONAL ECONOMIC DOWNTURN, THE SAN JOAQUIN VALLEY AND THE STATE OF CALIFORNIA CONTINUE TO EXPERIENCE POPULATION GROWTH. ACCORDING TO THE U.S. CENSUS BUREAU, THE POPULATION OF FRESNO COUNTY ROSE BY 16.4% BETWEEN 2000 AND 2010, WHILE THE STATE OF CALIFORNIA'S POPULATION ROSE BY 10% DURING THE SAME TIME PERIOD. IN 2011, THE POPULATION FOR FRESNO COUNTY WAS ESTIMATED AT 942,904. A GROWING POPULATION REQUIRES INCREASED INFRASTRUCTURE. HOWEVER, THE COMBINED 2010-2011 & 2011-2012 DEFICITS CREATED A $25.4 BILLION BUDGET GAP FOR CALIFORNIA WHICH HAS SLOWED INFRASTRUCTURE DEVELOPMENT AND HAS ACTUALLY DECREASED THE SERVICES THAT RESPOND TO THE NEEDS OF CALIFORNIANS. IT HAS AFFECTED THE POOR AND UNDERSERVED IN PARTICULAR, ESPECIALLY THOSE IN NEED OF MENTAL HEALTH SERVICES.FRESNO COUNTY IS AN AREA OF IMMENSE NEED, WITH FEWER HEALTH RESOURCES THAN THE REST OF THE STATE. IT IS A REGION OF GREAT DIVERSITY, WITH BOTH URBAN AND RURAL POPULATIONS, MANY IMMIGRANTS WITH LIMITED ENGLISH PROFICIENCY, AND A LOW INCOME POPULATION THAT IS HIGHER THAN THE STATE AVERAGE. ALTHOUGH FRESNO COUNTY'S $5 BILLION+ AGRICULTURAL INDUSTRY IS THE LARGEST IN THE UNITED STATES, THE COUNTY IS SUSCEPTIBLE TO THE VAGARIES OF ADVERSE WEATHER, WORKER SHORTAGES AND INTERNATIONAL COMPETITION. OF 58 COUNTIES IN CALIFORNIA, FRESNO HAS ONE OF THE HIGHEST RATES FOR TEEN PREGNANCY, LOW BIRTH-WEIGHT, INFANT DEATHS, ASTHMA, AND DEATHS DUE TO DIABETES. SOME OF THE CAUSES OF POOR HEALTH IN FRESNO COUNTY INCLUDE HIGH POVERTY, LACK OF HEALTH INSURANCE, POPULATION DIVERSITY, AND LACK OF MEDICAL INFRASTRUCTURE.ETHNIC, CULTURAL AND LINGUISTIC DIVERSITY CONTINUES TO INCREASE IN THE SAN JOAQUIN VALLEY, WHICH HAS A SIGNIFICANT POPULATION OF IMMIGRANTS AND REFUGEES, LINKING BACK TO EARLY SETTLEMENTS BY NATIVE AMERICANS AND THE EARLY CALIFORNIANOS WHO FARMED THIS REGION OF THE SAN JOAQUIN VALLEY. CALIFORNIA IS HOME TO 97 NATIVE AMERICAN TRIBES AND OUR REGION HOLDS SEVEN DIFFERENT TRIBAL LANDS PRIMARILY IN MADERA, FRESNO, AND TULARE COUNTY. IN 2011, THE U.S. CENSUS BUREAU ESTIMATED THAT FRESNO COUNTY'S TOTAL POPULATION IS 50.9% HISPANIC OR LATINO, 32.4% WHITE, 10.6% ASIAN AND PACIFIC ISLANDER, 5.9% AFRICAN-AMERICAN AND 3.0% NATIVE AMERICAN. THIS DIVERSITY HAS SIGNIFICANT IMPLICATIONS FOR HEALTHCARE DELIVERY WHEN WE LOOK AT THE LINGUISTIC NEEDS OF RESIDENTS WHO SEEK CARE. ACCORDING TO THE U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION, FRESNO COUNTY HAS 66 DIFFERENT LANGUAGES USED AT HOME. NEARLY HALF THE POPULATION OF FRESNO COUNTY (46.43%) ARE LIVING AT 200% OF THE FEDERAL POVERTY LEVEL. BY COMPARISON, 32.8% OF CALIFORNIANS AS A WHOLE LIVE AT THIS INCOME. WITHOUT A DOUBT, THE POVERTY LEVEL IN THE REGION IS IMPACTED BY THE LARGER ECONOMIC CHALLENGE POSED BY THE CURRENT ECONOMIC CLIMATE WHICH CREATED HIGH UNEMPLOYMENT RATES THROUGHOUT CALIFORNIA. THE REGION HAS EXPERIENCED FOUR TO SIX PERCENTAGE POINTS HIGHER RATES OF UNEMPLOYMENT THAN THE REST OF CALIFORNIA (FOR EXAMPLE, FRESNO COUNTY = 14.7% VS. CALIFORNIA OVERALL = 10.9%)ACCORDING TO THE AMERICAN LUNG ASSOCIATION, FRESNO-MADERA RANKS NO. 2 ON THE LIST OF THE TOP TEN MOST POLLUTED CITIES IN THE UNITED STATES. ASTHMA, CHRONIC BRONCHITIS, EMPHYSEMA AND CARDIOVASCULAR DISEASE HAVE A SIGNIFICANT IMPACT ON THE HEALTH OF THE PEOPLE OF FRESNO. PART VI, LINE 5: OTHER INFORMATION - SAINT AGNES MEDICAL CENTER'S CONTINUING MEDICAL EDUCATION (CME) PROGRAM STRIVES TO IMPROVE PATIENT CARE BY PROVIDING HIGH QUALITY EDUCATIONAL ACTIVITIES THAT ENHANCE PHYSICIAN KNOWLEDGE AND SKILLS AND PROMOTE LIFELONG LEARNING. PHYSICIANS WHO ATTEND SAINT AGNES MEDICAL CENTER'S CME ACTIVITIES EARN CREDITS TO SUPPORT THEIR STATE LICENSES AND BOARD CERTIFICATIONS. THE CLINICAL RESEARCH CENTER CONDUCTS PHARMACEUTICAL AND DEVICE STUDIES IN A WIDE RANGE OF THERAPEUTIC AREAS. CLINICAL TRIALS OF INVESTIGATIONAL DRUGS AND DEVICES, WHICH ARE SUPPORTED BY THE INDUSTRY, PROVIDE PATIENTS ACCESS TO INVESTIGATIONAL TREATMENTS AND SERVICES USUALLY AT NO ADDITIONAL COST. CLINICAL RESEARCH IS ALSO RESPONSIBLE FOR THE ADMINISTRATION OF THE INSTITUTIONAL REVIEW BOARD (IRB), WHICH ENSURES THAT THE RIGHTS AND WELFARE OF ALL HUMAN SUBJECTS INVOLVED IN CLINICAL RESEARCH ARE PROTECTED. APPROXIMATELY 750 VOLUNTEERS GENEROUSLY PROVIDE CARE AND SERVICE TO SAINT AGNES MEDICAL CENTER'S PATIENTS, STAFF, PHYSICIANS AND GUESTS. IN ADDITION TO SUPPORTING VARIOUS DEPARTMENTS AND PROGRAMS WITHIN THE HOSPITAL, MANY OF THESE INDIVIDUALS REPRESENT SAINT AGNES MEDICAL CENTER WITHIN THE COMMUNITY, VOLUNTEERING THEIR TIME TO SUCH COMMUNITY PROJECTS AS READING TO THE BLIND, MENTORING ELEMENTARY SCHOOL CHILDREN, COORDINATING BLOOD DRIVES, SUPPORTING THE COMMUNITY FOOD BANK, AND SUPPORTING THE AMERICAN CANCER SOCIETY, HABITAT FOR HUMANITY, SPCA AND THE "BABY TRACKING" INFANT IMMUNIZATION PROGRAM.SAINT AGNES PLAYS A CRITICAL ROLE IN EFFORTS TO END HOMELESSNESS BY FINANCIALLY SUPPORTING AND SERVING ON THE BOARD OF FRESNO FIRST STEPS HOME, AN INITIATIVE LED BY MAYOR ASHLEY SWEARINGEN. IN ADDITION TO SERVING THE HOMELESS POPULATION (AS ADDRESSED IN EARLIER SECTION), SAINT AGNES PARTICIPATED IN REMOVING HOMELESS ENCAMPMENTS AND MOVING INDIVIDUALS INTO STABILIZED LONG-TERM HOUSING. PART VI, LINE 6: SAINT AGNES MEDICAL CENTER IS A MEMBER OF CHE TRINITY HEALTH, THE SECOND-LARGEST CATHOLIC HEALTH CARE SYSTEM IN THE COUNTRY. CHE TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEFINE - AND ACHIEVE - COMMUNITY BENEFIT GOALS THAT INCLUDE IMPLEMENTING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, CHE TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS SERVING THOSE WHO ARE POOR AND UNINSURED, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, PROMOTING WELLNESS AND REACHING OUT TO UNDERSERVED POPULATIONS. OVERALL, THE ORGANIZATION INVESTS MORE THAN $800 MILLION IN SUCH COMMUNITY BENEFITS AND WORKS TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ENHANCE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVE BY ADDRESSING EACH COMMUNITY'S SPECIFIC NEEDS. FOR MORE INFORMATION ABOUT CHE TRINITY HEALTH, VISIT WWW.NEWHEALTHMINISTRY.ORG. 1 AMERICAN HEART ASSOCIATION (WESTERN STATES AFFILIATE) 7425 N PALM BLUFF AVE STE 101 FRESNO CA 93711 135613797 501(C)(3) 15000 SPONSORSHIP FOR FUND-RAISING EVENT CATHOLIC CHARITIES OF THE DIOCESE OF FRESNO 149 N FULTON ST FRESNO CA 93701 941678938 501(C)(3) 16000 SPONSORSHIP FOR FUND-RAISING EVENT CENTRAL CALIFORNIA WOMEN'S CONFERENCE PO BOX 26214 FRESNO CA 93729 770178140 501(C)(3) 17000 SPONSORSHIP FOR FUND-RAISING EVENT MARCH OF DIMES FOUNDATION (CENTRAL VALLEY DIVISION) 4201 W SHAW SUITE 105 FRESNO CA 93722 131846366 501(C)(3) 5000 SPONSORSHIP FOR FUND-RAISING EVENT UNIVERSITY OF CALIFORNIA SAN FRANCISCO FOUNDATION 220 MONTGOMERY ST 5TH FLOOR SAN FRANCISCO CA 94104 942829914 501(C)(3) 5000 SPONSORSHIP FOR FUND-RAISING EVENT GREATER FRENSO CHAMBER OF COMMERCE 2331 FRESNO STREET FRESNO CA 93721 940489640 501(C)(6) 7500 SPONSORSHIP FOR FUND-RAISING EVENT HEALTHCARE FOUNDATON OF NORTHERN AND CENTRAL CALIFORNIA 1215 K STREET SACRAMENTO CA 95814 861147825 501(C)(3) 25000 ANNUAL FUNDING COMMITMENT FOR THE FRESNO MEDICAL RESPITE CENTER 6 1 TRANSPORTATION SERVICES 101 18019 COST MEDICAL TRANSPORT/PUBLIC TRANSPORTATION TEMPORARY HOUSING & IN-HOME ASSISTANCE 3 1370 COST TEMPORARY HOUSING & ASSISTED LIVING PHARMACEUTICALS 81 12516 COST PHARMACEUTICALS FUNERAL EXPENSES 15 3450 COST FUNERAL EXPENSES MEDICAL EQUIPMENT & SUPPLIES 59 8940 COST MEDICAL EQUIPMENT & SUPPLIES HEALTH INSURANCE/COBRA 7 4138 COST HEALTH INSURANCE/COBRA MISCELLANEOUS 3 364 COST ELECTRIC BILL AND DMV RENEWAL PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DONATIONS MADE BY SAINT AGNES MEDICAL CENTER TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE. DONATIONS ARE INCLUDED IN COMMUNITY BENEFITS IN SCHEDULE H IF THE CONTRIBUTION HAS BEEN FORMALLY RESTRICTED TO A COMMUNITY BENEFIT ACTIVITY THAT MEETS THE CRITERIA TO BE REPORTED ON SCHEDULE H. X 1 1 1 1 0 0 0 0 0 0 0 NANCY HOLLINGSWORTH 0 395641 0 148871 0 75734 0 99032 0 20918 0 740196 0 10423 DEBRA CANALES 0 508488 0 236816 0 106740 0 82290 0 19743 0 954077 0 22307 CHRISTINE SARRICO 0 280902 0 0 0 87385 0 46273 0 15243 0 429803 0 0 VREELAND JONES ESQ 0 221583 0 0 0 6155 0 15823 0 16119 0 259680 0 0 MARK BATEMAN 54000 290315 0 0 0 20072 0 12500 0 14865 54000 337752 0 0 JOSEPH SWEDISH 0 1402192 0 786411 0 1044897 0 572762 0 28714 0 3834976 0 520902 KEDRICK ADKINS 0 784856 0 366716 0 670047 0 112792 0 13375 0 1947786 0 265335 J RICHARD O'CONNELL 0 607209 0 284428 0 144773 0 97104 0 33319 0 1166833 0 0 STEPHEN SOLDO MD 0 395007 0 79174 0 18120 0 20000 0 19900 0 532201 0 0 STACY VAILLANCOURT 0 235421 0 56610 0 9418 0 18850 0 12723 0 333022 0 0 DEBBIE CHAPPELL 166203 0 0 0 8085 0 32051 0 15147 0 221486 0 0 0 DEBRA PASLEY RN 0 160911 0 0 0 35094 0 9520 0 7830 0 213355 0 0 TINA DEMARCO 0 486000 0 0 0 0 0 12500 0 0 0 498500 0 0 GERALD MARGOSIAN 263176 0 0 0 21177 0 42322 0 22935 0 349610 0 0 0 PATRICIA HARGER 0 203015 0 41339 0 10026 0 19572 0 18558 0 292510 0 0 KEVIN KOZUKI 210166 0 0 0 95 0 11566 0 7765 0 229592 0 0 0 TY DUONG 201283 0 0 0 3499 0 12127 0 7766 0 224675 0 0 0 THOMAS ANDERSON 0 403580 0 74406 0 71176 0 25000 0 21429 0 595591 0 0 JARELL E WILLIAMSON ESQ 0 164409 0 0 0 349 0 5110 0 18562 0 188430 0 0 MICHAEL MURPHY 0 139488 0 0 0 41394 0 4650 0 11980 0 197512 0 0 TONI KAZARIAN 166273 0 0 0 7573 0 76892 0 7852 0 258590 0 0 0 MARYANN STATBILE INTER HLTH INV 120151 0 0 0 0 0 0 0 0 0 120151 0 0 0 PART I, LINE 1A DURING CALENDAR 2012, SAINT AGNES MEDICAL CENTER PAID THE FOLLOWING COUNTRY CLUB DUES: NANCY HOLLINGSWORTH - $5,400 NONE OF THE CLUB DUES WERE INCLUDED IN TAXABLE INCOME AS THE COUNTRY CLUB WAS USED FOR BUSINESS PURPOSES ONLY. PART I, LINE 3 SAINT AGNES MEDICAL CENTER IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. SAINT AGNES MEDICAL CENTER'S CEO IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF SAINT AGNES MEDICAL CENTER'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINES 4A-B THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT IN CALENDAR 2012. THIS AMOUNT IS INCLUDED IN COLUMN B(III): CHRISTINE SARRICO - $56,100 IN ADDITION, COLUMN (C) OF SCHEDULE J, PART II INCLUDES $38,251 OF SEVERANCE FOR CHRISTINE SARRICO WHICH WAS UNPAID AS OF 12/31/12. THE $38,251 WAS PAID AND INCLUDED IN CHRISTINE SARRICO'S TAXABLE INCOME IN 2013. PART I, LINE 4B: THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH CASH BALANCE RESTORATION AND RETENTION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETENTION BENEFITS PLUS RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($250,000 FOR 2012). THE FOLLOWING ACCRUALS FOR 2012 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $100,292 DEBRA CANALES - $60,671 NANCY HOLLINGSWORTH - $56,313 J. RICHARD O'CONNELL - $77,104 JOSEPH SWEDISH - $543,977 PART II: THE FOLLOWING INDIVIDUALS ARE VESTED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING VESTED SERP AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEDRICK ADKINS - $185,540 JOSEPH SWEDISH - $530,000 COLUMN F OF SCHEDULE J INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. SUPPLEMENTAL INFORMATION PART III PART II: MARK BATEMAN - THE AMOUNT LISTED IN COLUMN B(I) OF SCHEDULE J, PART II REPRESENTS THE AMOUNT PAID BY SAINT AGNES MEDICAL CENTER IN CALENDAR 2012 TO B.E. SMITH, INC. FOR MR. BATEMAN'S SERVICES AS INTERIM COO. SAINT AGNES MEDICAL CENTER DOES NOT KNOW HOW MUCH MR. BATEMAN RECEIVED AS WAGES FROM B.E. SMITH, INC. IN CALENDAR 2012. PART II: MARYANN STABILE - THE AMOUNT LISTED IN COLUMN B(I) OF SCHEDULE J, PART II REPRESENTS THE AMOUNT PAID BY SAINT AGNES MEDICAL CENTER IN CALENDAR 2012 TO INTERIM HEALTH INNOVATIONS, LLC FOR MS. STABILE'S SERVICES AS INTERIM CNO. SAINT AGNES MEDICAL CENTER DOES NOT KNOW HOW MUCH MS. STABILE RECEIVED AS WAGES FROM INTERIM HEALTH INNOVATIONS, LLC IN CALENDAR 2012. PART II: PHILLIP ROBINSON - THE AMOUNT LISTED IN COLUMN B(I) OF SCHEDULE J, PART II REPRESENTS THE AMOUNT PAID BY SAINT AGNES MEDICAL CENTER IN CALENDAR 2012 TO TATUM, LLC FOR MR. ROBINSON'S SERVICES AS INTERIM CFO AND TREASURER. SAINT AGNES MEDICAL CENTER DOES NOT KNOW HOW MUCH MR. ROBINSON RECEIVED AS WAGES FROM TATUM, LLC IN CALENDAR 2012. ALEXANDER SANCHEZ FAMILY MEMBER OF PHILLIP SANCHEZ, VICE CHAIR 103727 EMPLOYMENT ARRANGEMENT 0 X 1570 DONOR VALUED X AUCTION ITEMS 371 164460 DONOR VALUED X COUNTRY CLUB MEMBERSHIP 1 9620 DONOR VALUED 0 0 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTIONS: PART I, COLUMN (B): SAINT AGNES MEDICAL CENTER RECEIVES GIFT-IN-KIND DONATIONS IN SUPPORT OF FUNDRAISING EVENTS. THESE DONATIONS ARE PRIMARILY AUCTION ITEMS, AND THE REVENUE FOR THESE ITEMS IS NOT RECORDED UNLESS THE ITEMS ARE SOLD DURING THE AUCTION. ITEMS THAT DO NOT SELL AT THE AUCTION ARE RETURNED TO THE DONOR. DONATED SUPPLIES ARE ALSO RECEIVED FOR THE FUNDRAISING EVENTS AND ARE RECORDED AT FAIR MARKET VALUE. FORM 990, PART VI, SECTION A, LINE 2 MS. DIANNE NURY - SAMC TRUSTEE, AND MR. CRAIG SALADINO - SAMC TRUSTEE, HAVE A BUSINESS RELATIONSHIP. MR. NEIL KOENIG - SAMC TRUSTEE, AND MR. CRAIG SALADINO - SAMC TRUSTEE, HAVE A BUSINESS RELATIONSHIP. MR. A THOMAS FERDINANDI, JR. - SAMC VICE CHAIR, AND MR. CRAIG SALADINO - SAMC TRUSTEE, HAVE A BUSINESS RELATIONSHIP. MR. MICHAEL MARTINEZ - SAMC BOARD CHAIR HAS A BUSINESS RELATIONSHIP WITH DR. STEPHEN SOLDO, SAMC KEY EMPLOYEE. FORM 990, PART VI, SECTION A, LINE 3 SAINT AGNES MEDICAL CENTER CONTRACTED WITH THE FOLLOWING COMPANIES FOR THE PROVISION OF INTERIM EXECUTIVE SERVICES: - B.E. SMITH, INC., FOR INTERIM COO SERVICES UNTIL 2/12 - INTERIM HEALTH INNOVATIONS, LLC, FOR INTERIM CNO SERVICES UNTIL 5/12 - TATUM, LLC, FOR INTERIM CFO SERVICES AS OF 10/12 SEE SCHEDULE J, PART III FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF SAINT AGNES MEDICAL CENTER IS TRINITY HEALTH CORPORATION. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A TRINITY HEALTH CORPORATION IS THE SOLE MEMBER OF SAINT AGNES MEDICAL CENTER. TRINITY HEALTH CORPORATION HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF TRUSTEES OF SAINT AGNES MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, TRINITY HEALTH CORPORATION MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. TRINITY HEALTH CORPORATION MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, A MATERIAL CHANGE IN MISSION, AND MODIFICATIONS TO GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING, THE FORM 990 FOR SAINT AGNES MEDICAL CENTER IS REVIEWED BY SENIOR MANAGEMENT. THE MEMBERS OF THE BOARD OF TRUSTEES RECEIVE A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C SAINT AGNES MEDICAL CENTER HAS ADOPTED A CONFLICT OF INTEREST POLICY WHICH CONTAINS THE ELEMENTS IN THE MODEL CONFLICT OF INTEREST POLICY ISSUED BY THE IRS. IT APPLIES TO ALL "INTERESTED PERSONS" OF SAINT AGNES MEDICAL CENTER, WHICH INCLUDES TRUSTEES, PRINCIPAL OFFICERS AND EXECUTIVES, AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. INTERESTED PERSONS ARE REQUIRED TO ACT AT ALL TIMES IN A MANNER CONSISTENT WITH SAINT AGNES MEDICAL CENTER'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO SAINT AGNES MEDICAL CENTER OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE BOARD OF TRUSTEES OF SAINT AGNES MEDICAL CENTER IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO SAINT AGNES MEDICAL CENTER. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE REVIEWED WITH THE BOARD OF TRUSTEES OF SAINT AGNES MEDICAL CENTER ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF SAINT AGNES MEDICAL CENTER ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 SAINT AGNES MEDICAL CENTER IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE ANNUAL REPORT (WHICH INCLUDES COMMUNITY BENEFIT MINISTRY INFORMATION) AND CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, SAINT AGNES MEDICAL CENTER INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFILIATES: -2,990,674. EQUITY LOSS IN UNCONSOLIDATED AFFILIATES: -172,399. FORM 990, PART XII, LINE 2: SAINT AGNES MEDICAL CENTER'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY13 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. 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