SRM ALLIANCE HOSPITAL SERVICES: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- SRM ALLIANCE HOSPITAL SERVICES (EIN 68-0395200)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-10
- IRS object ID
- 201311309349302811
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule F
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-10T14:27:41-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18111 VON KARMAN AVENUE SUITE 1000 | AddressLine1 |
| City | IRVINE | City |
| State | CA | State |
| ZIP Code | 92612 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 680395200 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SRM ALLIANCE HOSPITAL SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % JANE STONE | InCareOfName |
| Name Control | SRMA | NameControl |
| Phone | 7075255300 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 NORTH MCDOWELL BLVD | AddressLine1 |
| City | PETALUMA | City |
| State | CA | State |
| ZIP Code | 94954 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KEVIN KLOCKENGA MICHEL RICCIONI | Name |
| Title | CEO & CFO | Title |
| Date Signed | 2013-05-06 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9497942300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PETALUMA VALLEY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | KEVIN KLOCKENGA | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1165 MONTGOMERY DRIVE | AddressLine1 |
| City | SANTA ROSA | City |
| State | CA | State |
| ZIP Code | 95405 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 83947446 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Group Exemption Number | 0928 | GroupExemptionNumber |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.STJHS.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1996 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | WE ARE COMMITTED TO EXTENDING THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE IN THE COMMUNITIES WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 577 | TotalNbrEmployees |
| Total Nbr Volunteers | 187 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 1746879 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1698455 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 78533242 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 82077261 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 97906 | InvestmentIncomePriorYear |
| Investment Income Current Year | 88435 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -120092 | OtherRevenuePriorYear |
| Other Revenue Current Year | -92199 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 80257935 | TotalRevenuePriorYear |
| Total Revenue Current Year | 83771952 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 51050 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 47809 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 47613960 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 47739939 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 354367 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 34892665 | OtherExpensePriorYear |
| Other Expenses Current Year | 37064871 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 82557675 | TotalExpensesPriorYear |
| Total Expenses Current Year | 84852619 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -2299740 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1080667 | RevenuesLessExpensesCY |
| Total Assets BOY | 32692309 | TotalAssetsBOY |
| Total Assets EOY | 35000706 | TotalAssetsEOY |
| Total Liabilities BOY | 19962303 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 23433015 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 12730006 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 11567691 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SEE SCHEDULE O | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 78383972 | Expense |
| Grants | 47809 | Grants |
| Revenue | 82077261 | Revenue |
| Description | SEE SCHEDULE O | Description |
| Total Program Service Expense | 78383972 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | true | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 106 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 577 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | false | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JANE STONE | NamePerson |
| Telephone Number | 7075255300 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 141 STONY CIRCLE SUITE 140 | AddressLine1 |
| City | SANTA ROSA | City |
| State | CA | State |
| ZIP Code | 95401 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| JIM CARR | ||||||||
| BOARD MEMBER/CHAIRPERSON | 5.0 | X | ||||||
| SISTER JUDITH DUGAN | ||||||||
| BOARD MEMBER | 2.0 | X | ||||||
| PETER GRAUERT | ||||||||
| BOARD MEMBER (PART YEAR) | 2.0 | X | ||||||
| KATHRYN POWELL | ||||||||
| BOARD MEMBER | 2.0 | X | ||||||
| PAMELA TUFT | ||||||||
| BOARD MEMBER | 2.0 | X | ||||||
| RAJESH RANADIVE MD | ||||||||
| BOARD MEMBER | 2.0 | X | 24925 | |||||
| SISTER CHRISTINE RAY | ||||||||
| BOARD MEMBER | 2.0 | X | ||||||
| ANNETTE WALKER | ||||||||
| BOARD MEMBER | 2.0 | X | 0 | 680658 | 47692 | |||
| KEVIN KLOCKENGA | ||||||||
| CEO - CHIEF EXECUTIVE OFFICER | 7.0 | X | 0 | 706868 | 12915 | X | ||
| JO SANDERSFELD | ||||||||
| SEC/VP MISSION INTEGRATION | 7.0 | 0 | 313302 | 34949 | X | |||
| MICHEL RICCIONI | ||||||||
| CFO-CHIEF FINANCIAL OFFICER | 7.0 | 0 | 461162 | 39278 | X | |||
| JANE READ | ||||||||
| VP-OPERATIONS | 43.0 | 320792 | 0 | 23722 | X | |||
| JANETTE MARLOW | ||||||||
| STAFF NURSE III - CNA | 32.0 | 210028 | 0 | 31527 | X | |||
| JAMES SWANSON | ||||||||
| STAFF NURSE II - CNA | 40.0 | 201262 | 0 | 7743 | X | |||
| GARY MAHAN | ||||||||
| MANAGER - PHARMACY | 40.0 | 182323 | 0 | 34299 | X | |||
| JUDITH RYDER | ||||||||
| DIRECTOR - HOSPICE SERVICES | 40.0 | 171397 | 0 | 42890 | X | |||
| PAULA GRIFFITH | ||||||||
| STAFF NURSE IV - CNA | 32.0 | 169176 | 0 | 36425 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1279903 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2161990 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 311440 | TotalOtherCompensation |
| Number Individuals GT100 K | 80 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| STAFF CARE INC | |||||
| PO BOX 281923 | ATLANTA | GA | 303841923 | HOSPITALISTS | 741082 |
| PETALUMA SURGICAL ASSOCIATES LLC | |||||
| 108 LYNCH CREEK WAY STE 7 | PETALUMA | CA | 94954 | OR MANAGMENT | 537000 |
| M ATCHISON CRNA INC | |||||
| 107 MACINNES CT | NAPA | CA | 945583159 | ANESTHESIA COVERAGE | 511000 |
| QUANTUM HEALTHCARE ASSOCIATES INC | |||||
| PO BOX 634850 | CINCINNATI | OH | 452634850 | PHYSICIAN SERVICES | 487254 |
| MEDICAL STAFFING NETWORK HLTHCARE | |||||
| PO BOX 203000 | DALLAS | TX | 753203000 | REGISTRY | 443634 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 10 | NumberOfContractorsGT100K |
| Fundraising Events | 459021 | FundraisingEvents |
| Related Organizations | 185717 | RelatedOrganizations |
| Government Grants | 27400 | GovernmentGrants |
| All Other Contributions | 1026317 | AllOtherContributions |
| Noncash Contributions | 23317 | NoncashContributions |
| Total Contributions | 1698455 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICES | 622110 | 81597807 | 81597807 |
| EHR REVENUE | 900099 | 312226 | 312226 |
| CAFETERIA REVENUE | 722210 | 87393 | 87393 |
| OTHER OPERATING REVENUE | 900099 | 79835 | 79835 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 82077261 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 88435 | TotalRevenueColumn |
| Exclusion | $88,435 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 72395 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 459021 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 175494 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -103099 | TotalRevenueColumn |
| Exclusion | -$103,099 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 10900 | GrossIncomeGaming |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10900 | TotalRevenueColumn |
| Exclusion | $10,900 | ExclusionAmount |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 83771952 | TotalRevenueColumn |
| Related Or Exempt Function Income | 82077261 | RelatedOrExemptFunctionIncome |
| Exclusion | -$3,764 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47809 | Total |
| Program Services | 47809 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 774806 | Total |
| Program Services | 210396 | ProgramServices |
| Management And General | 564410 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35805100 | Total |
| Program Services | 34360937 | ProgramServices |
| Management And General | 1230368 | ManagementAndGeneral |
| Fundraising | 213795 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2133600 | Total |
| Program Services | 2017486 | ProgramServices |
| Management And General | 104673 | ManagementAndGeneral |
| Fundraising | 11441 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6329178 | Total |
| Program Services | 6118128 | ProgramServices |
| Management And General | 153014 | ManagementAndGeneral |
| Fundraising | 58036 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2697255 | Total |
| Program Services | 2549152 | ProgramServices |
| Management And General | 132339 | ManagementAndGeneral |
| Fundraising | 15764 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 537000 | Total |
| Program Services | 537000 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 404412 | Total |
| Management And General | 404412 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86530 | Total |
| Management And General | 86530 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7946 | Total |
| Program Services | 7946 | ProgramServices |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17349088 | Total |
| Program Services | 15008762 | ProgramServices |
| Management And General | 2333875 | ManagementAndGeneral |
| Fundraising | 6451 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 183065 | Total |
| Program Services | 584 | ProgramServices |
| Management And General | 182208 | ManagementAndGeneral |
| Fundraising | 273 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1968947 | Total |
| Program Services | 1880651 | ProgramServices |
| Management And General | 84457 | ManagementAndGeneral |
| Fundraising | 3839 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 378621 | Total |
| Program Services | 358109 | ProgramServices |
| Management And General | 19710 | ManagementAndGeneral |
| Fundraising | 802 | Fundraising |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 972385 | Total |
| Program Services | 945621 | ProgramServices |
| Management And General | 144 | ManagementAndGeneral |
| Fundraising | 26620 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 275150 | Total |
| Program Services | 240996 | ProgramServices |
| Management And General | 34154 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12271 | Total |
| Program Services | 9887 | ProgramServices |
| Management And General | 2384 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43033 | Total |
| Program Services | 41387 | ProgramServices |
| Management And General | 1583 | ManagementAndGeneral |
| Fundraising | 63 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3650910 | Total |
| Program Services | 3556751 | ProgramServices |
| Management And General | 93976 | ManagementAndGeneral |
| Fundraising | 183 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 478956 | Total |
| Program Services | 460639 | ProgramServices |
| Management And General | 17621 | ManagementAndGeneral |
| Fundraising | 696 | Fundraising |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| MEDICAL SUPPLIES | 6419584 | 6419584 | ||
| HOSPITAL FEE | 2967675 | 2967675 | ||
| All other expenses | 1329298 | 644472 | 668422 | 16404 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 84852619 | Total |
| Program Services | 78383972 | ProgramServices |
| Management And General | 6114280 | ManagementAndGeneral |
| Fundraising | 354367 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3908703 | BOY |
| EOY | 4571906 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10533782 | BOY |
| EOY | 9126747 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 304667 | BOY |
| EOY | 76899 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 861175 | BOY |
| EOY | 975498 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 126956 | BOY |
| EOY | 195215 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 45449793 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 29274814 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15243766 | BOY |
| EOY | 16174979 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 75174 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1713260 | BOY |
| EOY | 3804288 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32692309 | BOY |
| EOY | 35000706 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8922369 | BOY |
| EOY | 8320070 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11039934 | BOY |
| EOY | 15112945 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19962303 | BOY |
| EOY | 23433015 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10485401 | BOY |
| EOY | 9636993 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2244605 | BOY |
| EOY | 1930698 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12730006 | BOY |
| EOY | 11567691 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32692309 | BOY |
| EOY | 35000706 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1080667 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -81648 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $7,946 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 7946 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PORTION OF DUES PAID TO HOSPITAL ASSOCIATIONS FOR LOBBYING | Identifier |
| Return Reference | SCHEDULE C, PART II-B, LINE 1I | ReturnReference |
| Explanation | PORTION OF DUES PAID TO HOSPITAL ASSOCIATION FOR LOBBYING ACTIVITIES; DURING THE PAST YEAR, ST. JOSEPH HEALTH SYSTEM HAS CONDUCTED AN ADVOCACY EFFORT WHICH INCLUDED SOME LOBBYING ACTIVITY. THESE INCLUDED MEETING WITH LOCAL, STATE, AND FEDERAL LEGISLATORS, THEIR STAFF AND OTHER GOVERNMENTAL OFFICIALS; AND COMMUNICATIONS TO LEGISLATORS ADVOCATING POSITIONS ON LEGISLATION. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Land | Land |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 0 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14747093 | OtherCostOrOtherBasis |
| Depreciation | 9749268 | Depreciation |
| Book Value | 4997825 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 27572539 | OtherCostOrOtherBasis |
| Depreciation | 19525546 | Depreciation |
| Book Value | 8046993 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3130161 | OtherCostOrOtherBasis |
| Book Value | 3130161 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 16174979 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DEFERRED FINANCING COSTS, NET | 1360494 |
| HOSPITAL FEE | 2420632 |
| RECEIVABLE - THIRD PARTY PAYOR | 16975 |
| OTHER RECEIVABLES | 6187 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 3804288 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO AFFILIATES | $14,571,838 |
| INTERCO WITH HEALTH SYSTEM-BONDS | $541,107 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 15112945 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ASC 740 (FIN48) FOOTNOTE | Identifier |
| Return Reference | SCHEDULE D, PART X, LINE 2 | ReturnReference |
| Explanation | ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, CLARIFIES THE ACCOUNTING FOR INCOME TAXES BY PRESCRIBING A MINIMUM RECOGNITION THRESHOLD THAT A TAX POSITION IS REQUIRED TO MEET BEFORE BEING RECOGNIZED IN THE FINANCIAL STATEMENTS. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE, AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT JUNE 30, 2012 OR 2011. | Explanation |
Schedule F IRS990ScheduleF
Accts Actvs Out US Table AcctsActvsOutUSTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | Central America and the Caribbean | Region |
| Type Of Activities Conducted | Program Services | TypeOfActivitiesConducted |
| Specific Services Provided | CAPTIVE INSURANCE | SpecificServicesProvided |
| Total Expenditures | 398005 | TotalExpenditures |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Amount Spent | 398005 | SubtotalAmountSpent |
| Total Amount Spent | 398005 | TotalAmountSpent |
| Transfer To Foreign Corp | true | TransferToForeignCorp |
| Interest In Foreign Trust | false | InterestInForeignTrust |
| Own Foreign Corp | false | OwnForeignCorp |
| Passive Foreign Invest Co | false | PassiveForeignInvestCo |
| Foreign Partnership | false | ForeignPartnership |
| Boycott Countries | false | BoycottCountries |
Form990 Schedule F Part V Form990ScheduleFPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ACCOUNTING METHOD | Identifier |
| Return Reference | SCHEDULE F, PART I, LINE 3, COLUMN (F) | ReturnReference |
| Explanation | THE ACCRUAL METHOD OF ACCOUNTING WAS USED TO DETERMINE THE AMOUNT IN COLUMN (F). | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1 |
| Gross Receipts Event1 | 188762 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 146092 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 42670 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 24855 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 18749 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 22043 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 13276 | OtherDirectExpensesEvent1 |
| Name Of Event2 | BENEDETTI | NameOfEvent2 |
| Gross Receipts Event2 | 300784 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 276376 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 24408 | GrossRevenueEvent2 |
| Food And Beverage Event2 | 46328 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 800 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 35650 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 2 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 41870 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 36553 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 5317 | GrossRevenueOtherEvents |
| Non Cash Prizes Other Events | 4356 | NonCashPrizesOtherEvents |
| Rent Facility Costs Other Events | 950 | RentFacilityCostsOtherEvents |
| Food And Beverage Other Events | 2205 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 920 | EntertainmentOtherEvents |
| Other Direct Expenses Other Events | 5362 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 531416 | GrossReceiptsTotal |
| Charitable Contributions Total | 459021 | CharitableContributionsTotal |
| Gross Revenue Total Events | 72395 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 29211 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 19699 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 70576 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 1720 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 54288 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 175494 | DirectExpenseSummaryEvents |
| Net Income Summary | -103099 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 500. | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1374108 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1374108 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01620 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15861377 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12199676 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3661701 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04320 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3353876 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2579148 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 774728 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00910 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20589361 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14778824 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5810537 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06850 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 117350 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 24601 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 92749 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3500 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3500 | NetCommunityBenefitExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 60026 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 60026 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 180876 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 24601 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 156275 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20770237 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14803425 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5966812 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07030 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2917 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 1908 | DirectOffsettingRevenue |
| Net Community Building Expense | 1010 | NetCommunityBuildingExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 5834 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 3815 | DirectOffsettingRevenue |
| Net Community Building Expense | 2019 | NetCommunityBuildingExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2917 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 1908 | DirectOffsettingRevenue |
| Net Community Building Expense | 1010 | NetCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 11668 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 7631 | DirectOffsettingRevenue |
| Net Community Building Expense | 4039 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $6,344,851 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 22109500 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 29528984 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -7419484 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SRM ALLIANCE HOSPITAL SERVICES | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 NORTH MCDOWELL BLVD | AddressLine1 |
| City | PETALUMA | City |
| State | CA | State |
| ZIP Code | 94954 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SRM ALLIANCE HOSPITAL SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 500. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Other Factors | X | OtherFactors |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 6 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (6 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| HOSPICE OF PETALUMA | ||||
| 416 PAYRAN STREET | PETALUMA | CA | 95954 | HOSPICE |
| LYNCH CREEK IMAGINGRADIOLOGY | ||||
| 151 LYNCH CREEK | PETALUMA | CA | 94954 | IMAGING/RADIOLOGY |
| HOSPICE OF NORTH COUNTY | ||||
| 205 EAST STREET | HEALDSBURG | CA | 95448 | HOSPICE |
| HOSPICE OF SANTA ROSA | ||||
| 491 BENTON STREET | SANTA ROSA | CA | 95405 | HOSPICE |
| HOSPICE OF SANTA ROSA | ||||
| 821 MENDOCINO AVENUE | SANTA ROSA | CA | 95405 | HOSPICE |
| HOSPICE OF SANTA ROSA | ||||
| 495 BENTON STREET | SANTA ROSA | CA | 95405 | HOSPICE |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| SCHEDULE H, PART I, LINE 7 | THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM, WHICH UTILIZES COSTS FOR ALL SEGMENTS AND PATIENT TYPES. SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICES NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS WERE INCLUDED. | |
| SCHEDULE H, PART II | SRM ALLIANCE HOSPITAL (DBA PETALUMA VALLEY HOSPITAL) HAS WORKED IN PARTNERSHIP WITH OTHER PUBLIC AND PRIVATE AGENCIES AND RESIDENTS IN THE PETALUMA AREA FOR MORE THAN A DECADE ON EFFORTS TO IMPROVE COMMUNITY HEALTH AND BUILD A HEALTHIER COMMUNITY; INCLUDING COMMUNITY ORGANIZING AND ADVOCACY TO MOBILIZE RESIDENTS TO MAKE SIGNIFICANT CHANGES IN HEALTH-RELATED POLICIES, PRACTICES, AND ENVIRONMENT. PETALUMA VALLEY HOSPITALS EMERGENCY DEPARTMENT MANAGER CONTINUED TO BE AN ACTIVE LEADER IN PETALUMAS COALITION TO PREVENT ABUSE OF ALCOHOL, TOBACCO, AND OTHER DRUGS DURING FY11. DURING THIS TIME, SHE LED THE GROUPS SPEAKERS BUREAU, PRESENTING TO MIDDLE SCHOOL AND HIGH SCHOOL STUDENTS, AS WELL AS THEIR PARENTS, ON THE DANGERS OF YOUTH DRINKING. THE NEIGHBORHOOD CARE STAFF (NCS) IS A PROGRAM THAT MENTORS GRASSROOTS LEADERSHIP TO ADDRESS LOCAL COMMUNITY HEALTH AND QUALITY OF LIFE ISSUES. NCS MODELS AND MENTORS COMMUNITY REPRESENTATIVES IN THESE KEY FUNCTIONS: THE IDENTIFICATION OF LOCAL ASSETS, PROVIDING FORUMS FOR DIALOGUE, SURFACING AND SUPPORTING LOCAL LEADERS, FACILITATING THE DEVELOPMENT OF SELF-SUSTAINING COMMUNITY GROUPS, FACILITATING COMMUNITY-BASED STRATEGIC PLANNING, HELPING TO BUILD LINKAGES TO AND BETWEEN COMMUNITY RESOURCES, AND ADVOCATING FOR COMMUNITY PARTICIPATION IN THE ISSUES THAT MOST AFFECT IT. IN FY12, NCS MENTORED 128 GRASSROOTS COMMUNITY LEADERS IN LOW-INCOME NEIGHBORHOODS IN THE PETALUMA AREA. THESE RESIDENT LEADERS DEVELOPED LOCAL ACTION PLANS ADDRESSING TWO KEY SOCIAL DETERMINANTS OF HEALTH THAT RESULTED IN NEARLY 2,000 (1,977) ACTIONS OF ADVOCACY, EDUCATION, AND ORGANIZING TO REDUCE OBSTACLES TO HEALTHY FOOD AND PHYSICAL ACTIVITY; AND TO INCREASE NEIGHBORHOOD SAFETY. AGENTS OF CHANGE TRAINING IN OUR NEIGHBORHOODS (ACTION) IS A COMPANION PROGRAM TO NCS THAT PROVIDES LEADERSHIP AND ADVOCACY TRAINING. IN FY12 PROVIDED FOLLOW-UP MENTORING TO ACTION GRADUATES WHO SERVE AS LEADERS OF THE SUNRISE COMMUNITY GARDEN, AND PROVIDED LEADERSHIP TRAINING AND MENTORING TO 35 CHILDREN AND YOUTH. CIRCLE OF SISTERS IS A FREE VIOLENCE PREVENTION AFTER-SCHOOL PROGRAM FOR GIRLS AGES 10 TO 14. THE PROGRAM PARTICIPANTS ATTEND SCHOOLS WITH HIGH RATES OF FREE AND REDUCED LUNCHES. IN FY 2012, CIRCLE OF SISTERS PARTNERED WITH THE BOYS & GIRLS CLUB OF PETALUMA AND MARIN TO SERVE 22 GIRLS IN PETALUMA. | COMMUNITY BUILDING ACTIVITIES |
| SCHEDULE H, PART III, LINE 4 | THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT. COLLECTION ACTIONS ARE NOT PURSUED ON THESE ACCOUNTS ONCE THEY ARE RECLASSIFIED AS FINANCIAL ASSISTANCE. THERE IS NO OTHER AMOUNT OF BAD DEBT THAT SHOULD BE REPORTED AS FINANCIAL ASSISTANCE. FINANCIAL STATEMENT FOOTNOTE DESCRIBING BAD DEBT: THE ORGANIZATION RECEIVES PAYMENT FOR SERVICES RENDERED TO PATIENTS FROM FEDERAL AND STATE GOVERNMENTS UNDER THE MEDICARE AND MEDICAID PROGRAMS, PRIVATELY SPONSORED MANAGED CARE PROGRAMS FOR WHICH PAYMENT IS MADE BASED ON TERMS DEFINED UNDER FORMAL CONTRACTS, AND OTHER PAYORS. THE ORGANIZATION BELIEVES THERE ARE NO SIGNIFICANT RISKS ASSOCIATED WITH RECEIVABLES FROM GOVERNMENT PROGRAMS. RECEIVABLES FROM CONTRACTED AND OTHERS ARE FROM VARIOUS PAYORS WHO ARE SUBJECT TO DIFFERING ECONOMIC CONDITIONS, AND DO NOT REPRESENT ANY CONCENTRATED RISKS TO THE ORGANIZATION. THE ORGANIZATION ANALYZES ITS HISTORICAL EXPERIENCE AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING A COST-TO-CHARGE RATIO. WE CALCULATE THE OVERALL HOSPITAL COST TO CHARGE RATIO USING GROSS CHARGES AND OPERATIONAL COSTS. WE APPLIED THAT RATIO TO THE GROSS CHARGES WRITTEN OFF TO BAD DEBT. ANY PAYMENTS ON PATIENT ACCOUNTS REDUCE THE AMOUNT CALCULATED FOR BAD DEBT. NO DISCOUNTS ARE APPLIED. | |
| SCHEDULE H, PART III, LINE 8 | AS A CATHOLIC HEALTH CARE MINISTRY, THE ORGANIZATION FOLLOWS THE CATHOLIC HEALTH ASSOCIATION'S COMMUNITY BENEFIT REPORTING GUIDELINES AND THEREFORE DOES NOT REPORT MEDICARE AS A COMMUNITY BENEFIT. THE COST ACCOUNTING SYSTEM CALCULATES COSTS AT THE DEPARTMENTAL LEVEL AND APPLIES IT TO EACH PATIENT ACCOUNT. WE THEN USE THE TOTAL COSTS OF ALL THE APPLICABLE ACCOUNTS TO DETERMINE MEDICARE COSTS. | |
| SCHEDULE H, PART III, LINE 9B | PETALUMA VALLEY HOSPITAL PATIENT ACCOUNTS ARE NOT FORWARDED TO COLLECTION STATUS WHEN THE PATIENT MAKES A GOOD FAITH EFFORT TO RESOLVE OUTSTANDING ACCOUNT BALANCES. SUCH EFFORTS INCLUDE APPLYING FOR FINANCIAL ASSISTANCE, NEGOTIATING A PAYMENT PLAN, OR APPLYING FOR MEDICAID COVERAGE. PRIOR TO ADVANCING ANY ACCOUNT FOR EXTERNAL COLLECTION, THE ORGANIZATION PERFORMS AN EVALUATION TO IDENTIFY IF THE ACCOUNT QUALIFIES FOR CHARITY CARE. ACCOUNTS FOR PATIENTS WHO QUALIFY FOR CHARITY CARE ARE WRITTEN OFF AND COLLECTION EFFORTS ARE NOT PURSUED. | |
| SCHEDULE H, PART V, SECTION B, LINE 11H | THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT. | |
| SCHEDULE H, PART V, SECTION B, LINE 13G | THE ORGANIZATION ADHERES TO STATE REGULATIONS IN PUBLICIZING ITS FINANCIAL ASSISTANCE POLICY. THESE REGULATIONS INCLUDE THE POSTING OF THE FULL POLICY ON THE OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT (OSHPD) WEBSITE. IN ADDITION, POLICY NOTICES ARE POSTED IN CONSPICUOUS AREAS SUCH AS EMERGENCY DEPARTMENTS, BILLING OFFICES, ADMISSIONS OFFICES AND OTHER OUTPATIENT SETTINGS. INDIVIDUAL NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH BILLINGS FOR PATIENTS WHO HAVE NOT PROVIDED PROOF OF THIRD-PARTY COVERAGE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE ALSO PROVIDED UPON INQUIRY. WRITTEN NOTICES ARE PROVIDED IN ALL LANGUAGES SPOKEN BY 5% OR MORE OF THE HOSPITAL'S PATIENT POPULATION. | |
| SCHEDULE H, PART V, SECTION B, LINE 19D | FOR PATIENTS WITH A FAMILY INCOME BETWEEN 201% AND 350% OF FEDERAL POVERTY GUIDELINES (FPG), THE HOSPITAL FACILITY USES MEDICARE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. FOR PATIENTS WITH A FAMILY INCOME BETWEEN 351% AND 500% OF FPG, THE AVERAGE OF NEGOTIATED COMMERCIAL INSURANCE RATES IS USED TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED. | |
| NEEDS ASSESSMENT | THE COMMUNITY HEALTH NEEDS ASSESSMENT OF 2011 IS A COLLABORATIVE EFFORT BY SUTTER MEDICAL CENTER OF SANTA ROSA, ST. JOSEPH HEALTH SYSTEM SONOMA COUNTY (SANTA ROSA MEMORIAL HOSPITAL & PETALUMA VALLEY HOSPITAL), KAISER PERMANENTE MEDICAL CENTER SANTA ROSA AND THE SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES TO SPOTLIGHT THE HEALTH, WELL-BEING AND FUTURE OF THE CHILDREN OF SONOMA COUNTY, WITH INPUT GATHERED FROM HOSPITAL BOARDS AND STAFF, AS WELL AS COMMUNITY MEMBERS, WHO PARTICIPATED IN FOCUS GROUPS THROUGHOUT THE COUNTY. THESE PARTNERS HAVE JOINED FORCES IN THE PAST IN THEIR JOINT NEEDS ASSESSMENTS TO ADDRESS A NUMBER OF SIGNIFICANT COMMUNITY HEALTH ISSUES PREVENTION OF DANGEROUS FALLS BY SENIORS, THE LACK OF DIVERSITY IN THE HEALTH CARE WORKFORCE, AND THE NEED FOR IMMUNIZATION CLINICS. THE HEALTH PROBLEMS RAISED IN THE NEEDS ASSESSMENT ARE PREVENTABLE WITH CONCERTED ACTION ON THE PART OF PARTNERS AND THE COMMUNITY. TO THIS END, THE NEEDS ASSESSMENT EMPLOYS THE SPECTRUM OF PREVENTION A FUNDAMENTAL MODEL IN PUBLIC HEALTH, WHICH ACKNOWLEDGES THAT A BROAD RANGE OF FACTORS PLAY A ROLE IN HEALTH. POLICIES, LEGISLATION AND ORGANIZATIONAL PRACTICES ARE ALL POWERFUL INFLUENCES IN SHAPING AN INDIVIDUALS ATTITUDES AND THE ENVIRONMENT THAT DETERMINES THE WAY PEOPLE LIVE. | SCHEDULE H, PART VI, LINE 2 |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | OUR MISSION IS TO PROVIDE QUALITY CARE TO ALL OUR PATIENTS, REGARDLESS OF ABILITY TO PAY. WE BELIEVE THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY PETALUMA VALLEY HOSPITAL HAS A PATIENT FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES FREE OR DISCOUNTED SERVICES TO ELIGIBLE PATIENTS. THE HOSPITAL POSTS NOTICES INFORMING THE PUBLIC OF THE FINANCIAL ASSISTANCE PROGRAM IN HIGH VOLUME INPATIENT AND OUTPATIENT SERVICE AREAS OF THE HOSPITAL INCLUDING BUT NOT LIMITED TO THE EMERGENCY DEPARTMENT, BILLING OFFICE, INPATIENT ADMISSION AND OUTPATIENT REGISTRATION AREAS OR OTHER COMMON PATIENT WAITING AREAS OF THE HOSPITAL. NOTICES ARE ALSO POSTED AT ANY LOCATION WHERE A PATIENT MAY PAY THEIR BILL AND INCLUDE CONTACT INFORMATION ON HOW A PATIENT MAY OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR SUCH ASSISTANCE. THESE NOTICES ARE POSTED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT ARE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITALS SERVICE AREA. A PATIENT INFORMATION BROCHURE THAT DESCRIBES THE FEATURES OF THE FINANCIAL ASSISTANCE PROGRAM IS AVAILABLE TO PATIENTS AND MEMBERS OF THE GENERAL PUBLIC; AND A COPY OF THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE TO THE PUBLIC ON A REASONABLE BASIS. | SCHEDULE H, PART VI, LINE 3 |
| COMMUNITY INFORMATION | SONOMA COUNTY, THE NORTHERNMOST OF THE NINE GREATER SAN FRANCISCO BAY AREA COUNTIES, IS BORDERED ON THE NORTH BY MENDOCINO COUNTY, ON THE EAST BY LAKE AND NAPA COUNTIES, ON THE SOUTH BY MARIN COUNTY AND SAN PABLO BAY, AND ON THE WEST BY THE PACIFIC OCEAN. IN 2006, SONOMA COUNTY HAD THE 17TH LARGEST COUNTY POPULATION OF THE 58 COUNTIES IN CALIFORNIA, WITH 480,000 RESIDENTS, WITH 110,000 CHILDREN AGES 0 TO 17. SANTA ROSA, THE COUNTY SEAT AND LARGEST CITY, HAS ONE-THIRD OF THE TOTAL POPULATION OF SONOMA COUNTY AND RANKS AS THE 30TH LARGEST CITY IN THE STATE. MUCH OF SONOMA COUNTY IS IN AREAS DEFINED AS RURAL. THESE RURAL AREAS HAVE BEEN FEDERALLY CLASSIFIED AS A MEDICALLY UNDERSERVED POPULATION (MUP) BASED ON LOW-INCOME POPULATION FACTORS AND ALSO AS PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA). PETALUMA IS A COMMUNITY WITH A POPULATION OF 54,496, LOCATED IN SOUTHERN SONOMA COUNTY, ABOUT 40 MILES NORTH OF SAN FRANCISCO. ALTHOUGH SONOMA COUNTY IS RELATIVELY AFFLUENT, MORE THAN ONE-FIFTH OF ITS POPULATION (21.9%) LIVES UNDER 200% OF THE FEDERAL POVERTY LEVEL, AND NEARLY ONE-THIRD (32.8%) OF SONOMA HOUSEHOLDS EARN LESS THAN $40,000 PER YEAR. THE MAJORITY OF SONOMA COUNTYS POPULATION IS EITHER WHITE (68.3%) OR LATINO (21.2%), WITH 4.7% ASIAN, 1.2% AFRICAN-AMERICAN, AND 1% AMERICAN INDIAN/ALASKA NATIVE MAKING UP THE REMAINDER. WHILE PETALUMA IS A COMMUNITY WITH THE APPEARANCE OF WIDESPREAD AFFLUENCE, IT CONTAINS SIGNIFICANT POCKETS OF VULNERABILITY, IN WHICH FAMILIES FACE FINANCIAL, LINGUISTIC, CULTURAL, AND CITIZENSHIP DOCUMENTATION BARRIERS. FOR EXAMPLE, FOR THE EAST SIDE OF THE CITY, CALIFORNIA DEPARTMENT OF EDUCATION STATISTICS FOR THE 2007-2008 SCHOOL YEAR SHOW THAT 75.8% OF MCDOWELL ELEMENTARY SCHOOLS STUDENTS ARE LATINO, 75.2% ARE ENGLISH LANGUAGE LEARNERS, AND 81.3% QUALIFY FOR THE FEDERAL FREE OR REDUCED MEAL PROGRAM. AT NEARBY MCKINLEY ELEMENTARY SCHOOL, 67.2% ARE LATINO, 68% ARE ENGLISH LANGUAGE LEARNERS, AND 81.1% QUALIFY FOR FREE OR REDUCED MEALS. | SCHEDULE H, PART VI, LINE 4 |
| PROMOTION OF COMMUNITY HEALTH | THE GOVERNING BODY IS COMPRISED OF A MAJORITY OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND WHO ARE NOT EMPLOYEES, CONTRACTORS, OR FAMILY MEMBERS. THE SUB-COMMITTEE OF THE BOARD OF TRUSTEES, KNOWN AS THE COMMUNITY BENEFIT COMMITTEE, OVERSAW THE DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY BENEFIT PLAN EVERY THREE YEARS, AS WELL AS AN ANNUAL COMMUNITY BENEFIT REPORT. THE COMMITTEE ALSO PROVIDES GENERAL DIRECTION TO PETALUMA VALLEY HOSPITAL REGARDING: 1) BUDGETING DECISIONS, 2) COMMUNITY BENEFIT PROGRAM CONTENT, 3) COMMUNITY BENEFIT PROGRAM DESIGN, 4) TARGET GEOGRAPHIC/POPULATION, 5) PROGRAM CONTINUATION OR DISCONTINUATION, 6) FUND DEVELOPMENT SUPPORT, AND 7) COMMUNITY WIDE ENGAGEMENT. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. GIVING BACK TO THE COMMUNITY IS INTEGRATED INTO EVERY ASPECT OF OUR ORGANIZATION. AS A MEMBER OF THE FAITH-BASED HEALTH MINISTRY OF ST. JOSEPH HEALTH SYSTEM, WE PROVIDE FREE AND DISCOUNTED CARE VIA OUR FINANCIAL ASSISTANCE PROGRAM AND HAVE A FUNDING STREAM TO ADDRESS THE NEEDS OF THE ECONOMICALLY POOR AND VULNERABLE IN THE COMMUNITIES WE SERVE. SRM ALLIANCE HOSPITAL DEMONSTRATES ORGANIZATIONAL COMMITMENT TO THE COMMUNITY THROUGH THE ALLOCATION OF STAFF, FINANCIAL RESOURCES, PARTICIPATION AND COLLABORATION. ITS VICE PRESIDENT OF MISSION INTEGRATION IS RESPONSIBLE FOR COORDINATING IMPLEMENTATION OF SENATE BILL 697 PROVISIONS AS WELL AS THE OPPORTUNITIES FOR EXECUTIVE MANAGEMENT TEAM, PHYSICIANS, AND OTHER MANAGEMENT AND STAFF TO PARTICIPATE IN PLANNING AND CARRYING OUT THE COMMUNITY BENEFIT PLAN THROUGH PARTICIPATION IN COMMUNITY BOARDS AND COMMITTEES; AS WELL AS THROUGH VOLUNTEERISM WITH ORGANIZATIONS SUCH AS THE REDWOOD EMPIRE FOOD BANK, UNITED WAY, SONOMA COUNTY VOLUNTEER CENTER, AMERICAN HEART ASSOCIATION, AND OTHERS. THE COMMUNITY BENEFIT COMMITTEE IS A JOINT COMMITTEE OF THE BOARDS OF TRUSTEES OF SANTA ROSA MEMORIAL AND SRM ALLIANCE HOSPITALS (SJHS-SC ENTITIES), AND SUPPORTS THESE BOARDS IN OVERSEEING COMMUNITY BENEFIT ACTIVITIES IN ACCORDANCE WITH ITS BOARD APPROVED CHARTER. THE COMMITTEE CONSISTS OF AT LEAST THREE MEMBERS OF THE BOARDS OF TRUSTEES AND HAS A MAJORITY OF MEMBERS FROM THE COMMUNITY WHO HAVE KNOWLEDGE OR EXPERIENCE WITH POPULATIONS WITH DISPROPORTIONATE UNMET HEALTH NEEDS IN THE COMMUNITIES SERVED. DURING FY11, MEMBERS OF THE SJHS-SC EXECUTIVE MANAGEMENT TEAM AND TRUSTEES OF PETALUMA VALLEY HOSPITAL MADE SITE VISITS OUT IN THE COMMUNITIES TO SEE THE COMMUNITY BENEFIT CLINICS AND PROGRAMS IN ACTION, AND TO SPEAK WITH SOME OF THOSE BEING SERVED. OUR MISSION IS TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF PEOPLE IN THE COMMUNITIES WE SERVE. WE BELIEVE THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY PETALUMA VALLEY HOSPITAL AS A MINISTRY OF ST. JOSEPH HEALTH SYSTEM, HAS A PATIENT FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES FREE OR DISCOUNTED SERVICES TO ELIGIBLE PATIENTS. ON AN ANNUAL BASIS, TEN PERCENT OF OUR NET INCOME IS DEVOTED TO FUND COMMUNITY PROGRAMS FOR THE ECONOMICALLY POOR (CARE FOR THE POOR FUNDS). SPECIFICALLY, FUNDS ARE USED FOR OUTREACH PROGRAMS, DEFINED AS THOSE SERVICES THAT ADDRESS A SPECIFIC UNMET HEALTH NEED AND ARE SEPARATE FROM TRADITIONAL ACUTE CARE SERVICES. IN ADDITION TO DEVOTING A PERCENTAGE OF OUR NET INCOME TO COMMUNITY PROGRAMS FOR THE ECONOMICALLY POOR VIA CARE FOR THE POOR FUNDS, WE STRIVE TO ANNUALLY BUDGET A PORTION OF OUR TOTAL OPERATING EXPENSES FOR HEALTHY COMMUNITIES AND COMMUNITY HEALTH EFFORTS. | SCHEDULE H, PART VI, LINE 5 |
| AFFILIATED HEALTH CARE SYSTEM | SRM ALLIANCE HOSPITAL IS PART OF ST. JOSEPH HEALTH SYSTEM - SONOMA COUNTY, ONE OF THE NORTHERN CALIFORNIA MINISTRIES OF A NETWORK OF HOSPITALS AND CLINICS KNOWN AS ST. JOSEPH HEALTH SYSTEM (SJHS), THE CENTRAL OFFICES OF WHICH ARE IN ORANGE COUNTY. SJHS-SC OPERATES TWO HOSPITALS, URGENT CARE AND COMMUNITY CLINICS, A HOSPICE, HOME HEALTH SERVICES, AND OTHER FACILITIES FOR TREATING THE HEALTHCARE NEEDS OF THE COMMUNITY IN SONOMA COUNTY AND THE REGION. OUR CORE FACILITY IS: PETALUMA VALLEY HOSPITAL, APPROXIMATELY 40 MILES NORTH OF SAN FRANCISCO IN THE TOWN OF PETALUMA, WHICH IS AN 80-BED ACUTE CARE HOSPITAL. PETALUMA VALLEY HOSPITAL IS A HEALING MINISTRY OF ST. JOSEPH HEALTH SYSTEM, AN INTEGRATED HEALTHCARE DELIVERY SYSTEM SPONSORED BY THE ST. JOSEPH HEALTH MINISTRY. ST. JOSEPH HEALTH SYSTEM IS ORGANIZED INTO THREE REGIONS: NORTHERN CALIFORNIA, SOUTHERN CALIFORNIA, AND WEST TEXAS/EASTERN NEW MEXICO. THE SYSTEM INCLUDES 14 ACUTE CARE HOSPITALS, HOME HEALTH AGENCIES, HOSPICE CARE, OUTPATIENT SERVICES, COMMUNITY CLINICS, AND PHYSICIAN ORGANIZATIONS. EACH ASSOCIATED MINISTRY WORKS TO LIVE OUT ITS MISSION TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITIES IT SERVES. IN 1986, ST. JOSEPH HEALTH SYSTEM CREATED A PLAN AND BEGAN AN EFFORT TO FURTHER ITS COMMITMENT TO NEIGHBORS IN NEED. WITH A VISION OF REACHING BEYOND THE WALLS OF ITS HEALTHCARE FACILITIES AND TRANSCENDING TRADITIONAL EFFORTS OF PROVIDING FINANCIAL ASSISTANCE FOR THOSE IN NEED OF ACUTE SERVICES, ST. JOSEPH HEALTH SYSTEM CREATED THE ST. JOSEPH HEALTH SYSTEM FOUNDATION TO IMPROVE THE HEALTH OF LOW-INCOME INDIVIDUALS RESIDING IN LOCAL COMMUNITIES. OUR FOUNDATIONAL DOCUMENT, A VISION OF VALUES, FORMALIZES A POLICY THROUGH WHICH THE HOSPITAL MINISTRIES RETURN TEN PERCENT OF THEIR NET INCOME TO THE ST. JOSEPH HEALTH SYSTEM FOUNDATION TO SUPPORT OUTREACH EFFORTS FOR THE MATERIALLY POOR. THE FOUNDATION THEN FUNDS PROGRAMS IN COMMUNITIES SERVED BY ST. JOSEPH HEALTH HOSPITALS THAT EXEMPLIFY THE FOUR CORE VALUES OF ST. JOSEPH HEALTH SYSTEM: SERVICE, EXCELLENCE, DIGNITY, AND JUSTICE. | SCHEDULE H, PART VI, LINE 6 |
| STATE FILING OF COMMUNITY BENEFIT REPORT | WE REPORT TO CALIFORNIA OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT IN ACCORDANCE WITH CALIFORNIA SENATE BILL 697. | SCHEDULE H, PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | false | RecordsMaintained |
Recipient Table RecipientTable (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| COMMITTEE ON THE SHELTERLESS | |||||||
| PO BOX 2744 | PETALUMA | CA | 94953 | 680176855 | 501(C)3 | 10000 | GENERAL SUPPORT GENERAL SUPPORT HEART WORKS PROGRAM CA HOSPITAL PROGRAM FEE |
| PETALUMA PEOPLE SERVICES | |||||||
| 1500 PETALUMA BLVD SO | PETALUMA | CA | 94953 | 942271299 | 501(C)3 | 7500 | GENERAL SUPPORT |
| NORTHERN CALIFORNIA CENTER FOR WELL BEING | |||||||
| 365 B TESCONI CIRCLE | SANTA ROSA | CA | 95409 | 931144835 | 501(C)3 | 9500 | HEART WORKS PROGRAM |
| CALIFORNIA HEALTH FOUNDATION & TRUST | |||||||
| 1215 K ST STE 800 | SACRAMENTO | CA | 95814 | 941498697 | 501(C)3 | 20809 | CA HOSPITAL PROGRAM FEE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 4 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Form 990, Schedule I, Part I, Line 2 | Identifier |
| Return Reference | Description of Organization's Procedures for Monitoring the Use of Grants | ReturnReference |
| Explanation | DONATIONS TO OTHER ORGANIZATIONS ARE APPROVED BY MANAGEMENT TO ENSURE THEY SUPPORT THE MISSION OF SRM ALLIANCE HOSPITAL SERVICES. WE DO NOT MONITOR DONATIONS MADE. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Discretionary Spending Account | X | DiscretionarySpendingAccount |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | false | SubstantiationRequired |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ANNETTE WALKER | |||||||||||||
| 0 | 385462 | 0 | 185072 | 0 | 110124 | 0 | 12218 | 0 | 35474 | 0 | 728350 | 0 | 0 |
| KEVIN KLOCKENGA | |||||||||||||
| 0 | 419202 | 0 | 154934 | 0 | 132732 | 0 | 9757 | 0 | 3158 | 0 | 719783 | 0 | 0 |
| JO SANDERSFELD | |||||||||||||
| 0 | 188720 | 0 | 59999 | 0 | 64583 | 0 | 16229 | 0 | 18720 | 0 | 348251 | 0 | 0 |
| MICHEL RICCIONI | |||||||||||||
| 0 | 287700 | 0 | 90613 | 0 | 82849 | 0 | 12026 | 0 | 27252 | 0 | 500440 | 0 | 0 |
| JANE READ | |||||||||||||
| 195507 | 0 | 81128 | 0 | 44157 | 0 | 9084 | 0 | 14638 | 0 | 344514 | 0 | 0 | 0 |
| JANETTE MARLOW | |||||||||||||
| 206964 | 0 | 0 | 0 | 3064 | 0 | 20488 | 0 | 11039 | 0 | 241555 | 0 | 0 | 0 |
| JAMES SWANSON | |||||||||||||
| 197851 | 0 | 0 | 0 | 3411 | 0 | 7743 | 0 | 0 | 0 | 209005 | 0 | 0 | 0 |
| GARY MAHAN | |||||||||||||
| 167363 | 0 | 14291 | 0 | 669 | 0 | 14504 | 0 | 19795 | 0 | 216622 | 0 | 0 | 0 |
| JUDITH RYDER | |||||||||||||
| 142696 | 0 | 16962 | 0 | 11739 | 0 | 15834 | 0 | 27056 | 0 | 214287 | 0 | 0 | 0 |
| PAULA GRIFFITH | |||||||||||||
| 165034 | 0 | 0 | 0 | 4142 | 0 | 15411 | 0 | 21014 | 0 | 205601 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Supplemental Compensation Information | SCHEDULE J, PART 1, LINE 1A | ST. JOSEPH HEALTH SYSTEM ALLOWS FOR COMPANION TRAVEL FOR CERTAIN PRE-APPROVED, MINISTRY SPONSORED EVENTS. COMPANION TRAVEL IS TREATED AS TAXABLE COMPENSATON IN MOST CASES. IN THE CASE THAT COMPANION TRAVEL IS NOT RELATED AS TAXABLE COMPENSATION, THE INDIVIDUAL IS PROVIDING A SERVICE TO THE HEALTH SYSTEM AS A REPRESENTATIVE WITH KNOWLEDGE OF THE COMMUNITIES AND MINISTRIES WE SERVE. MEMBERS OF THE BOARD AND EXECUTIVE MANAGEMENT TEAMS ARE SELECTED TO PARTICIPATE IN AN ANNUAL PILGRIMAGE TO LEPUY, FRANCE, WHERE THE SISTERS FIRST CONGREGATION WAS FORMED. THE PURPOSE OF THE PILGRIMAGE IS FOR THE ORGANIZATION'S LEADERS TO DEVELOP A DEEPER UNDERSTANDING OF THE ROOTS AND HERITAGE OF THE ORGANIZATION IN ORDER TO CARRY OUT THE MISSION. COMPANION TRAVEL IS CONSIDERED TO BE AN ESSENTIAL PART OF THIS EXPERIENCE AND THE COMPANION ACTS AS A REPRESENTATIVE WITH KNOWLEDGE OF THE COMMUNITIES AND MINISTRIES WE SERVE. THE FOLLOWING OFFICER RECEIVED A BENEFIT FOR COMPANION TRAVEL THAT WAS INTENDED TO BE COMPENSATION. THE BENEFITS WERE PAID BY ITS ULTIMATE TAX-EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM. MICHEL RICCIONI - $3,272 EXECUTIVES RECEIVE A PERCENTAGE OF BASE COMPENSATION FOR DISCRETIONARY SPENDING. THESE AMOUNTS ARE INCLUDED IN OTHER REPORTABLE COMPENSATION. |
| SCHEDULE J, PART I, LINE 3 | THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. SEE SCHEDULE O FORM 990, PART VI, LINE 15A FOR THE PROCESS THAT IS COMPLETED BY ST. JOSEPH HEALTH SYSTEM. | |
| SCHEDULE J, PART I, LINE 4B | EXECUTIVES COULD PARTICIPATE IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN UNDER INTERNAL REVENUE CODE 457(F). THE PLAN WAS FROZEN EFFECTIVE DECEMBER 31, 2007 AFTER WHICH TIME NO FURTHER CONTRIBUTIONS WERE PERMITTED TO THE PLAN. THIS PLAN WILL CEASE TO EXIST ONCE ALL BENEFITS HAVE BEEN DISTRIBUTED IN ACCORDANCE WITH PROVISIONS OF THE PLAN. | |
| SCHEDULE J, PART I, LINE 7 | A PORTION OF THE EXECUTIVES SALARIES ARE PLACED "AT-RISK" AND ARE NOT AWARDED UNLESS SPECIFIC STRATEGIC OBJECTIVE TARGETS ARE MET OR EXCEEDED. THE AT-RISK EXECUTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD EXECUTIVES FOR TEAM PERFORMANCE THAT SUPPORTS THE STRATEGIC GOALS AND SUCCESSFUL PERFORMANCE OF ST. JOSEPH HEALTH SYSTEM. AT-RISK PAY IS AWARDED TO ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS, AND THE CHIEF EXECUTIVE OFFICER BASED ON ACHIEVING OR SURPASSING SPECIFIC GOALS THAT ARE PREDETERMINED BY THE BOARD OF TRUSTEES PRIOR TO THE BEGINNING OF THE FISCAL YEAR. THE GOALS INCLUDE OUR STRATEGIC OBJECTIVES OF PERFECT CARE, SACRED ENCOUNTERS AND HEALTHIEST COMMUNITIES AS WELL AS FISCAL STEWARDSHIP. EACH OF THESE FACTORS IS TAKEN INTO CONSIDERATION WHEN DETERMINING THE PERCENTAGE OF AT-RISK PAY. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990, PART III, LINE 1 | SRM ALLIANCE HOSPITAL IS COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF PEOPLE IN THE COMMUNITIES WE SERVE. |
| PROGRAM SERVICE ACCOMPLISHMENTS | FORM 990, PART III, LINE 4A | REALIZING OUR MISSION SRM ALLIANCE HOSPITAL HAS BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE LOCAL COMMUNITY FOR OVER 30 YEARS, SERVING THE COMMUNITIES OF SOUTHERN SONOMA COUNTY AND MARIN COUNTY REGIONS. SRM ALLIANCE HOSPITAL, APPROXIMATELY 40 MILES NORTH OF SAN FRANCISCO JUST OFF THE HIGHWAY 101 CORRIDOR IN SOUTHERN SONOMA COUNTY IN THE TOWN OF PETALUMA, IS AN 80-BED ACUTE CARE HOSPITAL. ITS SERVICES INCLUDE A 24-HOUR EMERGENCY DEPARTMENT, INTENSIVE/CORONARY CARE UNIT, FAMILY BIRTH CENTER, INPATIENT MEDICAL/SURGICAL UNIT, DAY SURGERY, IMAGING, LABORATORY, AND RESPIRATORY, PHYSICAL AND OCCUPATIONAL THERAPIES. AS A MEMBER OF ST. JOSEPH HEALTH SYSTEM (SJHS), SRM ALLIANCE HOSPITAL IS COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE. THIS MISSION HAS GUIDED OUR CATHOLIC HEALTHCARE MINISTRY SINCE THE OPENING OF OUR FIRST HOSPITAL IN EUREKA, CALIFORNIA 100 YEARS AGO. THE SISTERS OF ST. JOSEPH OF ORANGE TRACE THEIR ROOTS BACK TO 17TH CENTURY FRANCE AND THE UNIQUE VISION OF A JESUIT PRIEST NAMED JEAN-PIERRE MEDAILLE. HE SOUGHT TO ORGANIZE AN ORDER OF RELIGIOUS WOMEN WHO, RATHER THAN REMAINING SAFELY CLOISTERED IN A CONVENT, VENTURED OUT INTO THE COMMUNITY TO SEEK OUT "THE DEAR NEIGHBORS" AND MINISTER TO THEIR NEEDS. THE CONGREGATION MANAGED TO SURVIVE THE TURBULENCE OF THE FRENCH REVOLUTION AND EVENTUALLY EXPANDED, NOT ONLY THROUGHOUT FRANCE, BUT THROUGHOUT THE WORLD. IN 1912 A SMALL GROUP OF SISTERS OF ST. JOSEPH WENT TO EUREKA, CALIFORNIA, AT THE INVITATION OF THE LOCAL BISHOP, TO ESTABLISH A SCHOOL. A FEW YEARS LATER, THE GREAT INFLUENZA EPIDEMIC OF 1918 CAUSED THE SISTERS TO TEMPORARILY SET ASIDE THEIR EDUCATION EFFORTS TO CARE FOR THE ILL. THEY REALIZED IMMEDIATELY THAT THE SMALL COMMUNITY DESPERATELY NEEDED A HOSPITAL. THROUGH BOLD FAITH, FORESIGHT, AND FLEXIBILITY IN 1920, THE SISTERS OPENED THE 28-BED ST. JOSEPH HOSPITAL OF EUREKA, THE FIRST ST. JOSEPH HEALTH SYSTEM MINISTRY. SRM ALLIANCE HOSPITAL IS COMMITTED TO THREE SYSTEM WIDE MISSION OUTCOMES: EVERY INTERACTION WILL BE EXPERIENCED AS A SACRED ENCOUNTER. THE GOAL OF SACRED ENCOUNTER HAS A DIRECT CONNECTION TO THE OVERALL MISSION. OUR VALUE OF DIGNITY CALLS FOR US TO RESPECT EACH PERSON AS AN INHERENTLY VALUABLE MEMBER OF THE HUMAN COMMUNITY AND AS A UNIQUE EXPRESSION OF LIFE. WE STRIVE TO DO THIS BY KEEPING AT THE FOREFRONT OF OUR MINDS THE UNDERSTANDING OF THE IMPACT WE CAN HAVE ON ONE ANOTHER WITH EVERY ACTION WE TAKE. THE MAIN GOAL SURROUNDING SACRED ENCOUNTERS IS TO PROVIDE CARE TO PATIENTS DISTINGUISHED BY EASE OF USE, TIMELY ACCESS, SAFETY, AND HIGH RELIABILITY WITH AN EMPHASIS ON PATIENT SAFETY AND PATIENT SATISFACTION. SRM ALLIANCE HOSPITAL HAS IMPLEMENTED EVIDENCED BASED BEST PRACTICE STANDARD WORK TO ADDRESS WHAT WE DO & HOW WE DO WHAT WE DO TO ADDRESS ALL EIGHT KEY HCAHPS COMPOSITE MEASURES OF PATIENT EXPERIENCE. ANY LOCATION PERFORMING BELOW MINISTRY HCAHPS PERFORMANCE GOALS MUST PROVIDE COUNTERMEASURE FOR IMPROVEMENT TO EXECUTIVE LEADERSHIP. ALL STANDARD WORK INCLUDES EDUCATION, MONITORING & COACHING, IS AUDITED DAILY FOR REAL TIME PROGRESS REPORT TO ALL LEVELS OF THE ORGANIZATION, AND RELIES ON THE INFRASTRUCTURE PROVIDED BY SONOMA WAY AND OUR PERFORMANCE IMPROVEMENT AND IMPLEMENTATION TEAM OF EDUCATORS TO SUPPORT SUSTAINMENT. STANDARD WORK IS CONSIDERED HARD WIRED WHEN IT IS PERFORMED CONSISTENTLY AT 90% ON AUDIT OUTCOME DATA. FALLOUTS FROM 90% PERFORMANCE LASTING TWO WEEKS REQUIRE IMMEDIATE ACTION PLANS FOR RESTORATION OF PERFORMANCE. ALL OF THESE INITIATIVES HAVE EDUCATION, STANDARD WORK AND COACHING/MENTORING OF STAFF. AUDITS WITH VISUAL MANAGEMENT BOARDS TRACK PROJECTS AND UNITS ARE CONSIDERED HARD-WIRED IF ALL AUDITS ARE AT 90% FOR 2 SIMULTANEOUS WEEKS. IN ADDITION SRM ALLIANCE HOSPITAL IMPLEMENTED A "SPOTLIGHTING PROGRAM," WHICH IS AN INITIATIVE THAT GIVES CAREGIVERS NEW TOOLS TO SHOW THEIR COMPASSION, HONOR PATIENT DIGNITY AND FOSTER AN ENVIRONMENT IN WHICH PATIENTS FEEL SAFE AND NURTURED. SPECIFICALLY, THE FOCUS WAS ON THREE MOMENTS: ADMISSION, BED TIME AND DISCHARGE. DEPARTMENTS LOOKED CLOSELY AT EVERY ASPECT OF THESE EXPERIENCES, DETERMINED THE TONE THEY WANTED TO ESTABLISH AND THEN EXPLORED WHAT CAREGIVERS COULD DO AND SAY TO FOSTER A SACRED ENCOUNTER. THE IDEA WAS TO CREATE TOOLS THAT ALLOW THE CAREGIVERS TO REACH OUT AND HAVE AUTHENTIC ENCOUNTERS WITH THE PATIENTS. ALL PATIENTS WILL RECEIVE PERFECT CARE. IT IS OUR ATTENTION TO DETAIL AND THE SMALLEST IMPERFECTIONS OF EACH PATIENT'S EXPERIENCE THAT DRIVES A DEEPER UNDERSTANDING AND ULTIMATELY A SUSTAINABLE APPROACH TO THE ACHIEVEMENT OF PERFECT CARE. OUR MISSION IS TO CONTINUALLY IMPROVE THE HEALTH AND QUALITY OF LIFE OF PEOPLE IN THE COMMUNITIES WE SERVE. OUR VISION IS THAT EVERY PATIENT WE CARE FOR RECEIVES PERFECT CARE. PERFECT CARE MEANS THAT EVERY PATIENT GETS THE HIGHEST STANDARD OF CARE, EVERY TIME. TO ACHIEVE THOSE GOALS, WE PARTICIPATE IN THE FOLLOWING QUALITY PROGRAM: - CENTER FOR MEDICARE & MEDICAID SERVICES PARTICIPANT IN THE PARTNERSHIP FOR PATIENTS; HOSPITAL ENGAGEMENT NETWORK-A VOLUNTARY PROGRAM TO REDUCE HARM AND IMPROVE CARE IN THE U.S. IN ADDITION WE HAVE RECEIVED THE FOLLOWING NATIONAL RECOGNITION: - LEAPFROG RECOGNITION 2012: "A" RATING FOR HOSPITAL SAFETY THE COMMUNITIES WE SERVE WILL BE AMONG THE HEALTHIEST IN OUR NATION. WE SEEK TO DEVELOP COMMUNITY HEALTH INITIATIVES THAT IMPACT LONG-TERM HEALTH ACROSS THE ENTIRE COMMUNITY. IN PURSUIT OF THIS OUTCOME, SRM ALLIANCE HOSPITAL ENGAGED LOW-INCOME COMMUNITY MEMBERS IN PREVENTION ACTIVITIES THAT SUPPORT HEALTHY NUTRITION AND PHYSICAL ACTIVITY. THE PROMOTORES DE SALUD PROVIDED THE CDC'S "YOUR HEART, YOUR LIFE" TRAINING TO 8 SPANISH SPEAKING VOLUNTEERS, WITH TWO PREVIOUS VOLUNTEERS SERVING AS CO-FACILITATORS. IN ADDITION, 35 RESIDENTS FROM THE AFFORDABLE HOUSING COMPLEX, ROUNDWALK VILLAGE, AND THE SURROUNDING NEIGHBORHOOD RECEIVED LEADERSHIP TRAINING AND MENTORING FOR THE COMPLETION OF THE SUNRISE COMMUNITY GARDEN; BUILT IN PARTNERSHIP WITH PETALUMA BOUNTY AND THE CITY OF PETALUMA. PROGRAM SERVICE ACCOMPLISHMENTS FINANCIAL ASSISTANCE PROGRAM WE BELIEVE THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY SRM ALLIANCE HOSPITAL, HAS A PATIENT FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES FREE AND/OR DISCOUNTED SERVICES TO ELIGIBLE PATIENTS. FACTORS USED IN DETERMINING ELIGIBILITY FOR PATIENT FINANCIAL ASSISTANCE INCLUDE INCOME LEVEL, ASSET LEVEL, AND MEDICAL INDIGENCE. IN THIS FISCAL YEAR, SRM ALLIANCE HOSPITAL PROVIDED $1,374,108 IN CHARITY CARE WITH 1,212 PERSONS SERVED. SENIOR CARE MANAGEMENT AS PART OF A COORDINATED CONTINUUM OF CARE WITHIN THE HOSPITAL THAT INCLUDES CASE MANAGEMENT, HOSPICE, AND OTHER DEPARTMENTS, AS WELL AS COMMUNITY PARTNERS, THE COMMUNITY BENEFIT TEAM CONTRIBUTED TO A SIGNIFICANT REDUCTION IN HOSPITAL RE-ADMISSIONS FOR CONGESTIVE HEART FAILURE AMONG LOW-INCOME SENIORS. SRM ALLIANCE HOSPITAL ACHIEVED SIGNIFICANT IMPROVEMENT; ENDING THE YEAR WITH A RATE OF 7.55% HOSPITAL RE-ADMISSIONS FOR THE 53 INDIVIDUALS AGES 65 AND ABOVE SEEN AT THE HOSPITAL FOR CHF, AS COMPARED TO AN EXPECTED RATE OF 21.41%. THE HOSPITAL INVESTED $52,136 IN SERVICES TO LOW-INCOME SENIORS IN THE PETALUMA AREA. CHILDHOOD OBESITY PREVENTION IN ADDITION TO THE ACTIVITIES MENTIONED ABOVE FOR THE HEALTHIEST COMMUNITIES OUTCOME, SRM ALLIANCE HOSPITAL ALSO PARTNERED WITH THE PETALUMA EDUCATIONAL FOUNDATION TO BRING THE "SPINNING TOWARDS SUCCESS" PROGRAM TO SAN ANTONIO COMMUNITY HIGH SCHOOL. THIS PROGRAM BRINGS SPIN CLASS TO APPROXIMATELY 100 AT-RISK HIGH SCHOOL STUDENTS, INCLUDING PARENTING TEENS. THE PROGRAM ALSO SERVED STUDENTS PARTICIPATING IN THE AREA'S HOME-SCHOOLING INITIATIVE. SRM ALLIANCE HOSPITAL INVESTED $12,217 IN THIS PROGRAM TO PREVENT OVERWEIGHT AND OBESITY IN TEENS AND IN THEIR YOUNG CHILDREN. FOR MORE INFORMATION ABOUT SRM ALLIANCE HOSPITAL, PLEASE VISIT WWW.STJOSEPHHEALTH.ORG. FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM, PLEASE VISIT WWW.STJHS.ORG. |
| DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS | Form 990, Part VI, LINE 6 | SANTA ROSA MEMORIAL HOSPITAL IS THE SOLE CORPORATE MEMBER OF SRM ALLIANCE HOSPITAL SERVICES. |
| DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS | FORM 990, PART VI, LINE 7A | SRM ALLIANCE HOSPITAL SERVICES HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE SRM ALLIANCE HOSPITAL BOARD. ALL TRUSTEE APPOINTMENTS THAT COME FROM THE SRM ALLIANCE HOSPITAL BOARD AS NOMINATIONS MUST BE APPROVED BY SANTA ROSA MEMORIAL HOSPITAL. |
| DESCR CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS | FORM 990, PART VI, LINE 7B | THE RESERVED RIGHTS IN OUR TIER GOVERNANCE STRUCTURE CONTEMPLATE APPROVAL BY SANTA ROSA MEMORIAL HOSPITAL, ITS SOLE CORPORATE MEMBER, FOR THE FOLLOWING: A. ESTABLISHING THE PHILOSOPHY, OBJECTIVES AND PURPOSES OF THE ORGANIZATION; B. LONG-TERM AND SHORT-TERM FINANCING; C. SALE, LEASE, DISPOSITION OR HYPOTHECATION OF REAL PROPERTY; D. ANNUAL BUDGETS; E. CAPITAL EXPENDITURES; F. ORGANIZATION'S STRATEGIC PLANS; G. MERGER OR DISSOLUTION; H. APPOINTMENT OR REMOVAL OF FISCAL AUDITORS; I. APPOINTMENT OR REMOVAL OF TRUSTEES, OFFICERS OF THE BOARD AND CHIEF EXECUTIVE OFFICER; J. AMENDMENT OR RESCISSION OF THE BYLAWS; K. EXERCISE THE POWERS WHICH ARE RESERVED TO THE ORGANIZATION IN ITS CAPACITY AS A CORPORATE MEMBER OF ANY SUBSIDIARY; AND L. EXERCISE SUCH OTHER POWERS AS MAY BE REQUIRED OR PERMITTED BY LAW AND BY THE ARTICLES OF INCORPORATION AND THE BYLAWS. |
| PROCESS USED BY MANAGEMENT AND/OR GOVERNING BODY TO REVIEW 990 | FORM 990, PART VI, LINE 11B | THE FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION AS APPLICABLE. THE FORM 990 WAS THEN REVIEWED BY AN OFFICER OF THE ORGANIZATION. A COPY OF THE FORM 990 FILING WAS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD FOR THE MARCH 2013 MEETING. DURING THE FINANCE COMMITTEE MEETING, MANAGEMENT PRESENTED AND DISCUSSED CERTAIN DISCLOSURE AND INFORMATION INCLUDED IN THE FORM 990. THE FINANCE COMMITTEE CHAIR THEN PROVIDED A SUMMARY AT THE FULL BOARD MEETING. |
| DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST | FORM 990, PART VI, LINE 12C | OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANNUALLY ON THE CONFLICT OF INTEREST DISCLOSURE FORM THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE. ADDITIONAL DISCLOSURE SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL APPARENT, OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF ANY CONTRACT, TRANSACTION, OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. WHEN A CONFLICT OF INTEREST IS IDENTIFIED, SUCH CONFLICT IS DISCLOSED TO THE COMPLIANCE COMMITTEE. IF THE CONFLICT INVOLVES A MEMBER OF THAT COMMITTEE, THE REMAINING COMMITTEE MEMBERS REVIEW THE MATTER AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE OFFICER, TRUSTEE, OR KEY EMPLOYEE MAY NOT BE PRESENT DURING ANY MEETING IN WHICH THE COMMITTEE CONDUCTS ITS EVALUATION, EXCEPT TO ANSWER QUESTIONS AS MAY BE NECESSARY. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, THE COMMITTEE CONDUCTS ITS EVALUATION AND FORWARDS ITS FINDING AND RECOMMENDATIONS TO THE SJHS CHIEF COMPLIANCE OFFICER. IF THE COMMITTEE DETERMINES AN UNRESOLVED CONFLICT OF INTEREST EXITS, THE COMMITTEE WILL EVALUATE AND RECOMMEND CONFLICT MITIGATION STRATEGIES. THE SJHS CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH SJHS GENERAL COUNSEL WILL REVIEW THE COMMITTEE FINDING, RECOMMENDATIONS AND MITIGATION STRATEGIES, AND PRESENT RECOMMENDATIONS TO THE BOARD FOR DISCUSSION AND VOTE. |
| PROCESS USED TO DETERMINE COMPENSATION | FORM 990, PART VI, LINES 15A & 15B | THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY ITS TAX EXEMPT PARENT, ST. JOSEPH HEALTH SYSTEM, AND IS DISCLOSED AS A PERSON PAID BY A RELATED ORGANIZATION. THE EXECUTIVE COMPENSATION PROCESS AT ST JOSEPH HEALTH SYSTEM IS ADMINISTERED BY A COMMITTEE OF INDEPENDENT TRUSTEES. THEY FOLLOW A BOARD-APPROVED CHARTER AND OVERALL EXECUTIVE COMPENSATION PHILOSOPHY. THE CHARTER EMPOWERS THE SJHS BOARD WORKLIFE COMMITTEE TO ADMINISTER THE EXECUTIVE COMPENSATION PROGRAM AND PROCESS ON BEHALF OF THE FULL BOARD OF TRUSTEES OF SJHS. OVERALL, THE PHILOSOPHY IS INTENDED TO REWARD A BROAD SPECTRUM OF HIGH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE EXPECTATIONS, AS WELL AS THE RETENTION OF KEY MANAGEMENT TALENT. THE SJHS EXECUTIVE COMPENSATION PHILOSOPHY DEFINES THE MARKET FOR ADMINISTERING COMPENSATION AS A COMPARABLE SET OF NOT-FOR-PROFIT HEALTH CARE DELIVERY SYSTEMS. SJHS PROVIDES COMPENSATION TO ITS SENIOR EXECUTIVES IN THE FORM OF BASE SALARY, AN ANNUAL INCENTIVE PROGRAM AND BENEFITS. TO FULFILL THEIR RESPONSIBILITY, THE COMMITTEE REGULARLY REVIEWS INFORMATION FROM MULTIPLE SOURCES OF MARKET DATA. THEY USE THIS INFORMATION TO SUPPORT THEIR DECISIONS REGARDING ONGOING EFFECTIVENESS AND ADMINISTRATION OF THE PROGRAM. THE WORKLIFE COMMITTEE IS COMPRISED OF SEVERAL INDEPENDENT MEMBERS OF THE BOARD. THEY MEET AT LEAST 3 TIMES A YEAR AND MAKE ALL CRITICAL DECISIONS IN EXECUTIVE SESSION. THESE DECISIONS ARE DOCUMENTED IN DETAILED MINUTES AND APPROVED IN SUBSEQUENT MEETINGS. THE COMMITTEE IS EMPOWERED TO ENGAGE OUTSIDE COUNSEL AND CONSULTING SUPPORT AS NEEDED. THE WORKLIFE COMMITTEE PERFORMED ITS LAST COMPENSATION REVIEW FOR ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS AND THE CHIEF EXECUTIVE OFFICER IN JUNE 2012. |
| AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC | FORM 990, PART VI, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE SJHS COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE SJHS INTERNET SITE. AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990. |
| HOURS DEVOTED TO RELATED ORGANIZATIONS | FORM 990, PART VII | CERTAIN EXECUTIVES AND BOARD MEMBERS OF THIS ORGANIZATION ALSO DEVOTED TIME TO OTHER ENTITIES RELATED TO THE FILING ORGANIZATION. THE HOURS DEVOTED TO THE RELATED ORGANIZATIONS ARE NOT GENERALLY TRACKED BY THE ENTITY. |
| OTHER CHANGES IN NET ASSETS OR FUND BALANCES | FORM 990, PART XI, LINE 5 | EQUITY TRANSFER OF $(81,648) |
| OVERSIGHT OR SELECTION PROCESS | FORM 990, PART XII, LINE 2C | THE ST. JOSEPH HEALTH SYSTEM BOARD APPROVED THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (30 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| COVENANT HEALTH PARTNERS | ||||||||||
| 3615 19TH STREET | LUBBOCK | TX | 79410 | 611573313 | HEALTHCARE | TX | 501(C)(3) | 11, I | CHS | true |
| COVENANT HEALTH SYSTEM | ||||||||||
| 3615 19TH STREET | LUBBOCK | TX | 79410 | 752765566 | HEALTHCARE | TX | 501(C)(3) | 3 | SJHS | true |
| COVENANT HEALTH SYSTEM FOUNDATION | ||||||||||
| 4000 24TH STREET | LUBBOCK | TX | 79410 | 752897026 | HEALTHCARE | TX | 501(C)(3) | 7 | CHS | true |
| COVENANT MEDICAL GROUP | ||||||||||
| 3420 22ND PLACE | LUBBOCK | TX | 79410 | 752743883 | HEALTHCARE | TX | 501(C)(3) | 3 | CHS | true |
| HOME CARE PARTNERS | ||||||||||
| 1165 MONTGOMERY DR | SANTA ROSA | CA | 95405 | 680318656 | INACTIVE | CA | 501(C)(3) | 3 | SRMH | true |
| HOSPICE OF LUBBOCK | ||||||||||
| 1102 SLIDE ROAD | LUBBOCK | TX | 79414 | 752133781 | HEALTHCARE | TX | 501(C)(3) | 9 | CHS | true |
| LUBBOCK METHODIST HOSPITAL FOUNDATION | ||||||||||
| 3615 19TH STREET | LUBBOCK | TX | 79410 | 752220963 | HEALTHCARE | TX | 501(C)(3) | 7 | CHS | true |
| METHODIST CHILDREN'S HOSPITAL | ||||||||||
| 3610 21ST STREET | LUBBOCK | TX | 79410 | 752428911 | HEALTHCARE | TX | 501(C)(3) | 3 | CHS | true |
| METHODIST HOSPITAL LEVELLAND | ||||||||||
| 1900 COLLEGE AVENUE | LEVELLAND | TX | 79336 | 752246348 | HEALTHCARE | TX | 501(C)(3) | 3 | CHS | true |
| METHODIST HOSPITAL PLAINVIEW | ||||||||||
| 2601 DIMMITT ROAD | PLAINVIEW | TX | 79072 | 752426010 | HEALTHCARE | TX | 501(C)(3) | 3 | CHS | true |
| MISSION HOSPITAL REG MED CTR FDN | ||||||||||
| 27700 MEDICAL CENTER ROAD | MISSION VIEJO | CA | 92691 | 330406118 | HEALTHCARE | CA | 501(C)(3) | 7 | MHRMC | true |
| MISSION HOSPITAL REGIONAL MEDICAL CENTER | ||||||||||
| 27700 MEDICAL CENTER ROAD | MISSION VIEJO | CA | 92691 | 951643360 | HEALTHCARE | CA | 501(C)(3) | 3 | SJHS | true |
| QUEEN OF THE VALLEY MEDICAL CENTER | ||||||||||
| 1000 TRANCAS STREET | NAPA | CA | 94558 | 941243669 | HEALTHCARE | CA | 501(C)(3) | 3 | SJHS | true |
| REDWOOD MEMORIAL FOUNDATION | ||||||||||
| 3300 RENNER DRIVE | FORTUNA | CA | 95540 | 942779313 | FOUNDATION | CA | 501(C)(3) | 7 | RMH | true |
| REDWOOD MEMORIAL HOSPITAL | ||||||||||
| 3300 RENNER DRIVE | FORTUNA | CA | 95540 | 941384665 | HEALTHCARE | CA | 501(C)(3) | 3 | SJHS | true |
| SANTA ROSA MEMORIAL HOSPITAL | ||||||||||
| 1165 MONTGOMERY DR | SANTA ROSA | CA | 95405 | 941231005 | HEALTHCARE | CA | 501(C)(3) | 3 | SJHS | false |
| SISTERS OF ST JOSEPH OF ORANGE | ||||||||||
| 480 S BATAVIA | ORANGE | CA | 92868 | 951643383 | RELIGIOUS ORG | CA | 501(C)(3) | 1 | NA | false |
| ST JOSEPH HEALTH FDN OF N CALIFORNIA | ||||||||||
| PO BOX 552 | SANTA ROSA | CA | 95405 | 680338070 | INACTIVE | CA | 501(C)(3) | 11, I | SRMH | true |
| ST JOSEPH HEALTH MINISTRY | ||||||||||
| 3345 MICHELSON DR STE 100 | IRVINE | CA | 92612 | 271666576 | RELIGIOUS ORG | CA | 501(C)(3) | 1 | SSJO | false |
| ST JOSEPH HEALTH SYSTEM | ||||||||||
| 3345 MICHELSON DR STE 100 | IRVINE | CA | 92612 | 953589356 | HEALTHCARE | CA | 501(C)(3) | 11, I | SJHM | false |
| ST JOSEPH HEALTH SYSTEM FOUNDATION | ||||||||||
| 3345 MICHELSON DR STE 100 | IRVINE | CA | 92612 | 330143024 | HEALTHCARE | CA | 501(C)(3) | 7 | SJHS | true |
| ST JOSEPH HOME CARE NETWORK | ||||||||||
| 170 PROFESSIONAL CENTER DR B | ROHNERT PARK | CA | 94928 | 680331084 | HEALTHCARE | CA | 501(C)(3) | 9 | SJHS | true |
| ST JOSEPH HOSPITAL OF EUREKA | ||||||||||
| 2700 DOLBEER STREET | EUREKA | CA | 95501 | 941156596 | HEALTHCARE | CA | 501(C)(3) | 3 | SJHS | true |
| ST JOSEPH HOSPITAL OF ORANGE | ||||||||||
| 1100 WEST STEWART DRIVE | ORANGE | CA | 92868 | 951643359 | HEALTHCARE | CA | 501(C)(3) | 3 | SJHS | true |
| ST JUDE HOSPITAL YORBA LINDA | ||||||||||
| 279 E IMPERIAL HWY 750 | FULLERTON | CA | 92835 | 330185031 | HEALTHCARE | CA | 501(C)(3) | 3 | SJHS | true |
| ST JUDE HOSPITAL INC | ||||||||||
| 101 EAST VALENCIA MESA DRIVE | FULLERTON | CA | 92835 | 951643325 | HEALTHCARE | CA | 501(C)(3) | 3 | SJHS | true |
| ST JUDE MEMORIAL FOUNDATION | ||||||||||
| 1440 N HARBOR BLVD 200 | FULLERTON | CA | 92835 | 953607229 | HEALTHCARE | CA | 501(C)(3) | 11, I | SJMC | true |
| ST MARY MEDICAL CENTER | ||||||||||
| 18300 HIGHWAY 18 | APPLE VALLEY | CA | 92307 | 951914489 | HEALTHCARE | CA | 501(C)(3) | 3 | SJHS | true |
| ST MARY OF THE PLAINS HOSPITAL FDN | ||||||||||
| 4000 24TH STREET | LUBBOCK | TX | 79410 | 751653181 | HEALTHCARE | CA | 501(C)(3) | 7 | CHS | true |
| TALLER SAN JOSE | ||||||||||
| 801 NORTH BROADWAY | SANTA ANA | CA | 92701 | 593816355 | WORKFORCE DEV | TX | 501(C)(3) | 2 | SSJO | true |
Form990 Schedule R Part III Form990ScheduleRPartIII (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType |
|---|---|---|---|---|---|---|---|---|
| ST JOSEPH HLTH SYS HOME HLTH | ||||||||
| SEE PART VII | ORANGE | CA | 92868 | 330282945 | HOME HEALTH | CA | NA | N/A |
| ST JOSEPH HLTH SYS HOME CARE | ||||||||
| 330307672 | HOME HEALTH | CA | NA | N/A | ||||
| METHODIST DIAGNOSTIC IMAGING | ||||||||
| 752343261 | HEALTHCARE SVCS | TX | NA | N/A | ||||
| SHA LLC | ||||||||
| 752569094 | HEALTHCARE SVCS | TX | NA | N/A | ||||
| LUBBOCK SURGERY CENTER LTD | ||||||||
| 752177401 | HEALTHCARE SVCS | TX | NA | N/A | ||||
| COVENANT LONG-TERM CARE LP | ||||||||
| 205033419 | HEALTHCARE SVCS | TX | NA | N/A | ||||
| HERITAGE INVESTMENT GROUP | ||||||||
| 271000061 | INVESTMENT | CA | NA | N/A | ||||
| MISSION AMBULATORY SURGICENTER | ||||||||
| 330355575 | HEALTHCARE SVCS | CA | NA | N/A | ||||
| COMPREHENSIVE IMAGING PARTNERS | ||||||||
| 264591502 | HEALTHCARE SVCS | CA | NA | N/A | ||||
| ST JOSEPH PHYSICIAN VENTURES | ||||||||
| REAL ESTATE | CA | NA | N/A | |||||
Form990 Schedule R Part IV Form990ScheduleRPartIV (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | Province Or StateAddressForeign/ProvinceOrState | CountryAddressForeign/Country | Legal Domicile Foreign CountryLegalDomicileForeignCountry |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ST JOSEPH PROF SVCS ENTERPRISES INC | |||||||||||||
| 3345 MICHELSON DR STE 100 | IRVINE | CA | 92612 | 330155323 | HEALTHCARE SVCS | CA | NA | C-CORP | |||||
| AMERICAN UNITY GROUP LTD | |||||||||||||
| CAPTIVE INSURANCE | NA | C-CORP | 58 PAR LA-VILLA RD | HAMILTON | HM HX | BD | BD | ||||||
| ALLIANCE PHYSICIAN SERVICES | |||||||||||||
| INACTIVE | CA | NA | C CORP | ||||||||||
| MISSION VIEJO MEDICAL VENTURES | |||||||||||||
| 27800 MEDICAL CENTER RD 354 | MISSION VIEJO | CA | 92691 | 330212905 | HEALTHCARE SVCS | CA | NA | C CORP | |||||
| MISSION MEDICAL CENTER ASSOCIATION | |||||||||||||
| 27800 MEDICAL CENTER RD 354 | MISSION VIEJO | CA | 92691 | 330212905 | HEALTHCARE SVCS | CA | NA | C CORP | |||||
| ST JOSEPH YORBA PARK | |||||||||||||
| 330212905 | INACTIVE | CA | NA | C CORP | |||||||||
| LUBBOCK METHODIST HOSP SVCS | |||||||||||||
| PO BOX 1201 | LUBBOCK | TX | 79410 | 330201044 | HEALTHCARE SVCS | TX | NA | C CORP | |||||
| LUBBOCK METHODIST HOSP PRACTICE MGMT | |||||||||||||
| PO BOX 1201 | LUBBOCK | TX | 79410 | 752118585 | INACTIVE | TX | NA | C CORP | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| SANTA ROSA MEMORIAL HOSPITAL | ||
| O | 20450000 | ACCRUAL |
| SANTA ROSA MEMORIAL HOSPITAL | ||
| N | 457391 | ACCRUAL |
| AMERICAN UNITY GROUP LTD | ||
| Q | 398005 | ACCRUAL |
| ST JOSEPH HEALTH SYSTEM FOUNDATION | ||
| C | 185717 | ACCRUAL |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP | Identifier |
| Return Reference | SCHEDULE R, PART III | ReturnReference |
| Explanation | ST. JOSEPH HEALTH SYSTEM HOME HEALTH AGENCY EIN: 33-0282945 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE. 200 ORANGE, CA 92868-2012 ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES EIN: 33-0307672 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE. 100 ORANGE, CA 92868-2012 METHODIST DIAGNOSTIC IMAGING EIN: 75-2343261 ADDRESS: 4005 24TH STREET LUBBOCK, TX 79410 SHA, LLC EIN: 75-2569094 ADDRESS: 12940 NORTH HIGHWAY 183 AUSTIN, TX 78750 LUBBOCK SURGERY CENTER, LTD. EIN: 75-2177401 ADDRESS: 4000 24TH STREET LUBBOCK, TX 79410 COVENANT LONG-TERM CARE, LP EIN: 20-5033419 ADDRESS: 4000 24TH STREET LUBBOCK, TX 79410 HERITAGE INVESTMENT GROUP I, LLC EIN: 27-1000061 ADDRESS: 3345 MICHELSON DR, STE 100 IRVINE, CA 92612 MISSION AMBULATORY SURGICENTER, LTD EIN: 33-0355575 ADDRESS: 27800 MEDICAL CENTER ROAD, STE. 362 MISSION VIEJO, CA 92691 COMPREHENSIVE IMAGING PARTNERS OF ORANGE COUNTY, LLC EIN: 26-4591502 ADDRESS: ONE CITY BOULEVARD WEST, SUITE 1100 ORANGE, CA 92868 ST. JOSEPH PHYSICIAN VENTURES I, LLC EIN: 45-4521884 ADDRESS: 1100 WEST STEWART DRIVE ORANGE, CA 92868 | Explanation |