LODI MEMORIAL HOSPITAL ASSOCIATION INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- LODI MEMORIAL HOSPITAL ASSOCIATION INC (EIN 94-1044474)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-12
- IRS object ID
- 201313169349305246
- Schema version
- 2012v2.1
- 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 H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-12T16:05:12-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 910189318 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MOSS ADAMS LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3121 WEST MARCH LANE SUITE 100 | AddressLine1 |
| City | STOCKTON | City |
| State | CA | State |
| ZIP Code | 952192303 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 941044474 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LODI MEMORIAL HOSPITAL ASSOCIATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LODI | NameControl |
| Phone | 2093343411 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 975 S FAIRMONT AVENUE | AddressLine1 |
| City | LODI | City |
| State | CA | State |
| ZIP Code | 95240 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOSEPH P HARRINGTON | Name |
| Title | CEO & PRESIDENT | Title |
| Phone | 2093343411 | Phone |
| Date Signed | 2013-11-06 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TRACY S PAGLIA | Name |
| PTIN | P00366884 | PTIN |
| Phone | 2099556100 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LODI MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOSEPH P HARRINGTON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 975 S FAIRMONT AVENUE | AddressLine1 |
| City | LODI | City |
| State | CA | State |
| ZIP Code | 95240 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 200282361 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.LODIHEALTH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1945 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 15 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1513 | TotalNbrEmployees |
| Total Nbr Volunteers | 209 | TotalNbrVolunteers |
| Total Gross UBI | 45483 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 466 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 882450 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 509921 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 195604502 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 190645854 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1717581 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1773545 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 14293 | OtherRevenuePriorYear |
| Other Revenue Current Year | 38829 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 198218826 | TotalRevenuePriorYear |
| Total Revenue Current Year | 192968149 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 41241 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 163525 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 86376106 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 86177988 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 169969 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 114207849 | OtherExpensePriorYear |
| Other Expenses Current Year | 108578472 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 200625196 | TotalExpensesPriorYear |
| Total Expenses Current Year | 194919985 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -2406370 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1951836 | RevenuesLessExpensesCY |
| Total Assets BOY | 283619824 | TotalAssetsBOY |
| Total Assets EOY | 271434032 | TotalAssetsEOY |
| Total Liabilities BOY | 175027439 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 167772972 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 108592385 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 103661060 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | AS A NOT-FOR-PROFIT, HEALTH-CARE DELIVERY SYSTEM, LODI MEMORIAL HOSPITAL IS DEDICATED TO:- IMPROVING COMMUNITY HEALTH;- PROVIDING QUALITY AND TIMELY HEALTH-CARE SERVICES, RANGING FROM HEALTH PROMOTION AND EDUCATION TO DIAGNOSTICS, ACUTE-INPATIENT CARE, REHABILITATION SERVICES AND HOME CARE;- EXPANDING COMMUNITY ACCESS TO CARE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 147977991 | Expense |
| Grants | 163525 | Grants |
| Revenue | 185833864 | Revenue |
| Description | LODI MEMORIAL HOSPITAL IS A NON-PROFIT, ACUTE CARE HOSPITAL PROVIDING HIGH QUALITY SERVICES THAT PROMOTE HEALTH AND REHABILITATION, PREVENT DISEASE, AND TREAT AND CARE FOR THE SICK AND INJURED. HOSPITAL STAFF, MEDICAL STAFF AND THE GOVERNING BOARD ARE DEDICATED TO TREATING ALL PATIENTS AND VISITORS AS INDIVIDUALS WITH EQUAL DIGNITY, RESPECT AND QUALITY OF CARE.LODI MEMORIAL HOSPITAL TREATS AND PROVIDES CARE TO ITS PATIENTS THROUGH INPATIENT AND OUTPATIENT SERVICES. INPATIENTS RECEIVE CARE THROUGH MEDICAL-SURGICAL, PERI-OPERATIVE, PERI-NATAL, PEDIATRIC, INTENSIVE CARE, AND ACUTE-PHYSICAL REHABILITATION SERVICES.OUTPATIENT CARE INCLUDES 24-HOUR EMERGENCY, DIAGNOSTIC SERVICES, SURGERY, REHABILITATION AND EDUCATION.LODI MEMORIAL HOSPITAL IDENTIFIES THE HEALTH-CARE AND HEALTH MAINTENANCE NEEDS AND PREFERENCES OF THE COMMUNITY IT SERVES. DIAGNOSTIC, REHABILITATIVE, EDUCATIONAL, TREATMENT AND PREVENTATIVE SERVICES ARE DEVELOPED AS APPROPRIATE FOR A HOSPITAL OF THIS SIZE AND ROLE.LODI MEMORIAL HOSPITAL, CONSISTENT WITH ITS NON-PROFIT STATUS, DEVELOPS FINANCIAL RESOURCES TO ADEQUATELY SUPPORT HEALTH MAINTENANCE AND PATIENT-CARE SERVICES; CHARITY CARE FOR THOSE UNABLE TO PAY, WORKING CAPITAL NEEDS; AND CAPITAL REQUIREMENTS OF PLANT, EQUIPMENT AND ENVOLVING TECHNOLOGY. EVERY EFFORT IS MADE TO KEEP COSTS AFFORDABLE FOR PATIENTS WHILE CONTINUOUSLY STRIVING TO IMPROVE THE QUALITY OF SERVICE. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 8244953 | Expense |
| Grants | 0 | Grants |
| Revenue | 4793544 | Revenue |
| Description | LODI MEMORIAL COMMUNITY CLINICS ARE LICENSED UNDER THE DEPARTMENT OF PUBLIC HEALTH SERVICES REGULATIONS, AND ARE OWNED AND OPERATED BY THE LODI MEMORIAL HOSPITAL ASSOCIATION, INC., A NOT-FOR-PROFIT ENTITY AND WILL PROVIDE MEDICAL CARE TO ANY AGE. A COMMUNITY CLINIC UNIT OFFERS SERVICES DURING POSTED HOURS OF BUSINESS, WITH AT LEAST ONE PHYSICIAN EXPERIENCED IN THE COMMUNITY CLINIC PRACTICE. SPECIALTY CONSULTATION WILL BE AVAILABLE BY PHONE OR REFERRAL TO MEMBERS OF THE MEDICAL STAFF. IN 2012, THERE WERE FOUR (4) COMMUNITY CLINICS LICENSED AND OPERATIONAL. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 156222944 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 288 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1513 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 15 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CYNTHIA BUTLER INTERIM CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2093343411 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 975 S FAIRMONT AVE FINANCE DEPT | AddressLine1 |
| City | LODI | City |
| State | CA | State |
| ZIP Code | 95240 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (30 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 |
|---|---|---|---|---|---|---|---|---|
| SORBERA THOMAS MD | ||||||||
| BOARD MEMBER & LMCC PHYSICIAN | 40.00 | X | 333829 | 0 | 8468 | |||
| ADDINGTON RON | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| AGUIRE ELIZABETH | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| CRABTREE STEVE | ||||||||
| VICE CHAIR | 2.00 | X | 0 | 0 | 0 | X | ||
| CUMMINS WILLIAM LEE | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| DILLON CECIL | ||||||||
| BOARD MEMBER, CHAIR | 5.00 | X | 0 | 0 | 0 | X | ||
| FERREE CHRISTEEN | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| GILL PARAMPAL MD | ||||||||
| BOARD MEMBER | 2.00 | X | 197125 | 0 | 0 | |||
| HALEY PAUL | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| KIRST JEFF | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| KHAN TAJ | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| MCCAFFREY ROBERT DR | ||||||||
| BOARD MEMBER (UNTIL 05/2012) | 2.00 | X | 0 | 0 | 0 | |||
| MILANO ELVIRA MD | ||||||||
| CHIEF OF MEDICAL STAFF (2011-2012) | 2.00 | X | 0 | 0 | 0 | |||
| MURDACA ANNETTE | ||||||||
| BOARD MEMBER/CHAIR OF LMCC COMMITTEE | 2.00 | X | 0 | 0 | 0 | |||
| OLSON DEBBIE | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| PHELPS DAN | ||||||||
| SECRETARY/TREASURER | 2.00 | X | 0 | 0 | 0 | X | ||
| PATRICK ROBERT PAT | ||||||||
| BOARD MEMBER (EFF 05/2012) | 2.00 | X | 0 | 0 | 0 | |||
| SHULMAN MONA | ||||||||
| BOARD MEMBER (EFF 05/2012) | 2.00 | X | 0 | 0 | 0 | |||
| HARRINGTON JOSEPH P | ||||||||
| CEO & PRESIDENT | 50.00 | 353636 | 0 | 64045 | X | |||
| KREUTNER RONALD K | ||||||||
| CFO & VICE PRESIDENT TO 6/22/12 | 50.00 | 121350 | 0 | 6745 | X | |||
| BUTLER CYNTHIA B | ||||||||
| INTERIM CFO BEGINNING 6/23/12 | 50.00 | 150351 | 0 | 12197 | X | |||
| MORENO DEBBE JOYCE | ||||||||
| CHIEF NURSING OFFICER | 50.00 | 203283 | 0 | 16469 | X | |||
| SEY MARK | ||||||||
| CHIEF ADMINISTRATIVE OFFICER | 50.00 | 183701 | 0 | 12745 | X | |||
| WOOTON ROBYN | ||||||||
| VP OF FUND DEVELOPMENT | 50.00 | 152760 | 0 | 11972 | X | |||
| SCHNEIDER PAMELA | ||||||||
| EXECUTIVE DIRECTOR-O/P SVCS | 50.00 | 154520 | 0 | 12253 | X | |||
| LAVIOLA STEVEN MD | ||||||||
| PHYSICIAN, COMMUNITY CLINICS | 40.00 | 366065 | 0 | 5921 | X | |||
| CONNOLY JOHN PATRICK MD | ||||||||
| PHYSICIAN, COMMUNITY CLINICS | 40.00 | 339922 | 0 | 8721 | X | |||
| FREUNDEDMUND A MD | ||||||||
| PHYSICIAN, COMMUNITY CLINICS | 40.00 | 363921 | 0 | 8468 | X | |||
| YAO WEIPING MD | ||||||||
| PHYSICIAN, COMMUNITY CLINICS | 40.00 | 350507 | 0 | 5921 | X | |||
| MULLEN KENNETH MD | ||||||||
| PHYSICIAN, COMMUNITY CLINICS | 28.00 | 281688 | 0 | 4473 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3552658 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 178398 | TotalOtherCompensation |
| Number Individuals GT100 K | 161 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| HARBISON MAHONEY HIGGINS BUILDERS INC | |||||
| 15 BUSINESS PARK WAY SUITE 101 | SACRAMENTO | CA | 95828 | CONSTRUCTION CONTRACTOR | 4568183 |
| QUANTUM HEALTHCARE MEDICAL ASSOCIATES I | |||||
| PO BOX 634850 | CINCINNATI | OH | 45263 | PHYSICIAN PROFESSIONAL SERVICES - HOSPIT | 2512604 |
| PREMIER ANESTHESIA | |||||
| 2655 NORTHWINDS PARKWAY | ALPHAETA | GA | 30009 | PHYSICIAN PROFESSIONAL SERVICES - ANESTH | 2207257 |
| HEALTHCARE RESOURCE GROUP INC | |||||
| 12610 E MIRABEAU PARKWAY SUITE 800 | SPOKANE VALLEY | WA | 99216 | PATIENT BILLING AND COLLECTIONS SERVICE | 1129396 |
| GE HEALTHCARE | |||||
| 3000 N GRANDVIEW BLVD | WAUKESHA | WI | 53188 | BIOMEDICAL MAINTENACE SERVICE | 1100108 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 39 | NumberOfContractorsGT100K |
| Membership Dues | 17535 | MembershipDues |
| Government Grants | 187282 | GovernmentGrants |
| All Other Contributions | 305104 | AllOtherContributions |
| Total Contributions | 509921 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SVC REVENUE | 621400 | 188357892 | 188357892 |
| CAPITATION FEES | 621990 | 1497587 | 1497587 |
| LOSS FROM ADVANCED IMAGING CENTER | 621400 | -49270 | -49270 |
| LOSS FROM LODI SURGICAL | 621400 | -296273 | -296273 |
| LOSS FR TRINITY PLAZA SURGERY CEN | 621400 | -2510957 | -2510957 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3646875 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3646875 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 190645854 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 889978 | TotalRevenueColumn |
| Exclusion | $889,978 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 120103 | TotalRevenueColumn |
| Exclusion | $120,103 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 218419 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 235302 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -16883 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -16883 | TotalRevenueColumn |
| Related Or Exempt Function Income | -18446 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 1563 | UnrelatedBusinessRevenue |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 7818374 | Securities |
| Other | 24000 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 6893686 | Securities |
| Other | 185224 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 924688 | Securities |
| Other | -161224 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 763464 | TotalRevenueColumn |
| Exclusion | $763,464 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|
| MANAGEMENT FEES - VITAL | 541610 | 43920 | 43920 | |
| OTHER REVENUE | 900099 | 11792 | $11,792 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 55712 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 192968149 | TotalRevenueColumn |
| Related Or Exempt Function Income | 190627408 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 45483 | UnrelatedBusinessRevenue |
| Exclusion | $1,785,337 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 152525 | Total |
| Program Services | 152525 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11000 | Total |
| Program Services | 11000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1995449 | Total |
| Program Services | 1435322 | ProgramServices |
| Management And General | 477761 | ManagementAndGeneral |
| Fundraising | 82366 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 472493 | Total |
| Program Services | 354495 | ProgramServices |
| Management And General | 117998 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71743518 | Total |
| Program Services | 53805853 | ProgramServices |
| Management And General | 17909809 | ManagementAndGeneral |
| Fundraising | 27856 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 927694 | Total |
| Program Services | 695043 | ProgramServices |
| Management And General | 231352 | ManagementAndGeneral |
| Fundraising | 1299 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5478326 | Total |
| Program Services | 4105190 | ProgramServices |
| Management And General | 1366453 | ManagementAndGeneral |
| Fundraising | 6683 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5560508 | Total |
| Program Services | 4166692 | ProgramServices |
| Management And General | 1386925 | ManagementAndGeneral |
| Fundraising | 6891 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 230281 | Total |
| Program Services | 230281 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 618772 | Total |
| Program Services | 306999 | ProgramServices |
| Management And General | 311773 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54520 | Total |
| Management And General | 54520 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33190 | Total |
| Program Services | 24901 | ProgramServices |
| Management And General | 8289 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 115437 | Total |
| Management And General | 115437 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17541411 | Total |
| Program Services | 13153971 | ProgramServices |
| Management And General | 4378429 | ManagementAndGeneral |
| Fundraising | 9011 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52289 | Total |
| Program Services | 35841 | ProgramServices |
| Management And General | 11930 | ManagementAndGeneral |
| Fundraising | 4518 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21868781 | Total |
| Program Services | 16401888 | ProgramServices |
| Management And General | 5459530 | ManagementAndGeneral |
| Fundraising | 7363 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1726393 | Total |
| Program Services | 1295255 | ProgramServices |
| Management And General | 431138 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10631793 | Total |
| Program Services | 7964162 | ProgramServices |
| Management And General | 2650950 | ManagementAndGeneral |
| Fundraising | 16681 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 119464 | Total |
| Program Services | 89630 | ProgramServices |
| Management And General | 29834 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 88095 | Total |
| Program Services | 66037 | ProgramServices |
| Management And General | 21981 | ManagementAndGeneral |
| Fundraising | 77 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12292420 | Total |
| Program Services | 9222590 | ProgramServices |
| Management And General | 3069830 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 992608 | Total |
| Program Services | 744720 | ProgramServices |
| Management And General | 247888 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBTS | 30581962 | 30581962 | ||
| HOSP MEDI-CAL QLTY ASSU | 10638887 | 10638887 | ||
| DUES, SUBSCRIPTIONS, BO | 371141 | 275864 | 91824 | 3453 |
| PHYSICIAN RECRUITMENT | 278152 | 208688 | 69464 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 342876 | Total |
| Program Services | 255148 | ProgramServices |
| Management And General | 83957 | ManagementAndGeneral |
| Fundraising | 3771 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 194919985 | Total |
| Program Services | 156222944 | ProgramServices |
| Management And General | 38527072 | ManagementAndGeneral |
| Fundraising | 169969 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 155990 | BOY |
| EOY | 162960 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13244488 | BOY |
| EOY | 12631307 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4074495 | BOY |
| EOY | 2553635 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33074425 | BOY |
| EOY | 35817702 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 69307 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3359243 | BOY |
| EOY | 3380948 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8774412 | BOY |
| EOY | 5488204 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 252034180 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 85512544 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 171146400 | BOY |
| EOY | 166521636 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32946803 | BOY |
| EOY | 31526218 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10714457 | BOY |
| EOY | 4725422 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6059804 | BOY |
| EOY | 8626000 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 283619824 | BOY |
| EOY | 271434032 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28407383 | BOY |
| EOY | 23982081 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 145880000 | BOY |
| EOY | 143020000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 740056 | BOY |
| EOY | 770891 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 175027439 | BOY |
| EOY | 167772972 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 107663766 | BOY |
| EOY | 102924259 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 928619 | BOY |
| EOY | 736801 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 108592385 | BOY |
| EOY | 103661060 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 283619824 | BOY |
| EOY | 271434032 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1951836 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 153046 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | -3132535 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | 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) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $33,190 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 33190 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | A PORTION OF DUES PAID TO CALIFORNIA HOSPITAL ASSOCIATION & THE HOSPITAL COUNCIL OF NORTHERN CALIFORNIA ARE CONSIDERED TO BE FOR LOBBYING ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3655763 | OtherCostOrOtherBasis |
| Book Value | 3655763 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 614559 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 132464589 | OtherCostOrOtherBasis |
| Depreciation | 33728967 | Depreciation |
| Book Value | 99350181 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3547103 | OtherCostOrOtherBasis |
| Depreciation | 1101682 | Depreciation |
| Book Value | 2445421 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 106618321 | OtherCostOrOtherBasis |
| Depreciation | 49267810 | Depreciation |
| Book Value | 57350511 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5133845 | OtherCostOrOtherBasis |
| Depreciation | 1414085 | Depreciation |
| Book Value | 3719760 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 166521636 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CONDITIONAL ASSET RETIREMENT | Description |
| Amount | $770,891 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 770891 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | WE FOLLOW FASB GUIDANCE RELATING TO ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THESE GUIDELINES PRESCRIBE A COMPREHENSIVE MODEL FOR RECOGNIZING, MEASURING, PRESENTING AND DISCLOSING IN THE CONSOLIDATED FINANCIAL STATEMENTS TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN. THEY ALSO PROVIDE ACCOUNTING GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE AND TRANSITION. AS OF DECEMBER 31, 2012, WE ARE NOT AWARE OF ANY UNCERTAIN TAX POSITIONS FOR ANY YEARS OPEN UNDER FEDERAL OR STATE OF CALIFORNIA STATUTES OF LIMITATIONS. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 300.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent350 | X | Pcent350 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 1301 | PersonsServed |
| Total Community Benefit Expense | 2933421 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2933421 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01780 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 14 | NumberOfActivitiesOrPrograms |
| Persons Served | 42275 | PersonsServed |
| Total Community Benefit Expense | 32125102 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 31152532 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 972570 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00590 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 15 | NumberOfActivitiesOrPrograms |
| Persons Served | 43576 | PersonsServed |
| Total Community Benefit Expense | 35058523 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 31152532 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3905991 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02370 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 11 | NumberOfActivitiesOrPrograms |
| Persons Served | 31091 | PersonsServed |
| Total Community Benefit Expense | 3011729 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 52486 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2959243 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01800 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 265223 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 156114 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 109109 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 6 | NumberOfActivitiesOrPrograms |
| Persons Served | 23618 | PersonsServed |
| Total Community Benefit Expense | 8992175 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6534267 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2457908 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01500 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 294750 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 294750 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 17 | NumberOfActivitiesOrPrograms |
| Persons Served | 54709 | PersonsServed |
| Total Community Benefit Expense | 12563877 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6742867 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5821010 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03550 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 32 | NumberOfActivitiesOrPrograms |
| Persons Served | 98285 | PersonsServed |
| Total Community Benefit Expense | 47622400 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 37895399 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9727001 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05920 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 379380 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 379380 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00230 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 379380 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 379380 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00230 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $3,186,321 | BadDebtExpenseAmount |
| Amount Attributable To | 1115212 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 45457536 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 50198898 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -4741362 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV (4 entries)
| Description Ent Primary ActivityDescriptionEntPrimaryActivity | Organization Profit Or OwnershipOrganizationProfitOrOwnership | Officers Etc Profit Or OwnershipOfficersEtcProfitOrOwnership | Physicans Profit Or OwnershipPhysicansProfitOrOwnership |
|---|---|---|---|
| 1 TRINITY PLAZA SURGERY CENTER LLC | |||
| AMBULATORY SURGERY CENTER | 0.94000 | 0.00000 | 0.06000 |
| 2 ADVANCED IMAGING CENTER AT LODI MEMORIAL HOSPITAL LLC | |||
| DIAGNOSTIC IMAGING CENTER (WITH MRI) | 0.51000 | 0.00000 | 0.49000 |
| 3 LODI OUTPATIENT SURGERY CENTER | |||
| AMBULATORY SURGERY CENTER | 0.31000 | 0.00000 | 0.40100 |
| 4 ENDOSCOPY CENTER OF LODI LLC | |||
| AMBULATORY SURGERY CENTER | 0.31000 | 0.00000 | 0.40100 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 2 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)
| Facility NumberFacilityNumber | Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Er24 HoursEr24Hours | OtherOther | Address Line2Address/AddressLine2 |
|---|---|---|---|---|---|---|---|---|---|
| LODI MEMORIAL HOSPITAL | |||||||||
| 1 | 975 S FAIRMONT AVE | LODI | CA | 95240 | X | X | X | GENERAL ACUTE CARE BEDS = 190 | |
| LODI MEMORIAL HOSPITAL - WEST | |||||||||
| 2 | 800 LOWER SACRAMENTO ROAD ACUTE | LODI | CA | 95242 | X | X | ACUTE PHY REHAB = 24 BEDS | PHYS | |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)
| Hospital Facility NumberHospitalFacilityNumber | Eligibility Criteria ExplainedEligibilityCriteriaExplained | Uses FPG FreeUsesFPGFree | FPG Free PercentFPGFreePercent | Uses FPG DiscountedUsesFPGDiscounted | FPG Discount PercentFPGDiscountPercent | Explains BasisExplainsBasis | Income LevelIncomeLevel | Asset LevelAssetLevel | Medical IndigencyMedicalIndigency | Explains Application MethodExplainsApplicationMethod | Includes Publicity MeasuresIncludesPublicityMeasures | Posted On WebsitePostedOnWebsite | Attached To InvoicesAttachedToInvoices | Posted In Emergency RoomPostedInEmergencyRoom | Posted In Admission OfficePostedInAdmissionOffice | Provided On AdmissionProvidedOnAdmission | Available On RequestAvailableOnRequest | Actions On NonpaymentActionsOnNonpayment | Collection ActivitiesCollectionActivities | Notify Upon AdmissionNotifyUponAdmission | Notify Before DischargeNotifyBeforeDischarge | Notified All PatientsNotifiedAllPatients | Documented DeterminationDocumentedDetermination | Nondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicy | Used Other MethodUsedOtherMethod | Amounts Generally BilledAmountsGenerallyBilled | Gross ChargesGrossCharges |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LODI MEMORIAL HOSPITAL | |||||||||||||||||||||||||||
| 1 | 1 | 1 | 300.000000000000 | 1 | 350.000000000000 | 1 | X | X | X | 1 | 1 | X | X | X | X | X | X | 1 | 0 | X | X | X | X | 1 | X | 0 | 0 |
| LODI MEMORIAL HOSPITAL - WEST | |||||||||||||||||||||||||||
| 2 | 1 | 1 | 300.000000000000 | 1 | 350.000000000000 | 1 | X | X | X | 1 | 1 | X | X | X | X | X | X | 1 | 0 | X | X | X | X | 1 | X | 0 | 0 |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 9 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (9 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| LODI OUTPATIENT SURGERY CENTER | ||||
| 521 S HAM LANE | LODI | CA | 95242 | AMBULATORY SURGICAL CENTERS |
| ENDOSCOPY CENTER OF LODI LLC | ||||
| 840 S FAIRMONT AVE SUITE 1 | LODI | CA | 95240 | AMBULATORY SURGERY CENTER |
| LODI MEMORIAL COMM CLINIC - MILLSBRIDGE | ||||
| 1901 KETTLEMAN LANE SUITE 200 | LODI | CA | 95242 | COMMUNITY CLINIC |
| LODI MEMORIAL HOSP HOME HEALTH AGENCY | ||||
| 800 S LOWER SACRAMENTO RD | LODI | CA | 95242 | HOME HEALTH AGENCY |
| TRINITY PLAZA SURGICAL CENTER LLC | ||||
| 10200 TRINITY PARKWAY SUITE 101 | STOCKTON | CA | 95219 | AMBULATORY SURGERY CENTER |
| ADV IMAGING CENTER AT LODI MEM HOSP LLC | ||||
| 999 S FAIRMONT AVENUE SUITE 110 | LODI | CA | 95240 | DIAGNOSTIC IMAGING OUTPATIENT CENTER |
| LODI MEMORIAL COMMUNITY CLINIC - VINE | ||||
| 1235 W VINE ST SUITE 22 | LODI | CA | 95240 | COMMUNITY CLINIC |
| LODI MEMORIAL COMMUNITY CLINIC - TRINITY | ||||
| 10200 TRINITY PARKWAY SUITE 102 | STOCKTON | CA | 95219 | COMMUNITY CLINIC |
| LODI MEMORIAL SURGICAL GROUP | ||||
| 999 S FAIRMONT AVENUE SUITE 100 | LODI | CA | 95240 | COMMUNITY CLINC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | Return ReferenceReturnReference | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 7: COST IS ASSIGNED UTILIZING OUR INTERNAL COST ACCOUNTING SYSTEM (EPSI). COST IS ESTIMATED BY UTILIZING RELATIVE VALUE UNITS ASSIGNED TO EACH PRODUCT (I.E. CHARGEABLE TEST, SUPPLY, OR PROCEDURE). EACH PRODUCT'S RELATIVE VALUE IS ESTIMATED BY EACH DEPARTMENT DIRECTOR BASED ON RESOURCES EXPENDED FOR EACH DEPARTMENT PRODUCT. DEPARTMENT COSTS ARE ALLOCATED TO EACH PRODUCT BASED ON ACCUMULATED RELATIVE VALUES. EACH PATIENT ACCUMULATES PRODUCTS DURING THEIR VISIT. THE TOTAL COST FOR EACH PATIENT REPRESENTS THE SUM OF ALL THE PRODUCTS PROVIDED TO THEM DURING THEIR VISIT OR INPATIENT STAY. THE ABOVE IS THE CACULATION FOR HOSPITAL CHARGES. FOR COMMUNITY CLINICS, HOSPITAL BASED CLINICS, HOSPITAL BASED HOME HEALTH AGENCY AND TWO SURGERY CENTER JOINT VENTURES A COST TO CHARGE RATIO WAS CALCULATED BASED ON THE DIRECT COSTS OF THESE LINES OF BUSINESS. | ||
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 30581962. | ||
| OVERVIEW:CHA: "THE HOSPITAL PROVIDER FEE IS CRUCIAL TO THE PRESERVATION OF CALIFORNIA'S ENTIRE SAFETY NET, WHICH IS WHY CALIFORNIA'S SAFETY-NET HOSPITALS INITIATED PROVIDER FEE LEGISLATION, AND WHY ALL CALIFORNIA HOSPITALS SUPPORT IT. THE PROGRAM USES FEES ASSESSED BY THE STATE ON HOSPITALS TO DRAW DOWN FEDERAL MATCHING FUNDS, WHICH ARE THEN ISSUED AS SUPPLEMENTAL PAYMENTS TO HOSPITALS. THE HOSPITAL PROVIDER FEE IS AN INTEGRAL ELEMENT TO IMPROVING ACCESS TO HEALTH CARE FOR SOME OF CALIFORNIA'S MOST VULNERABLE RESIDENTS."THE 30 MONTH HOSPITAL QA FEE / SUPPLEMENTAL MEDI-CAL FEE FOR SERVICE (FFS) REVENUE PROGRAM WAS APPROVED BY CMS IN JUNE 2012. THE MEDI-CAL MANAGED CARE PORTION WAS NOT APPROVED UNTIL JUNE 2013. PERIOD COVERED JULY 1, 2011 - DECEMBER 31, 2013, WHICH COMPRISE 10 CALENDAR QUARTERS.BENEFIT TO LMH:IN 2012 WE RECORDED ON A PRORATED BASIS 18 MONTHS (7/1/2011-12/31/2012) OF THE HOSPITAL QA FEE / SUPPLEMENTAL MEDI-CAL FEE FOR SERVICE (FFS) PROGRAM'S EXPENSES AND REVENUES. NONE OF THE MANAGED CARE PORTION WAS RECORDED IN 2012. - TOTAL REVENUES EARNED FROM THIS PROGRAM TOTALED $15,322,180.20 - TOTAL FEES EXPENSED FOR THIS PROGRAM TOTALED $10,778,490.58 - ADDITIONAL FEES EXPENSED FOR THE CALIFORNIA HEALTH FOUNDATION AND TRUST TOTALED $139,603.97INCOME EARNED WAS CREDITED TO THE MEDI-CAL PROGRAM AND GREATLY REDUCED THE UNREIMBURSED COST OF THE MEDI-CAL PROGRAM IN 2012 WHICH IN TURN REDUCED THE CHARITY CARE COSTS REPORTED ON SCHEDULE H COMPARED TO 2011. | SCHEDULE H, PART I EXPLANATION | |
| PART II: THE HOSPITAL PROVIDES MANY COMMUNITY-BUILDING ACTIVITIES TO INCREASE ACCESS TO PRIMARY-CARE SERVICES AND REDUCE THE NUMBER OF PATIENTS WHO PRESENT THEMSELVES TO THE EMERGENCY DEPARTMENT SEEKING CARE FOR MEDICAL CONDITIONS OR INJURIES THAT COULD HAVE EASILY BEEN TREATED AT THE ONSET BY A PRIMARY-CARE PHYSICIAN. THE FOLLOWING WERE LAUNCHED AND ARE NOW SUSTAINED BY THE HOSPITAL TO ADDRESS THE NEED FOR ACCESS TO CARE: A FREE CLINIC; THREE HOSPITAL BASED PRIMARY-CARE CLINICS, AN OBSTETRIC CLINIC AND A PEDIATRIC CLINIC; TWO PRIMARY-CARE COMMUNITY CLINICS AND ONE SPECIALTY COMMUNITY CLINIC. THE CLINICS ALSO KEEP LOCAL PHYSICIANS PRACTICING MEDICINE IN THE AREA. MANY PHYSICIANS WOULD HAVE RETIRED OR MOVED OUT OF THE AREA TO PRACTICE IN A HEALTH SYSTEM IF THE HOSPITAL HAD NOT AGREED TO EMPLOY THEM OR MANAGE THEIR PRACTICES. SO THAT ADULTS CAN WORK WHILE THEIR CHILDREN AND PARENTS ARE SAFELY AND LOVINGLY CARED FOR DURING THE DAY, THE HOSPITAL OFFERS AN AFFORDABLE CHILD-CARE CENTER AND AN ADULT-DAY-CARE CENTER. ADDITIONALLY, THE HOSPITAL PROVIDES NURSE TRAINING, SALARIES AND SUPPORT FOR NINE PARISH-NURSE PROGRAMS SO THAT PEOPLE IN THEIR CHURCHES HAVE ACCESS TO HEALTH EDUCATION, PREVENTION AND OTHER SUPPORTIVE SERVICES. TO PREVENT DISEASE AND INJURY AND ENCOURAGE WELLNESS, HEALTH NEWSLETTERS ARE MAILED TO 85,000 SERVICE-AREA HOUSEHOLDS AND MADE AVAILABLE ON THE HOSPITAL WEB SITE THREE TIMES A YEAR. SAN JOAQUIN COUNTY IS AMONG THE MOST DIFFICULT COUNTIES IN THE STATE WHEN IT COMES TO RECRUITING PHYSICIANS TO PRACTICE MEDICINE, AND THE HOSPITAL DEVOTES SIGNIFICANT FINANCIAL AND HUMAN RESOURCES TO THAT EFFORT. | ||
| PART III, LINE 4: FINANCIAL STATEMENT NOTE 18. "UNCOMPENSATED CARE AND COMMUNITY BENEFIT COSTS: OUR POLICY IS TO PROVIDE SERVICE TO ALL WHO REQUIRE IT, REGARDLESS OF THEIR ABILITY TO PAY. AS SUCH, WE PROVIDE SUBSTANTIAL AMOUNTS OF UNCOMPENSATED CARE. WHEN THIS CARE IS PROVIDED TO PATIENTS WHO LACK FINANCIAL RESOURCES AND THEREFORE ARE DEEMED MEDICALLY INDIGENT, IT IS CLASSIFIED AS CHARITY CARE. WHEN IT IS PROVIDED TO PATIENTS WHO HAVE THE MEANS TO PAY, BUT DECLINE TO DO SO, IT IS CLASSIFIED AS PROVISION FOR UNCOLLECTIBLE ACCOUNTS. SOME UNDETERMINED PORTION OF THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS REPRESENTS CARE TO INDIGENT PATIENTS WHO WE HAVE BEEN UNABLE TO IDENTITY AS CHARITY. NEITHER CHARITY CARE NOR THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS REFLECTED IN NET PATIENT SERVICE REVENUES. IN ADDITION, WE PROVIDE SERVICES TO POOR AND UNDERSERVED PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR ARE UNINSURED OR UNDERINSURED, INCLUDING PATIENTS INSURED UNDER CERTAIN GOVERNMENT-REIMBURSED PUBLIC AID PROGRAMS. SUCH PROGRAMS PAY PROVIDERS AMOUNTS THAT ARE LESS THAN ESTABLISHED CHARGES FOR THE SERVICES PROVIDED TO THE RECIPIENTS AND FREQUENTLY THE PAYMENTS ARE LESS THAN THE COSTS OF RENDERING THE SERVICES."COSTING METHODOLOGY:UTILIZING THE PREVIOUS COSTING METHODOLOGY AS OUTLINED IN RESPONSE TO PART I LINE 7, ALL PATIENTS ARE ASSIGNED A PAYOR CLASS (I.E. CHARITY, SELF PAY, MEDICARE, MEDI-CAL, MANAGED CARE). THE COST BY PAYOR IS A SUMMATION OF ALL PATIENTS IN THE ASSIGNED PAYOR CLASS. COMMUNITY BENEFIT RATIONALE: IN ADDITION TO 4C: UNINSURED PATIENTS ARE SCREENED FOR MEDICAID LINKAGE, GIVEN ASSISTANCE IN APPLYING FOR MEDICAID AND IF INELIGIBLE FOR MEDICAID ARE GIVEN INFORMATION REGARDING OUR CHARITY CARE POLICY AND ENCOURAGED TO APPLY FOR CHARITY CARE. OFTEN THE INFORMATION GATHERED IN THE MEDICAID APPLICATION WILL MAKE THIS DETERMINATION "AUTOMATIC". IF ADDITIONAL INFORMATION IS REQUIRED WE ATTEMPT TO CONTACT THE PATIENT.THE AMOUNTS WRITTEN OFF AS BAD DEBT (ASSIGNED TO A COLLECTION AGENCY) ARE NET OF ANY APPLICABLE PAYMENTS OR DISCOUNTS. ANY PAYMENTS RECEIVED AFTER AN ACCOUNT IS ASSIGNED TO A COLLECTION AGENCY REDUCE THE BAD DEBT EXPENSE IN THE PERIOD RECEIVED.OF THE TOTAL UNINSURED PATIENTS SEEN IN 2012: 47% QUALIFIED FOR CHARITY CARE AND 51% WERE WRITTEN OFF TO BAD DEBTS. IT IS DIFFICULT TO ASCERTAIN HOW MANY UNINSURED WRITTEN OFF TO BAD DEBTS WOULD QUALIFY FOR CHARITY CARE. ALL BAD DEBT WRITE OFFS ARE SENT TO A COLLECTION AGENCY. IF AN ACCOUNT QUALIFIES FOR CHARITY CARE AFTER SENT TO AN AGENCY, NO FURTHER COLLECTION ACTIVITY IS PURSUED AND THE "BAD DEBT" ACCOUNT IS WRITTEN OFF IN FULL - WE HAVE NOT TRACKED THESE IN THE PAST AS PART OF OUR CHARITY CARE EXPENSE BUT ESTIMATE AT LEAST 35% OF OUR BAD DEBT COSTS REPRESENT CHARITY CARE. | ||
| PART III, LINE 8: THE COSTS OF PROVIDING CARE TO MEDICARE RECIPIENTS OFTEN EXCEED THE GOVERNMENT'S REIMBURSEMENT FOR THESE SERVICES. FOR COST ASSIGNED TO MEDICARE PATIENTS, PLEASE SEE RESPONSE IN PART III, LINE 4.FEE REIMBURSED CHARGES FOR LABORATORY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY WITH INCIDENTAL CHARGES FOR SUPPLIES AND DRUGS WERE OBTAINED FROM THE MEDICARE PS&R. COST TO CHARGE RATIOS (CCR) FROM THE FILED COST REPORT WERE UTILIZED TO CALCULATE MEDICARE COSTS. MEDICARE REVENUES FOR THESE SERVICES WERE $45,457,536; COSTS WERE $50,198,898.THE COST ACCOUNTING SYSTEM IS USED FOR HOSPITAL CHARGES - ALL INPATIENT, OUTPATIENT, EMERGENCY AND URGENT CARE - FOR ALL PAYORS. A COST TO CHARGE RATIO WAS USED FOR SEGMENTS THAT ARE NOT YET INCLUDED IN THE COST ACCOUNTING SYSTEM: PRIMARILY HOSPITAL BASED CLINICS, COMMUNITY CLINICS, HOME HEALTH AND OUR RURAL HEALTHCARE CLINIC. 96.3% OF OUR CONSOLIDATED GROSS REVENUES ARE CAPTURED IN THE COST ACCOUNTING SYSTEM. | ||
| PART III, LINE 9B: UNINSURED PATIENTS ARE SCREENED FOR MEDICAID LINKAGE, GIVEN ASSISTANCE IN APPLYING FOR MEDICAID AND IF INELIGBLE FOR MEDICAID ARE GIVEN INFORMATION REGARDING OUR CHARITY CARE (FINANCIAL ASSISTANCE)POLICY AND ENCOURAGED TO APPLY FOR CHARITY CARE (FINANCIAL ASSISTANCE). | ||
| PART V, SECTION B, LINE 20D: THE FINANCIAL ASSISTANCE (CHARITY CARE) POLICY CHARGES THE PATIENT 10% OF GROSS CHARGES IF THEIR POVERTY LEVEL IS BETWEEN 300% AND 350% OF THE FEDERAL GUIDELINES. THE 10% OF GROSS CHARGES APPROXIMATES THE HOSPITAL'S REIMBURSEMENT FROM MEDICARE AND IS THE MAXIMUM CHARGED TO INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE. | LODI MEMORIAL HOSPITAL | |
| PART V, SECTION B, LINE 20D: THE FINANCIAL ASSISTANCE (CHARITY CARE) POLICY CHARGES THE PATIENT 10% OF GROSS CHARGES IF THEIR POVERTY LEVEL IS BETWEEN 300% AND 350% OF THE FEDERAL GUIDELINES. THE 10% OF GROSS CHARGES APPROXIMATES THE HOSPITAL'S REIMBURSEMENT FROM MEDICARE AND IS THE MAXIMUM CHARGED TO INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE. | LODI MEMORIAL HOSPITAL - WEST | |
| SECTION B APPLIES TO BOTH LODI MEMORIAL HOSPITAL AND LODI MEMORIAL HOSPITAL - WEST. | SCHEDULE H, PART V, FACILITY INFORMATION: | |
| PART VI, LINE 2: EVERY THREE YEARS LODI MEMORIAL HOSPITAL ASSESSES COMMUNITY HEALTH NEEDS BY 1)CONSULTING WITH REPRESENTATIVES FROM A VARIETY OF COMMUNITY CONSTITUENCIES TO REVIEW THE NEEDS OF EACH CONSTITUENCY; 2)REVIEWING SERVICE-AREA MORBIDITY AND MORTALITY HEALTH DATA PROVIDED BY THE CALIFORNIA DEPARTMENT OF HEALTH SERVICES; 3)COMPILING SOCIO-ECONOMIC DATA TO DETERMINE WHERE THE GREATEST NEEDS EXIST WITHIN THE HOSPITAL-SERVICE AREA; AND 4)ASKING AREA RESIDENTS TO COMPLETE A HEALTH SURVEY REGARDING THEIR PERSONAL HEALTH AND NOTIONS ABOUT GOOD HEALTH. ONCE THE DATA IS COLLECTED, IT IS REVIEWED AND ASSESSED BY THE HOSPITAL'S COMMUNITY ADVISORY BOARD, BOARD OF DIRECTORS AND HOSPITAL MANAGERS TO DETERMINE WHAT SERVICES AND GAP AREAS MAY NEED ENHANCING OR ADDRESSING TO IMPROVE HEALTH WITHIN THE REALM OF THE HOSPITAL'S RESOURCES TO DO SO. | ||
| PART VI, LINE 3: SIGNS ARE PROMINENTLY POSTED IN THE ADMISSIONS, EMERGENCY AND BILLING DEPARTMENTS OF THE HOSPITAL, IN ADDITION TO ALL THE HOSPITAL CLINICS, TO ADVISE PATIENTS AND VISITORS THAT THEY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE AND HOW TO WORK WITH HOSPITAL STAFF TO OBTAIN IT. THE SAME INFORMATION IS INCLUDED IN PATIENT-ADMISSION PACKETS AND POSTED ON THE HOSPITAL WEB SITE. HOSPITAL CASE MANAGERS ARE VIGILANT OF PATIENTS NEEDING FINANCIAL ASSISTANCE AND FOLLOW UP WITH THOSE IN NEED. FINANCIAL ASSISTANCE INCLUDES APPLYING FOR MEDICAID AS WELL AS CHARITY CARE. | ||
| PART VI, LINE 4: NEARLY ALL OF THE INDIVIDUALS SEEKING CARE FROM LODI MEMORIAL HOSPITAL RESIDE IN ONE OF FIVE COUNTIES: SAN JOAQUIN, SACRAMENTO, SOLANO, AMADOR, AND CALAVERAS. ABOUT HALF OF THE HOSPITAL'S PATIENTS RESIDE WITHIN A FIVE-MILE RADIUS OF THE HOSPITAL IN SAN JOAQUIN COUNTY. GEOGRAPHICALLY, THE HOSPITAL SITS AT THE NORTHERN END OF THE SAN JOAQUIN VALLEY WHERE THE RESIDENTS ARE AMONG THE POOREST AND LEAST EDUCATED OF ALL THE STATE'S COUNTIES. IN ADDITION, SAN JOAQUIN COUNTY HAS AMONG THE WORST UNEMPLOYMENT RATES IN THE STATE'S COUNTIES; NEARLY TWO IN 10 RESIDENTS ARE UNEMPLOYED. ALSO SAN JOAQUIN COUNTY IS GROUND-ZERO FOR THE MORTGAGE CRISIS IN THIS COUNTRY. THE COUNTY IS ALSO AMONG THE MOST VIOLENT IN WHICH TO LIVE IN THE COUNTRY DUE TO SIGNIFICANT GANG ACTIVITY AND POVERTY. HOSPITAL PATIENTS REPRESENT DIVERSITY: ABOUT 30 PERCENT ARE HISPANIC, WITH MANY OF THOSE PATIENTS BEING MONOLINGUAL SPANISH SPEAKERS. ANOTHER THREE PERCENT ARE PAKISTANI, MANY OF WHOM SPEAK ONLY URDU OR PASHTU. ADDITIONALLY THERE IS A SIGNIFICANT POPULATION OF HOSPITAL PATIENTS WHO ARE GREATER THAN 80 YEARS OF AGE. THE MAJOR HEALTH ISSUES OF THE COUNTY ARE HEART DISEASE, STROKE, CANCER, DIABETES AND OBESITY. | ||
| PART VI, LINE 5: THE HOSPITAL CONDUCTS MYRIAD ACTIVITIES TO PROMOTE COMMUNITY HEALTH. THOSE ACTIVITIES INCLUDE BUT ARE NOT LIMITED TO HEALTH FAIRS WITH FREE MEDICAL SCREENINGS FOR HIGH CHOLESTEROL, HIGH-BLOOD PRESSURE, DIABETES AND LOW-OXYGEN SATURATION LEVELS; REFERRALS TO FREE CLINICS OR LOCAL PHYSICIANS FOR THOSE WITH HIGH VALUES; A VARIETY OF LINKED VIDEOS TO THE HOSPITAL WEB PAGE, FACEBOOK PAGE, YOUTUBE PAGE, AND TWITTER RELATED TO HEALTH EDUCATION AND PREVENTION; A WELLNESS PROGRAM FOR HOSPITAL EMPLOYEES THAT IS ROOTED IN EXERCISE AND NUTRITION SO THAT EMPLOYEES MAY LEAD BY EXAMPLE; A MONTHLY NUTRITION COLUMN IN THE LOCAL NEWSPAPER; HOSPITAL STAFF SERVING ON THE BOARDS OF REGIONAL NGOS; DONATIONS OF MATERIALS AND EQUIPMENT TO NGOS; EMPLOYEE DONATIONS OF FOOD AND CLOTHING TO THE NEEDY; AND THE HOSPITAL IS THE SECOND LARGEST YEAR-ROUND EMPLOYER IN LODI SO THAT EMPLOYEES MAY REINVEST THEIR EARNINGS IN THE LOCAL ECONOMY. THE HOSPITAL HAS ALSO ADOPTED THE MOST IMPOVERISHED, LARGEST AND MOST DIVERSE SCHOOL IN THE LOCAL SCHOOL DISTRICT TO HELP EDUCATE STUDENTS, PARENTS AND TEACHERS IN PREVENTION. IN THAT EFFORT THE HOSPITAL HOSTS AT THE SCHOOL HEALTH AND EDUCATION FAIRS; PARTICIPATES IN CLASSROOM TEACHING AND HEALTH DEMONSTRATIONS; AND PARTICIPATES IN CAREERS FAIRS AT THE SCHOOL. DUE TO HAND-WASHING EDUCATION ALONE, THE SCHOOLS ABSENTEE RATES HAVE DECLINED DRAMATICALLY. FOR STUDENTS TO LEARN, THEY MUST BE IN SCHOOL; AND FOR SCHOOLS TO RECEIVE STATE FUNDING, THEY MUST MAINTAIN THEIR ATTENDANCE. | ||
| PART VI, LINE 6: N/A | ||
| CA | PART VI, LINE 7 | REPORTS FILED WITH STATES |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALIFORNIA HEALTH FOUNDATION & TRUST | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1215 K ST STE 800 | AddressLine1 |
| City | SACRAMENTO | City |
| State | CA | State |
| ZIP Code | 95814 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 941498697 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 139604 | AmountOfCashGrant |
| Purpose Of Grant | HOSPITAL QA FEE PROGRAM PLEDGES | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | STIPENDS AND SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 11 | NumberOfRecipients |
| Amount Of Cash Grant | 11000 | AmountOfCashGrant |
| Method Of Valuation | FMV | MethodOfValuation |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FORM 990, SCHEDULE I, PART I, LINE 2 EXPLANATION | Identifier |
| Explanation | THE GRANTS WE MONITOR ARE SPECIFIC TO THE GRANTOR'S NEEDS AND REQUESTS. IN 2012 WE RECEIVED GRANT FUNDS TO USE AS STIPENDS OR SCHOLARSHIPS FOR MEDICAL ASSISTANT STUDENTS THAT INTERN AT OUR CLINICS. THE MAXIMUM GIVEN TO ANY ONE STUDENT IS $1,000 AFTER THEY COMPLETE THE INTERNSHIP PROGRAM. 1099'S ARE ISSUED ON THESE SCHOLARSHIPS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)
| TitleTitle | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SORBERA THOMAS MD | ||||||||||||||
| BOARD MEMBER & LMCC PHYSICIAN | 296327 | 0 | 37502 | 0 | 0 | 0 | 0 | 0 | 8468 | 0 | 342297 | 0 | 0 | 0 |
| GILL PARAMPAL MD | ||||||||||||||
| BOARD MEMBER | 197125 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 197125 | 0 | 0 | 0 |
| HARRINGTON JOSEPH P | ||||||||||||||
| CEO & PRESIDENT | 347636 | 0 | 0 | 0 | 6000 | 0 | 55324 | 0 | 8721 | 0 | 417681 | 0 | 0 | 0 |
| BUTLER CYNTHIA B | ||||||||||||||
| INTERIM CFO BEGINNING 6/23/12 | 150351 | 0 | 0 | 0 | 0 | 0 | 3476 | 0 | 8721 | 0 | 162548 | 0 | 0 | 0 |
| MORENO DEBBE JOYCE | ||||||||||||||
| CHIEF NURSING OFFICER | 199083 | 0 | 0 | 0 | 4200 | 0 | 4212 | 0 | 12257 | 0 | 219752 | 0 | 0 | 0 |
| SEY MARK | ||||||||||||||
| CHIEF ADMINISTRATIVE OFFICER | 179501 | 0 | 0 | 0 | 4200 | 0 | 4024 | 0 | 8721 | 0 | 196446 | 0 | 0 | 0 |
| WOOTON ROBYN | ||||||||||||||
| VP OF FUND DEVELOPMENT | 148260 | 0 | 0 | 0 | 4500 | 0 | 3251 | 0 | 8721 | 0 | 164732 | 0 | 0 | 0 |
| SCHNEIDER PAMELA | ||||||||||||||
| EXECUTIVE DIRECTOR-O/P SVCS | 154520 | 0 | 0 | 0 | 0 | 0 | 3532 | 0 | 8721 | 0 | 166773 | 0 | 0 | 0 |
| LAVIOLA STEVEN MD | ||||||||||||||
| PHYSICIAN, COMMUNITY CLINICS | 366065 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 5921 | 0 | 371986 | 0 | 0 | 0 |
| CONNOLY JOHN PATRICK MD | ||||||||||||||
| PHYSICIAN, COMMUNITY CLINICS | 339922 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 8721 | 0 | 348643 | 0 | 0 | 0 |
| FREUNDEDMUND A MD | ||||||||||||||
| PHYSICIAN, COMMUNITY CLINICS | 351920 | 0 | 12001 | 0 | 0 | 0 | 0 | 0 | 8468 | 0 | 372389 | 0 | 0 | 0 |
| YAO WEIPING MD | ||||||||||||||
| PHYSICIAN, COMMUNITY CLINICS | 251599 | 0 | 98908 | 0 | 0 | 0 | 0 | 0 | 5921 | 0 | 356428 | 0 | 0 | 0 |
| MULLEN KENNETH MD | ||||||||||||||
| PHYSICIAN, COMMUNITY CLINICS | 190827 | 0 | 90861 | 0 | 0 | 0 | 0 | 0 | 4473 | 0 | 286161 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4B | ReturnReference |
| Explanation | LMH HAS A 457(F) SERP WHICH IS LIMITED TO SELECT MEMBERS OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES. PARTICIPANTS ARE SELECTED BY THE BOARD OF DIRECTORS OR AN AUTHORIZED OFFICER. THE AMOUNT OF THE DEFERRED COMPENSATION UNDER THE PLAN FOR A PARTICIPANT FOR A PLAN YEAR SHALL BE SPECIFIED IN THE PARTICIPANT'S PARTICIPATION AGREEMENT OR, IF NOT SO SPECIFIED, THE AMOUNT DETERMINED BY THE EMPLOYER FOR SUCH PLAN YEAR IN THE EMPLOYER'S SOLE AND ABSOLUTE DISCRETION. A PARTICIPANT BECOMES FULLY VESTED IN THE PARTICIPANT'S ACCOUNT UPON THE EARLIEST OF NORMAL RETIREMENT, DATE OF DEATH OR DATE OF DISABILITY WHILE STILL AN EMPLOYEE, DATE OF TERMINATION OR DEMOTION BY THE EMPLOYER IF THE EVENT OCCURS WITHIN THE TWELVE MONTH PERIOD FOLLOWING A CHANGE IN CONTROL, THE EMPLOYER'S INVOLUNTARY TERMINATION OF THE PARTICIPANT'S EMPLOYMENT WITHOUT CAUSE. IF THE PARTICIPANT CEASES TO BE AN EMPLOYEE PRIOR TO BECOMING FULLY VESTED, THE EMPLOYEE SHALL NOT BE ENTITLED TO ANY BENEFIT UNDER THIS PLAN. ANY AMOUNTS CREDITED TO A PARTICIPANT'S ACCOUNT THAT ARE NOT VESTED AT THAT TIME SHALL BE FORFEITED. DISTRIBUTIONS UNDER THE PLAN COMMENCE WITHIN 90 DAYS FOLLOWING VESTING AND NOT LATER THAN MARCH 15 OF THE CALENDAR YEAR FOLLOWING THE CALENDAR YEAR OF VESTING. NO PLAN CONTRIBUTIONS AND NO PAYMENTS WERE MADE FROM THE PLAN DURING THE YEAR. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALIFORNIA STATEWIDE COMMUNITES DEVELOPMENT AUTHORITY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 680164610 | IssuerEIN |
| Date Issued | 2007-12-01 | DateIssued |
| Issue Price | 150629537 | IssuePrice |
| Description Of Purpose | SEE SUPPLEMENTAL INFORMATION | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 6980000 | AmountRetired |
| Total Proceeds | 155391552 | TotalProceeds |
| Amount In Reserve Fund | 11403106 | AmountInReserveFund |
| Capitalized Interest | 18234618 | CapitalizedInterest |
| Issuance Costs From Proceeds | 1547800 | IssuanceCostsFromProceeds |
| Credit Enhancement | 5651669 | CreditEnhancement |
| Capital Expenditures | 118554358 | CapitalExpenditures |
| Year Of Subst Completion | 2012 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 1 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 1 | NoRebateDue |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 1 | ProcToUndertkCorrectiveAction |
Form990 Schedule K Part VI Form990ScheduleKPartVI (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SCHEDULE K PART IV, ARBITRAGE, LINE 2C | DATE REBATE COMPUTATION PERFORMED | ISSUER NAME: CALIFORNIA STATEWIDE COMMUNITES DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 02/14/2013 |
| SCHEDULE K SUPPLENTAL INFORMATION | THE DIFFERENCE OF $4,762,015 BETWEEN THE ISSUE PRICE IN PART I, COLUMN (E) AND THE TOTAL PROCEEDS OF ISSUE IN PART II, LINE 3 IS DUE TO THE CUMULATIVE INVESTMENT EARNINGS (2007-2012) ON PROJECT FUNDS AND RESERVE FUNDS. | |
| PART I; COLUMN F: | DESCRIPTION OF PURPOSE: | TO CONSTRUCT AND EQUIP: GENERAL ACUTE CARE ADDITION & NEW EMERGENCY DEPT. TO ALSO REMODEL WITH NEW EQUIPMENT: KITCHEN AND CAFETERIA. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| MAUREEN MCCAFFREY | |||
| DAUGHTER OF ROBERT MCCAFFREY, BOARD MEMBER | 114309 | EMPLOYEE OF LODI MEMORIAL HOSPITAL | 0 |
| P GILL OBSTETRICS AND GYNECOLOGY | |||
| >5% OWNED PARTNERSHIP BY PARAMPAL GILL, CURRENT BOARD MEMBER | 358184 | PHYSICIAN PROFESSIONAL SERVICE-OB CLINIC | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | ASSOCIATION MEMBERSHIP IS OPEN TO ANYONE FOR A ONE-TIME, LIFETIME FEE OF $100. MEMBERS PARTICIPATE IN THE ANNUAL ELECTION OF BOARD MEMBERS WHO DIRECT THE HOSPITAL. | |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS PARTICIPATE IN THE ANNUAL ELECTION OF BOARD MEMBERS WHO DIRECT THE HOSPITAL. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BOARD OF DIRECTORS CANNOT SELL OR DISSOLVE THE CORPORATION - A 2/3RDS VOTE OF THE ASSOCIATION MEMBERS WOULD BE REQUIRED. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE DRAFT OF THE FORM 990 IS PRESENTED TO THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS OF LODI MEMORIAL HOSPITAL TO REVIEW. THE REVIEWED DRAFT COPY IS THEN PROVIDED ELECTRONICALLY TO THE FULL BOARD PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | MEMBERS OF THE BOARD, COMMITTEES, OFFICERS AND MANAGEMENT ARE REQUIRED TO REVIEW, ATTEST AND DISCLOSE ANY POTENTIAL CONFLICT OF INTERESTS ON AN ANNUAL BASIS. IN ADDITION, IT IS VERBALLY REQUESTED AT EVERY BOARD MEETING FOR ALL MEMBERS TO DECLARE IF THEY HAVE A CONFLICT OF INTEREST ON ANY AGENDA ITEM AND TO ABSTAIN FROM VOTING ON SAID ITEM. | |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD OF DIRECTORS HAS A CEO COMPENSATION COMMITTEE, WHO REVIEWS THE CEO'S PERFORMANCE AND COMPENSATION AT LEAST ANNUALLY WHOSE SPECIFIC RESPONSIBILITIES INCLUDE: SCHEDULING AND COMPLETING AN ANNUAL REVIEW OF THE CEO'S PERFORMANCE, REVIEWING AND ESTABLISHING PERFORMANCE CRITERIA FOR THE CEO, AN ANNUAL REVIEW OF THE CEO'S JOB DESCRIPTION, SOLICITING INPUT FROM OTHER SOURCES ON CEO PERFORMANCE, ANNUALLY REVIEWING MARKET AREA COMPENSATION AND BENEFITS FOR HOSPITAL CEOS TO DETERMINE FAIR MARKET VALUE COMPENSATION, ANNUALLY PROVIDE VERBAL AND WRITTEN FEEDBACK TO CEO ON PERFORMANCE. THE BOARD OF DIRECTORS HAS A CEO COMPENSATION COMMITTEE THAT ALSO ESTABLISHES A COMPENSATION PHILOSOPHY FOR CEO AND SENIOR MANAGEMENT, REVIEWS AND APPROVES THE CEO RECOMMENDATION FOR CAO, CNO, CFO AND VP COMPENSATION AND REVIEWS AND APPROVES MANAGEMENT COMMITTEE INCENTIVE COMPENSATION. IN ADDITION, LODI MEMORIAL HOSPITAL (LMH) PARTICIPATES IN AN ANNUAL COMPENSATION SURVEY SPONSORED BY THE CALIFORNIA HOSPITAL ASSOCIATION, THE HOSPITAL COUNCIL OF NORTHERN & CENTRAL CALIFORNIA AND THE HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA. LMH SUBMITS THEIR WAGE AND SALARY DATA TO AN INDENDENDENT THIRD PARTY WHICH PRODUCES A REPORT BY JOB TITLE AND JOB DESCRIPTION THAT COMPARES SALARIES BY REGION WITHIN CALIFORNIA FOR ALL HOSPITALS WHO PARTICIPATE IN THE SURVEY. | |
| FORM 990, PART VI, SECTION C, LINE 19 | AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. | |
| FORM 990, PART XI, LINE 9: | INCOME OF SUBSIDIARY - VITAL 49,597. INCOME OF SUBSIDIARY - LRHS -370,651. BOOK/TAX K-1 DIFFERENCES -2,811,481. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TRINITY PLAZA SURGERY CENTER LLC | ||||||||||||||
| 10200 TRINITY PARKWAY SUITE 101 | STOCKTON | CA | 95219 | 260358326 | AMBULATORY SURGICAL CENTER | CA | N/A | RELATED | -2510957 | 4108985 | 0 | 1 | 0.94000 | |
| ADVANCED IMAGING CENTER AT LODI MEMORIAL HOSPITAL LLC (AIC) | ||||||||||||||
| 1001 S FAIRMONT AVE | LODI | CA | 95240 | 943407786 | DIAGNOSTIC IMAGING / MRI OUTPATIENT TREATMENT CENTER | CA | N/A | RELATED | -49270 | 593432 | 0 | 0 | 0.51000 | |
| LODI SURGICAL VENTURES LLC (LSV) | ||||||||||||||
| 975 S FAIRMONT AVE | LODI | CA | 95240 | 454239289 | MAJ. OWNER OF LLC OPERATING AMBULATORY SURGERY CENTERS | CA | N/A | RELATED | -296221 | 1930375 | 0 | 1 | 0.60780 | |
| ARTEL LLC | ||||||||||||||
| 521 S HAM LANE | LODI | CA | 95240 | 263513966 | AMBULATORY SURGICAL CENTERS | CA | RELATED | 0 | 0 | 0.31000 | LODI SURGICAL VENTURES LLC | |||
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| VITAL ENTERPRISES INC DBA MEMORIAL HOME MED-EQUIP | ||||||||||||
| 1115 S FAIRMONT AVE SUITE 1 | LODI | CA | 95240 | 680021729 | DURABLE MEDICAL EQUIPMENT COMPANY | CA | N/A | C | 439590 | 679041 | 1.00000 | 1 |
| LODI REGIONAL HEALTH SYSTEMS INC | ||||||||||||
| 975 S FAIRMONT AVE | LODI | CA | 95240 | 680398894 | PHYSICIAN MANAGEMENT AND MEDICAL OFFICE BUILDING DEVELOPMENT & MANAGEMENT | CA | N/A | C | 2092250 | 15051971 | 1.00000 | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (13 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| TRINITY PLAZA SURGERY CENTER LLC | ||
| O | 802799 | FMV |
| LODI REGIONAL HEALTH SYSTEMS INC | ||
| O | 353193 | FMV |
| VITAL ENTERPRISE INC | ||
| O | 224699 | FMV |
| LODI REGIONAL HEALTH SYSTEMS INC | ||
| Q | 221231 | FMV |
| TRINITY PLAZA SURGERY CENTER LLC | ||
| D | 2814410 | FMV |
| LODI REGIONAL HEALTH SYSTEMS INC | ||
| K | 180795 | FMV |
| LODI REGIONAL HEALTH SYSTEMS INC | ||
| P | 65302 | FMV |
| TRINITY PLAZA SURGERY CENTER LLC | ||
| Q | 1086611 | FMV |
| ARTEL LLC | ||
| D | 2710192 | FMV |
| ARTEL LLC | ||
| A | 129758 | FMV |
| LODI REGIONAL HEALTH SYSTEMS INC | ||
| D | 115693 | FMV |
| VITAL ENTERPRISE INC | ||
| A | 31104 | FMV |
| ADVANCED IMAGING CENTER AT LODI MEMORIAL HOSPITAL LLC (AIC) | ||
| A | 8063 | FMV |