2013-05-01T18:46:01-05:00 2012-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2011-07-01 680127677 Mark Twain St Joseph's Healthcare Corporation % CRYSTAL CARRASCO FINANCE DE MARK 2097543521 768 Mountain Ranch Road San Andreas CA 95249 Jacob Lewis 2013-04-23 true 4159635100 2011 2016-03-07 17:11:31Z JACOB LEWIS CFO 768 MOUNTAIN RANCH ROAD SAN ANDREAS CA 95249 68320788 false X www.dignityhealth.org X 1987 CA To continuously improve the health status of our community. 8 4 344 42 0 0 368501 46555 51421244 50114674 1239637 1359373 312068 203032 53341450 51723634 451057 457511 0 0 27204408 27205394 0 0 1740 23068280 25732288 50723745 53395193 2617705 -1671559 47454837 42747759 9679791 7370903 37775046 35376856 TO CONTINUOUSLY IMPROVE THE HEALTH STATUS OF OUR COMMUNITY. false false 46265867 457511 50114674 The hospital provides routine patient care in private and semi-private rooms as well as various inpatient and outpatient ancillary services such as x-ray, lab, emergency room, etc. During the fiscal year 2012, 1,340 patients were admitted to the facility and 72,542 patient visits were recorded at our 5 rural health clinics. 46265867 true true false true false false false false false false true true false false true false false true false false false false false false false false true true true false true false false false false false false false false false false false false false true false false false false true 135 0 true 344 true false false false false false false false false false false X 8 4 false false false false true true true true true false false false true true true true true false false false CA X CRYSTAL CARRASCO FINANCE DE 9168512106 3400 DATA DRIVE RANCHO CORDOVA CA 95670 X Dr Dean Kelaita 4.0 X 24000 0 0 Dr Chris Krpan 4.0 X 78500 0 0 Ken McInturf 4.0 X 0 0 0 Lewis Steele 4.0 X 0 0 0 Donald Wiley 4.0 X 0 638670 83873 Robert Campana 4.0 X X 0 0 0 Dr William Griffin 4.0 X X 0 0 0 Katherine Medeiros 4.0 X X 0 425234 68186 David Woodhams DDS 4.0 X X 0 0 0 Feliciano Jiron 40.0 X 0 672194 44902 Jacob Lewis 40.0 X 0 190867 24324 Craig Marks 40.0 X 0 0 0 Patty Monczewski 16.0 X 0 265391 23484 Melissa M Cuevas 40.0 X 190886 0 48551 Star Hildabrand 40.0 X 166718 0 30342 Jill Ortiz 40.0 X 195421 0 48350 Rafael A Rosado-Cosme 40.0 X 199764 0 17501 Peggy E Seever 40.0 X 225529 0 26712 Johanna Vermeltfoort 40.0 X 160983 0 21253 Tracy Church X 0 157113 27769 1241801 2349469 465247 72 true true false RODGER ORMAN MD INC PO BOX 2189 MURPHYS CA 95247 Medical Services 673187 DIEDE CONSTRUCTION PO BOX 1007 WOODBRIDGE CA 95258 Construction Service 587808 ALLIANCE HEALTHCARE SERVICES FILE 55826 LOS ANGELES CA 900745826 Imaging Services 412692 DAVIS REED CONSTRUCTION INC 12250 EL CAMINO REAL SUITE 325 SAN DIEGO CA 92130 Construction Service 362588 RENNER IAN G MD 704 MOUNTAIN RANCH RD SUITE 104 SAN ANDREAS CA 95249 Physician Services 306254 15 46555 46555 MEDICARE / MEDICAID PAYMENTS 900099 26505661 26505661 0 0 PATIENT REV/CHARITY CARE 900099 23501901 23501901 0 0 MED OFFICE BLDG 900099 53888 53888 HEALTH FAIR REVENUE 900099 32959 32959 EDUCATION 900099 8149 8149 12116 12116 0 0 50114674 422053 0 0 422053 0 0 0 0 0 0 0 0 0 0 17534474 0 16597154 0 937320 0 937320 937320 0 0 0 ADMIN SERVICES FOR MOB TENANTS 561000 51588 51588 ACCOUNTING SERVICES FOR DISTRICT 561499 42000 42000 CAFETERIA 900099 66180 66180 43264 43264 203032 51723634 50114674 0 1562405 453106 453106 4405 4405 0 0 351197 320927 30270 0 21330352 19490132 1838480 1740 606958 551295 55663 3368256 3059515 308741 1548631 1406760 141871 0 137379 137379 47967 47967 6404 6404 0 93089 93089 7959168 5191937 2767231 408696 12385 396311 1193031 1058483 134548 2336668 2305356 31312 0 939180 628764 310416 132656 61107 71549 0 55888 16982 38906 290415 290415 0 2078632 2044025 34607 1336580 975954 360626 BAD DEBT 4787546 4787546 0 0 MEDICAL SUPPLIES 3417746 3414251 3495 0 FOOD SUPPLIES 162730 135585 27145 0 RECRUITING 149595 0 149595 0 198918 56937 141981 53395193 46265867 7127586 1740 1260 1260 0 2654800 0 0 11392797 5353438 49705 0 0 0 541999 449993 983299 1065218 324345 2085043 33814019 19779902 14132584 14034117 15817415 12732428 3570518 3315475 333101 673811 0 0 307814 382176 47454837 42747759 2057037 2551177 0 0 904583 0 0 0 0 0 0 0 0 0 0 0 6718171 4819726 9679791 7370903 X 37441946 34703045 249331 590042 83769 83769 37775046 35376856 47454837 42747759 X -1671559 -726631 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 6404 6404 false PART II - B, Line 1i Lobbying expenditures paid directly by the filing organization for annual membership dues: National Association of Rural Health $180 American Association of Diabetes Educators $ 41 SHRM ORG $ 14 AICPA $ 10 ----- SUBTOTAL $245 Lobbying expenditures paid by the Parent organization for annual membership dues where expenses are allocated to the hospital: California Hospital Association $4,653 Catholic Health Association $429 American Hospital Association $1,077 ------ SUBTOTAL $6,159 ------ TOTAL $6,404 ====== 0 0 16233932 8698551 7535381 3077059 2016365 1060694 13050682 8362949 4687733 1452346 702037 750309 14034117 POOLED INVESTMENTS 3315475 F 3315475 0 DEFERRED COMPENSATION 57303 DUE TO RELATED PARTIES 4600359 PENSION PAYABLE 133000 OTHER NON-CURRENT LIABILITIES 29064 4819726 true true X true X true X 500. true true false true true 689 418145 0 418145 0.00860 17290 8149563 6484190 1665373 0.03430 4173 2421536 1091129 1330407 0.02740 22152 10989244 7575319 3413925 0.07030 9 2399 34349 0 34349 0.00070 0 0 0 0 0.00000 1 20 5206 0 5206 0.00010 0 0 0 0 0.00000 5 2143 120339 0 120339 0.00250 15 4562 159894 0 159894 0.00330 15 26714 11149138 7575319 3573819 0.07360 0 0 0 0 0.00000 0 0 0 0 0.00000 1 20 274 0 274 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 1 20 274 0 274 0.00000 true 1843438 0 16154361 19418814 -3264453 X true true 1 1 Mark Twain St Joseph's Healthcare Corp

768 Mountain Ranch Rd San Andreas CA 95249

X X X X Mark Twain St Joseph's Healthcare Corp 1 true true 200. true 500. true X X X X X X X true true X X true false true X false false 5 Angels Camp Family Medical Center

Angels Towne Center 222 S Main Str Angels Camp CA 95222

HEALTH CENTER Valley Springs Family Medical Center

1919 Vista Del Lago Drive Valley Springs CA 95222

health center San Andreas Clinic

704 Mt Ranch Road Suite 103 San Andreas CA 95249

HEALTH CENTER Arnold Family Medical Center

Meadowmont Center 2182 Highway 4 ARNOLD CA 95223

HEALTH CENTER Copperopolis Family Medical Center

3505 Spangler Lane 400 Copperopolis CA 95228

HEALTH CENTER Schedule H, Part I, Line 7, column (f) The amount of bad debt expense included on Form 990, Part IX, line 25, column (A) is $4,787,546 and has been subtracted for purposes of calculating the percentages in column (f). Schedule H, Part I, Line 7 MTSJHC follows the method used by Dignity Health. For purposes of calculating the amounts provided in the table, MTSJHC uses a cost accounting system that combines relative value units (RVU) and cost to charge ratios (CCR) to allocate costs to the patient level. The cost accounting system algorithm allocates total operating expenses to the procedure charge code level based upon an RVU for procedures that have been studied and assigned an RVU, or based upon a CCR for unstudied procedures that do not have an RVU assigned. When a CCR is used, the system calculates that CCR on a departmental specific basis at each individual facility where the services were provided. The calculation is similar to the Worksheet 2 of Schedule H, Ratio of Patient Care Cost to Charges, except it is calculated on a departmental specific basis, not in the aggregate. The allocated procedure charge code level costs are then rolled up to the patient level based upon the billed procedure charge codes associated with those services provided to each specific patient. This is done for all patient segments including inpatient, outpatient, emergency department, private insurance, Medicaid, Medicare, uninsured and self pay. The cost accounting system is utilized to determine the unreimbursed cost of Medicaid and other means-tested government programs. The cost of charity care is calculated by applying the CCR derived from the cost accounting system on a per facility basis, to the charges incurred on patients that qualify for charity care at the respective facility. The actual cost is reported for other community benefit activities such as community health improvement services, community benefit operations and cash and in-kind donations. Schedule H, Part II - Community Building Activities Mark Twain St. Joseph's Hospital has formed many relationships with community organizations to improve community health, improve access to health care, and provide health education and in other ways that benefit our residents. In the area of Local Community Organizing, Mark Twain St. Joseph's Hospital provides transportation services to persons who have scheduled appointments for radiation therapy outside the local community. This transportation is also available to other patients if schedule permits. We work closely on developing community-wide plans for disaster preparedness and provide respirator fit testing for all first responders in the community. Schedule H, Part III, Line 4 The amount of the organization's bad debt at cost is determined by applying the CCR (see above) to patient charges that are deemed to be uncollectible. This amount represents the cost of services provided to patients who are unable or refuse to pay their bills and do not qualify for free or discounted care, government sponsored programs or other financial assistance, and are otherwise uninsured. Any portion of a patient bill remaining after applying financial, uninsured or other discounts or payments received on the account that are ultimately determined to be uncollectible are written off to bad debt. As noted in Part I, Line 3, MTSJHC provides free or discounted care to uninsured or under-insured individuals at or below 500% of the Federal Poverty Level. MTSJH also provides patients options for prompt pay discounts, discounts for the medically indigent, and interest-free extended payment plans for patients who have demonstrated good faith and are cooperating in resolving their hospital bills. All accounts for eligible uninsured patients receive an automatic uninsured discount of 25% for patients seen. The expected patient payment amount on the patient's bill reflects this discount. MTSJHC makes every effort in determining if a patient qualifies for charity care upon admission. MTSJHC follows Dignity Health's financial assistance policy. Dignity Health's financial assistance policy is communicated to patients upon admission and is available in the languages primarily spoken in the community. It is also posted in various common areas of the hospital and is provided upon billing if eligibility is not previously determined. Eligibility is reevaluated as needed and amounts are classified as charity as soon as eligibility is known. Dignity Health also utilizes a Payment Assistance Rank Ordering (PARO) scoring system to assist in determining if a patient may qualify for charity care even though they have not applied for it. PARO is a methodology that applies consistent screening and application standards to all patients utilizing historical data to develop a predictive model for healthcare financial assistance. In its development, special attention was paid to those socio-economic factors that might adversely affect those patients deserving the most attention. Other criteria are also utilized to ensure that no services that have qualified as charity are reported as bad debt. As such, MTSJHC does not believe that any amounts included in Part III, Line 2, are attributable to patients eligible under the organization's charity care policy. The following is an excerpt from Dignity Health and its subordinate corporations' consolidated annual audited financial statements for the year ended June 30, 2012, related to accounts receivable and allowances for charity and doubtful accounts: Patient accounts receivable and net patient service revenue are reported at the net realizable amount from patients, third-party payers, and others for services rendered. MTSJHC manages its collection risk by regularly reviewing its accounts and contracts and by providing appropriate allowances. Reserves for charity and uncollectible amounts have been established and are netted against patient accounts receivable in the consolidated balance sheet. Schedule H, Part III, Line 8 MTSJHC prepares Medicare cost reports in a manner that comports with Provider Reimbursement Manual (PRM) 15-1, 2150ff and PRM 15-2, 1000ff. As such, the following language per the PRM 15-1 describes the computation of costs per the Medicare Cost Report: Total allowable costs of a provider are apportioned between program beneficiaries and other patients so that the share borne by the program is based upon actual services received by program beneficiaries. The ratio of covered beneficiary charges to total patient charges for the services of each ancillary department is applied to the cost of the department. Added to this amount is the cost of routine services for program beneficiaries, determined on the basis of a separate average cost per diem for all patients for general routine patient care areas. Another factor to be considered is a separate average cost per diem for each intensive care unit, coronary care unit, and other special care inpatient hospital units. Dignity Health believes that the entire Medicare shortfall of $519.9 million, as reported below in Part VI, Line 6, constitutes community benefit. The IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. Medicare shortfalls must be absorbed by MTSJHC in order to continue treating the elderly in our communities. The hospitals provide care regardless of this shortfall and thereby relieve the federal government of the burden of paying the full cost for Medicare beneficiaries. This shortfall includes $3.2 million reported on Part III, Section B, Line 7, primarily for fee for service Medicare patients, as well as the unreimbursed portion of Medicare Managed Care and Medicare Capitated programs for MTSJHC. Schedule H, Part III, Line 9b MTSJHC ensures that patient accounts are processed fairly and consistently. MTSJHC also follows Dignity Health's collection policy. Dignity Health's collection policy contains provisions that prohibit the collection of amounts due from patients who the organization knows qualify for charity care. Accounts with incorrect or incomplete demographic information are assigned to a collection agency if MTSJHC or billing company retained by Dignity Health is unable to obtain an updated address through skip tracing or other means. For patients who have an application pending for either government-sponsored financial assistance or for assistance under Dignity Health's Patient Payment Assistance Policy, or where the patient is attempting in good faith to settle an outstanding bill with the facility via payment plans, MTSJHC will not knowingly send that patient's bill to an outside collection agency. Legal action will not be pursued to collect debts from patients who have qualified for charity or are cooperating in good faith to resolve their debt. MTSJHC does not impose wage garnishments or liens on primary residences. On self-pay accounts that do not meet the criteria noted above, the initial determination of assignment to a collection agency will vary depending on the nature of the account with the final decision being at the discretion of MTSJHC'S patient financial assistance department. Upon assignment of such a patient account to a collection agency, MTSJHC requires the agency to comply with the Fair Debt Collection Practices Act. Schedule H, Part V, Section B Part V, Section B, Line 13g All language regarding the policy is communicated to patients via the methods outlined below. 1. Signage in all admitting areas; 2. At the point of registration, all patients receive brochures explaining the facility's charity care program and the availability of government sponsored programs; 3. All initial statements to uninsured patients includes verbiage informing patients of the facility's charity care program and a copy of the charity care application. A telephone number is provided for patients to request further information about the program and assistance is available in languages other than English; 4. Information about the facility's charity care program, access to the application, and contact information is available on the facility's webpage. Part V, Section B, Line 19d Patients who are applying for discounts under the discount provision of Hospital Fair Pricing Act - California Health and Safety Code 127400 whose household income is at or below 350% of the FPL are eligible to receive services at the highest average rate the hospital would receive for providing services from Medicare, Medicaid, or any other government-sponsored health program of health benefit in which the hospital participates, whichever is greater. Schedule H, Part VI, Line 2 - Needs Assessment A Community Health Needs Assessment was last conducted in 2011, as required by State law (SB 697). It was a collaborative effort involving the Mark Twain St. Joseph's Health Care District Board of Directors, The Calaveras County Department of Public Health, practicing physicians, various community members and the Calaveras County Superintendent of Schools and various Board members. The needs assessment was a primary tool used by the hospital to determine its community benefit plan, which outlined how the hospital gave back to the community in the form of health care and other community services to address unmet community health needs. This assessment incorporated components of primary data collection and secondary data analysis that focused on the health and social needs of the MTSJH Service Area. The primary Service Area encompassed the cities, towns and communities of Calaveras County that include 20 zip code areas. Targeted interviews were used to gather primary data collection information and opinions from members of the MTSJH community. For the interviews, community leaders were contacted and asked to participate in the needs assessment. 80% of those contacted agreed to participate. Secondary data were collected by obtaining and analyzing a variety of local, county and state sources to present a community profile, birth and death characteristics, access to health care, chronic diseases, social issues, and school and student characteristics. The Community Needs Assessment identified the following sizeable and severe needs: Health Issues -Residents have high rates of death from cancer, lung disease and heart disease. -A large percentage of youth (16.2%) suffer from asthma. -Disease rates of arthritis, asthma, cancer, heart disease and hypertension are high in the County. -The area has high rates of skin, cervical and colon cancer. -Limited services and service providers make it difficult to access mental health, obstetrical and specialty care services. -Females suffer from diabetes at higher rates than men in the County. -An increase in preventive care is needed, including flu shots, Pap smears, mammograms and other recommended routine screening tests. -There is inadequate attention given to preventive care, healthy lifestyles, nutrition and exercise. Social/Demographic Issues -The area reflects an aging population with a median age of 49.2 years. The population of seniors is 30.3%. -A declining economy is impacting the community by increased joblessness, decreases in employer-based health insurance, higher costs for transportation and decreased availability of affordable housing. -A lack of providers in the County (primary care, mental health, specialists) negatively impacts access to care and requires residents to travel outside of the County to obtain services. -Large numbers of youth and adults are overweight and obese. -Smoking among adults and teens is a concern. -ER usage increases among the County's poorest residents. Schedule H, Part VI, Line 3 - Patient Education of Eligibility for Assistance Communication of the Financial Assistance Program to Patients and the Public: Information about patient financial assistance is available at MTSJHC and all of its community locations, including a contact number for patients to call for information and assistance. The information is disseminated by MTSJHC by various means to include notices on patient bills, brochures at all registration desks and in all waiting rooms, and notices posted in the emergency department. Such information is provided in English and Spanish. At the point of registration, all patients receive brochures explaining the facility's charity care program and the availability of government sponsored programs. Uninsured patients receive copies of the charity care and Medicaid applications in addition to the brochure upon admission to the facility. It is MTSJHC's policy that at the time of patient billing, MTSJHC provides to all uninsured patients the same billing information concerning services and charges provided to all other patients who receive care at MTSJHC. If financial assistance eligibility is not determined prior to billing, initial billing statements to uninsured patients include a request to the patient to provide any insurance information that was valid for the dates of service billed, a statement informing patients without insurance coverage they may be eligible for a government sponsored program or facility funded charity care, instructions on how to apply for a government program or charity care and the provision of such applications. Additionally, MTSJHC, in partnership with Calaveras County, provides County Social Workers to assist patients in obtaining governmental assistance in the Valley Springs and Arnold Rural Health Clinics. Any member of MTSJHC staff or medical staff may refer a patient for financial assistance. The patient, a family member, a close friend or an associate of the patient may also make a request for financial assistance. Schedule H, Part VI, Line 4 - Community Information Calaveras County is approximately 130 miles east of San Francisco, 60 miles southeast of Sacramento, and 50 miles east of Stockton. The total population is about 43,000 with an area of 1,008 square miles. Our only incorporated city, the Angels Camp, has a population of about 5,400. In Calaveras County, the poorest residents have been severely impacted by the recession and the elimination of programs and services that local governments are no longer able to fund. The growing gap in needed services has placed at risk the health of hundreds of underserved individuals and families who are now turning to emergency departments for basic non-acute medical services because they have lost or lack a primary care provider. Our 5 Family Medical Centers (rural health clinics) help to fill this gap. However, it is still estimated that 28% of the visits to the ED are for non-emergent care. Access to care for these patient populations requires collaborative problem solving at the community level. Not-for-profit health providers must work together to leverage resources and maximize health assets in innovative ways to restore what has been lost, enhance what still exists and ensure sustainable health programs and services are developed and available over the long-term to the populations that need them the most. Community-based collaboration has been and will be a priority and will continue to drive community benefit efforts in the future. It will become more important for community stakeholders to work in partnerships to maximize the limited resources that are available. * Total population - 45,052 * The population by ethnic group is 82.9% White, 10.8% Hispanic, 1.4% Asian, and 1.0% Black and 3.9% other. * Average income is $53,037 * Uninsured is 18.42% * Unemployment is 13.1% * No High School Diploma is 1.8% * Renter is 21% * CNI Score is 3.1% * Medicaid patients is 18.42% * Other hospitals: 0 Calaveras County is a Health Professional Shortage Area (HPSA) and portions of the County are Medically Underserved Areas (MUA). Schedule H, Part VI, Line 5 - Promotion of Community Health Hospital Leadership oversees community benefit activities for the hospital as it meets the health and wellness needs of the local community. Several members of Mark Twain's senior and middle management team serve the community on a variety of community based not for profit Boards, such as Children and Families Commission, Habitat for Humanity, Calaveras County Business Council, Soroptomists International, Chamber of Commerce and United Way, to name a few. The Hospital is governed by a Board of Trustees, the majority of whom reside within its primary service area and who are not employees, contractors or family members thereof. In addition, most employees have linkages to various service organizations throughout the communities. Community involvement is evidenced by participation of local business and community leaders in the Hospital's Governing Boards, Finance Committee, Ethics Committee and our Parish Nurse Advisory Committee. MTSJHC extends medical staff privileges to all qualified physicians in and outside its community who request said privileges. All surplus funds generated by MTSJHC are reinvested back into the organization to improve patient care and provide health care services to its community. Schedule H, Part VI, Line 6 - Affiliated Health Care System MTSJHC is affiliated with Dignity Health. Affiliates of Dignity Health also promote the health of additional communities in Bakersfield, San Bernardino, San Francisco, San Andreas, and Grass Valley/Nevada City, California. These affiliates follow practices similar to those noted above in determining the unmet healthcare needs of their communities. Total unsponsored community benefit expense for Dignity Health and its subordinate corporations for the year ended June 30, 2012, is as follows: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 108,530 188,380,000 2.0% Unpaid Costs of Medicaid/Medi-Cal 1,060,508 571,491,000 6.0% Other Means-tested Programs 280,517 66,067,000 0.7% Community Services: Community Health Services 525,831 53,467,000 0.6% Health Professions Education 86 27,000 0.0% Subsidized Health Services 193,751 28,297,000 0.3% Donations 155,219 33,140,000 0.3% Community Building Activities 12,811 1,623,000 0.0% Community Benefit Operations 3,884 8,911,000 0.1% Total Community Services for the poor 891,582 125,465,000 1.3% Total Benefits for the Poor 2,341,137 951,403,000 10.0% Benefits for the Broader Community: Community Services: Community Health Services 585,949 17,034,000 0.2% Health Professions Education 68,974 69,132,000 0.7% Subsidized Health Services 9,430 2,210,000 0.0% Research 26,281 30,049,000 0.3% Donations 165,149 7,584,000 0.1% Community Building Activities 38,641 3,138,000 0.0% Community Benefit Operations 87 1,446,000 0.0% Total Benefits for the Broader Community 894,511 130,593,000 1.3% Total Community Benefits 3,235,648 1,081,996,000 11.3% Unpaid Costs of Medicare 1,116,214 519,981,000 5.4% Total Community Benefits including Cost of Medicare 4,351,862 1,601,977,000 16.7% STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI CA, true Mark Twain Foundation 768 Mountain Ranch Rd San Andreas CA 95249 680023507 501(c)(3) 238699 0 N/A N/A Foundation Support California Health Foundation and Trust 1215 K Str Ste 800 Sacramento CA 95814 941498697 501(c)(3) 209856 0 N/A N/A Service for the Poor and betterment of healthcare 2 0 PART I, LINE 2 As a 501(C)(3) organization, we provide assistance to various charitable organizations to promote Dignity Health's mission. A designated committee consisting primarily of the executive team establishes and evaluates priorities and allocation of funds with emphasis on promotion of healthy communities and community collaboration. We do not monitor and report program outcomes. Spending is tracked on an ongoing basis to ensure that it is generally within the budgeted amount. true true false false false false false false false Donald Wiley 0 390141 0 231865 0 16664 0 43254 0 40619 0 722543 0 0 Katherine Medeiros 0 276630 0 130121 0 18483 0 30624 0 37562 0 493420 0 0 Feliciano Jiron 0 181758 0 138069 0 352367 0 18347 0 26555 0 717096 0 0 Jacob Lewis 0 157050 0 30340 0 3477 0 16706 0 7618 0 215191 0 0 Patty Monczewski 0 222698 0 41633 0 1060 0 15113 0 8371 0 288875 0 0 Melissa M Cuevas 160293 0 29392 0 1201 0 16645 0 31906 0 239437 0 0 0 Star Hildabrand 91231 0 71319 0 4168 0 9298 0 21044 0 197060 0 0 0 Jill Ortiz 174568 0 13118 0 7735 0 16527 0 31823 0 243771 0 0 0 Rafael A Rosado-Cosme 124288 0 0 0 75476 0 7098 0 10403 0 217265 0 0 0 Peggy E Seever 223764 0 1100 0 665 0 16097 0 10615 0 252241 0 0 0 Johanna Vermeltfoort 146798 0 6950 0 7235 0 8821 0 12432 0 182236 0 0 0 Tracy Church 0 118846 0 0 0 38267 0 11588 0 16181 0 184882 0 0 PART I, LINE 3 Although the organization employs personnel, the Organization relied on a related organization, Dignity Health, that used one or more of the methods described in Schedule J, Part I, Line 3, to establish the Organization's top management official's compensation. See Schedule O disclosure for Form 990, Part VI, Section B, Line 15a for additional information. PART I, LINE 4a The organization's key employees and its highest compensated employees participate in a severance plan that provides market-standard compensation, ranging from payments of 6 months to 2 years of base compensation, depending on the executive's position, in the event of a position elimination or other involuntary termination, in accordance with the guidelines of the plan. Payments were made to one officer and one top highest compensated employee during 2011 pursuant to this plan; Feliciano Jiron, $346,676, and Rafael Rosado-Cosme, $69,024. PART I, LINE 4b Certain officers and key employees participate in the DIGNITY HEALTH Excess Benefit Plan, a nonqualified supplemental benefit plan limited to participants in the DIGNITY HEALTH retirement plan whose benefits are affected by the limitations imposed by Sections 401(a)(17) and 415 of the Internal Revenue Code. Benefit service under this plan was frozen as of January 1, 2008. No payments were made to any listed persons during 2011 pursuant to this plan. Certain listed persons are eligible to participate in the 2007 DIGNITY HEALTH Executive Deferred Compensation Plan, a nonqualified 457(f) plan that is subject to substantial risk of forfeiture, as required by the IRS. The 2007 Executive Deferred Compensation Plan is for executives hired prior to June 30, 2006. The benefit is intended to bridge the difference, if any, between the benefit provided under the Dignity Health Excess Benefit Plan had benefit service not been frozen at January 1, 2008, and the benefits provided from all other qualified and non-qualified plans. No benefit under this formula will vest under this 457(f) plan before the attainment of age 62 or the completion of 15 years of service. No payments were made under this plan during 2011. Certain listed persons participate in the DIGNITY HEALTH Key Employee Share Option Plan (KeySOP), which was frozen in May 2002. The KeySOP program was established in 2001 with the purpose of providing income deferral opportunities to employees eligible for the company's key employee retention program. No payments were made under this plan during 2011. PART II - SUPPLEMENTAL DISCLOSURES The organization's executive compensation philosophy is designed to assist the organization in attracting and retaining the caliber of executives required to enable the organization to fulfill its mission of providing high quality healthcare for all persons regardless of their ability to pay for services, improving the quality of life in the communities the organization serves, promoting patient and employee satisfaction, and ensuring financial stability. A substantial portion of executive compensation is performance based and is linked to organizational goals approved in advance by the Human Resources and Compensation Committee. These goals include attainment of annual and long-term financial performance, certain healthcare quality standards and the organization's commitment to serving the poor and disenfranchised in the communities it serves. Part III - Supplemental Disclosures Dr. Dean Kelaita'S and Dr. Chris Krpan's compensation is for physician services provided to the organization. FORM 990, PARTS VI and XII FORM 990, PART VI, SECTION A, LINE 6: The hospital is jointly owned by Dignity Health, a 501(c)(3) exempt organization and Mark Twain Healthcare District (the district). FORM 990, PART VI, SECTION A, LINE 7a: DIGNITY HEALTH and the District, as the corporate members, ratify the selection of members and approve new Board members of the organization. Each owner designates two Board members, and each pair of designated Board members selects a county resident; these six select the seventh voting member, who must also be a county resident. FORM 990, PART VI, SECTION A, LINE 7b: Reserved rights of the corporate members (DIGNITY HEALTH and the District) include adoption of mission and philosophy statements, amendment or restatement of articles of incorporation and bylaws, dissolution of the corporation, acquisition of another corporation, creation of a new subsidiary, merger or consolidation with another corporation, participation as a general or limited partner in any venture, incurring long-term indebtedness in excess of normal operating requirements, ratification of board member appointments and dismissals, selection and removal of independent auditors, and transactions outside the ordinary course of business. FORM 990, PART VI, SECTION B, LINE 11A: Management presented the draft of the Form 990 to the Board before filing the form with the Internal Revenue Service. The Board's review included all information reported on the Form 990 with the exception of individuals' compensation amounts reported which were directly reviewed by the Vice President of Human Resources. In the process of its preparation, the Form 990 was reviewed at various levels of Finance and Accounting (Regional DIGNITY HEALTH management and Corporate Tax Department), as well as reviewed by Mark Twain's Finance Manager and CFO (who signs the form) and by an independent accounting firm engaged to review the return before filing. FORM 990, PART VI, SECTION B, LINE 12c: The Organization has adopted DIGNITY HEALTH's Conflicts of Interest Policy. The Organization's Board is charged with monitoring proposed or ongoing transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to these policies, an annual conflict of interest disclosure statement, aimed at determining any family and business relationships and transactions, or other transactions that may pose a potential conflict, is distributed to all covered persons (e.g., board members, officers and executive leadership, key employees and all management personnel whose responsibilities include business decisions which may give rise to conflicts of interest). Covered persons are also required to disclose real or potential conflicts at the time such conflicts arise. When an individual becomes a covered person and annually thereafter, each covered person is required to submit an updated disclosure statement and to sign a statement affirming that he/she: (1) has received a copy of the policy applicable to their position; (2) has read the policy and understands said policy; and (3) agrees to comply with all requirements of the policy, including completing the conflicts of interest disclosure statement. As required by the policy, the President/CEO and EVP/General Counsel prepare annual reports of reported conflicts of interest which are provided to the Board of Directors, Committee Chairs, and key leaders of the organization to enable responsible individuals to monitor and manage disclosed conflicts of interest in the organization's best interests. The procedures for addressing any conflict of interest related to a proposed transaction include, but are not limited to, the following: (1) the conflicting interest is fully disclosed to the Board; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the person with the conflict of interest is excluded from the discussion and approval of such transaction; (4) if warranted, alternatives to the proposed transaction are investigated, and competitive bids or comparable valuations are obtained; (5) the transaction or action must be approved by a majority of disinterested persons, based on certain criteria; and (6) any conflicting issues arising during the course of a Board meeting which cannot be resolved may be referred to an independent committee of the Board of Directors. FORM 990, PART VI, SECTION B, LINE 15a: Although the organization employs personnel, the top management official is compensated by Dignity Health. For 2011 compensation, DIGNITY HEALTH's Compensation and Benefits department conducted an annual review and analysis to provide benchmarking data for the total compensation and benefits package of the top management official. Appropriate comparability data for similar jobs in peer companies (both taxable and tax-exempt) WAS obtained from independent third-party survey sources. FORM 990, PART VI, SECTION B, LINE 15b: The Hospital relied on a related organization, Dignity Health, that used one or more of the methods described in Schedule J, Part I, Line 3, to establish the Chief Financial Officer's compensation. Compensation of other highly paid key employees is based on a comprehensive evaluation focusing on all aspects of the incumbent's assigned duties and assessed performance in carrying out the philosophy and mission of DIGNITY HEALTH. Additionally, comparative data and market surveys regarding compensation in the surrounding marketplace are considered. FORM 990, PART VI, SECTION C, LINE 19: Federal tax laws do not mandate that the organization's governing documents, conflict of interest policy and financial statements be made available for public inspection. The organization makes its financial statements available upon request. FORM 990, PART XI, LINE 5 Change in unrealized (losses); $(1,067,341). Interest in net assets of unconsolidated Foundation; $340,710. FORM 990, PART XII, LINE 3B THE ORGANIZATION'S FEDERAL AWARDS WERE INCLUDED IN DIGNITY HEALTH'S CONSOLIDATED OMB CIRCULAR A-133 AUDITED SCHEDULE OF FEDERAL EXPENDITURES. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Donald Wiley TITLE:Board Member HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Katherine Medeiros TITLE:Board Member/ President SNMH HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Patty Monczewski TITLE:Interim President & CEO HOURS:24 Dignity Health 185 Berry Street San Francisco CA 94107 941196203 Hospital CA 501(c)(3) 3 NA false Mark Twain St Joseph Hospital Auxiliary 788 Mountain Ranch Rd San Andreas CA 95249 942340081 Volunteer svc CA 501(c)(3) 11d NA false false true false false true false false false false false true true true false true false true false NONE