MARK TWAIN MEDICAL CENTER: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- MARK TWAIN MEDICAL CENTER (EIN 68-0127677)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-04-30
- IRS object ID
- 201211219349300426
- Schema version
- 2010v3.7
- 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 L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-04-30T13:09:34-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 SECOND STREET SUITE 1400 | AddressLine1 |
| City | SAN FRANCISCO | City |
| State | CA | State |
| ZIP Code | 94105 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 680127677 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mark Twain St Joseph's | BusinessNameLine1 |
| Business Name Line2 | Healthcare Corporation | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MARK | NameControl |
| Phone | 2097543521 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 768 Mountain Ranch Road | AddressLine1 |
| City | San Andreas | City |
| State | CA | State |
| ZIP Code | 95249 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JACOB LEWIS | Name |
| Title | CFO | Title |
| Date Signed | 2012-04-25 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4159635100 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JACOB LEWIS CFO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 768 MOUNTAIN RANCH ROAD | AddressLine1 |
| City | SAN ANDREAS | City |
| State | CA | State |
| ZIP Code | 95249 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 75736334 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.chwhealth.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1987 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | To continuously improve the health status of our community. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 366 | TotalNbrEmployees |
| Total Nbr Volunteers | 68 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1151100 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 368501 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 50209449 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 51421244 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 758526 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1239637 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 232682 | OtherRevenuePriorYear |
| Other Revenue Current Year | 312068 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 52351757 | TotalRevenuePriorYear |
| Total Revenue Current Year | 53341450 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 162512 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 451057 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 25677183 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 27204408 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 323745 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 20724666 | OtherExpensePriorYear |
| Other Expenses Current Year | 23068280 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 46564361 | TotalExpensesPriorYear |
| Total Expenses Current Year | 50723745 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 5787396 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2617705 | RevenuesLessExpensesCY |
| Total Assets BOY | 44752898 | TotalAssetsBOY |
| Total Assets EOY | 47454837 | TotalAssetsEOY |
| Total Liabilities BOY | 11708232 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9679791 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 33044666 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 37775046 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO CONTINUOUSLY IMPROVE THE HEALTH STATUS OF OUR COMMUNITY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 44316409 | Expense |
| Grants | 451057 | Grants |
| Revenue | 51431314 | Revenue |
| Description | 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 2011, 1,365 patients were admitted to the facility and 37,999 patient visits were recorded at our 5 rural health clinics. | Description |
| Total Program Service Expense | 44316409 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | true | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | true | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | true | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 153 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 366 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | false | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | CA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CRYSTAL CARRASCO FINANCE DEPT | NamePerson |
| Telephone Number | 9168512106 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3400 DATA DRIVE | AddressLine1 |
| City | RANCHO CORDOVA | City |
| State | CA | State |
| ZIP Code | 95670 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (16 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 |
|---|---|---|---|---|---|---|---|---|
| Dr Dean Kelaita | ||||||||
| Board Member | 4.0 | X | 15100 | 0 | 0 | |||
| Ken McInturf | ||||||||
| Board Member | 4.0 | X | 0 | 0 | 0 | |||
| Colleen Smart thru 22011 | ||||||||
| Board Member | 4.0 | X | 0 | 0 | 0 | |||
| Lewis Steele | ||||||||
| Board Member | 4.0 | X | 0 | 0 | 0 | |||
| Donald Wiley | ||||||||
| Board Member | 4.0 | X | 0 | 651183 | 81121 | |||
| Robert Campana | ||||||||
| Chairman | 4.0 | X | 0 | 0 | 0 | X | ||
| Tracy Church thru 52011 | ||||||||
| Secretary | 4.0 | X | 0 | 483918 | 69554 | X | ||
| David Woodhams DDS | ||||||||
| Treasurer | 4.0 | X | 0 | 0 | 0 | X | ||
| Feliciano Jiron | ||||||||
| President & CEO | 40.0 | 0 | 304671 | 47460 | X | |||
| Jacob Lewis | ||||||||
| VP & CFO | 40.0 | 0 | 191197 | 29599 | X | |||
| Melissa M Cuevas | ||||||||
| VP & CNE | 40.0 | 189535 | 0 | 53201 | X | |||
| Anthony C Halat | ||||||||
| Physician | 40.0 | 262947 | 0 | 40725 | X | |||
| Maria Michnowski | ||||||||
| Physician | 40.0 | 240600 | 0 | 42217 | X | |||
| Jill Ortiz | ||||||||
| Director of Pharmacy | 40.0 | 194945 | 0 | 59591 | X | |||
| Joann Rosenfeld | ||||||||
| Physician | 40.0 | 275977 | 0 | 43975 | X | |||
| Tran C Thuy | ||||||||
| Physician | 40.0 | 227071 | 0 | 31693 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1406175 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1630969 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 499136 | TotalOtherCompensation |
| Number Individuals GT100 K | 61 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| RODGER ORMAN MD INC | |||||
| PO BOX 2189 | MURPHYS | CA | 95247 | Medical Services | 684214 |
| ALLIANCE HEALTHCARE SERVICES | |||||
| FILE 55826 | LOS ANGELES | CA | 900745826 | Diagnostic Imaging S | 523257 |
| EMERGENCY PHYSICIAN MED GROUP | |||||
| PO BOX 79345 | CITY OF INDUSTRY | CA | 917169345 | Medical Services | 260966 |
| SILVER OAK MEDICAL OFFICE INC | |||||
| PO BOX 636 | SAN ANDREAS | CA | 95249 | Medical Services | 243990 |
| AIRE SERV OF THE GOLD COUNTRY | |||||
| PO BOX 533 | VALLEY SPRINGS | CA | 95252 | Maintenance Services | 232183 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 14 | NumberOfContractorsGT100K |
| Government Grants | 146712 | GovernmentGrants |
| All Other Contributions | 221789 | AllOtherContributions |
| Noncash Contributions | 221789 | NoncashContributions |
| Total Contributions | 368501 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT REV/CHARITY CARE | 900099 | 25771927 | 25771927 |
| MED OFFICE BLDG | 900099 | 55633 | 55633 |
| MEDICARE / MEDICAID PAYMENTS | 900099 | 25547121 | 25547121 |
| OTHER RELATED/EXEMPT INCOME | 900099 | 46563 | 46563 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 51421244 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 484143 | TotalRevenueColumn |
| Exclusion | $484,143 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 22925146 | Securities |
| Other | 225232 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 22173095 | Securities |
| Other | 221789 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 752051 | Securities |
| Other | 3443 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 755494 | TotalRevenueColumn |
| Exclusion | $755,494 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|---|
| ADMIN SERVICES FOR MOB TENANTS | 561000 | 64493 | 0 | $64,493 | |
| CAFETERIA | 900099 | 64389 | $64,389 | ||
| MEDICAL RECORDS SALES | 900099 | 10070 | 10070 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 173116 | TotalRevenueColumn |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $173,116 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 312068 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 53341450 | TotalRevenueColumn |
| Related Or Exempt Function Income | 51431314 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,541,635 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 451057 | Total |
| Program Services | 451057 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 239482 | Total |
| Program Services | 219432 | ProgramServices |
| Management And General | 18237 | ManagementAndGeneral |
| Fundraising | 1813 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 105974 | Total |
| Program Services | 105974 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21289805 | Total |
| Program Services | 19400090 | ProgramServices |
| Management And General | 1718796 | ManagementAndGeneral |
| Fundraising | 170919 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1087075 | Total |
| Program Services | 990585 | ProgramServices |
| Management And General | 87763 | ManagementAndGeneral |
| Fundraising | 8727 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3004498 | Total |
| Program Services | 2737813 | ProgramServices |
| Management And General | 242565 | ManagementAndGeneral |
| Fundraising | 24120 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1477574 | Total |
| Program Services | 1346423 | ProgramServices |
| Management And General | 119289 | ManagementAndGeneral |
| Fundraising | 11862 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96731 | Total |
| Program Services | 14763 | ProgramServices |
| Management And General | 81968 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17493 | Total |
| Management And General | 17493 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5523 | Total |
| Management And General | 5523 | ManagementAndGeneral |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74404 | Total |
| Management And General | 74404 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7014580 | Total |
| Program Services | 4513154 | ProgramServices |
| Management And General | 2501232 | ManagementAndGeneral |
| Fundraising | 194 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 260027 | Total |
| Program Services | 5370 | ProgramServices |
| Management And General | 254657 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1300270 | Total |
| Program Services | 1107492 | ProgramServices |
| Management And General | 191882 | ManagementAndGeneral |
| Fundraising | 896 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1858165 | Total |
| Program Services | 1827115 | ProgramServices |
| Management And General | 31050 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 946145 | Total |
| Program Services | 506161 | ProgramServices |
| Management And General | 338410 | ManagementAndGeneral |
| Fundraising | 101574 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 101029 | Total |
| Program Services | 79360 | ProgramServices |
| Management And General | 21669 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66671 | Total |
| Program Services | 25070 | ProgramServices |
| Management And General | 41601 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 337007 | Total |
| Program Services | 337007 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1915831 | Total |
| Program Services | 1877360 | ProgramServices |
| Management And General | 38471 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 362861 | Total |
| Program Services | 362861 | ProgramServices |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 4627460 | 4627460 | |
| MEDICAL SUPPLIES | 3604199 | 3603772 | 427 |
| FOOD SUPPLIES | 175290 | 132388 | 42902 |
| RECRUITING | 111599 | 111599 | |
| DUES & SUBSCRIPTIONS | 75722 | 11517 | 64205 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 117273 | Total |
| Program Services | 34185 | ProgramServices |
| Management And General | 79448 | ManagementAndGeneral |
| Fundraising | 3640 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50723745 | Total |
| Program Services | 44316409 | ProgramServices |
| Management And General | 6083591 | ManagementAndGeneral |
| Fundraising | 323745 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1658 | BOY |
| EOY | 1260 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5222815 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6546873 | BOY |
| EOY | 11392797 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 67965 | BOY |
| EOY | 49705 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78459 | BOY |
| EOY | 541999 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 953585 | BOY |
| EOY | 983299 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 171159 | BOY |
| EOY | 324345 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 31874690 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 17742106 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14436950 | BOY |
| EOY | 14132584 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13481408 | BOY |
| EOY | 15817415 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3229988 | BOY |
| EOY | 3570518 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 222585 | BOY |
| EOY | 333101 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 339453 | BOY |
| EOY | 307814 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44752898 | BOY |
| EOY | 47454837 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5706599 | BOY |
| EOY | 2057037 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 904583 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6001633 | BOY |
| EOY | 6718171 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11708232 | BOY |
| EOY | 9679791 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 32822082 | BOY |
| EOY | 37441946 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 138815 | BOY |
| EOY | 249331 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 83769 | BOY |
| EOY | 83769 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33044666 | BOY |
| EOY | 37775046 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44752898 | BOY |
| EOY | 47454837 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2617705 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 2112675 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $5,523 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 5523 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PART II - B, Line 1i | Identifier |
| Explanation | Lobbying expenditures paid directly by the filing organization for annual membership dues: Natl Rural Health Assoc $22 AMER Dietetic Association $19 ----- SUBTOTAL $41 Lobbying expenditures paid by the Parent organization for annual membership dues where expenses are allocated to the hospital: American Hospital Association $ 576 Catholic Health Association $ 363 Hospital Association of So. Cal $4,543 ------ SUBTOTAL $5,482 ------ TOTAL $5,523 ====== | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Land | Land |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15637430 | OtherCostOrOtherBasis |
| Depreciation | 8145878 | Depreciation |
| Book Value | 7491552 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3077059 | OtherCostOrOtherBasis |
| Depreciation | 1864164 | Depreciation |
| Book Value | 1212895 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11618762 | OtherCostOrOtherBasis |
| Depreciation | 7054296 | Depreciation |
| Book Value | 4564466 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1541439 | OtherCostOrOtherBasis |
| Depreciation | 677768 | Depreciation |
| Book Value | 863671 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 14132584 | TotalOfBookValueLandBuildings |
| Financial Derivatives | FinancialDerivatives | |
| Closely Held Equity Interests | CloselyHeldEquityInterests |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | POOLED INVESTMENTS | Description |
| Book Value | 3570518 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 3570518 | TotalOfBookValueSecurities |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED COMPENSATION | $42,381 |
| DUE TO RELATED PARTIES | $6,496,371 |
| PENSION PAYABLE | $152,000 |
| OTHER NON-CURRENT LIABILITIES | $27,419 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 6718171 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 500. | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 601 | PersonsServed |
| Total Community Benefit Expense | 194117 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 194117 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00420 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 18910 | PersonsServed |
| Total Community Benefit Expense | 7355895 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8030621 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -674726 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01460 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 4610 | PersonsServed |
| Total Community Benefit Expense | 2372614 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1626572 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 746042 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01620 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 24121 | PersonsServed |
| Total Community Benefit Expense | 9922626 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9657193 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 265433 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00580 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 15093 | PersonsServed |
| Total Community Benefit Expense | 55536 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 450 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 55086 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 12776 | PersonsServed |
| Total Community Benefit Expense | 266733 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 266733 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00580 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 27869 | PersonsServed |
| Total Community Benefit Expense | 322269 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 450 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 321819 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00700 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 51990 | PersonsServed |
| Total Community Benefit Expense | 10244895 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9657643 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 587252 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01280 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 4208 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 4208 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 140 | PersonsServed |
| Total Community Building Expense | 1986 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 1986 | NetCommunityBuildingExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 64 | PersonsServed |
| Total Community Building Expense | 1221 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 1221 | NetCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 204 | PersonsServed |
| Total Community Building Expense | 7415 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 7415 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $1,726,262 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 11472558 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 23526490 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -12053932 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mark Twain St Joseph's Healthcare Corp | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 768 Mountain Ranch Rd | AddressLine1 |
| City | San Andreas | City |
| State | CA | State |
| ZIP Code | 95249 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er Other | X | ErOther |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mark Twain St Joseph's Healthcare Corp | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 5 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Angels Camp Family Medical Center | ||||
| Angels Towne Center 222 S Main St | 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 |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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 $4,627,460 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 CHW. 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, provide health education and in other ways that benefit our residents. In the area of Physical Improvements and Housing, the hospital supports the Resource Connection new Community Garden and continues to work with the local chapter of Habitat for Humanity by providing resources including the recyclable furniture from hospital renovations. We also partner with the Hospital Foundation on "Pink in the Night" activities which light up several communities during Breast Cancer Awareness Month. In the area of Leadership Development and Training for Members of the Community, the hospital organized the 5th Annual Summer Health Career Camp for high school seniors and juniors who are interested in a future health career. The hospital also participated in various Career Day activities at local high schools. We continue to participate in the Chamber of Commerce's Leadership Calaveras program and provide education about local health care access. 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 CHW's financial assistance policy. CHW'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. CHW 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 CHW and its subordinate corporations' consolidated annual audited financial statements for the year ended June 30, 2011, 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. CHW believes that the entire Medicare shortfall of $429.3 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 $12.0 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 CHW's collection policy. CHW'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 CHW 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 CHW'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 VI, Line 2 - Needs Assessment | A Community Health Needs Assessment was last conducted in 2008, 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 (17.9%) 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 44.6 years. The population of seniors is 18.2%. -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 | 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. | 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 City of Angels has a population of about 3,200. Calaveras County has been designated by the Health Resources & Services Administration, Department of Health & Human Services as a health professional shortage area (HPSA). Mark Twain St. Joseph's Hospital is the sole community hospital in Calaveras County. Mark Twain St. Joseph's Hospital's Family Medical Centers include five Federally-qualified Rural Health Clinics strategically located in remote communities of Calaveras County. Geographic Area and Target Population: The population (2010) of Calaveras County by ethnic group is 86.5% White, 10.3% Hispanic, 1.2% Asian, .8% Black and 1.2% Native American. Our top ten admitting diagnoses for FY 2010 were Major Joint Replacement; Esophagitis, Gastroent & Misc. Digestive Disorders; Septicemia; Heart Failure; Chronic Obstructive Pulmonary Disease; Pneumonia; Cellulitis; Cardiac Arrhythmia; Kidney/Urinary Infection; and CVA. Mark Twain's patient population (gross charges) consists of 48.3% Medicare, 15.0% Medi-Cal, 27.7% Commercial and 9.0% other. Catholic Healthcare West developed a Community Needs Index (CNI) that considers in aggregate the socio-economic barriers residents face. Each geographic service area, determined by 80% or more of hospital discharges, was considered. The higher the score, the greater risk residents of the zip code have in needing health services. CHW's community benefit efforts have a primary focus on the areas with disproportionate unmet health-related needs. Primary Service Area CNI Score 95252 2.4 95249 3.8 95222 3.8 95247 3.0 95223 2.4 95246 3.0 95245 3.2 95228 2.8 Total 2.9 | |
| 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 CHW. Affiliates of CHW 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 CHW and its subordinate corporations for the year ended June 30, 2011, is as follows: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 97,422 152,563,579 1.6% Unpaid Costs of Medicaid/Medi-Cal 1,035,601 444,972,896 4.7% Other Means-tested Programs 253,140 63,978,237 0.7% Community Services: Community Health Services 552,089 49,285,673 0.5% Health Professions Education 21,637 10,998,382 0.1% Subsidized Health Services 219,756 37,388,406 0.4% Donations 233,077 37,415,522 0.4% Community Building Activities 15,081 1,642,251 0.0% Community Benefit Operations 19,210 6,983,659 0.1% Total Community Services for the poor 1,060,850 143,713,893 1.5% Total Benefits for the Poor 2,447,013 805,228,605 8.5% Benefits for the Broader Community: Community Services: Community Health Services 2,004,902 23,003,029 0.2% Health Professions Education 52,255 65,128,468 0.7% Subsidized Health Services 124,290 11,026,699 0.1% Research 5,057 24,166,007 0.3% Donations 202,417 7,914,381 0.1% Community Building Activities 63,555 8,148,278 0.1% Community Benefit Operations 937 2,883,276 0.0% Total Benefits for the Broader Community 2,453,413 142,270,138 1.5% Total Community Benefits 3,562,475 571,626,794 10.0% Unpaid Costs of Medicare 1,109,062 429,356,656 4.5% Total Community Benefits including Cost of Medicare 6,009,488 1,376,855,399 14.5% | |
| Schedule H, Part I, line 7b, column (f) | In January 2010, the State of California enacted legislation that provided for supplemental Medi-Cal payments to certain hospitals funded by a quality assurance fee paid by participating hospitals and matching federal funds ("the 2010 Hospital Fee Program"). The legislation covered the period of April 1, 2009 through December 31, 2010. The Centers for Medicare & Medicaid Services approved the 2010 Hospital Fee Program in its entirety in December 2010, and therefore all activity of the program was recognized during the year ended June 30, 2011. Fee-for-service supplemental payments of $2.1 million recognized during the year are reflected under the Medicaid program as direct offsetting revenue (Part I, line 7b, column d). This net reduction in the cost of the Medicaid program is driving a large decrease in the overall cost of community benefit expense as a percent of total expenses when compared to prior year which was 7.11%. The California Hospital Association created a private program, the California Health Foundation and Trust ("CHFT"), established for several purposes, including aggregating and distributing financial resources to support charitable activities at various hospitals and health systems in California. Upon approval of the legislation noted above in December 2010, MTSJHC recorded a pledge to a grant fund established by CHFT in the amount $0.2 million. The grant is reported under other benefits (Part I, line 7i, column c), as cash and in-kind contributions to community groups. | |
| STATE FILING OF COMMUNITY BENEFIT REPORT | CA, | 990 SCHEDULE H, PART VI |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|---|---|---|
| Mark Twain Foundation | ||||||||||
| 768 Mountain Ranch Rd | San Andreas | CA | 95249 | 680023507 | 501(c)(3) | 220995 | 0 | N/A | N/A | Foundation Support |
| California Health Foundation and Trust | ||||||||||
| 1215 K Street Ste 800 | Sacramento | CA | 95814 | 941498697 | 501(c)(3) | 218800 | 0 | N/A | N/A | Improve access to and betterment of healthcare |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PART I, LINE 2 | Identifier |
| Explanation | As a 501(C)(3) organization, we provide assistance to various charitable ORGANIzATiONS TO PROMOTE CHW'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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Donald Wiley | |||||||||||||
| 0 | 382627 | 0 | 253945 | 0 | 14611 | 0 | 43411 | 0 | 37710 | 0 | 732304 | 0 | 0 |
| Tracy Church thru 52011 | |||||||||||||
| 0 | 300691 | 0 | 181373 | 0 | 1854 | 0 | 34514 | 0 | 35040 | 0 | 553472 | 0 | 0 |
| Feliciano Jiron | |||||||||||||
| 0 | 192207 | 0 | 104903 | 0 | 7561 | 0 | 16904 | 0 | 30556 | 0 | 352131 | 0 | 0 |
| Jacob Lewis | |||||||||||||
| 0 | 148572 | 0 | 39536 | 0 | 3089 | 0 | 17112 | 0 | 12487 | 0 | 220796 | 0 | 0 |
| Melissa M Cuevas | |||||||||||||
| 155612 | 0 | 32849 | 0 | 1074 | 0 | 25647 | 0 | 27554 | 0 | 242736 | 0 | 0 | 0 |
| Anthony C Halat | |||||||||||||
| 252861 | 0 | 150 | 0 | 9936 | 0 | 16339 | 0 | 24386 | 0 | 303672 | 0 | 0 | 0 |
| Maria Michnowski | |||||||||||||
| 238987 | 0 | 150 | 0 | 1463 | 0 | 13614 | 0 | 28603 | 0 | 282817 | 0 | 0 | 0 |
| Jill Ortiz | |||||||||||||
| 166111 | 0 | 21338 | 0 | 7496 | 0 | 32023 | 0 | 27568 | 0 | 254536 | 0 | 0 | 0 |
| Joann Rosenfeld | |||||||||||||
| 274263 | 0 | 450 | 0 | 1264 | 0 | 23072 | 0 | 20903 | 0 | 319952 | 0 | 0 | 0 |
| Tran C Thuy | |||||||||||||
| 226350 | 0 | 450 | 0 | 271 | 0 | 19513 | 0 | 12180 | 0 | 258764 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART I, LINE 3 | Although the organization employs personnel, the Organization relied on a related organization, Catholic Healthcare West, 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. No payments were made to any listed persons during 2010 pursuant to this plan. |
| PART I, LINE 4b | Certain officers and key employees participate in the CHW Excess Benefit Plan, a nonqualified supplemental benefit plan limited to participants in the CHW 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 2010 pursuant to this plan. Certain listed persons hired prior to June 30, 2006 are eligible to participate in the 2007 CHW Executive Deferred Compensation Plan, a nonqualified 457(f) plan that is subject to substantial risk of forfeiture, as required by the IRS. The 2007 CHW Executive Deferred Compensation Plan is intended to to bridge the difference, if any, between the benefit provided under the CHW 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 2010. Certain listed persons participate in the CHW 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 2010. |
| PART II - SUPPLEMENTAL DISCLOSURES | The organization's executive compensation philosophy is designed tto 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 COMPENSATION IS FOR PHYSICIAN SERVICES PROVIDED TO THE ORGANIZATION. |
Schedule L IRS990ScheduleL
Loan Table LoanTable (3 entries)
| Purpose Of LoanPurposeOfLoan | Loan From OrganizationLoanFromOrganization | Original PrincipalOriginalPrincipalAmount | Balance DueBalanceDue | DefaultDefault | Approved By BoardApprovedByBoard | Written AgreementWrittenAgreement |
|---|---|---|---|---|---|---|
| Dr Anthony Halat | ||||||
| physician loan | X | $35,191 | 27638 | true | false | true |
| DR Jo Ann Rosenfeld | ||||||
| physician loan | X | $43,956 | 15116 | false | false | true |
| DR Tran C Thuy | ||||||
| physician loan | X | $20,000 | 6951 | false | false | true |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | 49705 | TotalBalanceDue |
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Randall Smart | |||
| SON OF BOD, C SMART | 28206 | MEDICAL STAFF PAYMENTS | false |
| LORI SKEVINGTON | |||
| DAUGHTER OF BOD, C SMART | 77768 | COMPENSATION | false |
Schedule M IRS990ScheduleM
| Field | Value | IRS element (for citing) |
|---|---|---|
| Works Of Art | WorksOfArt | |
| Art Historical Treasures | ArtHistoricalTreasures | |
| Art Fractional Interest | ArtFractionalInterest | |
| Books And Publications | BooksAndPublications |
Clothing And Household Goods ClothingAndHouseholdGoods
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Noncash Contribs Rptd F990 | 221789 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | Resale value | MethodOfDeterminingRevenues |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cars And Other Vehicles | CarsAndOtherVehicles | |
| Boats And Planes | BoatsAndPlanes | |
| Intellectual Property | IntellectualProperty | |
| Securities Publicly Traded | SecuritiesPubliclyTraded | |
| Securities Closely Held Stock | SecuritiesCloselyHeldStock | |
| Securities Prtnrshp Trust Intrsts | SecuritiesPrtnrshpTrustIntrsts | |
| Securities Miscellaneous | SecuritiesMiscellaneous | |
| Qualified Contrib Hist Struct | QualifiedContribHistStruct | |
| Qualified Contrib Other | QualifiedContribOther | |
| Real Estate Residential | RealEstateResidential | |
| Real Estate Commercial | RealEstateCommercial | |
| Real Estate Other | RealEstateOther | |
| Collectibles | Collectibles | |
| Food Inventory | FoodInventory | |
| Drugs And Medical Supplies | DrugsAndMedicalSupplies | |
| Taxidermy | Taxidermy | |
| Historical Artifacts | HistoricalArtifacts | |
| Scientific Specimens | ScientificSpecimens | |
| Archaeological Artifacts | ArchaeologicalArtifacts | |
| Number Of8283 Received | 0 | NumberOf8283Received |
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | true | ReviewProcessUnusualNCGifts |
| Third Parties Used | false | ThirdPartiesUsed |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE | FORM 990, PART VI, SECTION A, LINE 6: The hospital is jointly owned by Catholic Healthcare West (CHW), a 501(c)(3) exempt organization and Mark Twain Healthcare District (the district). FORM 990, PART VI, SECTION A, LINE 7a: CHW 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 (CHW 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 990 was reviewed at various levels of Finance and Accounting (Regional CHW 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 CHW'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 the Conflicts of Interest Policy, an annual conflict of interest questionnaire, 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). Covered persons are required to disclose real or potential conflicts at the time such conflicts arise. When someone becomes a covered person and annually thereafter, each covered person is required to sign a statement affirming that he/she: (1) has received a copy of the Conflicts of Interest Policy; (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 questionnaire. The completed questionnaires are reviewed by CHW's Legal Department and any persons with actual or potential conflicts are informed via written communication. The procedures for addressing any conflict of interest 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) alternatives to the proposed transaction are investigated, competitive bids or comparable valuations are obtained; (5) any conflicting issues during the course of a Board meeting which cannot be resolved is referred to the Governance Committee; and (6) the transaction or action must be approved by a majority of disinterested persons. All conflicts of interest, whether resolved or unresolved, are reported in the Organization's Form 990. FORM 990, PART VI, SECTION B, LINE 15a: Although the organization employs personnel, the top management official is compensated by Catholic Healthcare West (CHW). FOR 2010 COMPENSATION, CHW'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, Catholic Healthcare West, 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 CHW and its sponsoring congregations. 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 gains/(losses); $2,002,158. Interest in net assets of unconsolidated Foundation; $110,517. | |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:Donald Wiley TITLE:Board Member HOURS:40 | FORM 990 PART VII |
| HOURS DEVOTED FOR RELATED ORGANIZATION | NAME:Tracy Church (thru 5/2011) TITLE:Secretary HOURS:40 | FORM 990 PART VII |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| Catholic Healthcare West | |||||||||
| 185 Berry Street | San Francisco | CA | 94107 | 941196203 | Hospital | CA | 501(c)(3) | 3 | NA |
| Mark Twain St Joseph Hospital Auxiliary | |||||||||
| 788 Mountain Ranch Rd | San Andreas | CA | 95249 | 942340081 | Volunteer ser | CA | 501(c)(3) | 11d | NA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | true | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NONE | BusinessNameLine1 |