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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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-04-30T13:09:34-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line155 SECOND STREET SUITE 1400AddressLine1
CitySAN FRANCISCOCity
StateCAState
ZIP Code94105ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN680127677EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mark Twain St Joseph'sBusinessNameLine1
Business Name Line2Healthcare CorporationBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlMARKNameControl
Phone2097543521Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1768 Mountain Ranch RoadAddressLine1
CitySan AndreasCity
StateCAState
ZIP Code95249ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJACOB LEWISName
TitleCFOTitle
Date Signed2012-04-25DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone4159635100Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJACOB LEWIS CFONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1768 MOUNTAIN RANCH ROADAddressLine1
CitySAN ANDREASCity
StateCAState
ZIP Code95249ZIPCode
FieldValueIRS element (for citing)
Gross Receipts75736334GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.chwhealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1987YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTo continuously improve the health status of our community.ActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees366TotalNbrEmployees
Total Nbr Volunteers68TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1151100ContributionsGrantsPriorYear
Contributions Grants Current Year368501ContributionsGrantsCurrentYear
Program Service Revenue Prior Year50209449ProgramServiceRevenuePriorYear
Program Service Revenue CY51421244ProgramServiceRevenueCY
Investment Income Prior Year758526InvestmentIncomePriorYear
Investment Income Current Year1239637InvestmentIncomeCurrentYear
Other Revenue Prior Year232682OtherRevenuePriorYear
Other Revenue Current Year312068OtherRevenueCurrentYear
Total Revenue Prior Year52351757TotalRevenuePriorYear
Total Revenue Current Year53341450TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year162512GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY451057GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year25677183SalariesEtcPriorYear
Salaries Etc Current Year27204408SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year323745TotalFundrsngExpCurrentYear
Other Expense Prior Year20724666OtherExpensePriorYear
Other Expenses Current Year23068280OtherExpensesCurrentYear
Total Expenses Prior Year46564361TotalExpensesPriorYear
Total Expenses Current Year50723745TotalExpensesCurrentYear
Revenues Less Expenses Prior Year5787396RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2617705RevenuesLessExpensesCY
Total Assets BOY44752898TotalAssetsBOY
Total Assets EOY47454837TotalAssetsEOY
Total Liabilities BOY11708232TotalLiabilitiesBOY
Total Liabilities EOY9679791TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY33044666NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY37775046NetAssetsOrFundBalancesEOY
Mission DescriptionTO CONTINUOUSLY IMPROVE THE HEALTH STATUS OF OUR COMMUNITY.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense44316409Expense
Grants451057Grants
Revenue51431314Revenue
DescriptionThe 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 Expense44316409TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPtrueLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096153NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees366NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledCAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonCRYSTAL CARRASCO FINANCE DEPTNamePerson
Telephone Number9168512106TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13400 DATA DRIVEAddressLine1
CityRANCHO CORDOVACity
StateCAState
ZIP Code95670ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Dr Dean Kelaita
Board Member4.0X1510000
Ken McInturf
Board Member4.0X000
Colleen Smart thru 22011
Board Member4.0X000
Lewis Steele
Board Member4.0X000
Donald Wiley
Board Member4.0X065118381121
Robert Campana
Chairman4.0X000X
Tracy Church thru 52011
Secretary4.0X048391869554X
David Woodhams DDS
Treasurer4.0X000X
Feliciano Jiron
President & CEO40.0030467147460X
Jacob Lewis
VP & CFO40.0019119729599X
Melissa M Cuevas
VP & CNE40.0189535053201X
Anthony C Halat
Physician40.0262947040725X
Maria Michnowski
Physician40.0240600042217X
Jill Ortiz
Director of Pharmacy40.0194945059591X
Joann Rosenfeld
Physician40.0275977043975X
Tran C Thuy
Physician40.0227071031693X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1406175TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1630969TotalReportableCompFrmRltdOrgs
Total Other Compensation499136TotalOtherCompensation
Number Individuals GT100 K61NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
RODGER ORMAN MD INC
PO BOX 2189MURPHYSCA95247Medical Services684214
ALLIANCE HEALTHCARE SERVICES
FILE 55826LOS ANGELESCA900745826Diagnostic Imaging S523257
EMERGENCY PHYSICIAN MED GROUP
PO BOX 79345CITY OF INDUSTRYCA917169345Medical Services260966
SILVER OAK MEDICAL OFFICE INC
PO BOX 636SAN ANDREASCA95249Medical Services243990
AIRE SERV OF THE GOLD COUNTRY
PO BOX 533VALLEY SPRINGSCA95252Maintenance Services232183
FieldValueIRS element (for citing)
Number Of Contractors GT100 K14NumberOfContractorsGT100K
Government Grants146712GovernmentGrants
All Other Contributions221789AllOtherContributions
Noncash Contributions221789NoncashContributions
Total Contributions368501TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT REV/CHARITY CARE9000992577192725771927
MED OFFICE BLDG9000995563355633
MEDICARE / MEDICAID PAYMENTS9000992554712125547121
OTHER RELATED/EXEMPT INCOME9000994656346563
FieldValueIRS element (for citing)
Total Program Service Revenue51421244TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column484143TotalRevenueColumn
Exclusion$484,143ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities22925146Securities
Other225232Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities22173095Securities
Other221789Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities752051Securities
Other3443Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column755494TotalRevenueColumn
Exclusion$755,494ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ADMIN SERVICES FOR MOB TENANTS561000644930$64,493
CAFETERIA90009964389$64,389
MEDICAL RECORDS SALES9000991007010070

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column173116TotalRevenueColumn
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$173,116ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue312068TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column53341450TotalRevenueColumn
Related Or Exempt Function Income51431314RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,541,635ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total451057Total
Program Services451057ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total239482Total
Program Services219432ProgramServices
Management And General18237ManagementAndGeneral
Fundraising1813Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total105974Total
Program Services105974ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total21289805Total
Program Services19400090ProgramServices
Management And General1718796ManagementAndGeneral
Fundraising170919Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1087075Total
Program Services990585ProgramServices
Management And General87763ManagementAndGeneral
Fundraising8727Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3004498Total
Program Services2737813ProgramServices
Management And General242565ManagementAndGeneral
Fundraising24120Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1477574Total
Program Services1346423ProgramServices
Management And General119289ManagementAndGeneral
Fundraising11862Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total96731Total
Program Services14763ProgramServices
Management And General81968ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total17493Total
Management And General17493ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total5523Total
Management And General5523ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total74404Total
Management And General74404ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total7014580Total
Program Services4513154ProgramServices
Management And General2501232ManagementAndGeneral
Fundraising194Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total260027Total
Program Services5370ProgramServices
Management And General254657ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1300270Total
Program Services1107492ProgramServices
Management And General191882ManagementAndGeneral
Fundraising896Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1858165Total
Program Services1827115ProgramServices
Management And General31050ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total946145Total
Program Services506161ProgramServices
Management And General338410ManagementAndGeneral
Fundraising101574Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total101029Total
Program Services79360ProgramServices
Management And General21669ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total66671Total
Program Services25070ProgramServices
Management And General41601ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total337007Total
Program Services337007ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1915831Total
Program Services1877360ProgramServices
Management And General38471ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total362861Total
Program Services362861ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT46274604627460
MEDICAL SUPPLIES36041993603772427
FOOD SUPPLIES17529013238842902
RECRUITING111599111599
DUES & SUBSCRIPTIONS757221151764205

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total117273Total
Program Services34185ProgramServices
Management And General79448ManagementAndGeneral
Fundraising3640Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total50723745Total
Program Services44316409ProgramServices
Management And General6083591ManagementAndGeneral
Fundraising323745Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1658BOY
EOY1260EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY5222815BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6546873BOY
EOY11392797EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY67965BOY
EOY49705EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY78459BOY
EOY541999EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY953585BOY
EOY983299EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY171159BOY
EOY324345EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis31874690LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec17742106LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY14436950BOY
EOY14132584EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY13481408BOY
EOY15817415EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY3229988BOY
EOY3570518EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY222585BOY
EOY333101EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY339453BOY
EOY307814EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY44752898BOY
EOY47454837EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5706599BOY
EOY2057037EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
EOY904583EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY6001633BOY
EOY6718171EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY11708232BOY
EOY9679791EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY32822082BOY
EOY37441946EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY138815BOY
EOY249331EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY83769BOY
EOY83769EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY33044666BOY
EOY37775046EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY44752898BOY
EOY47454837EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2617705ReconcilationRevenueExpenses
Reconcilation Other Changes2112675ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$5,523OtherActivitiesAmount
Total Lobbying Expenditures IIB5523TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPART II - B, Line 1iIdentifier
ExplanationLobbying 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

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
LandLand

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis15637430OtherCostOrOtherBasis
Depreciation8145878Depreciation
Book Value7491552BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3077059OtherCostOrOtherBasis
Depreciation1864164Depreciation
Book Value1212895BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis11618762OtherCostOrOtherBasis
Depreciation7054296Depreciation
Book Value4564466BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1541439OtherCostOrOtherBasis
Depreciation677768Depreciation
Book Value863671BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings14132584TotalOfBookValueLandBuildings
Financial DerivativesFinancialDerivatives
Closely Held Equity InterestsCloselyHeldEquityInterests

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionPOOLED INVESTMENTSDescription
Book Value3570518BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities3570518TotalOfBookValueSecurities
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
DEFERRED COMPENSATION$42,381
DUE TO RELATED PARTIES$6,496,371
PENSION PAYABLE$152,000
OTHER NON-CURRENT LIABILITIES$27,419
FieldValueIRS element (for citing)
Total Of Amounts6718171TotalOfAmounts

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage500.DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served601PersonsServed
Total Community Benefit Expense194117TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense194117NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served18910PersonsServed
Total Community Benefit Expense7355895TotalCommunityBenefitExpense
Direct Offsetting Revenue8030621DirectOffsettingRevenue
Net Community Benefit Expense-674726NetCommunityBenefitExpense
Percent Of Total Expense0.01460PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Persons Served4610PersonsServed
Total Community Benefit Expense2372614TotalCommunityBenefitExpense
Direct Offsetting Revenue1626572DirectOffsettingRevenue
Net Community Benefit Expense746042NetCommunityBenefitExpense
Percent Of Total Expense0.01620PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served24121PersonsServed
Total Community Benefit Expense9922626TotalCommunityBenefitExpense
Direct Offsetting Revenue9657193DirectOffsettingRevenue
Net Community Benefit Expense265433NetCommunityBenefitExpense
Percent Of Total Expense0.00580PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Persons Served15093PersonsServed
Total Community Benefit Expense55536TotalCommunityBenefitExpense
Direct Offsetting Revenue450DirectOffsettingRevenue
Net Community Benefit Expense55086NetCommunityBenefitExpense
Percent Of Total Expense0.00120PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Persons Served12776PersonsServed
Total Community Benefit Expense266733TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense266733NetCommunityBenefitExpense
Percent Of Total Expense0.00580PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Persons Served27869PersonsServed
Total Community Benefit Expense322269TotalCommunityBenefitExpense
Direct Offsetting Revenue450DirectOffsettingRevenue
Net Community Benefit Expense321819NetCommunityBenefitExpense
Percent Of Total Expense0.00700PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Persons Served51990PersonsServed
Total Community Benefit Expense10244895TotalCommunityBenefitExpense
Direct Offsetting Revenue9657643DirectOffsettingRevenue
Net Community Benefit Expense587252NetCommunityBenefitExpense
Percent Of Total Expense0.01280PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Building Expense4208TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense4208NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served140PersonsServed
Total Community Building Expense1986TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense1986NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served64PersonsServed
Total Community Building Expense1221TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense1221NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served204PersonsServed
Total Community Building Expense7415TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense7415NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$1,726,262BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare11472558AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare23526490CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-12053932MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Mark Twain St Joseph's Healthcare CorpBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1768 Mountain Ranch RdAddressLine1
CitySan AndreasCity
StateCAState
ZIP Code95249ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er OtherXErOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Mark Twain St Joseph's Healthcare CorpBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities5NumberOfOtherFacilities

Other Facilities OtherFacilities (5 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Angels Camp Family Medical Center
Angels Towne Center 222 S Main StAngels CampCA95222HEALTH CENTER
Valley Springs Family Medical Center
1919 Vista Del Lago DriveValley SpringsCA95222health center
San Andreas Clinic
704 Mt Ranch Road Suite 103San AndreasCA95249HEALTH CENTER
Arnold Family Medical Center
Meadowmont Center 2182 Highway 4ARNOLDCA95223HEALTH CENTER
Copperopolis Family Medical Center
3505 Spangler Lane 400CopperopolisCA95228HEALTH CENTER

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

IdentifierIdentifierExplanationExplanationReturn 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 7MTSJHC 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 ActivitiesMark 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 4The 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 8MTSJHC 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 9bMTSJHC 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 AssessmentA 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 forCommunication 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 InformationCalaveras 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 HealthHospital 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 SystemMTSJHC 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 REPORTCA,990 SCHEDULE H, PART VI

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistanceMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistancePurpose Of GrantPurposeOfGrant
Mark Twain Foundation
768 Mountain Ranch RdSan AndreasCA95249680023507501(c)(3)2209950N/AN/AFoundation Support
California Health Foundation and Trust
1215 K Street Ste 800SacramentoCA95814941498697501(c)(3)2188000N/AN/AImprove access to and betterment of healthcare
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPART I, LINE 2Identifier
ExplanationAs 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

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Donald Wiley
03826270253945014611043411037710073230400
Tracy Church thru 52011
0300691018137301854034514035040055347200
Feliciano Jiron
0192207010490307561016904030556035213100
Jacob Lewis
014857203953603089017112012487022079600
Melissa M Cuevas
155612032849010740256470275540242736000
Anthony C Halat
2528610150099360163390243860303672000
Maria Michnowski
2389870150014630136140286030282817000
Jill Ortiz
166111021338074960320230275680254536000
Joann Rosenfeld
2742630450012640230720209030319952000
Tran C Thuy
226350045002710195130121800258764000

Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)

IdentifierIdentifierExplanationExplanation
PART I, LINE 3Although 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 4aThe 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 4bCertain 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 DISCLOSURESThe 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 DisclosuresDr. Dean Kelaita'S COMPENSATION IS FOR PHYSICIAN SERVICES PROVIDED TO THE ORGANIZATION.

Schedule L IRS990ScheduleL

Loan Table LoanTable (3 entries)

Purpose Of LoanPurposeOfLoanLoan From OrganizationLoanFromOrganizationOriginal PrincipalOriginalPrincipalAmountBalance DueBalanceDueDefaultDefaultApproved By BoardApprovedByBoardWritten AgreementWrittenAgreement
Dr Anthony Halat
physician loanX$35,19127638truefalsetrue
DR Jo Ann Rosenfeld
physician loanX$43,95615116falsefalsetrue
DR Tran C Thuy
physician loanX$20,0006951falsefalsetrue
FieldValueIRS element (for citing)
Total Balance Due49705TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Randall Smart
SON OF BOD, C SMART28206MEDICAL STAFF PAYMENTSfalse
LORI SKEVINGTON
DAUGHTER OF BOD, C SMART77768COMPENSATIONfalse

Schedule M IRS990ScheduleM

FieldValueIRS element (for citing)
Works Of ArtWorksOfArt
Art Historical TreasuresArtHistoricalTreasures
Art Fractional InterestArtFractionalInterest
Books And PublicationsBooksAndPublications

Clothing And Household Goods ClothingAndHouseholdGoods

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Noncash Contribs Rptd F990221789NoncashContribsRptdF990
Method Of Determining RevenuesResale valueMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Cars And Other VehiclesCarsAndOtherVehicles
Boats And PlanesBoatsAndPlanes
Intellectual PropertyIntellectualProperty
Securities Publicly TradedSecuritiesPubliclyTraded
Securities Closely Held StockSecuritiesCloselyHeldStock
Securities Prtnrshp Trust IntrstsSecuritiesPrtnrshpTrustIntrsts
Securities MiscellaneousSecuritiesMiscellaneous
Qualified Contrib Hist StructQualifiedContribHistStruct
Qualified Contrib OtherQualifiedContribOther
Real Estate ResidentialRealEstateResidential
Real Estate CommercialRealEstateCommercial
Real Estate OtherRealEstateOther
CollectiblesCollectibles
Food InventoryFoodInventory
Drugs And Medical SuppliesDrugsAndMedicalSupplies
TaxidermyTaxidermy
Historical ArtifactsHistoricalArtifacts
Scientific SpecimensScientificSpecimens
Archaeological ArtifactsArchaeologicalArtifacts
Number Of8283 Received0NumberOf8283Received
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftstrueReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI - GOVERNANCE, MANAGEMENT, DISCLOSUREFORM 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 5Change in unrealized gains/(losses); $2,002,158. Interest in net assets of unconsolidated Foundation; $110,517.
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Donald Wiley TITLE:Board Member HOURS:40FORM 990 PART VII
HOURS DEVOTED FOR RELATED ORGANIZATIONNAME:Tracy Church (thru 5/2011) TITLE:Secretary HOURS:40FORM 990 PART VII

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Catholic Healthcare West
185 Berry StreetSan FranciscoCA94107941196203HospitalCA501(c)(3)3NA
Mark Twain St Joseph Hospital Auxiliary
788 Mountain Ranch RdSan AndreasCA95249942340081Volunteer serCA501(c)(3)11dNA
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1NONEBusinessNameLine1