2012-05-10T15:36:24-05:00 2011-06-30 GRANT THORNTON LLP ONE CALIFORNIA STREET SUITE 2300 SAN FRANCISCO CA 94111 990 2010-07-01 912154437 Saint Louise Regional Hospital SAIN 6505516601 9400 No Name Uno Gilroy CA 95020 Nicole Thomson 2012-05-08 true JOE DETRANE 4159863900 2010 2016-02-24 21:20:13Z Joanne Allen 9400 No Name Uno Gilroy CA 95020 95597257 false 0928 X www.saintlouisehospital.org X 2001 CA See attachment 1 14 11 581 122 0 0 963760 1418229 94127543 93868939 351471 22909 416057 287180 95858831 95597257 0 0 0 0 52359995 54769170 0 0 0 45433001 42942547 97792996 97711717 -1934165 -2114460 41839880 43791510 58104148 62154238 -16264268 -18362728 X IN THE SPIRIT OF OUR FOUNDERS, ST. VINCENT DE PAUL, ST. LOUISE DE MARILLAC, AND ST. ELIZABETH ANN SETON, THE DAUGHTERS OF CHARITY HEALTH SYSTEM IS COMMITTED TO SERVING THE SICK AND THE POOR. WITH JESUS CHRIST AS OUR MODEL, WE ADVANCE AND STRENGTHEN THE HEALING MISSION OF THE CATHOLIC CHURCH BY PROVIDING COMPREHENSIVE, EXCELLENT HEALTHCARE THAT IS COMPASSIONATE AND ATTENTIVE TO THE WHOLE PERSON: BODY, MIND AND SPIRIT. WE PROMOTE HEALTHY FAMILIES, RESPONSIBLE STEWARDSHIP OF THE ENVIRONMENT, AND A JUST SOCIETY THROUGH VALUE-BASED RELATIONSHIPS AND COMMUNITY-BASED COLLABORATION. false false 77631001 0 93868939 Saint Louise Regional Hospital is a 93-bed acute care hospital offering a wide range of services to residents in Santa Clara and San Benito Counties in California. Additional information about St. Louise Regional Hospital's charitable activities can be found on schedule O. 77631001 true true false false false false false false false true false false true true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false false true 157 0 true 581 true false false false false false false false false false false false false false false false X 14 11 false false false false true true true true true false false true true true true true true true true false CA X WAHID CHOUDHURY 6505516601 203 REDWOOD SHORES PKWY 800 Redwood City CA 94065 X ALLEN HAYES 2.0 X X 0 0 0 SISTER MARION BILL DC 2.0 X 0 0 0 SISTER JOSEPHINE BURNS DC 2.0 X 0 0 0 SISTER ANN LEITAO DC 2.0 X X 0 0 0 GEORGE CHIALA 2.0 X 0 0 0 GEORGE GREEN MD 2.0 X 160070 0 0 SISTER FRAN CILUAGA DC 2.0 X X 0 0 0 SISTER MICHELE RANDALL DC 2.0 X 0 0 0 MARK AHN MD 2.0 X 0 0 0 ROBERT ISSAI 2.0 X 0 1108923 284616 MAURY K HARWOOD MD 2.0 X 81900 0 0 ROGER LUCERO MD 2.0 X 0 0 0 SISTER JUDITH SCHOMISCH DC 2.0 X 0 0 0 SISTER MARTHA GARCIA DC 2.0 X 0 0 0 JOANNE ALLEN 40.0 X 0 396040 107903 CAROL FURGURSON 40.0 X 261220 0 31827 NICOLE THOMSON 40.0 X 162861 0 21213 CYNTHIA T MURRAY 40.0 X 244761 0 30627 MARC A QUARLES 40.0 X 205795 0 33227 GEORGE F ENDRESS 40.0 X 200925 0 30627 MARILYN GERRIOR 40.0 X 195172 0 30627 Bernice Ramsey 40.0 X 192584 0 30627 1705288 1504963 601294 138 false true false Elite Anesthesia Med Grp 18535 Serra Avenida Dr MORGAN HILL CA 95037 Physician Services 489673 Fritter Schulz 9460 No Name Uno GILROY CA 95020 Physician Services 435808 CA Emergency Physicians 2100 Powell St EMERYVILLE CA 94608 Physician Services 434171 Community Counselling Service PO Box 27462 NEW YORK NY 10087 Consulting 391564 BARRY SWENSON BUILDER 777 NORTH FIRST STREET 5TH FLOOR SAN JOSE CA 95112 Construction 353952 39 681538 736691 1418229 NET PATIENT REVENUE 621110 93331880 93331880 BUILDING REVENUE 531120 445455 445455 OTHER OPERATING REVENUE 900099 91604 91604 93868939 22909 22909 0 0 0 0 0 0 GIFT SHOP 453220 55271 55271 CAFETERIA 722210 167225 167225 HOME DELIVERED MEALS 624210 37347 37347 27337 27337 287180 95597257 93868939 310089 0 0 0 0 756881 241970 514911 0 39698529 28654400 11044129 3518759 2506734 1012025 7991482 5693064 2298418 2803519 1997203 806316 0 527614 527614 134181 95589 38592 0 0 0 10403132 9373272 1029860 288446 205486 82960 436064 310648 125416 1865880 1617728 248152 0 1246018 970113 275905 33603 33603 0 99481 70870 28611 2864092 2864092 0 3056224 2790541 265683 1393851 992968 400883 SUPPLIES 9473774 9050310 423464 BAD DEBTS 4626193 4626193 PROVIDER FEE 3280676 3280676 LICENSES AND TAXES 376175 267984 108191 EQUIPMENT RENTAL MAINTENANCE 1216035 866293 349742 1621108 1154867 466241 97711717 77631001 20080716 0 0 1466855 12072963 12602866 1012523 950358 426869 1505523 70325476 47014866 25005059 23310610 1026327 1001521 2296139 2953777 41839880 43791510 900959 1332490 57203189 60821748 58104148 62154238 X -16264268 -18362728 -16264268 -18362728 41839880 43791510 X -2114460 16000 X X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6511544 6511544 44002307 20070332 23931975 18155078 26944534 -8789456 1656547 0 1656547 23310610 DUE FROM RELATED ORGANIZATION 2953777 2953777 0 PENSION OBLIGATION 4788389 OTHER ACCRUED LIABILITIES 7063087 LONG TERM DEBT 47030460 DUE TO GOVERNMENT AGENCIES 1939812 60821748 Schedule D, Part X, line 2 FIN 48 (ASC 740) Footnote Daughters of Charity Health System and its affiliates do not have a liability for uncertain tax positions under FIN 48 (ASC 740) on their consolidated financial statements for the year ended June 30, 2011. As such, there was no FIN 48 (ASC 740) disclosure in the footnotes to the consolidated financial statements of Daughters of Charity Health System. true true X true X true X true true false true true 1 2002762 2002762 0.02150 19097547 13392663 5704884 0.06130 1 21100309 13392663 7707646 0.08280 17 5201 272781 170207 102574 0.00110 1 3067 3067 5 12896 73754 37229 36525 0.00040 23 18097 349602 207436 142166 0.00150 24 18097 21449911 13600099 7849812 0.08430 2 5 606179 606179 0.00650 2 5 606179 606179 0.00650 true 4626193 0 27415997 38179478 -10763481 X true true 1 1 SAINT LOUISE REGIONAL HOSPITAL

9400 NO NAME UNO GILROY CA 95020

X X X SAINT LOUISE REGIONAL HOSPITAL 1 true true 200. true 200. true X X X X X X X true true X X X X X X true X X true X X X X X X true X false false Part I, line 3c N/A Part I, line 6a St. Louise Regional Hospital (SLRH) prepares an annual Community Benefit Report. It is developed in conjunction with SLRH's strategic planning process that is based on the Community Needs Assessment, organizational capacity, and resource allocation. Reports on community benefit activities and outcomes are provided by managers and directors responsible for specific community benefit programs. Quarterly reports are presented to the SLRH Board of Directors and Daughters of Charity Health System (DCHS) corporate offices. An annual update is prepared and presented to the SLRH Board of Directors for approval. The annual update is made available to medical center leadership, key stakeholders, DCHS, and the community. The annual update is presented to the California Office of Statewide Planning and Development, in accordance with SB697. SLRH's Community Benefit Report is developed using results from the Community Needs Assessment, data and input provided by the managers and directors responsible for specific community benefit programs, feedback from the Community Benefits Committee, and direction from the vice president of Mission Integration. St. Louise Regional Hospital's Board of Directors reviews and gives final approval of SLRH's Community Benefit Report. Continual monitoring and evaluation of existing Healthy Community Initiatives provide vital information to the strategic planning process for community benefit programs. Part I, line 7, column (f) Form 990, Part IX, line 25, Column A for SLRH reflects a bad debt expense of $4,626,193 which is not included in the line 7 calculation. Part I, Line 7 SLRH utilizes a cost accounting system that determines costs for providing medical services based on the organizations relationship of costs to charges. Part II N/A Part III, line 4 SLRH is included in the DCHS Consolidated Audited Financial Statements. The financial statements for FY 2011 do not contain a separate footnote on bad debts. Bad debt expense is estimated by utilizing historical collections data of self-pay patients. Part III, line 8 SLRH utilizes a cost accounting system that determines costs for providing medical services based on the organizations relationship of costs to charges. Part III, line 9b SLRH follows the Collection Practices as outlined in DCHS Charity Care and Financial Discount and Financial Assistance operating policies. For patients who qualify for charity care and financial discount, SLRH provides the patient with a written notice prior to commencing collection activities. The notice states that nonprofit counseling services may be available in the area and provides information concerning state and federal law requirements for debt collectors. SLRH does not pursue legal action for non-payment of bills against any household where the primary wage earner(s) is unemployed or there are not significant income sources. SLRH does not assign patients meeting an agreed upon monthly payment plan to a collection agency and does not report the patient to credit bureaus. SLRH does not report adverse information to a consumer credit agency or commence civil action for nonpayment of a patient debt prior to 150 days after the initial billing of the patient. SLRH does not use wage garnishments or liens on real property as a means of collecting unpaid hospital bills for eligible patients. SLRH expects its external collection agencies to not pursue legal action against an eligible patient without prior approval from SLRH. SLRH expects its external collection agencies to follow Fair Debt and Collection Practices, Assembly Bill AB774 and act in a manner that treats individuals with dignity, respect and compassion. In addition, for patients who qualify for financial assistance, SLRH does not pursue legal action for non-payment of bills against any household where the primary wage earner(s) is unemployed, uninsured or there are not significant income sources or assets. SLRH does not assign eligible patients meeting an agreed upon monthly payment plan to a collection agency and does not report the patient to credit bureaus. SLRH does not use liens on real property as a means of collecting unpaid hospital bills for eligible patients. For patients qualified for Financial Assistance: Part VI, Question 2 In an effort to identify the most critical health care needs in SLRH's service area, a Community Needs Assessment is conducted every three years. The most recent assessment was completed in 2010. It is an integral part of the Medical Center's Strategic Planning process, which is managed by the Medical Center's Management Council. The results of the Needs Assessment are integrated into the Medical Center's long-range planning activity, as well as program specific planning. During the annual update of the Medical Center's strategic plan, data derived from the Community Needs Assessment is integrated with the external environment analysis and the organizational analysis. METHODOLOGY The 2010 Santa Clara County Health Profile Report was conducted in collaboration with the Santa Clara County Public Health Department and the Community Benefits Coalition of the Hospital Council of Northern and Central California, South Bay Section. Participating organizations included the following: o Community Health Partnership o Council on Aging Silicon Valley o El Camino Hospital o First 5 Santa Clara County o Healthy Silicon Valley o Hospital Council of Northern and Central CA, South Bay Section o Kaiser Permanente Santa Clara o Kaiser Permanente San Jose o Kids in Common o Lucile Packard Children's Hospital o O'Connor Hospital o Palo Alto Medical Foundation o Project Cornerstone o Saint Louise Regional Hospital o Santa Clara County Office of Education o Santa Clara County Public Health Department o Santa Clara County Social Services Agency o Santa Clara County Family Health Foundation o Santa Clara Family Health Plan o Santa Clara Valley Health and Hospital System o Silicon Valley Community Foundation o Silicon Valley's University Partner for Research and Innovative Solutions o Stanford Hospital and Clinics o The Health Trust o United Way Silicon Valley o YMCA of Silicon Valley Representatives of this group of organizations met regularly to identify challenges, and opportunities for health care organizations, government agencies, and community organizations to improve the health and quality of life of Santa Clara County residents. Suggestions regarding data questions were discussed and agreed upon. Saint Louise Regional Hospital staff participated in the preparation of the 2010 Santa Clara County Health Profile Report. The challenge in preparing this report is to present the most pressing needs knowing that some significant issues may remain unaddressed. Another identified challenge is the lack of data that is zip code specific. Therefore, four areas in the County were oversampled. These included San Jose, Gilroy, Mountain View, and Sunnyvale. Overall, Santa Clara County is healthy but a closer look reveals disparities leaving certain populations at a higher risk for chronic diseases. Disparities are differences in health status defined by characteristics such as race/ethnicity, income or education levels. Based on the demographic data showing that Gilroy has a Hispanic population of 59% and Santa Clara County has a Hispanic population of 26%, Santa Clara County and Gilroy, in particular, have the following areas to improve: 1) access to healthcare: o declined from 2000 to 2009 o more Hispanics -40%- are uninsured 2) prevention of risk factors especially obesity leading to chronic disease: o increased from 52% to 56% from 2000 to 2009 o more Hispanics -68%- are overweight/obese 3) increasing support of persons with diabetes: o number of persons with diabetes increased from 5% to 8% from 2000 to 2009 o higher proportion: 11% of Hispanics have diabetes. The risk factors leading to heart disease, a leading cause of death in Santa Clara County, include diabetes, high blood pressure, and high cholesterol. Each of these risk factors have a higher incidence in Gilroy than in the County and in the state. Part VI Question 3 Patients who present at SLRH's Emergency Department and SLRH's Admitting Department are provided with a financial assistance packet that consists of an informational flyer on various programs for which they may be eligible, along with the contact number for SLRH's Health Benefits Resource Center (HBRC). The flyer is in English and Spanish. The packet includes a Medi-Cal application, as well as a Charity Care application. Should they make an appointment with HBRC, patients can fill out the forms prior to their appointment. HBRC staff visits Cash/Self-Pay patients at bedside, screens patients and identifies the programs for which they are eligible. If they have no linkage, HBRC provides information about other programs for which they may qualify such as Charity Care. In addition, there are signs posted in English and Spanish in the Patient Financial Services department and at every point of registration stating that SLRH has financial assistance and charitable programs available for qualified low income, uninsured patients who may not have the ability to meet the financial obligation of their hospital services and a contact number to call. After discharge, the back of the monthly patient bills includes this same statement. Part VI Question 4 DEMOGRAPHICS AND HEALTH AND SOCIAL INDICATORS Saint Louise Regional Hospital serves a Primary Service Area (PSA) that includes Gilroy, Morgan Hill, and Hollister. The smaller communities of San Martin in Santa Clara County and San Juan Bautista in San Benito County are also a part of SLRH's Service Area and have relatively stable populations of under 6,000. The demographic data shown on the table below is obtained from the web site: U.S.Census Bureau, 2006 - 2008 American Community Survey 3-Year Estimates. GILROY TOTAL POPULATION: 48,064 HISPANIC POPULATION: 58.9% FAMILIES WITH INCOME BELOW $50,000: 39% MEDIAN AGE: 33.6 EDUCATION LEVEL BELOW HIGH SCHOOL: 26% MORGAN HILL TOTAL POPULATION: 36,747 HISPANIC POPULATION: 34.5% FAMILIES WITH INCOME BELOW $50,000: 28% MEDIAN AGE: 36.3 EDUCATION LEVEL BELOW HIGH SCHOOL: 10% HOLLISTER TOTAL POPULATION: 32,012 HISPANIC POPULATION: 59.9% FAMILIES WITH INCOME BELOW $50,000: 36% MEDIAN AGE: 30.2 EDUCATION LEVEL BELOW HIGH SCHOOL: 30% SANTA CLARA COUNTY TOTAL POPULATION: 1,734,756 HISPANIC POPULATION: 25% FAMILIES WITH INCOME BELOW $50,000: 27% MEDIAN AGE: 36.6 EDUCATION LEVEL BELOW HIGH SCHOOL: 14% Growth Gilroy continues to grow and more recent statistics from the 2010 Santa Clara County Health Profile Report show the population closer to 52,000. As the city grows so do the emergency needs of the residents. As noted, SLRH is currently exploring expanding our emergency department. Economic status The people of Gilroy remain the poorest of the 3 cities noted. The challenge for SLRH continues to be to provide care for people without insurance. To that end, we are expanding the services in our Health Benefits Resource Center to provide additional assistance to adult persons without insurance. Additionally nearly 50% of the people over 24 and living in Gilroy have minimal education. This presents challenges for providing education to our clients both inpatient and outpatient. Future Needs in South County Saint Louise Regional Hospital is monitoring the need for additional medical services as the population increases in our service area. Our strategic initiatives involve expansion at both our Gilroy and Morgan Hill campuses. This is significant because some ethnicities have higher rates of incidence of certain diseases. For example, heart disease is the number one cause of death in Latino communities, which makes up the largest percentage of SLRH's service area population. SLRH is addressing this through its Vida Sana/Healthy Life Community Wellness program. Community Building Activities. SLRH's Community Building Activities address some of the key root causes of health issues, including access to healthcare. We promote the health of the community we serve by recruiting physicians to meet the health needs of our community according to the county assessment of our communities. The following is a list of the local organizations and agencies that SLRH participated with: The South County Collaborative is a community partnership sharing strengths and resources in order to provide access to a full range of healthcare services. Over 50 agencies are represented including schools, healthcare, businesses, and community members. The Collaborative meets monthly and annually sets goals to improve the quality of life in South County. The Director of Community Health serves as a member of the Board of Directors as well as the co-chair of the Nutrition and Health Sub-Committee. The Nutrition and Health Sub-Committee meets monthly to collaborate on ways to improve health and nutrition in South County. Some of the activities of this committee included: planning and sponsoring of a workshop related to the effects of poverty on health in the Latino community during Binational Health Week in October 2009; advocacy for prevention activities related to obesity and chronic health conditions; increased utilization of the Food Stamp program by providing food assistance training; supported the implementation of a breastfeeding project; and the CUP grant to promote drug/alcohol free communities. The Latino Dementia Care Network Advisory Group meets quarterly to improve access to services provided by the Alzheimers Association to Latinos affected by this disorder. Gilroy Community Health Day is a collaborative effort of several local agencies serving the underserved. SLRH was actively involved with the planning and sponsorship of this event. The health screening results assisted us in setting priorities. The Migrant Collaborative has as one if its objectives: to host the Celebraci?n del Campo which is an event honoring migrant workers. Coordination of the health and wellness section and sponsorship of this event was provided. Results from health screening assisted in our assessment of priorities. Tracking results from health screenings provided at various locations in addition to the above events assisted us in setting priorities. The Gilroy Unified School District Health Council is a collaborative group that meets regularly to address the implementation of the Wellness Policy in each school. Participation on this council provided input into the many obstacles to healthy eating which are present in the schools and therefore in the community at large. The Council continues to work with parents to provide 100% compliance with this policy. Providing clinical coordination at the RotaCare Free Clinic each week provided an opportunity to evaluate the needs of those without access to healthcare benefits. Serving on the boards of the RotaCare Bay Area and RotaCare Free Clinics provided information regarding gaps in the healthcare system. Rebekah Children's Services Community Advisory Board meets quarterly to discuss needs as they pertain to the children between the ages of 5 through 18. The purpose of this advisory board is to provide the organization with professional and technical expertise and support, and to develop recommendations for the Strategic plan. Many of the young people need healthcare services and do not have the means of securing healthcare insurance. The Director of Community Health represented Saint Louise Regional Hospital on this board. Members of Senior Management and Saint Louise Regional Hospital associates served in a variety of roles on the various Chambers, Rotary and other community organizations. Part VI Question 5 Saint Louise Regional Hospital (SLRH), a California nonprofit religious corporation, is a 93 bed acute-care hospital in Gilroy, CA. The hospital has served the community since 1989, under sponsorship of the Daughters of Charity of St. Vincent de Paul. Saint Louise Regional Hospital is a member of the Daughters of Charity Health System. Saint Louise Regional Hospital is the largest hospital serving the growing communities of southern Santa Clara County and northern San Benito County, with only one other small hospital in our service area. Currently we also operate an Urgent Care Center on our Morgan Hill campus: De Paul Health Center. We believe our Catholic-sponsored, not-for-profit hospital plays a vital role in continuing to emphasize high quality, compassionate service to the underserved in this changing, challenging environment. At SLRH, we have the busiest emergency room per bed in Santa Clara County, this year alone we provided 26,230 visits. A Calstar emergency helicopter transport is based on our premises. Saint Louise also provides the latest minimally invasive surgical procedures available today; general medicine covering specialties that are not often seen in a small community hospital; maternal and child health services; wound care and hyperbaric medicine with two hyperbaric oxygen chambers on site; stroke and telemedicine program; physician referral services; physician health and wellness lectures; and support groups. The hospital's Breast Care Center, in a private suite on campus, provides mammography and advanced methods of cancer detection. Bone density screening is also available at the Breast Care Center. SLRH has some of the most advanced diagnostic equipment available including a 64 slice CT scanner, a high definition MRI, Ultra Sound, and Nuclear Medicine. A full service laboratory is available as well as cardiopulmonary diagnostic studies. The hospital is committed to being The Center for Health and Healing in the community it serves. Strategically, we are poised to both expand our Emergency Department on the Gilroy campus, and provide additional outpatient services on our Morgan Hill campus: De Paul Health Center. The Health Benefits Resource Center provides a one stop service center for low cost health insurance enrollment for children. The Center also provides referrals to Santa Clara Valley Medical Center Specialty clinics when ongoing medical care is needed. The HBRC provided services to over 800 clients in the past year. SLRH provides free individual and group classes and support groups in English and Spanish for persons with diabetes and their families. SLRH collaborates with the Silicon Valley YMCA through a Center for Disease Control (CDC) REACH grant to enhance the education of Spanish speaking persons with diabetes through a Promotores program. Health screenings are provided at a variety of locations and businesses. Sponsorship of Community Health events such as the Gilroy Community Health Day and the Celebraci?n del Campo is ongoing. In addition, SLRH participates in other community events such as the Mushroom Mardi Gras and Taste of Morgan Hill providing first aid services. SLRH also sponsors many community events related to health and wellness such as the "Run for Fitness" for Gilroy Unified School District; the St. Mary's School Walk-a-thon in Gilroy and the St Catherine's School Walk-a-thon in Morgan Hill. The president and CEO is Joanne Allen. Sister Ann Leitao is chair of the Board of Directors. Sister Rachela Silvestri, the Director of Community Health, is responsible for Community Benefit Program management and reporting. Part VI Question 6 The Daughters of Charity Health System (DCHS) is a regional health care system of hospitals and medical centers ("Local Health Ministries') spanning the California coast from the San Francisco Bay Area to Los Angeles. In the spirit of our founders, St. Vincent de Paul, St. Louise de Marillac and St. Elizabeth Ann Seton, the Daughters of Charity Health System is committed to serving the sick and the poor. With Jesus Christ as our model, we advance and strengthen the healing mission of the Catholic Church by providing comprehensive, excellent health care that is compassionate and attentive to the whole person: body, mind and spirit. We promote healthy families, responsible stewardship of the environment, and a just society through values-based relationships and community based collaboration. Every day in DCHS Local Health Ministries, dedicated associates, physicians and volunteers provide quality, compassionate care. These thousands of people are the hands and hearts of the Daughters of Charity, reaching out to provide comfort and holistic healing - body, mind and spirit - to the people of California, just as the first Daughters did more than 150 years ago. As a member of the Daughters of Charity Health System, SLRH continues to uphold its mission of providing quality medical services to the most vulnerable populations, the sick, the poor, the elderly, and children. SLRH is committed to the fulfillment of the mission of its founding sisters through the delivery of charitable services and care to the community. Part VI Question 7 SLRH annually updates its Community Benefits Report and SLRH files a copy of its Community Benefits Report on an annual basis with the State of California. false true false false false false false false false GEORGE GREEN MD 160070 0 0 0 0 0 0 0 0 0 160070 0 0 0 ROBERT ISSAI 0 884055 0 0 0 224868 0 263785 0 20831 0 1393539 0 0 JOANNE ALLEN 0 380666 0 0 0 15374 0 79976 0 27927 0 503943 0 0 CAROL FURGURSON 257443 0 0 0 3777 0 9534 0 22293 0 293047 0 0 0 NICOLE THOMSON 162406 0 0 0 455 0 7151 0 14062 0 184074 0 0 0 CYNTHIA T MURRAY 243679 0 0 0 1082 0 9534 0 21093 0 275388 0 0 0 MARC A QUARLES 204956 0 0 0 839 0 9534 0 23693 0 239022 0 0 0 GEORGE F ENDRESS 199861 0 0 0 1064 0 9534 0 21093 0 231552 0 0 0 MARILYN GERRIOR 192337 0 0 0 2835 0 9534 0 21093 0 225799 0 0 0 Bernice Ramsey 187768 0 0 0 4816 0 9534 0 21093 0 223211 0 0 0 COMPENSATION Schedule J, Part I, Line 3 THE CEO IS AN EMPLOYEE OF DAUGHTERS OF CHARITY HEALTH SYSTEM. DCHS USES ONE OR MORE OF THE FOLLOWING METHODS TO ESTABLISH TOP MANAGEMENT OFFICIALS' COMPENSATION: INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, FORM 990 OF OTHER ORGANIZATIONS, AND WRITTEN EMPLOYMENT CONTRACTS. NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B THE FOLLOWING INDIVIDUAL PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, WHICH IS INCLUDED IN COMPENSATION REPORTED ON SCHEDULE J, PART II, COLUMN C: ROBERT ISSAI $88,572 Form 990, Part III, Line 4a The Daughters of Charity Health System (DCHS) is a regional health care system of hospitals and medical centers ("Local Health Ministries') spanning the California coast from the San Francisco Bay Area to Los Angeles. In the spirit of our founders, St. Vincent de Paul, St. Louise de Marillac and St. Elizabeth Ann Seton, the Daughters of Charity Health System is committed to serving the sick and the poor. With Jesus Christ as our model, we advance and strengthen the healing mission of the Catholic Church by providing comprehensive, excellent health care that is compassionate and attentive to the whole person: body, mind and spirit. We promote healthy families, responsible stewardship of the environment, and a just society through values-based relationships and community based collaboration. Every day in DCHS Local Health Ministries, dedicated associates, physicians and volunteers provide quality, compassionate care. These thousands of people are the hands and hearts of the Daughters of Charity, reaching out to provide comfort and holistic healing - body, mind and spirit - to the people of California, just as the first Daughters did more than 150 years ago. As a member of the Daughters of Charity Health System, St. Louise Regional Hospital continues to uphold its mission of providing quality medical services to the most vulnerable populations, the sick, the poor, the elderly, and children. St. Louise Regional Hospital is committed to the fulfillment of the mission of its founding sisters through the delivery of charitable services and care to the community. During fiscal year ended June 30, 2011, St. Louise Regional Hospital provided total quantifiable community benefits of $ 60.2 million. After offsetting direct revenue, St. Louise Regional Hospital provided unsponsored community benefits of $ 19.2 million, at cost. Total unsponsored community benefits of $19.2 million, at cost consisted of quantifiable unsponsored benefits for the poor at a cost of $ 7.8 million, quantifiable unsponsored benefits to the broader community at a cost of $ 0.7 million, and quantifiable unsponsored benefits to beneficiaries of the Medicare program at a cost of $ 10.7 million. Form 990 Part IV, Line 12a, and Part XII, Line 2b and 2c The financial statements of the organization are consolidated by the Daughters of Charity Health System and include each of the affiliated Local Health Ministries, their related fundraising Foundations and other related organizations (as listed on Form 990 Schedule R) in accordance with GAAP and audited by an independent public accounting firm. The Daughters of Charity Health System's Board and Audit Committee of the Board have responsibility for oversight of the audit of the consolidated financial statements and selection of the independent public accounting firm. Form 990 Part VI, Line 6 St. Louise Regional Hospital has one member, Daughters of Charity Health System, a California nonprofit religious corporation. Form 990 Part VI, Line 7a The Member's Board of Directors may appoint the organization's directors and officers. Form 990 Part IV, Line 7b The sole member has broad powers including the power to amend the Bylaws and Articles of Incorporation, and approve, interpret and change any statement of mission, philosophy, role or purpose of St. Louise Regional Hospital. The member has the right to approve any merger, dissolution, consolidation or reorganization of St. Louise Regional Hospital. In addition, the member has the right to approve capital and operating budgets, approve debt incurred or guaranteed, approve the disposition of the assets, and establish policy concerning quality of care, finance and resources. Finally, the member has such other powers and rights as provided by the California Nonprofit Corporation Law. Form 990, Part VI, Line 11b Grant Thornton LLP and the System's finance staff work together to gather the required tax information necessary to complete the tax returns. The initial draft return is reviewed by Grant Thornton and the System's finance staff. After the return is discussed and reviewed, recommended changes are reflected on the return and a draft tax return is prepared. The draft tax return is presented to and reviewed with the Finance Committee of the Board and the Board of Directors. After approval of the tax return by the Finance Committee of the Board and the Board of Directors, a final version of the draft return is prepared. The full Board of Directors of the organization receives the final version of the draft return prior to the return being filed. Form 990, Part VI, Line 12c Daughters of Charity Health System ("DCHS") has a Conflict of Interest Policy that covers DCHS and all of its affiliates. The policy provides for a systematic and ongoing method of requiring individuals who have decision making responsibility to disclose and address potential and actual conflicts of interest. Covered individuals are required to complete an annual statement disclosing any conflicts of interest and have a duty to update the disclosure for any potential conflicts of interest that arise during the year. The Presidents/CEOs of the health ministries report the conflict of interest findings and resolutions to their respective Board of Directors. This policy is reviewed annually for compliance by the DCHS's Corporate Responsibility Officer. Form 990, Part VI, Line 15a and 15b The Daughters of Charity Health System ("DCHS") compensation programs cover DCHS and all of its affiliated Local Health Ministries. The CEO of each Local Health Ministry is employed by DCHS. The DCHS compensation programs are designed to recruit, retain, and motivate qualified executives. The programs are designed for positions that have a significant impact on the high-level strategic and policy direction of the Daughters of Charity Health System and its affiliated Local Health Ministries. All of the Local Health Ministry CEOs are paid directly by the Daughters of Charity Health System and covered by the Daughters of Charity Health System compensation programs. Market data analyses are made of comparable organizations within the industry and within the region. Total compensation is established for all executive positions to target similar total compensation of comparable organization market compensation. Base pay is established for all executive positions to target the median range of comparable organization market compensation. The Daughters of Charity Health System utilizes a benefits committee to review compensation and benefits. The Daughters of Charity Health System Board of Directors reviews and approves compensation recommended by the benefits committee, and documents its conclusion that the proposed compensation is reasonable. In evaluating and finalizing its determination of base pay and total compensation for comparable positions at comparable organizations in comparable markets, DCHS utilizes available market data analyses including the DCHS benefits committee, independent compensation consultant, Form 990 of other organizations, written employment contracts, compensation survey or study, recommendation of the benefits committee and approval by the DCHS Board of Directors. Form 990, Part VI, Line 19 St. Louise Regional Hospital makes its Form 990 available upon request. Form 990, Part XI, Line 5 The other changes in net assets or fund balances consist of the following: Change in Unrealized Gain on Investments $16,000 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER MARION BILL DC TITLE:HEALTH COUNSELOR HOURS:10 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GEORGE CHIALA TITLE:BOARD MEMBER HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GEORGE GREEN MD TITLE:BOARD MEMBER HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER FRAN CILUAGA DC TITLE:SECRETARY HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT ISSAI TITLE:BOARD MEMBER HOURS:51 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CAROL FURGURSON TITLE:VP COO HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NICOLE THOMSON TITLE:CFO HOURS:2 See Part VII See Part VII See Part VII false false true false false false false false false false false true true true true true false false Seton Medical Center o 1703237 Caritas Business Services l 2632984 St Louise Regional Hospital Foundation c 681538 St Louise Regional Hospital Foundation n 373789 St Louise Regional Hospital Foundation p 294618 Daughters of Charity Health System o 6606264 St Francis Medical Center o 1373409 Schedule R, Part II The following organizations listed below are related to the filing organization including the organization itself: Daughters of Charity Ministry Services Corporation 3663 Martin Luther King Jr. Blvd. Lynwood, CA 90262 EIN: 77-0482943 Col (B): Primary Activity - Managerial and consulting services in the areas of finance, administration and facilities to the Daughters of Charity of St. Vincent de Paul Province of the West ministries. Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501 (c)(3) Col (E): Public Charity Status - 1 Col (F): Direct Controlling Entity Name - Daughters of Charity of St. Vincent de Paul Province of the West Daughters of Charity Health System 26000 Altamont Road Los Altos Hills, CA 94022-4317 EIN: 91-2145484 Col (B): Primary Activity - Health System leadership and support to health ministries. Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11b Col (F): Direct Controlling Entity Name - Daughters of Charity Ministry Services Corporation Caritas Business Services 203 Redwood Shores Parkway, Suite 800 Redwood City, CA 94065 EIN: 51-0659139 Col (B): Primary Activity - Promote and support the activities of the Daughters of Charity Health System and its local health ministries by performing accounting, budgeting and patient financial services on a centralized basis, all of which must be provided internally by each hospital for its exempt operations if not provided by Caritas Business Services. Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Director Controlling Entity Name - Daughters of Charity Health System Hotel Dieu, Inc. 3663 Martin Luther King Blvd. Lynwood, California 90262 EIN: 95-475156 Col (B): Primary Activity - Low-Income residence for fragile senior citizens Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 9 Col (F): Director Controlling Entity Name - Daughters of Charity Ministry Services Corporation O'Connor Hospital 2105 Forest Avenue San Jose, CA 95128 EIN: 91-2154436 Col (B): Primary Activity - Hospital Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - Daughters of Charity Health System O'Connor Hospital Foundation 2105 Forest Avenue San Jose, CA 95128 EIN: 77-0006295 Col (B): Primary Activity - Fundraising Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - O'Connor Hospital Robert F. Kennedy Medical Center 26000 Altamont Road Los Altos Hills, CA 94022 EIN: 91-2154440 Col (B): Primary Activity - Hospital - Inactive Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - Daughters of Charity Health System Robert F. Kennedy Medical Center Foundation 26000 Altamont Road Los Altos Hills, CA 94022 EIN: 95-3745227 Line (B): Primary Activity - Fundraising - Inactive Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - Robert F. Kennedy Medical Center St. Francis Medical Center 3630 East Imperial Highway Lynwood, CA 90262 EIN: 91-2154439 Col (B): Primary Activity - Hospital Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - Daughters of Charity Health System St. Francis Medical Center of Lynwood Foundation 3630 East Imperial Highway Lynwood, CA 90262-2636 EIN: 95-3190773 Col (B): Primary Activity - Fundraising Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - St. Francis Medical Center Saint Louise Regional Hospital 9400 No Name Uno Gilroy, CA 95020 EIN: 91-2154437 Col (B): Primary Activity - Hospital Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - Daughters of Charity Health System Saint Louise Regional Hospital Foundation 18550 De Paul Drive Morgan Hill, CA 95037 EIN: 56-2384735 Col (B): Primary Activity - Fundraising Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - Saint Louise Regional Hospital St. Vincent Medical Center 2131 West 3rd Street Los Angeles, CA 90057 EIN: 91-2154438 Col (B): Primary Activity - Hospital Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - Daughters of Charity Health System St. Vincent de Paul Ethics Corporation 3630 East Imperial Hwy Lynwood, Ca 90262 EIN: 95-4426405 Col (B): Primary Activity - Supports DCHS Ministries Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501 (c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - St. Francis Medical Center St. Vincent Dialysis Center 2131 West 3rd Street Los Angeles, CA 90057 EIN: 95-3749293 Col (B): Primary Activity - Hospital Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - St. Vincent Medical Center St. Vincent Foundation 2131 West 3rd Street Los Angeles, CA 90057 EIN: 95-3922511 Col (B): Primary Activity - Fundraising Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - St. Vincent Medical Center St. Vincent Senior Center Nutrition Program, Inc. 2131 West 3rd Street Los Angeles, Ca 90057-1901 EIN: 95-3696693 Col (B): Primary Activity - Nutrition Program Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 9 Col (F): Direct Controlling Entity Name - Daughters of Charity Ministry Services Corporation Seton Medical Center 1900 Sullivan Avenue Daly City, CA 94015 EIN: 91-2154441 Col (B): Primary Activity - Hospital Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 3 Col (F): Direct Controlling Entity Name - Daughters of Charity Health System Seton Medical Center Foundation 1900 Sullivan Avenue Daly City, CA 94015 EIN: 94-2824033 Col (B): Primary Activity - Fundraising Col (C): Legal Domicile - CA Col (D): Exempt Code Section - 501(c)(3) Col (E): Public Charity Status - 11a Col (F): Direct Controlling Entity Name - Seton Medical Center Schedule R, Part III O'Connor Health Center 1, A California Limited Partnership 1960 The Alameda, Suite 20 San Jose, CA 95126 EIN: 77-0419045 Col (B): Primary Activity - Development and Rental Col (C): Legal Domicile - CA Col (D): Direct Controlling Entity Name - O'Connor Hospital Col (E): Predominant Income - Investment or other income excluded from tax under section 512, 513, or 514 Col (F): Share of Total Income - $523,745 Col (G): Share of end-of-year assets - $3,856,536 Col (H): Disproportionate Allocations - No Col (I): Code V - UBI Amount in Box 20 of Schedule K-1 (Form 1065) -$0 Col (J): General or Managing Partner - No Col (K): Percentage of Ownership - 75% Campbell-Gateway Square, A California Limited Partnership 1960 The Alameda, Suite 20 San Jose, CA 95126 EIN 77-0313494 Col (B): Primary Activity - Development and Rental Col (C): Legal Domicile - CA Col (D): Direct Controlling Entity Name - O'Connor Hospital Col (E): Predominant Income - Unrelated Business Income Col (F): Share of Total Income - $733,880 Col (G): Share of end-of-year assets - $6,055,051 Col (H): Disproportionate Allocations - No Col (I): Code V - UBI Amount in Box 20 of Schedule K-1 (Form 1065) -$0 Col (J): General or Managing Partner - No Col (K): Percentage of Ownership - 65% Schedule R, Part IV Marillac Insurance Company, Ltd. c/o Aon Insurance Managers (Cayman), Ltd. P.O. Box 69GT, B.W.I., Cayman Islands EIN: 98-0417930 Col (B): Primary Activity - Insurance Col (C): Legal Domicile - CJ Col (D): Direct Controlling Entity Name - Daughters of Charity Health System Col (E): Type of Entity - C Corporation Col (F): Share of Total Income - $10,484,306 Col (G): Share of end-of-year assets - $67,958,395 Col (H): Percentage ownership - 100%