2019-05-10T16:43:09-05:00 2018-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2017-07-01 941156295 Saint Francis Memorial Hospital % LARA CARTOSCELLI -FINANCE DE SAIN 4153536600 185 BERRY STREET SUITE 300 San Francisco CA 94107 SHELLY SCHORER CFO 4155442349 2019-05-10 true VALERIE J BALL P00178114 4159635100 162.135.0.56 94661320191305000004 2019-05-10 P 90AB267C569C5FCC3BF519CA5A19E59FC9BF12E3 2B5788CE322FF00EB493AD5B21DC7D604E87DE51 2017 2019-02-21 02:37:17Z CHARLES MCGETTIGAN CHAIR 900 Hyde Street San Francisco CA 94109 269984728 false X www.dignityhealth.org/saintfrancis X 1938 CA TO PROVIDE COMPASSIONATE, QUALITY, COST EFFECIVE MEDICAL AND HEALTHCARE RELATED SERVICES TO MEET THE NEEDS OF THE COMMUNITIES WE SERVE. 19 13 1231 85 89826 1659777 989790 199926411 245496811 17838594 3331903 1841904 2098040 221266686 251916544 3614090 5199219 0 0 139344845 136552391 0 0 0 106872427 112196397 249831362 253948007 -28564676 -2031463 319926839 303239888 110064324 93023323 209862515 210216565 X TO PROVIDE COMPASSIONATE, HIGH-QUALITY, AFFORDABLE HEALTH SERVICES FOR OUR SISTERS AND BROTHERS WHO ARE POOR AND DISENFRANCHISED; AND PARTNERING WITH OTHERS IN THE COMMUNITY TO IMPROVE THE QUALITY OF LIFE. false false 221428624 5199219 245496811 SAINT FRANCIS MEMORIAL HOSPITAL'S MISSION IS TO CONTRIBUTE TO THE HEALTH OF THE COMMUNITY THROUGH THE PROVISIONS OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST EFFECTIVE MANNER. THE HOSPITAL HAS 288 BEDS AND SERVICED PATIENTS AS FOLLOWS: OUTPATIENT VISITS OF 106,492; EMERGENCY VISITS OF 33,715; INPATIENT AND OUTPATIENT OPERATING ROOM CASES OF 3,377. INPATIENT SERVICES: ACUTE MEDICAL SURGICAL CARE AND REHAB, INTENSIVE AND BURN CARE, ADULT PSYCH, PHARMACY, CARDIOPULMONARY, SURGERY AND TELEMETRY UNIT. OUTPATIENT SERVICES: EMERGENCY CARE, SPORTS MEDICINE AND OCCUPATIONAL HEALTH CLINICS, PULMONARY REHAB, OUTPATIENT BURN CARE, SPINE AND JOINT/PAIN/MS CLINIC, DIAGNOSTIC IMAGING, RADIATION ONCOLOGY, GASTROINTESTINAL SERVICES AND PHYSICAL THERAPY SERVICES, HYPERBARIC OXYGEN CLINIC. SUPPORT SERVICES: CHAPLAINCY PROGRAM, FAMILY SUPPORT SERVICES, PALLIATIVE CARE, PARKING SERVICES, NURSING EDUCATION SERVICES, HEALTH SCIENCES LIBRARY; AS WELL AS SUPPORT, TIME AND MONEY TO ORGANIZATIONS AND INDIVIDUALS THROUGHOUT THE COMMUNITY. 221428624 true true false true false false false false false true true false true false true true false true false false false false false false false false true true true true true true false false false false false false false true false true false false false false false true false false false true 209 0 true 1231 true true true false false false false false false false false false X 19 13 false false false false true true true true true false false false true true true true true false false true true CA X LARA CARTOSCELLI -FINANCE DE 9166313334 10901 GOLD CENTER DRIVE SUITE 300 RANCHO CORDOVA CA 95670 X N Thomas Ahlberg MD Board Member 3.0 0.0 X 0 0 0 Amy Bossen MD Board Member 3.0 0.0 X 1551 0 0 Michaela Cassidy Board Member 3.0 0.0 X 0 0 0 Gary Chan MD Board Member 3.0 0.0 X 0 0 0 Robert Devens Board Member 3.0 0.0 X 0 0 0 Daniel Lentz MD Board Member 3.0 0.0 X 0 0 0 Man-Kit Leung MD Board Member 3.0 0.0 X 11500 0 0 Kimberly MacPherson Board Member 3.0 0.0 X 0 0 0 Michael Penn MD Board Member 3.0 0.0 X 0 0 0 Victor Prieto MD Board Member 3.0 0.0 X 0 0 0 Julie Soo JD Board Member 3.0 0.0 X 0 0 0 Todd A Strumwasser MD Board Member 3.0 40.0 X 0 1483476 177026 Peter Teng MD Board Member 3.0 0.0 X 0 0 0 Richard Ward MD Board Member 3.0 0.0 X 1551 0 0 Joseph Yang Board Member 3.0 0.0 X 0 0 0 Harris Goodman MD Vice Chair 3.0 0.0 X X 0 0 0 Robert Harvey MD Secretary 3.0 0.0 X X 0 0 0 David J Malone MD Vice-Chair 3.0 0.0 X X 0 0 0 Charles McGettigan Board Chair 3.0 3.0 X X 0 5250 0 David Klein MD President & CEO 40.0 0.0 X 0 944484 124785 George Lenzi Interim CFO 20.0 20.0 X 0 0 0 Clifford Loader Interim CFO 40.0 0.0 X 258507 0 18233 Charlene Battaglia Senior Director - Nursing 40.0 0.0 X 246512 0 30034 Bradley Grote Senior Director-Nursing Operat 40.0 0.0 X 317929 0 45852 Kathleen Jordan MD VP CMO 40.0 0.0 X 388426 0 75183 Raymond Miller Director-Pharmacy 40.0 0.0 X 235080 0 49745 Tracey Pierce VP, HR 40.0 0.0 X 353339 0 64827 Jill Welton VP Quality/CNO 40.0 0.0 X 483981 0 80202 Abbie Yant VP Communicaton Advocacy Hlth 40.0 0.0 X 193251 0 58760 Frances T L Chee Registered Nurse 40.0 0.0 X 239118 0 33993 Albina Guerrero Registered Nurse 40.0 0.0 X 244652 0 61541 Bradford K Moy Medical Director 40.0 0.0 X 236664 0 40978 Kibrom M Tewolde Director Nursing Burn Center 40.0 0.0 X 279431 0 48032 Yipi Yang Registered Nurse 40.0 0.0 X 249126 0 35983 3740618 2433210 945174 427 false true false SAN FRANCISCO CYBERKNIFE LLC 100 BAYVIEW CIRCLE NEWPORT CA 92660 Medical Services 2530000 INPATIENT SPECIALISTS OF CALIF PO BOX 742936 LOS ANGELES CA 900742936 Medical Services 1776159 TRIMEDX LLC 5451 LAKEVIEW PKWY S DR INDIANAPOLIS IN 46268 Management services 1574365 GALEN INPATIENT PHYSICIANS 2100 POWELL ST STE 900 EMERYVILLE CA 946081803 Medical Services 1073562 ANESTHESIOLOGISTS MED GR OF SF 900 HYDE ST SAN FRANCISCO CO 94109 Medical Services 717750 53 332261 657529 989790 PATIENT NET OF CHARITY AND BAD DEBT 900099 241682155 241682155 MEDICAL OFFICE BUILDING 621110 2526380 2526380 PHYSICIAN PROFESSIONAL FEES 900099 905205 905205 RALLY FAMILY VISITATION SERVICES 446110 303688 303688 CLINIC PROFESSIONAL FEES 900099 42967 42967 36416 36416 245496811 -697500 -697500 0 0 133097 28670 104427 0 104427 104427 20593644 1475274 17789417 250097 2804227 1225177 4029403 4029403 0 0 0 0 0 0 0 0 0 PARKING LOT FEES 812930 918316 0 0 918316 GIFT SHOP 453220 230097 0 0 230097 CAFETERIA 722514 287648 0 0 287648 557552 0 89826 467726 1993613 251916544 245496811 89826 5340117 X 5183900 5183900 15319 15319 0 0 2988267 2792819 195448 1482185 1482185 98560949 92667438 5893511 10243013 9433815 809198 16413567 14705675 1707892 6864410 6397630 466780 0 342411 342411 55983 55983 14568 14568 0 163666 163666 38062123 26265975 11796148 0 1259571 13254 1246317 3722944 2827327 895617 8150632 778800 7371832 0 3106385 3049743 56642 267971 134485 133486 0 107127 96504 10623 1199372 1199372 0 13373645 12592522 781123 1436908 1436908 MEDICAL SUPPLIES 19598612 19597796 816 0 MEDI-CAL PROVIDER FEE 18819790 18819790 0 0 LICENSES & TAXES 531846 346824 185022 0 DUES AND SUBSCRIPTION 306624 70672 235952 0 1676219 1519871 156348 253948007 221428624 32519383 0 X 5210 5060 0 0 71353 91966 33587868 39685875 0 0 0 0 3363220 316890 4049420 3563185 18412280 28462609 230221932 151267657 84173205 78954275 81869442 52607618 0 0 87167590 92288382 0 0 7227251 7264028 319926839 303239888 74798465 61368182 0 0 34446 4731 10000000 10000000 0 0 0 0 490100 351946 0 0 24741313 21298464 110064324 93023323 X 123856377 119060023 70013465 75193869 15992673 15962673 209862515 210216565 319926839 303239888 X -2031463 -978275 3363788 X X false true X true true true X false false false false false false false false true 14568 14568 false PART II - B, Line 1 LOBBYING EXPENDITURES PAID BY THE PARENT ORGANIZATION FOR ANNUAL MEMBERSHIP DUES WHERE EXPENSES ARE ALLOCATED TO THE HOSPITAL: AMERICAN HEALTHCARE PHILANTHROPY $ 8 CATHOLIC HEALTH ASSOCIATION $ 1,821 AMERICAN HOSPITAL ASSOCIATION $ 2,022 HOSPITAL ASSOCIATION OF SO CAL $ 10,495 340B HEALTH (FORMERLY SAFETY NET HOSPTALS)$ 222 ------- TOTAL $ 14,568 ======= 42582994 3743834 46326828 39180096 3402898 42582994 41498514 -1372418 946000 39180096 41664814 200 970214 1136714 41498514 36767665 94403 4859064 56318 41664814 0.34000 0.66000 true false 2094567 2094567 151050332 91716664 59333668 258262 258262 71383275 59292731 12090544 5435496 5435496 78954275 UNCONSOLIDATED FOUNDATION 91156541 F OWNERSHIP IN HEALTH-RELATED 1131841 C 92288382 0 DUE TO RELATED PARTIES 17947985 PENSION LIABILITY 2765744 OTHER NON CURRENT LIABILITIES 533001 DEFERRED COMPENSATION 51734 21298464 X Sch D, Part V, Line 4 THE ENDOWMENT FUNDS ARE INTENDED TO BE USED TO SUPPORT THE HOSPITAL'S HEALTHCARE NEEDS AND OTHER HOSPITAL PROGRAM NEEDS. Sch D, Part X, Line 2 - FIN 48 (ASC 740) FOOTNOTE DIGNITY HEALTH REVIEWS ITS TAX POSITIONS QUARTERLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. true true X true X true X 500. true true true false true true 2332 4303997 4303997 0.01690 15572 77960201 48574972 29385229 0.11570 176 332266 40729 291537 0.00110 18080 82596464 48615701 33980763 0.13370 8 1134 134537 134537 0.00050 4 644 368087 240352 127735 0.00050 3 1033 1055868 298153 757715 0.00300 6 6845 422347 23452 398895 0.00160 21 9656 1980839 561957 1418882 0.00560 21 27736 84577303 49177658 35399645 0.13930 1 1 571 571 2 34 5363 5363 3 35 5934 5934 true 1551942 0 44971808 61906036 -16934228 X true true 1 1 Saint Francis Memorial Hospital 900 Hyde St San Francisco CA 94109 www.saintfrancismemorial.org 220000069 X X X X Saint Francis Memorial Hospital 1 false false true X X X X X X X X X 15 true true true true X SEE SECTION C X true 15 true SEE SECTION C false true X 200. 500. X X X X true true X X X X true X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X X X true X false X X X X true X false false SCHEDULE H, PART V SCHEDULE H, PART V, SECTION B, LINE 5 THE 2015 CHNA TOOK INTO ACCOUNT COMMUNITY INPUT VIA COMMUNITY MEETINGS WITH TARGET RESIDENT POPULATIONS, IN ADDITION TO THE LEADERSHIP AND ACTIVE PARTICIPATION OF THE PUBLIC HEALTH DEPARTMENT AND MANY PUBLIC AND NON-PROFIT AGENCIES. TARGET POPULATIONS FOR THE COMMUNITY MEETINGS WERE SELECTED BASED ON FOUR FACTORS: 1) THE POPULATION HAS KNOWN HEALTH DISPARITIES, 2) LITTLE INFORMATION DESCRIBING THE HEALTH OF THE POPULATION WAS AVAILABLE, 3) THE POPULATION WAS NOT INCLUDED IN A RECENT HEALTH ASSESSMENT, AND 4) THE POPULATION WAS REACHABLE THROUGH AN EXISTING COMMUNITY GROUP. THE MAIN QUESTION ASKED OF MEETING PARTICIPANTS WAS, "WHAT ACTIONS CAN WE TAKE -INCLUDING RESIDENTS, COMMUNITY GROUPS, AND THE SAN FRANCISCO HEALTH IMPROVEMENT PARTNERSHIP - TO IMPROVE HEALTH?" PARTICIPANTS WERE ALSO ASKED ABOUT THE ASSETS AND BARRIERS WHICH EXIST IN THEIR COMMUNITIES REGARDING HEALTH. A TOTAL OF 127 PARTICIPANTS ATTENDED 11 MEETINGS. PARTICIPANTS CAME FROM A VARIETY OF BACKGROUNDS. THE ETHNIC GROUPS WITH THE LARGEST REPRESENTATION IN THE MEETINGS WERE LATINO (23 PERCENT), BLACK/AFRICAN AMERICAN (15 PERCENT), WHITE (17 PERCENT), AND ASIAN (12 PERCENT). OTHER SELF-REPORTED ETHNICITIES INCLUDED ARAB, FILIPINO, JEWISH, MIDDLE EASTERN, AND NATIVE AMERICAN. THE MAJORITY OF PARTICIPANTS WERE FEMALE (59 PERCENT). SCHEDULE H, PART V, SECTION B, LINE 6A DIGNITY HEALTH ST. MARY'S MEDICAL CENTER, SUTTER HEALTH CALIFORNIA PACIFIC MEDICAL CENTER, CHINESE HOSPITAL, KAISER PERMANENTE SAN FRANCISCO, UCSF MEDICAL CENTER SCHEDULE H, PART V, SECTION B, LINE 6B SAN FRANCISCO HEALTH IMPROVEMENT PARTNERSHIP MEMBERS INCLUDING: SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH, CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTE'S COMMUNITY ENGAGEMENT AND HEALTH POLICY PROGRAM AT UCSF, SAN FRANCISCO UNIFIED SCHOOL DISTRICT, THE OFFICE OF THE MAYOR, THE ASIAN AND PACIFIC ISLANDER HEALTH PARITY COALITION, HUMAN SERVICE NETWORK, CHICANO/LATINO/INDIGENA HEALTH EQUITY COALITION, AFRICAN AMERICAN COMMUNITY HEALTH COUNCIL, COMMUNITY CLINIC CONSORTIUM, 12 OTHER COMMUNITY ENGAGEMENT PARTNERS, AND FAITH BASED AND PHILANTHROPIC PARTNERS. SCHEDULE H, PART V, SECTION B, LINE 7A HTTPS://WWW.DIGNITYHEALTH.ORG/BAYAREA/LOCATIONS/SAINTFRANCIS/ABOUT-US/COMM UNITY-BENEFITS SCHEDULE H, PART V, SECTION B, LINE 10A DIGNITY HEALTH HOSPITAL FACILITY IMPLEMENTATION STRATEGY DOCUMENTS CAN BE ACCESSED AT HTTPS://WWW.DIGNITYHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH/COMMUNITY-HEALTH-P ROGRAMS-AND-REPORTS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS. IMPLEMENTATION STRATEGIES ARE ALSO ON HOSPITAL FACILITY'S WEB SITE, AT THE SAME LOCATION AS THEIR CHNA REPORTS LISTED IN PART V, SECTION B, LINE 7A ABOVE. SCHEDULE H, PART V, SECTION B, LINE 11 SAINT FRANCIS MEMORIAL HOSPITAL WILL ADDRESS THE FOLLOWING 2016 CHNA IDENTIFIED AND PRIORITIZED HEALTH NEEDS: ACCESS TO CARE; HEALTHY EATING AND PHYSICAL ACTIVITY; AND BEHAVIORAL/PSYCHOSOCIAL HEALTH. THE HOSPITAL IS ADDRESSING THESE NEEDS IN NUMEROUS WAYS DESCRIBED IN DETAIL IN THE IMPLEMENTATION STRATEGY, WHICH IS WIDELY AVAILABLE TO THE PUBLIC ONLINE. PROGRAMS INCLUDE: TENDERLOIN HEALTH IMPROVEMENT PARTNERSHIP (GREEN MOBILE HEALTH EDUCATION KITCHEN, TENDERLOIN SAFE PASSAGE, TENDERLOIN ECONOMIC DEVELOPMENT PROJECT, BOYS AND GIRLS CLUBS OF SAN FRANCISCO, TENDERLOIN INTRAVENOUS DRUG USE WORKGROUP); HEALTHRIGHT 360'S TENDERLOIN HEALTH SERVICES, EMERGENCY DEPARTMENT TRANSITIONS PROGRAM AND ADDICTION MEDICINE; HEALTHY SAN FRANCISCO; AND RALLY FAMILY VISITATION SERVICES. THE TENDERLOIN HEALTH IMPROVEMENT PARTNERSHIP IS A MULTI-SECTOR COLLECTIVE IMPACT INITIATIVE COMMITTED TO IMPROVE THE HEALTH, SAFETY AND WELL-BEING OF RESIDENTS IN SAN FRANCISCO'S TENDERLOIN NEIGHBORHOOD. IT IS DESIGNED SUPPORT AND ENHANCE COMMUNITY BUILDING CAPACITY NONPROFITS, BUSINESSES, GOVERNMENT AGENCIES, AND FUNDERS OPERATING WITHIN A SINGLE NEIGHBORHOOD, THE TENDERLOIN, TO WORK TOGETHER IN MORE COORDINATED WAYS TO IMPROVE RESIDENTS' HEALTH OUTCOMES. THE HOSPITAL WILL NOT DIRECTLY ADDRESS: SAFETY AND VIOLENCE PREVENTION; SUBSTANCE ABUSE; OR HOUSING STABILITY/HOMELESSNESS. THESE NEEDS ARE BEYOND THE HOSPITAL'S INSTITUTIONAL AND RESOURCE CAPACITY, AND ARE BEING ADDRESSED BY OTHERS IN THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 16A-16C HTTPS://WWW.DIGNITYHEALTH.ORG/BAYAREA/LOCATIONS/SAINTFRANCIS/PATIENTS-AND- VISITORS/FOR-PATIENTS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE SCHEDULE H, PART V, SECTION B, LINE 16J ADDITIONAL MEASURES TAKEN TO PUBLICIZE DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY INCLUDE THE PROVISION OF BROCHURES EXPLAINING AVAILABLE GOVERNMENT SPONSORED PROGRAMS AND THE FINANCIAL ASSISTANCE POLICY, A COPY OF THE FINANCIAL ASSISTANCE APPLICATION, A TELEPHONE NUMBER FOR PATIENTS TO REQUEST FURTHER INFORMATION ABOUT THE PROGRAM, AVAILABLITY OF INFORMATION IN LANGUAGES OTHER THAN ENGLISH, CONTACT INFORMATION FOR FINANCIAL COUNSELORS OR OTHER REPRESENTATIVES WHO CAN PROVIDE INFORMATION.THE FACILITY'S WEB SITE ALSO CONTAINS THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY OF THE POLICY, APPLICATION, BILLING AND COLLECTION POLICY, A DESCRIPTION OF THE AMOUNT GENERALLY BILLED AND A LISTING OF PROVIDERS AT EACH FACILITY THAT ARE COVERED AND NOT COVERED BY THE FINANCIAL ASSISTANCE POLICY. CONTACT INFORMATION CAN ALSO BE FOUND ON EACH FACILITY'S WEB PAGE. THE POLICYS PLAIN LANGUAGE SUMMARY IS INCLUDED IN THE HOSPITALS ANNUAL COMMUNITY BENEFIT REPORT WHICH IS WIDELY AVAILABLE TO THE PUBLIC ONLINE, IS IN THE CHARITY CARE REPORT SUBMITTED TO THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH, AND IS SHARED WITH THE HOSPITALS COMMUNITY HEALTH/COMMUNITY BENEFIT COMMITTEE WHICH INCLUDES COMMUNITY REPRESENTATIVES. 3 SMI Imaging LLC 6740 E Camelback Road Suite 101 Scottsdale AZ 85251 imaging Cyberknife 900 HYDE STREET San Francisco CA 94109 Oncology GoHealth Urgent Care Mangement LLC 5555 Glenride Connector Ste 700 Atlanta GA 30342 Clinic SCHEDULE H, PART I, LINE 7 FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, SFMH 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 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, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH AND CASH AND IN-KIND DONATIONS. SCHEDULE H, PART I, LINE 7B, COLUMN (F) BEGINNING IN 2009, THE STATE OF CALIFORNIA ESTABLISHED PROVIDER FEE PROGRAMS. THESE PROGRAMS ARE FUNDED BY QUALITY ASSURANCE FEES PAID BY PARTICIPATING HOSPITALS AND MATCHING FEDERAL FUNDS. SFMH RECOGNIZED QUALITY ASSURANCE FEES DURING THE YEAR OF $18.82 MILLION WHICH ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE RELATED TO UNREIMBURSED MEDICAID (PART I, LINE 7B, COLUMN C), AND RECOGNIZED FEE-FOR-SERVICE SUPPLEMENTAL PAYMENTS OF $23.44 MILLION DURING THE YEAR REFLECTED UNDER THE MEDICAID PROGRAM AS DIRECT OFFSETTING REVENUE (PART I, LINE 7B, COLUMN D). THIS NET INCREASE IN THE COST OF THE MEDICAID PROGRAM IS DRIVING THE INCREASE IN THE OVERALL COST OF COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSES WHEN COMPARED TO PRIOR YEARS. SCHEDULE H, PART I, LINE 7I INCLUDED IN CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT IS $162,157 IN GRANTS TO A FUND ESTABLISHED BY THE CALIFORNIA HEALTH FOUNDATION AND TRUST ("CHFT") FOR SEVERAL PURPOSES, INCLUDING AGGREGATING AND DISTRIBUTING FINANCIAL RESOURCES TO SUPPORT CHARITABLE ACTIVITIES AT VARIOUS HOSPITALS AND HEALTH SYSTEMS IN CALIFORNIA, CONSISTENT WITH CHFT'S MISSION OF SUPPORTING HEALTH CARE, ASSESS TO HEALTH CARE, RESEARCH AND EDUCATION. Schedule H, Part II - Community Building Activities SAINT FRANCIS MEMORIAL HOSPITAL'S EFFORTS TO PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES EXTEND BEYOND PROVIDING HEALTH CARE SERVICES. SAINT FRANCIS MEMORIAL HOSPITAL TAKES A PROACTIVE APPROACH TO ADDRESSING THE SOCIAL, ECONOMIC AND ENVIRONMENTAL BARRIERS TO GOOD HEALTH, AND SUPPORTS THE WORLD HEALTH ORGANIZATION DEFINITION OF HEALTH AS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING, NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY. SAINT FRANCIS MEMORIAL HOSPITAL SERVES AS MEMBERS OF COMMUNITY COALITIONS THAT FOCUS ON THE WELL-BEING OF SAN FRANCISCO AND THE TENDERLOIN NEIGHBORHOOD. COALITION BUILDING - UNDER COALITION BUILDING IS THE SAN FRANCISCO HEP B FREE, WHICH IS A CITYWIDE CAMPAIGN, CREATED TO EDUCATE, TEST, VACCINATE AND TREAT SAN FRANCISCO ASIAN AND PACIFIC ISLANDER (API) RESIDENTS OF HEPATITIS B (HBV). SAINT FRANCIS MEMORIAL HOSPITAL ALONG WITH OTHER COMMUNITY ORGANIZATIONS, HOSPITAL AND THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH ARE COLLABORATING TO PROVIDE CONVENIENT, FREE OR LOW-COST TESTING OPPORTUNITES AT STREET FAIRS AND CLINICS. WORKFORCE DEVELOPMENT - SAINT FRANCIS MEMORIAL HOSPITAL HAS PARTNERSHIPS WITH LOCAL HIGH SCHOOLS, COMMUNITY COLLEGES AND UNIVERSITIES TO ADDRESS HEALTH CARE WORKFORCE SHORTAGES, OFFERING HEALTH CAREER MENTORING PROJECTS AND PROVIDING SCHOOL-BASED AND COMMUNITY PROGRAMS THAT DRIVE ENTRY INTO HEALTH CAREERS AND NURSING PRACTICE. Schedule H, Part III - BAD DEBT, MEDICARE & COLLECTION PRACTICES SCHEDULE H, PART III, LINE 2 THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE CCR (SEE SCHEDULE H, PART I, LINE 7) 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, SFMH PROVIDES FREE OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS THAT FALL INTO THREE CATEGORIES; UNDER 200%, 201%-350% OR 351%-500% OF THE FEDERAL POVERTY LEVEL. SFMH ALSO PROVIDES PATIENTS OPTIONS FOR PROMPT PAY DISCOUNTS, 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 30%. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE. SCHEDULE H, PART III, LINE 3 SFMH MAKES EVERY EFFORT IN DETERMINING IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. SFMH FOLLOWS DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY. DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. DIGNITY HEALTH ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF AN UNINSURED PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL UNINSURED PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE FINANCIAL ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC 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 FINANCIAL ASSISTANCE WERE REPORTED AS BAD DEBT. AS SUCH, SFMH DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE. SCHEDULE H, PART III, LINE 4 THE FOLLOWING IS AN EXCERPT FROM DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS' CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2018, 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 PAYORS, AND OTHERS FOR SERVICES RENDERED. SFMH MANAGES ITS COLLECTION RISK BY REGULARLY REVIEWING ITS ACCOUNTS AND CONTRACTS AND BY PROVIDING APPROPRIATE ALLOWANCES. RESERVES FOR CHARITY AND UNCOLLECTIBLE AMOUNTS HAVE BEEN ESTABLISHED AND ARE NETTED AGAINST PATIENT ACCOUNTS RECEIVABLE IN THE CONSOLIDATED BALANCE SHEET. SCHEDULE H, PART III, LINE 8 SFMH 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 INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. DIGNITY HEALTH AND ITS SUBORDINATES BELIEVES THAT THE ENTIRE MEDICARE SHORTFALL OF $1.2 BILLION, 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 DIGNITY HEALTH HOSPITALS 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 $16.9 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 SFMH. SCHEDULE H, PART III, LINE 9B SFMH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. SFMH FOLLOWS DIGNITY HEALTH'S BILLING AND COLLECTION POLICY. DIGNITY HEALTH'S COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHOM THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF SFMH OR THE BILLING COMPANY RETAINED BY DIGNITY HEALTH IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED FINANCIAL ASSISTANCE OR FOR ASSISTANCE UNDER DIGNITY HEALTH'S PATIENT FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, SFMH 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. 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 THE BILLING COMPANY RETAINED BY DIGNITY HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, SFMH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT. SCHEDULE H, PART VI, LINE 2 - NEEDS ASSESSMENT IN ADDITION TO CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT AT LEAST EVERY THREE YEARS, SAINT FRANCIS MEMORIAL HOSPITAL CONTINUOUSLY ASSESSES THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES BY WORKING COLLABORATIVELY WITH LOCAL SAN FANCISCO DEPARTMENT OF PUBLIC HEALTH, FEDERALLY QUALIFIED HEALTH CENTERS, NON-PROFIT CLINICS, AND OTHER HEALTH, SOCIAL SERVICE AND COMMUNITY-BASED ORGANIZATIONS. SAINT FRANCIS MEMORIAL HOSPITAL ALSO GAINS AND MAINTAINS KNOWLEDGE OF HEALTH NEEDS IN PART THROUGH REFERRAL RELATIONSHIPS, SERVICE PLANNING ACTIVITIES, COMMUNITY HEALTH PARTNERSHIPS, AND LOCAL ADVOCACY CONDUCTED IN CONJUNCTION WITH COMMUNITY PARTNERS. SPECIFICALLY THROUGH THE TENDERLOIN HEALTH IMPROVEMENT PARTNERSHIP (TLHIP), SAINT FRANCIS MEMORIAL HOSPITAL AND THE SAINT FRANCIS FOUNDATION HOST REGULAR PARTNER ALIGNMENT CONFERENCES, CONVENING COMMUNITY-BASED ORGANIZATIONS AND REPRESENTATIVES FROM PUBLIC AND PRIVATE AGENCIES TO REVIEW SHARED CONTRIBUTIONS AND STRATEGIES TO ADDRESS HEALTH NEEDS IDENTIFIED BY TENDERLOIN RESIDENTS. TO HELP FURTHER UNDERSTAND THE NEEDS OF THE TENDERLOIN AND CENTRAL MARKET NEIGHBORHOOD AND INFORM HEALTH IMPROVEMENT STRATEGIES LED BY COMMUNITY-BASED ORGANIZATIONS, POLICY MAKERS AND RESIDENTS, THE CENTRAL MARKET TENDERLOIN DATA PORTAL (CMTL) WAS CREATED BY THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH IN PARTNERSHIP WITH TLHIP AND THE SAN FRANCISCO OFFICE OF ECONOMIC AND WORKFORCE DEVELOPMENT (OEWD). FOR MORE INFORMATION, VISIT HTTP://WWW.CMTLDATA.ORG/. SAINT FRANCIS MEMORIAL HOSPITAL CREATES AND MAKES WIDELY AVAILABLE TO THE PUBLIC ANNUAL COMMUNITY BENEFIT REPORTS THAT SUMMARIZE IDENTIFIED HEALTH NEEDS, UPDATE COMMUNITY DEMOGRAPHIC INFORMATION, AND REPORT ON RECENT AND PLANNED COMMUNITY HEALTH PROGRAMS, INCLUDING GOALS, OBJECTIVES AND MEASURABLE RESULTS. IN ADDITION, SAINT FRANCIS MEMORIAL HOSPITAL USES DATA ON ADMISSIONS FOR AMBULATORY CARE SENSITIVE CONDITIONS THAT EVIDENCE SUGGESTS COULD HAVE BEEN AVOIDED, AT LEAST IN PART, THROUGH MORE ROBUST COMMUNITY ACCESS TO OR USE OF PRIMARY AND PREVENTIVE CARE RESOURCES. SAINT FRANCIS MEMORIAL HOSPITAL ALSO MAKES FULL USE OF DIGNITY HEALTH'S COMMUNITY NEEDS INDEX (CNI), A TOOL DEVELOPED IN PARTNERSHIP WITH TRUVEN HEALTH ANALYTICS WHICH PROVIDES AN AGGREGATE SCORE OF THE SOCIOECONOMIC BARRIERS THAT PUT RESIDENTS AT GREATER RISK OF NEEDING HEALTH SERVICES. THE CNI AGGREGATES NINE INDICATORS INTO FIVE SOCIOECONOMIC FACTORS KNOWN TO CONTRIBUTE TO HEALTH DISPARITY. THE FIVE INCLUDE INCOME, CULTURE/LANGUAGE, EDUCATION, HOUSING STATUS, AND INSURANCE COVERAGE. THE INDEX IS CALCULATED ANNUALLY FOR EVERY ZIP CODE IN THE UNITED STATES. RESIDENTS OF COMMUNITIES WITH THE HIGHEST CNI SCORES WERE SHOWN TO BE TWICE AS LIKELY TO EXPERIENCE PREVENTABLE HOSPITALIZATION FOR MANAGABLE CONDITIONS AS COMMUNITIES WITH THE LOWEST CNI SCORES. THE CNI PROVIDES COMPELLING EVIDENCE FOR ADDRESSING SOCIOECONOMIC BARRIERS WHEN CONSIDERING HEALTH POLICY AND LOCAL HEALTH PLANNING. THE TOOL HIGHLIGHTS HEALTH CARE DISPARITIES AND ENABLES HEALTH CARE PROVIDERS, POLICYMAKERS, AND OTHERS TO TARGET RESOURCES WHERE THEY ARE MOST NEEDED. ADDITIONAL INFORMATION ABOUT THE CNI IS ACCESSIBLE AT HTTPS://WWW.DIGNITYHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH/COMMUNITY-HEALTH-P ROGRAMS-AND-REPORTS. THE DIGNITY HEALTH CNI FINDINGS ARE IN ALIGNMENT WITH THE OTHER HEALTH INDICATOR DATA FOUND ON THE SFHIP.ORG WEBSITE. SCHEDULE H, PART VI, LINE 3 - PATIENT EDUCATION PATIENT EDUCATION OF ELIGIBILITY FOR COMMUNICATION OF THE FINANCIAL ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC: SFMH FOLLOWS DIGNITY HEALTH'S FINANCIAL ASSISTANCE PROGRAM. INFORMATION ABOUT DIGNITY HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF THE SFMH'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS SFMH MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES SFMH SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT ALL UNINSURED PATIENTS RECEIVE AN UNINSURED DISCOUNT OF 30%, AND THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION OR WITH PROMPT PAYMENT. FINANCIAL ASSISTANCE INFORMATION, GOVERNMENT PROGRAM RESOURCE INFORMATION, TOOLS TO ASSIST PATIENTS IN FINDING HEALTH COVERAGE, ANSWERS TO FREQUENTLY ASKED BILLING QUESTIONS, AND OTHER SUCH INFORMATION CAN ALSO BE FOUND ON SFMH'S WEBSITE AT HTTPS://WWW.DIGNITYHEALTH.ORG/BAYAREA/LOCATIONS/SAINTFRANCIS/PATIENTS-ANDV ISITORS/FOR-PATIENTS/BILLING-AND-PAYMENT/FINANCIAL-ASSISTANCE AND ALSO ON DIGNITY HEALTH'S WEBSITE AT WWW.DIGNITYHEALTH.ORG. AT THE POINT OF REGISTRATION, BROCHURES ARE MADE AVAILABLE TO ALL PATIENTS EXPLAINING THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND THE AVAILABILITY OF GOVERNMENT SPONSORED PROGRAMS. COPIES OF THE FINANCIAL ASSISTANCE APPLICATION ARE MADE AVAILABLE TO ALL UNINSURED PATIENTS IN ADDITION TO THE BROCHURE UPON ADMISSION TO THE FACILITY. 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 THAT THEY MAY BE ELIGIBLE FOR A GOVERNMENT SPONSORED PROGRAM OR FACILITY FUNDED FINANCIAL ASSISTANCE, INSTRUCTIONS ON HOW TO APPLY FOR A GOVERNMENT PROGRAM OR FINANCIAL ASSISTANCE AND THE PROVISION OF SUCH APPLICATIONS. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF SFMH REQUIRES ALL INITIAL STATEMENTS TO UNINSURED PATIENTS TO INCLUDE VERBIAGE INFORMING PATIENTS OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND A COPY OF THE FINANCIAL ASSISTANCE APPLICATION. ALSO, ANY MEMBER OF THE SFMH STAFF OR MEDICAL STAFF MAY MAKE REFERRALS OF PATIENTS FOR FINANCIAL ASSISTANCE. THE PATIENT, A FAMILY MEMBER, A CLOSE FRIEND OR AN ASSOCIATE OF THE PATIENT MAY ALSO MAKE A REQUEST FOR FINANCIAL ASSISTANCE. SCHEDULE H, PART VI, LINE 4 - COMMUNITY INFORMATION SFMH IS THE ONLY HOSPITAL LOCATED IN DOWNTOWN SAN FRANCISCO. PATIENTS ACCESSING THE HOSPITAL'S SERVICES ENCOMPASS BOTH THE CITY'S RICHEST TO POOREST RESIDENTS. THE HOSPITAL PRIMARILY SERVES SAN FRANCISCO; HOWEVER, A NUMBER OF SPECIALIZED PROGRAMS DRAW PATIENTS FROM ALL OVER NORTHERN CALIFORNIA AND BEYOND. SAN FRANCISCO IS DENSELY POPULATED AND BOASTS CULTURALLY DIVERSE NEIGHBORHOODS IN WHICH RESIDENTS SPEAK MORE THAN 12 DIFFERENT LANGUAGES. PARTS OF SAN FRANCISCO (47 CENSUS TRACTS) ARE FEDERALLY-DESIGNATED AS MEDICALLY UNDERSERVED AREAS. MANY OF THE HOSPITALS COMMUNITY BENEFIT PROGRAMS FOCUS ON A NEARBY UNDERSERVERD NEIGHBORHOOD CALLED THE TENDERLOIN (ZIP CODE 94102). TOTAL POPULATION: 884,998 RACE/ETHNICITY: WHITE - NON-HISPANIC 40.1%; BLACK/AFRICAN AMERICAN -NON-HISPANIC 4.8%; HISPANIC OR LATINO 15.4%; ASIAN/PACIFIC ISLANDER 35.5%; ALL OTHERS 4.2% MEDIAN INCOME: $103,876 UNEMPLOYMENT: 3.9% NO HIGH SCHOOL DIPLOMA: 12.5% MEDICAID: 19.6% UNINSURED: 6.5% OTHER AREA HOSPITALS: 8 SCHEDULE H, PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH SAN FRANCISCO HEALTH IMPROVEMENT PARTNERSHIP (SFHIP) - SAINT FRANCIS MEMORIAL HOSPITAL STAFF ARE ACTIVE IN THE SFHIP LEADERSHIP AND STEERING COMMITTEES. SFHIP IS MOTIVATED BY A COMMON VISION, VALUES, AND COMMUNITY-IDENTIFIED HEALTH PRIORITIES AND AS SUCH SFHIP WILL DRIVE COMMUNITY HEALTH IMPROVEMENT EFFORTS IN SAN FRANCISCO. THE ROAD MAP FOR SFHIP IS SAN FRANCISCO'S COMMUNITY HEALTH IMPROVEMENT PLAN, THE DEVELOPMENT PROCESS FOR WHICH ENGAGED COMMUNITY RESIDENTS AND LOCAL PUBLIC HEALTH SYSTEM PARTNERS. THE PLAN IDENTIFIES SAN FRANCISCO'S HEALTH PRIORITIES AS WELL AS GOALS, OBJECTIVES, MEASURES, AND STRATEGIES FOR EACH PRIORITY. THE SAINT FRANCIS MEMORIAL HOSPITAL COMMUNITY BENEFIT PLAN IS DESIGNED TO ALIGN WITH SFHIP PRIORITIES. TENDERLOIN HEALTH IMPROVEMENT PARTNERSHIP (TLHIP) - SAINT FRANCIS MEMORIAL HOSPITAL CONTINUES TO PARTNER WITH THE SAINT FRANCIS FOUNDATION AS THE BACKBONE OF TLHIP TO STRENGTHEN AND ENHANCE THE CAPACITY OF TENDERLOIN ORGANIZATIONS USING A PLACE-BASED STRATEGY AND A FRAMEWORK THAT PROVIDES BETTER COORDINATION BETWEEN GOVERNMENT, BUSINESS, AND NON-PROFIT SECTORS, AND COMMUNITY TO CO-CREATE SOLUTIONS FOR DEEPER IMPACT ACROSS THE SOCIAL DETERMINANTS OF HEALTH. THE THREE CORE COMMUNITY PRIORITIES OF SAFETY, COMMUNITY CONNECTIONS, AND OPPORTUNITIES FOR HEALTHY CHOICES, AND FIVE TLHIP FOCUS AREAS. THE FOCUS AREAS ARE: ACTIVE VIBRANT, SAFE, AND CLEAN SHARED SPACES; BEHAVIORAL HEALTH AND MENTAL HEALTH; RESIDENT HEALTH; ECONOMIC OPPORTUNITY AND AFFORDABLE RETAIL; AND HOUSING ACCESS. SAN FRANCISCO HEP B FREE - SAINT FRANCIS MEMORIAL HOSPITAL CONTINUES TO BE AN ACTIVE PARTNER IN THE SAN FRANCISCO HEPATITIS B COALITION, PARTICIPATING IN COALITION ACTIVITIES INCLUDING SPONSORING THE ANNUAL GALA TO INCREASE AWARENESS OF HEPATITIS B. SAN FRANCISCO HEP B FREE STARTED AS A CITYWIDE CAMPAIGN OVER 10 YEARS AGO TO CREATE, EDUCATE, TEST, VACCINATE AND TREAT SAN FRANCISCO ASIAN AND PACIFIC ISLANDER (API) RESIDENTS OF HEPATITIS B (HBV). PARTNERS INCLUDE COMMUNITY-BASED ORGANIZATIONS, HOSPITALS, BUSINESSES AND THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH. AS A NOT-FOR-PROFIT HOSPITAL ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, SAINT FRANCIS MEMORIAL HOSPITAL REINVESTS ALL OF ITS SURPLUS FUNDS FROM OPERATING AND INVESTMENT ACTIVITIES TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND REPLACE EXISTING FACILITIES AND EQUIPMENT, INVEST IN TECHNOLOGICAL ADVANCEMENTS, AND SUPPORT COMMUNITY HEALTH PROGRAMS. THIS ACTIVE REINVESTMENT OF FUNDS MAKES IT POSSIBLE FOR SAINT FRANCIS MEMORIAL HOSPITAL TO DELIVER ON ITS MISSION, INCLUDING ENSURING THAT EVERYONE IN THE COMMUNITIES SERVED HAS ACCESS TO HEALTH CARE. SAINT FRANCIS MEMORIAL HOSPITAL IS GOVERNED BY A BOARD OF TRUSTEES. SPECIFIC COMMITTEES, INCLUDING THE COMMUNITY ADVISORY COMMITTEE, HAVE ORGANIZATIONAL POLICY-BASED ROLES TO SET PRIORITIES AND TO OVERSEE COMMUNITY BENEFIT AND HEALTH PROGRAMS. THE BOARD OF TRUSTEES RECEIVES REGULAR REPORTS ON ACTIVITIES AND PERFORMANCE. SAINT FRANCIS MEMORIAL HOSPITAL HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. IN ADDITION, SAINT FRANCIS MEMORIAL HOSPITAL FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY BY EXERCISING THE FOLLOWING: - OPERATING AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY; - PARTNERING WITH HEALTHRIGHT360'S TENDERLOIN HEALTH SERVICES (FORMERLY GLIDE HEALTH CLINIC), A FQHC SERVING THE UNDERSERVED IN THE TENDERLOIN NEIGHBORHOOD; - ENGAGING IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS IN THE TENDERLOIN NEIGHBORHOOD. SCHEDULE H, PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM SFMH IS AFFILIATED WITH DIGNITY HEALTH. AFFILIATES OF DIGNITY HEALTH ALSO PROMOTE THE HEALTH OF ADDITIONAL COMMUNITIES IN BAKERSFIELD, SAN BERNARDINO, SAN FRANCISCO, SAN ANDREAS, AND GRASS VALLEY/NEVADA CITY, CALIFORNIA. THESE AFFILIATES FOLLOW PRACTICES SIMILAR TO THOSE NOTED ABOVE IN DETERMINING THE UNMET HEALTHCARE NEEDS OF THEIR COMMUNITIES. TOTAL UNSPONSORED COMMUNITY BENEFIT EXPENSE FOR DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS FOR THE YEAR ENDED JUNE 30, 2018, IS AS FOLLOWS: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 85,916 108,592,000 0.8% Unpaid Costs of Medicaid/Medi-Cal 1,739,745 555,935,000 4.1% Other Means-tested Programs 13,398 13,971,000 0.1% Community Services: Community Health Services 317,655 23,099,000 0.2% Health Professions Education 14 209,000 0.0% Subsidized Health Services 26,310 3,432,000 0.0% Donations 100,355 39,204,000 0.3% Community Building Activities 2,657 4,468,000 0.0% Community Benefit Operations 1,446 9,166,000 0.1% Total Community Services for the poor 448,437 79,578,000 0.6% Total Benefits for the Poor 2,287,496 758,076,000 5.6% Benefits for the Broader Community: Community Services: Community Health Services 235,185 12,634,000 0.1% Health Professions Education 18,906 98,392,000 0.7% Subsidized Health Services 418 631,000 0.0% Research 284 10,954,000 0.1% Donations 32,055 3,204,000 0.1% Community Building Activities 13,295 3,702,000 0.0% Community Benefit Operations 4,836 1,028,000 0.0% Total Benefits for the Broader Community 304,979 130,545,000 0.9% Total Community Benefits 2,592,475 888,621,000 6.5% Unpaid Costs of Medicare 1,412,924 1,213,419,000 8.9% Total Community Benefits including Unpaid Cost of Medicare 4,005,399 2,102,040,000 15.4% true Dignity Health Medical Foundation 3400 Data Drive Rancho Cordova CA 95670 680220314 501(c)(3) 4656062 N/A N/A Medical Foundation Support California Health Foundation and Trust 1215 K St Ste 800 Sacramento CA 95814 941498697 501(c)(3) 162157 N/A N/A Community Health Saint Francis Foundation 900 Hyde Street San Francisco CA 94109 942597514 501(c)(3) 288991 N/A N/A Foundation Support San Francisco Bay Are Planning And Urban Research 654 MISSION ST San Francisco CA 94105 941498232 501(c)(3) 50000 N/A N/A Community Health HOSPITAL COUNCIL OF NORTHERN & CENTRAL CALIFORNIA 1215 K ST SUITE 800 SACRAMENTO CA 95814 941533644 501(c)(6) 10350 N/A N/A COMMUNITY HEALTH SAN FRANCISCO MARIN MEDICAL SOCIETY 1003A OREILLY AVE San Francisco CA 94129 940835165 501(c)(6) 6750 N/A N/A Community Health 4 2 Medical equipment supplies 24 1832 Book Medical supplies MEALS TO LOW INCOME SENIORS 6803 13487 Book MEALS/FOOD Sched I, Part I, Line 2 AS A 501(C)(3) ORGANIZATION, WE PROVIDE ASSISTANCE TO VARIOUS CHARITABLE ORGANIZATIONS TO PROMOTE DIGNITY HEALTH'S MISSION. A DESIGNATED COMMITTEE 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 ANNUAL SPENDING IS WITHIN THE BUDGETED AMOUNT. X X true true false true false false false false false false false Todd A Strumwasser MD Board Member 0 604407 0 860887 0 18182 0 124078 0 52948 0 1660502 0 0 David Klein MD President & CEO 0 424141 0 232848 0 287495 0 59979 0 64806 0 1069269 0 0 Clifford Loader Interim CFO 184800 0 45999 0 27708 0 18233 0 0 0 276740 0 0 0 Charlene Battaglia Senior Director - Nursing 222679 0 19917 0 3916 0 26744 0 3290 0 276546 0 0 0 Bradley Grote Senior Director-Nursing Operat 227960 0 65835 0 24134 0 31593 0 14259 0 363781 0 0 0 Kathleen Jordan MD VP CMO 335361 0 52269 0 796 0 36408 0 38775 0 463609 0 0 0 Raymond Miller Director-Pharmacy 213051 0 19652 0 2377 0 25758 0 23987 0 284825 0 0 0 Tracey Pierce VP, HR 276049 0 76675 0 615 0 34122 0 30705 0 418166 0 0 0 Jill Welton VP Quality/CNO 341926 0 107954 0 34101 0 44681 0 35521 0 564183 0 0 0 Abbie Yant VP Communicaton Advocacy Hlth 167384 0 21947 0 3920 0 21707 0 37053 0 252011 0 0 0 Frances T L Chee Registered Nurse 181751 0 2006 0 55361 0 18316 0 15677 0 273111 0 0 0 Albina Guerrero Registered Nurse 243160 0 1492 0 0 0 23115 0 38426 0 306193 0 0 0 Bradford K Moy Medical Director 234428 0 375 0 1861 0 26047 0 14931 0 277642 0 0 0 Kibrom M Tewolde Director Nursing Burn Center 207238 0 34377 0 37816 0 19282 0 28750 0 327463 0 0 0 Yipi Yang Registered Nurse 247301 0 1825 0 0 0 20927 0 15056 0 285109 0 0 0 PART I, LINE 3 ALTHOUGH THE ORGANIZATION EMPLOYS PERSONNEL, THE ORGANIZATION RELIED ON A RELATED ORGANIZATION, DIGNITY HEALTH, THAT USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART I, LINE 3, TO ESTABLISH THE ORGANIZATION'S PRESIDENT'S COMPENSATION. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A FOR ADDITIONAL INFORMATION. SCHEDULE J, PART I, LINE 1A TAX GROSS-UP PAYMENT WAS PROVIDED TO ONE KEY EMPLOYEE. THIS GROSS UP PAYMENT WAS INCLUDED AS TAXABLE COMPENSATION TO THE LISTED PERSON. THE ORGANIZATION PROVIDED HOUSING ALLOWANCE FOR PERSONAL USE TO ONE KEY EMPLOYEE. THE VALUE OF THE HOUSING WAS REPORTED AS TAXABLE INCOME TO THE INDIVIDUAL. SCHEDULE J, PART I, LINE 4A THE LISTED PERSONS PAID BY THE PARENT ORGANIZATION PARTICIPATE IN A SEVERANCE PLAN PROVIDED BY DIGNITY HEALTH 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 AND DEFERRED COMPENSATION PURSUANT TO THE PLAN ARRANGEMENT OCCURRED DURING 2017. THE ORGANIZATION'S NON-CONTRACTUAL EMPLOYEES PARTICIPATE IN A SEVERANCE PLAN PROVIDED BY SAINT FRANCIS MEMORIAL HOSPITAL THAT PROVIDES FAIR COMPENSATION, RANGING FROM PAYMENTS OF 2 WEEKS TO 18 WEEKS OF BASE COMPENSATION, DEPENDING ON THE EMPLOYEE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE PLAN. SEVERANCE FOR EMPLOYEES COVERED BY COLLECTIVE BARGAINING AGREEMENTS VARIES BY AGREEMENT. NO PAYMENTS AND DEFERRED COMPENSATION PURSUANT TO THE PLAN ARRANGEMENT OCCURRED DURING 2017. SCHEDULE J, PART I, LINE 4B CERTAIN LISTED PERSONS ARE ELIGIBLE TO PARTICIPATE IN NON-QUALIFIED 457(F) PLANS THAT ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE, AS REQUIRED BY THE IRS. THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR EXECUTIVES HIRED PRIOR TO JUNE 30, 2006. THE BENEFIT IS INTENDED TO BRIDGE THE DIFFERENCE, IF ANY, BETWEEN THE BENEFIT PROVIDED UNDER THE DIGNITY HEALTH EXCESS BENEFIT PLAN HAD BENEFIT SERVICE NOT BEEN FROZEN AT JANUARY 1, 2008, AND THE BENEFITS PROVIDED FROM ALL OTHER QUALIFIED AND NON-QUALIFIED PLANS. BENEFITS VEST UNDER THIS 457(F) PLAN AT THE LATER OF THE DATE THE PARTICIPANT ATTAINS AGE 62 OR IS CREDITED WITH 15 YEARS OF SERVICE. THE 2010 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR CERTAIN OFFICERS AND KEY EMPLOYEES, PRIMARILY THOSE WHO ARE NOT ELIGIBLE TO PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN OR THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN DESCRIBED ABOVE. THIS BENEFIT PROVIDES AN ANNUAL ACCRUAL OF 10% OF TOTAL COMPENSATION AND IS PAYABLE ANNUALLY ON JULY 1 ONCE VESTED, WHICH IS AGE 62 WITH 5 YEARS OF SERVICE; THE PLAN ALSO ALLOWS FOR SPECIAL AWARDS. NO PAYMENTS OCCURRED DURING 2017 PURSUANT TO THIS PLAN. COMPENSATION AMOUNTS FOR THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS DISCUSSED ABOVE ARE REPORTED AS DEFERRED COMPENSATION IN THE YEAR ACCRUED (SCHEDULE J, PART II, COLUMN C) AND ARE REFLECTED AGAIN AS REPORTABLE COMPENSATION IN THE YEAR PAID (SCHEDULE J, PART II, COLUMN B(III)). SCHEDULE J, PART III SUPPLEMENTAL DISCLOSURES THE ORGANIZATION'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE THE ORGANIZATION TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES THE ORGANIZATION SERVES, PROMOTING 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 COMPENSATION AND BENEFITS 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. TOTAL COMPENSATION, WHICH INCLUDES BASE SALARY, ANNUAL AND LONG-TERM INCENTIVE COMPENSATION, IS ESTABLISHED TO APPROXIMATE THE PREVAILING MARKET CONDITIONS FOR EXECUTIVES OF COMPANIES OF SIMILAR SIZE, REVENUES AND COMPLEXITY. PAYMENTS PURSUANT TO A LONG-TERM FINANCIAL PERFORMANCE GOAL WERE PAID IN CALENDAR YEAR 2017. A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033FYE4 2005-11-10 200000000 SEE PART VI - BOND 1 - CUSIP 13033 false false true A 0 0 10000000 0 0 0 0 0 0 10000000 0 0 2007 false false true true A false true true true true true 0.00100 0.00000 0.00100 false false 0.00000 false true A false false false true true false 0 false 0 true true A true BOND 1 - CUSIP 13033FYE4 SCHEDULE K, PART I, COLUMN (E) THE DIFFERENCE BETWEEN THE ISSUE PRICE IN PART I, COLUMN (E) AND PART II, LINE 3 IS PRIMARILY A RESULT OF THE COMPOSITE BOND ISSUE THAT WAS A POOLED FINANCING ISSUE. THE FULL ISSUE PRICE OF WHICH IS SHOWN IN PART I, COLUMN (E). IN COMPARISON, THE AMOUNT OF PROCEEDS SHOWN IN PART II, LINE 3 REFLECTS ONLY THE PORTION OF THE BOND ISSUE BORROWED BY SAINT FRANCIS MEMORIAL HOSPITAL AND CURRENTLY OUTSTANDING. A SMALL PART OF THE DIFFERENCE BETWEEN THE ISSUE PRICE AND PROCEEDS IS DUE TO INVESTMENT EARNINGS. SCHEDULE K, PART I, COLUMN (F) FINANCE ACQUISITION OF MEDICAL EQUIPMENT AND CONSTRUCTION AND RENOVATION OF HOSPITAL FACILITIES. SCHEDULE K, PART IV, LINE 2C AS OF THIS BOND ISSUE'S PRIOR REBATE COMPUTATION DATE OF 1/28/2015, IT WAS DETERMINED THAT NO REBATE WAS DUE. VICTOR PRIETO MD VICTOR PRIETO - BM 96469 MEDICAL SERVICES false PARAGON PATHOLOGY MEDICAL ASSOCIATE H GOODMAN - BM 535483 MEDICAL SERVICES false ROBERT HARVEY MD R HARVEY - BM (PROF CORP) 130650 MEDICAL SERVICES false Anesthesiologists Medical Grp of SF THOMAS AHLBERG - BM 717750 MEDICAL SERVICES false THOMAS AHLBERG THOMAS AHLBERG - BM 19619 LEASE PAYMENTS TO SFMH false Form 990, Part I, Line 7b Part I, Line 7b includes section 512(a)(7) qualified transportation fringe benefit amounts that are not revenue and therefore not reported on form 990. Form 990, PART VI,VII, XI and XII FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS DIGNITY HEALTH, A 501(C)(3) EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A DIGNITY HEALTH, AS THE SOLE CORPORATE MEMBER, RATIFIES THE SELECTION OF MEMBERS AND THE DIGNITY HEALTH BOARD APPROVES NEW BOARD MEMBERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B RESERVED RIGHTS OF THE CORPORATE MEMBER 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 11B THE FORM 990 WAS REVIEWED BY FINANCE AND ACCOUNTING (REGIONAL DIGNITY HEALTH MANAGEMENT AND CORPORATE TAX DEPARTMENT), WHICH WORKED CLOSELY WITH AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN. THE BOARD OF TRUSTEES HAS DELEGATED THE REVIEW OF THE FORM 990 TO THE FINANCE COMMITTEE. MANAGEMENT PROVIDED THE DRAFT OF THE FORM 990 TO THE FINANCE COMMITTEE BEFORE FILING THE RETURN WITH THE IRS FOR DISCUSSION AT THE COMMITTEE MEETING. THE DRAFT WAS COMPLETE EXCEPT IT EXCLUDED COMPENSATION INFORMATION. SUBSEQUENT TO ITS REVIEW, THE FINANCE COMMITTEE REPORTED BACK TO THE BOARD REGARDING ITS REVIEW AND PROVIDED A DRAFT TO THE BOARD OF TRUSTEES, AGAIN EXCLUDING COMPENSATION. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. UNDER SUCH POLICIES, THE EVP/GENERAL COUNSEL IS DESIGNATED AS THE ORGANIZATIONS FILING OFFICER AND RESPONSIBLE FOR COLLECTING, REVIEWING AND VALIDATING ANNUAL DISCLOSURES OF ALL COVERED PERSONS INCLUDING THE MEMBERS OF DIGNITY HEALTHS GOVERNING BODIES INCLUDING ITS BOARD OF DIRECTORS AND BOARD COMMITTEES, AS WELL AS DIGNITY HEALTHS OFFICERS AND EXECUTIVE LEADERS, KEY EMPLOYEES, MANAGEMENT PERSONNEL AT THE VICE PRESIDENT LEVEL AND ABOVE, AND ANY OTHER PERSONNEL DESIGNATED BY THE FILING OFFICER("COVERED PERSONS"). ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS ARISING FROM THE BUSINESS, OWNERSHIP, FINANCIAL AND PERSONAL INTERESTS HELD BY SUCH COVERED PERSONS OR THEIR FAMILY MEMBERS. COVERED PERSONS ARE REQUIRED TO DISCLOSE TO THEIR SUPERVISORS AND TO RELEVANT DECISION MAKERS ANY INTEREST THAT MAY PRESENT A CONFLICT OF INTEREST, OR THE APPEARANCE OF A CONFLICT OF INTEREST. SUCH DISCLOSURE IS REQUIRED ON A TRANSACTIONAL BASIS AT THE TIME SUCH CONFLICTS ARISE, WHEN AN INDIVIDUAL BECOMES A COVERED PERSON (E.G. UPON HIRING OR UPON PROMOTION), AND ANNUALLY THEREAFTER. AS PART OF THE ANNUAL DISCLOSURE SURVEY CONDUCTED PURSUANT TO THE COI POLICIES, EACH COVERED PERSON IS REQUIRED TO CERTIFY THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE COI POLICY OR COI POLICIES APPLICABLE TO HIS/HER POSITION; (2) HAS READ THE COI POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE COI POLICIES, INCLUDING COMPLETING THE CONFLICTS OF INTEREST DISCLOSURE SURVEY AS REQUIRED BY THE COI POLICIES. USING THE INFORMATION FROM THE ANNUAL DISCLOSURE SURVEY, THE FILING OFFICER PREPARES ANNUAL REPORTS OF REPORTED CONFLICTS OF INTEREST AND DISTRIBUTES THOSE REPORTS TO THE GOVERNING BODY CHAIRS, INCLUDING THE CHAIR OF THE BOARD OF DIRECTORS AND THE CHAIR OF DIGNITY HEALTH BOARD COMMITTEES, AS WELL AS TO KEY LEADERS OF THE ORGANIZATION TO ENABLE THE RESPONSIBLE INDIVIDUALS TO MONITOR AND MANAGE DISCLOSED CONFLICTS OF INTEREST AND ASSURE DECISIONS ARE MADE IN THE ORGANIZATION'S BEST INTERESTS. THE PROCEDURES FOR ADDRESSING A CONFLICT OF INTEREST RELATED TO A PROPOSED TRANSACTION IN THE CASE OF GOVERNING BODIES INCLUDE, BUT ARE NOT LIMITED TO: (1) THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST IS FULLY DISCLOSED TO THE APPLICABLE GOVERNING BODY AND ANY OTHER RELEVANT DECISION-MAKERS; (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 INTERESTED PERSON MAY BE EXCLUDED FROM THE DISCUSSION AND MUST BE EXCUSED FROM THE MEETING PRIOR TO AND DURING THE APPROVAL OF SUCH TRANSACTION; (4) IF WARRANTED, ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED, AND COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED; (5) THE TRANSACTION OR ACTION IS APPROVED BY A MAJORITY OF DISINTERESTED MEMBERS OF THE GOVERNING BODIES, CONSISTENT WITH ANY REQUIREMENTS OF BYLAWS AND COI POLICIES; AND (6) ANY CONFLICTING ISSUES ARISING DURING THE COURSE OF A GOVERNING BODY MEETING WHICH CANNOT BE RESOLVED MAY BE REFERRED TO AN INDEPENDENT COMMITTEE OF THE APPLICABLE GOVERNING BODY. THERE ARE SIMILAR CONFLICTS OF INTEREST PROVISIONS UNDER DIGNITY HEALTHS STANDARDS OF CONDUCT, WHICH ARE APPLICABLE TO ALL EMPLOYEES AND WHICH ARE ADMINISTERED BY THE VP/CORPORATE COMPLIANCE OFFICER WHO HAS REPORTING RESPONSIBILITY TO THE PRESIDENT/CEO AS WELL AS TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD OF DIRECTORS FORM 990, PART VI, SECTION B, LINE 15A ALTHOUGH THE ORGANIZATION EMPLOYS PERSONNEL, THE PRESIDENT IS COMPENSATED BY DIGNITY HEALTH. FOR 2017, DIGNITY HEALTH'S BOARD OF DIRECTORS APPOINTS A HUMAN RESOURCES AND COMPENSATION COMMITTEE, COMPRISED OF INDEPENDENT DIRECTORS, WHO ARE ACCOUNTABLE FOR SETTING REASONABLE COMPENSATION PACKAGES FOR EACH OFFICER AND CERTAIN KEY EMPLOYEES (INCLUDING THE PRESIDENT/CEO). THE HUMAN RESOURCES AND COMPENSATION COMMITTEE APPROVES, CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR OFFICERS AND KEY EXECUTIVES. THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ALSO ENGAGES OUTSIDE LEGAL COUNSEL AS NECESSARY AND QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALISTS (INDEPENDENT EXPERTS) TO REVIEW, ANALYZE AND PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGES OF OFFICERS AND KEY EXECUTIVES. APPROPRIATE COMPARABLE DATA IS OBTAINED FROM THE INDEPENDENT EXPERTS, (E.G., TOTAL ECONOMIC BENEFITS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR SIMILAR JOB RESPONSIBILITIES). KEY DELIBERATIONS OF THE COMMITTEE ARE DOCUMENTED IN MEETING MINUTES WHICH ARE APPROVED AT THE NEXT COMMITTEE MEETING AND PROVIDED TO THE BOARD OF DIRECTORS. THE DOCUMENTATION OF THE DELIBERATIONS INCLUDES (A) THE TERMS OF THE TRANSACTION APPROVED AND THE DATE APPROVED; (B) THE MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING DISCUSSION OF THE APPROVED TRANSACTION AND THOSE WHO VOTED ON IT; AND (C) THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE COMMITTEE AND HOW THE DATA WAS OBTAINED. FORM 990, PART VI, SECTION B, LINE 15B FOR 2017, THE PARENT ORGANIZATION'S HUMAN RESOURCES DEPARTMENT CONDUCTED AN ANNUAL REVIEW AND ANALYSIS TO PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGE OF KEY EXECUTIVES. THE COMPENSATION FOR THESE INDIVIDUALS WAS BASED ON THE QUALIFICATION AND EXPERIENCE OF THE CANDIDATES. COMPENSATION IS ALSO REVIEWED ANNUALLY AS PART OF THE MERIT INCREASE PROCESS. FORM 990, PART VI, SECTION C, LINE 19 FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY BE MADE AVAILABLE FOR PUBLIC INSPECTION. FORM 990 AND THE COPY OF AUDITED FINANCIAL STATEMENTS ATTACHED TO IT ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A T. STRUMWASSER, MD, C. MCGETTIGAN AND D. KLEIN RECEIVED COMPENSATION FOR SERVICES PROVIDED TO A RELATED ORGANIZATION, DIGNITY FORM 990, PART XI, LINE 9 SHARED JOINT VENTURE FUND BALANCE; $ (1,786,616) INTEREST IN NET ASSETS OF UNCONSOLIDATED FOUNDATION; $ 5,150,404 FORM 990, PART XII, LINE 3B THE ORGANIZATION'S FEDERAL AWARDS WERE INCLUDED IN DIGNITY HEALTH'S CONSOLIDATED OMB CIRCULAR A-133 AUDITED SCHEDULE OF FEDERAL EXPENDITURES SAFE HARBOR ELECTION DISCLOSURE TANGIBLE PROPERTY REGULATION STATEMENT SECTION 1.263(A)-1(F) DE MINIMIS SAFE HARBOR ELECTION TAXPAYER IS MAKING THE DE MINIMIS SAFE HARBOR ELECTION UNDER TREASURY REGULATION 1.263(A)-1(F) FOR ALL ELIGIBLE AMOUNTS PAID OR INCURRED DURING THE TAXABLE YEAR. FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL SERVICES/FEES TOTAL FEES:10431574 FORM 990 PART IX LINE 11G DESCRIPTION:REPAIRS & MAINTENANCE TOTAL FEES:5083477 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATIVE SERVICES TOTAL FEES:7754732 FORM 990 PART IX LINE 11G DESCRIPTION:REVENUE CYCLE SERVICES TOTAL FEES:6965829 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:2347071 FORM 990 PART IX LINE 11G DESCRIPTION:PARKING & SECURITY TOTAL FEES:1952093 FORM 990 PART IX LINE 11G DESCRIPTION:STORAGE/JANITORIAL/WASTE MGMT TOTAL FEES:1857680 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:1669667 DIGNITY HEALTH 185 Berry Street San Francisco CA 94107 941196203 Hospital CA 501(c)(3) 3 NA false false true true false false false false false false false false false true false false false false true false NONE