MARK TWAIN MEDICAL CENTER: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
MARK TWAIN MEDICAL CENTER (EIN 68-0127677)
Tax period
2016-07-01 to 2017-06-30
Filed
2018-05-04
IRS object ID
201841249349300824
Schema version
2016v3.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-05-04T12:15:25-05:00ReturnTs
Tax Period End2017-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line155 SECOND STREET SUITE 1400AddressLine1Txt
CitySAN FRANCISCOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94105ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN680127677EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Mark Twain Medical CenterBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% ROBIN AGUILLON ACCOUNTING DInCareOfNm
Business Name ControlMARKBusinessNameControlTxt
Phone2097543521PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1185 BERRY STREET SUITE 300AddressLine1Txt
CitySAN FRANCISCOCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94107ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCHRIS ROBERTSPersonNm
Person TitleVP & CFOPersonTitleTxt
Phone2097542614PhoneNum
Signature2018-05-02SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonVALERIE J BALLPreparerPersonNm
PTINP00178114PTIN
Phone4159635100PhoneNum
Preparation2018-05-03PreparationDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerCHRIS ROBERTS CFOPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1768 MOUNTAIN RANCH ROADAddressLine1Txt
CitySAN ANDREASCityNm
State AbbreviationCAStateAbbreviationCd
ZIP95249ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$73,485,792GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.marktwainmedicalcenter.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1987FormationYr
Legal Domicile StateCALegalDomicileStateCd
Activity Or MissionTo continuously improve the health status of our community. of our community.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee372TotalEmployeeCnt
Total Volunteers24TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$450,500PYContributionsGrantsAmt
CY Contributions Grants$9,965CYContributionsGrantsAmt
PY Program Service Revenue$63,162,045PYProgramServiceRevenueAmt
CY Program Service Revenue$58,834,010CYProgramServiceRevenueAmt
PY Investment Income$634,694PYInvestmentIncomeAmt
CY Investment Income$896,574CYInvestmentIncomeAmt
PY Other Revenue$533,928PYOtherRevenueAmt
CY Other Revenue$269,487CYOtherRevenueAmt
PY Total Revenue$64,781,167PYTotalRevenueAmt
CY Total Revenue$60,010,036CYTotalRevenueAmt
PY Grants And Similar Paid$370,085PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$374,755CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$35,747,681PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$34,895,666CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$32,790,987PYOtherExpensesAmt
CY Other Expenses$29,389,697CYOtherExpensesAmt
PY Total Expenses$68,908,753PYTotalExpensesAmt
CY Total Expenses$64,660,118CYTotalExpensesAmt
PY Revenues Less Expenses-$4,127,586PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$4,650,082CYRevenuesLessExpensesAmt
Total Assets BOY$46,290,454TotalAssetsBOYAmt
Total Assets EOY$45,185,982TotalAssetsEOYAmt
Total Liabilities BOY$9,034,710TotalLiabilitiesBOYAmt
Total Liabilities EOY$11,544,541TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$37,255,744NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$33,641,441NetAssetsOrFundBalancesEOYAmt
MissionTO CONTINUOUSLY IMPROVE THE HEALTH STATUS OF OUR COMMUNITY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$53,143,104ExpenseAmt
Grant$374,755GrantAmt
Revenue$58,834,010RevenueAmt
DescTHE HOSPITAL PROVIDES ROUTINE PATIENT CARE IN PRIVATE AND SEMI-PRIVATE ROOMS AS WELL AS VARIOUS INPATIENT AND OUTPATIENT ANCILLARY SERVICES SUCH AS X-RAY, LAB, EMERGENCY ROOM, ETC. DURING THE FISCAL YEAR 2017, 927 PATIENTS WERE ADMITTED TO THE FACILITY AND 72,488 OUTPATIENT VISITS WERE RECORDED INCLUDING VISITS AT OUR 5 RURAL HEALTH CLINICS.Desc
Total Program Service Expenses$53,143,104TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstYes (true)ReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntYes (true)BusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document96IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee372EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldCAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonROBIN AGUILLON ACCOUNTING DPersonNm
Phone9166313337PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line110901 GOLD CENTER DRIVE 3RD FLOORAddressLine1Txt
CityRANCHO CORDOVACityNm
State AbbreviationCAStateAbbreviationCd
ZIP95670ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Sean Anderson MD
Board Member20.00.0Yes (X)$98,340$0$15,488
Susan Atkinson
Board Member4.00.0Yes (X)$0$0$0
Cindy Holst
Board Member (thru 4/25/17)4.040.0Yes (X)$0$306,068$60,890
Charles Kassis
Board Member4.040.0Yes (X)$0$674,506$107,632
Dean Kelaita MD
Board Member (thru 1/24/17)4.00.0Yes (X)$6,600$0$0
Ken McInturf
Board Member (thru 11/29/16)4.00.0Yes (X)$0$0$0
Lin Reed
Board Member4.00.0Yes (X)$0$0$0
William Griffin MD
Chairman4.00.0Yes (X)$7,000$0$0Yes (X)
Katherine A Medeiros
Secretary (Thru 6/27/17)4.040.0Yes (X)$0$464,815$79,929Yes (X)
David Woodhams DDS
Treasurer4.00.0Yes (X)$0$0$0Yes (X)
Robert Diehl
President & CEO40.00.0$0$212,154$21,185Yes (X)
Chris L Roberts
VP & CFO40.00.0$232,183$0$51,315Yes (X)
Robert Allen
VP Clinics40.00.0$394,416$0$55,388Yes (X)
Katherine Mc Coy
VP & CNE40.00.0$212,026$0$32,927Yes (X)
John D Anderson MD
Physician40.00.0$261,593$0$35,824Yes (X)
Richard Gonzales MD
Family Practice Physician40.00.0$232,722$0$60,412Yes (X)
Jill Ortiz
Director of Pharmacy40.00.0$229,964$0$67,626Yes (X)
Sanaz Parsa MD
Physician40.00.0$240,836$0$40,203Yes (X)
Mohamad A Parsa MD
Physician40.00.0$331,160$0$57,422Yes (X)
Lawrence A Phillip
Former Officer0.00.0$0$147,332$11,492Yes (X)
Craig Marks
Former Officer0.00.0$0$576,984$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,246,840TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,381,859TotReportableCompRltdOrgAmt
Total Other Compensation$697,733TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K96IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Inpatient Service of CA Inc
7032 Collection Ctr DrCHICAGOIL60693medical services$1,211,296
Rodger Orman MD Inc
PO Box 2189MURPHYSCA95247medical services$767,204
Trimedx LLC
5451 Lakeview Pkwy S DrINDIANAIN46268mgmt svc - equipment$743,687
Elisabeth Siegler MD A PC
585 Stanislaus AveANGELS CAMPCA95222medical services$697,164
CRAIG H LOVETT MD INC
PO BOX 610ALTAVILLECA95221medical services$611,846
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K21CntrctRcvdGreaterThan100KCnt
All Other Contributions$9,965AllOtherContributionsAmt
Total Contributions$9,965TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT NET OF CHARITY AND BAD DEBT900099$34,254,110$34,254,110
MEDICARE/MEDICAID PAYMENTS900099$24,448,090$24,448,090
MEANINGFUL USE INCENTIVES900099$47,148$47,148
OUTPATIENT TELEHEALTH900099$30,000$30,000
BLOOD WORK FEES900099$15,685$15,685

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$38,977TotalRevenueColumnAmt
Related Or Exempt Func Income$38,977RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$58,834,010TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$197,774TotalRevenueColumnAmt
Exclusion$197,774ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$14,174,556SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$13,475,756SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$698,800SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$698,800TotalRevenueColumnAmt
Exclusion$698,800ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
CAFETERIA561000$137,349$137,349
TENANT SERVICES561110$99,545$99,545
A/R FINANCE CHARGE900099$11,743$11,743

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$20,850TotalRevenueColumnAmt
Exclusion$20,850ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$269,487OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$60,010,036TotalRevenueColumnAmt
Related Or Exempt Func Income$58,834,010RelatedOrExemptFuncIncomeAmt
Exclusion$1,166,061ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$374,755TotalAmt
Program Services$374,755ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$998,963TotalAmt
Program Services$925,476ProgramServicesAmt
Management And General$73,487ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$301,685TotalAmt
Program Services$301,685ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$24,659,050TotalAmt
Program Services$22,919,402ProgramServicesAmt
Management And General$1,739,648ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,690,479TotalAmt
Program Services$1,555,499ProgramServicesAmt
Management And General$134,980ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$5,477,282TotalAmt
Program Services$5,036,757ProgramServicesAmt
Management And General$440,525ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,768,207TotalAmt
Program Services$1,644,432ProgramServicesAmt
Management And General$123,775ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$111,873TotalAmt
Program Services$0ProgramServicesAmt
Management And General$111,873ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$11,772TotalAmt
Program Services$0ProgramServicesAmt
Management And General$11,772ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$4,913TotalAmt
Program Services$0ProgramServicesAmt
Management And General$4,913ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$64,007TotalAmt
Program Services$0ProgramServicesAmt
Management And General$64,007ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$12,564,748TotalAmt
Program Services$7,976,690ProgramServicesAmt
Management And General$4,588,058ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$682,383TotalAmt
Program Services$20,520ProgramServicesAmt
Management And General$661,863ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,176,528TotalAmt
Program Services$697,331ProgramServicesAmt
Management And General$479,197ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$3,701,027TotalAmt
Program Services$1,288,418ProgramServicesAmt
Management And General$2,412,609ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,285,330TotalAmt
Program Services$963,500ProgramServicesAmt
Management And General$321,830ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$74,058TotalAmt
Program Services$32,707ProgramServicesAmt
Management And General$41,351ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$48,822TotalAmt
Program Services$46,654ProgramServicesAmt
Management And General$2,168ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$102,791TotalAmt
Program Services$102,791ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,014,229TotalAmt
Program Services$1,949,884ProgramServicesAmt
Management And General$64,345ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$478,451TotalAmt
Program Services$478,451ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmtFundraisingFundraisingAmt
MEDICAL SUPPLIES$6,520,033$6,519,713$320$0
FOOD/INVENTORY EXPENSE$198,598$156,709$41,889$0
LICENSES AND TAXES$100,867$41,455$59,412$0
DUES AND SUBSCRIPTIONS$94,033$22,700$71,333$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$155,234TotalAmt
Program Services$87,575ProgramServicesAmt
Management And General$67,659ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$64,660,118TotalAmt
Program Services$53,143,104ProgramServicesAmt
Management And General$11,517,014ManagementAndGeneralAmt
Fundraising$0FundraisingAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XYes (X)InfoInScheduleOPartXInd

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,700BOYAmt
EOY$2,813EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$352,882BOYAmt
EOY$634,591EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$9,526,512BOYAmt
EOY$9,143,129EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$485,877BOYAmt
EOY$227,227EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,141,878BOYAmt
EOY$1,112,434EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$3,076,117BOYAmt
EOY$2,688,548EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$42,591,729LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$29,045,868LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$14,216,557BOYAmt
EOY$13,545,861EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$6,267,902BOYAmt
EOY$5,855,405EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$8,055,149BOYAmt
EOY$8,722,948EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$2,657,311BOYAmt
EOY$2,779,096EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$507,569BOYAmt
EOY$473,930EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$46,290,454BOYAmt
EOY$45,185,982EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$6,285,532BOYAmt
EOY$9,981,102EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$109,137BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,640,041BOYAmt
EOY$1,563,439EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$9,034,710BOYAmt
EOY$11,544,541EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$34,598,433BOYAmt
EOY$30,862,345EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,657,311BOYAmt
EOY$2,779,096EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$37,255,744BOYAmt
EOY$33,641,441EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$46,290,454BOYAmt
EOY$45,185,982EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$4,650,082ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$804,857NetUnrlzdGainsLossesInvstAmt
Prior Period Adjustments$109,137PriorPeriodAdjustmentsAmt
Other Changes In Net Assets$121,785OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$4,913OtherActivitiesAmt
Total Lobbying Expenditures$4,913TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II - B, Line 1iFormAndLineReferenceDesc
ExplanationLOBBYING EXPENDITURES PAID DIRECTLY BY THE FILING ORGANIZATION FOR ANNUAL MEMBERSHIP DUES: NATIONAL RURAL HEALTH ASSOCIATION $ 21 ----- SUBTOTAL $ 21 LOBBYING EXPENDITURES PAID BY THE PARENT ORGANIZATION FOR ANNUAL MEMBERSHIP DUES AND OTHER LOBBYING ACTIVITIES WHERE EXPENSES ARE ALLOCATED TO THE HOSPITAL: AMERICAN HOSPITAL ASSOCIATION $ 1,020 CHA/HASC/HOSPITAL COUNCIL $ 3,387 CATHOLIC HEALTH ASSOCIATION $ 453 340B HEALTH $ 32 -------- SUBTOTAL $ 4,892 -------- TOTAL $ 4,913 ========ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp
LandLandGrp

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$18,715,958OtherCostOrOtherBasisAmt
Depreciation$11,759,697DepreciationAmt
Book Value$6,956,261BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,261,390OtherCostOrOtherBasisAmt
Depreciation$2,926,494DepreciationAmt
Book Value$334,896BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$17,650,698OtherCostOrOtherBasisAmt
Depreciation$13,596,458DepreciationAmt
Book Value$4,054,240BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,963,683OtherCostOrOtherBasisAmt
Depreciation$763,219DepreciationAmt
Book Value$2,200,464BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$13,545,861TotalBookValueLandBuildingsAmt
Financial DerivativesFinancialDerivativesGrp
Closely Held Equity InterestsCloselyHeldEquityInterestsGrp

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescPOOLED INVESTMENTSDesc
Book Value$8,722,948BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$8,722,948TotalBookValueSecuritiesAmt

Invst Program Related Org InvstProgramRelatedOrgGrp

FieldValueIRS element (for citing)
DescINVSTMNT IN UNCONSOLIDATED FNDDesc
Book Value$2,779,096BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Program Rltd$2,779,096TotalBookValueProgramRltdAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
DUE TO RELATED PARTIES$1,296,432
PENSION PAYABLE$22,793
OTHER NON-CURRENT LIABILITIES$244,214
FieldValueIRS element (for citing)
Total Liability$1,563,439TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule D, Part X, Line 2 - FIN 48 (ASC 740) FOOTNOTEFormAndLineReferenceDesc
ExplanationDIGNITY HEALTH REVIEWS ITS TAX POSITIONS ANNUALLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other500.DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served257PersonsServedCnt
Total Community Benefit Expns$294,005TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$294,005NetCommunityBenefitExpnsAmt
Total Expense0.00450TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Persons Served26470PersonsServedCnt
Total Community Benefit Expns$18,402,259TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,413,491DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,988,768NetCommunityBenefitExpnsAmt
Total Expense0.12360TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Persons Served14PersonsServedCnt
Total Community Benefit Expns$5,523TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,298DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,225NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Persons Served26741PersonsServedCnt
Total Community Benefit Expns$18,701,787TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,414,789DirectOffsettingRevenueAmt
Net Community Benefit Expns$8,286,998NetCommunityBenefitExpnsAmt
Total Expense0.12820TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs10ActivitiesOrProgramsCnt
Persons Served1325PersonsServedCnt
Total Community Benefit Expns$468,405TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$468,405NetCommunityBenefitExpnsAmt
Total Expense0.00720TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Activities Or Programs5ActivitiesOrProgramsCnt
Persons Served1PersonsServedCnt
Total Community Benefit Expns$430,549TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$430,549NetCommunityBenefitExpnsAmt
Total Expense0.00670TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs15ActivitiesOrProgramsCnt
Persons Served1326PersonsServedCnt
Total Community Benefit Expns$898,954TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$898,954NetCommunityBenefitExpnsAmt
Total Expense0.01390TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs15ActivitiesOrProgramsCnt
Persons Served28067PersonsServedCnt
Total Community Benefit Expns$19,600,741TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$10,414,789DirectOffsettingRevenueAmt
Net Community Benefit Expns$9,185,952NetCommunityBenefitExpnsAmt
Total Expense0.14210TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$2,500TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,500NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$2,500TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,500NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$1,423,263BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$15,206,011ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$20,418,875CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$5,212,864MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Mark Twain Medical CenterBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1768 Mountain Ranch RoadAddressLine1Txt
CitySan AndreasCityNm
State AbbreviationCAStateAbbreviationCd
ZIP95249ZIPCd
FieldValueIRS element (for citing)
Website Addressdignityhealth.org/marktwainmedical/WebsiteAddressTxt
State License030000058StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Mark Twain Medical CenterBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE SECTION COwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLSEE SECTION CStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care500.FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSEE SECTION CFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE SECTION CFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE SECTION CFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE H, PART V, SECTION B, LINE 5FormAndLineReferenceDesc
ExplanationCHNA INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS RECENTLY CONDUCTED IN FISCAL YEAR 2017, AS REQUIRED BY STATE LAW (SB 697). IT WAS A COLLABORATIVE EFFORT INVOLVING THE MARK TWAIN MEDICAL CENTER COMMUNITY BOARD OF DIRECTORS, THE CALAVERAS COUNTY DEPARTMENT OF PUBLIC HEALTH, PRACTICING PHYSICIANS, VARIOUS COMMUNITY MEMBERS AND THE CALAVERAS COUNTY SCHOOL DISTRICT PERSONNELS AND VARIOUS BOARD MEMBERS. THE PURPOSE OF THIS CHNA IS TO IDENTIFY AND PRIORITIZE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY SERVED BY MARK TWAIN MEDICAL CENTER (MTMC). THE PRIORITIES IDENTIFIED IN THIS REPORT HELP TO GUIDE THE HOSPITALS COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND COMMUNITY BENEFIT ACTIVITIES, AS WELL AS ITS COLLABORATIVE EFFORTS WITH OTHER ORGANIZATIONS THAT SHARE A MISSION TO IMPROVE HEALTH. MTMC WORKED TO COLLECT THE PRIMARY AND SECONDARY DATA REQUIREMENTS OF THE CHNA WITH APPLIED SURVEY RESEARCH (ASR), A NONPROFIT, SOCIAL RESEARCH FIRM. THE CHNA DATA COLLECTION PROCESS TOOK PLACE OVER TWO MONTHS AND CULMINATED IN A REPORT WRITTEN FOR MTMC IN JUNE OF 2017. MTMC CONTRACTED WITH ASR TO CONDUCT PRIMARY RESEARCH. THEY USED THREE STRATEGIES FOR COLLECTING COMMUNITY INPUT: KEY INFORMANT INTERVIEWS WITH HEALTH EXPERTS, A COMMUNITY SUMMIT WITH A SELECTION OF COMMUNITY PARTNERS AND LOCAL EXPERTS, AND A SURVEY OF MARK TWAIN MEDICAL CENTER STAFF. ASR CONDUCTED PRIMARY RESEARCH VIA KEY INFORMANT INTERVIEWS WITH FOUR CALAVERAS COUNTY EXPERTS FROM VARIOUS ORGANIZATIONS. IN FEBRUARY AND MARCH OF 2017, EXPERTS WERE CONSULTED, INCLUDING THE COUNTY HEALTH OFFICER AND THE DIRECTOR OF PUBLIC HEALTH NURSING. ALL THESE EXPERTS HAD COUNTYWIDE EXPERIENCE AND EXPERTISE. EXPERTS WERE INTERVIEWED BY TELEPHONE FOR APPROXIMATELY ONE HOUR. INFORMANTS WERE ASKED TO IDENTIFY THE TOP NEEDS OF THEIR CONSTITUENCIES, HOW ACCESS TO HEALTHCARE HAS CHANGED IN THE POST-AFFORDABLE CARE ACT ENVIRONMENT, THE IMPACT OF THE PHYSICAL ENVIRONMENT ON HEALTH, AND THE EFFECT OF THE USE OF NEW TECHNOLOGIES FOR HEALTH-RELATED ACTIVITIES. EACH INTERVIEW WAS RECORDED AND SUMMARIZED AS A STAND-ALONE PIECE OF DATA. WHEN ALL INTERVIEWS HAD BEEN CONDUCTED, THE TEAM ANALYZED THE INFORMATION AND TABULATED ALL HEALTH NEEDS THAT WERE MENTIONED, ALONG WITH HEALTH DRIVERS DISCUSSED. ASR THEN MADE A LIST OF ALL OF THE CONDITIONS THAT HAD BEEN MENTIONED BY A KEY INFORMANT, COUNTED HOW MANY INFORMANTS LISTED THE CONDITION AND HOW MANY TIMES THEY HAD BEEN PRIORITIZED. IN APRIL 2017, MTMC SURVEYED STAFF AND STAKEHOLDERS (35 HOSPITAL EMPLOYEES AND 12 COMMUNITY STAKEHOLDERS) REGARDING THE PRIORITIZED HEALTH NEEDS. FOR THE FOUR IDENTIFIED NEEDS, THE SURVEY ASKED HOW THEIR WORK WAS IMPACTED, WHAT CURRENT EFFORTS THEY WERE INVOLVED IN TO ADDRESS THOSE NEEDS, AND IF THEY HAD SUGGESTIONS FOR STRATEGIES THAT THE HOSPITAL COULD IMPLEMENT, EITHER ALONE OR IN COLLABORATION WITH OTHER STAKEHOLDERS. THE SURVEY ALSO ASKED RESPONDENTS TO IDENTIFY ANY OTHER HIGH-PRIORITY NEEDS THAT HAD NOT YET BEEN DISCUSSED. ASR COMPILED THE RESEARCH AND PROVIDED COMPARISONS WITH EXISTING BENCHMARKS (HEALTHY PEOPLE 2020, STATEWIDE AND NATIONAL AVERAGES). SECONDARY DATA WAS COLLECTED FROM A VARIETY OF SOURCES INCLUDING BUT NOT LIMITED TO: FEDERAL, STATE, AND LOCAL GOVERNMENT AGENCIES; ACADEMIC INSTITUTIONS; ECONOMIC DEVELOPMENT GROUPS; HEALTH CARE INSTITUTIONS; AND ONLINE DATABASES. SCHEDULE H, PART V, SECTION B, LINE 7A HTTP://WWW.DIGNITYHEALTH.ORG/MARKTWAINMEDICAL/COMMUNITY-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 EACH HOSPITAL FACILITYS WEB SITE, AT THE SAME LOCATIONS AS THEIR CHNA REPORTS LISTED IN PART V, SECTION B, LINE 7a ABOVE. SCHEDULE H, PART V, SECTION B, LINE 11 MARK TWAIN MEDICAL CENTER TOOK NUMEROUS ACTIONS TO HELP ADDRESS IDENTIFIED NEEDS. HEALTH PRIORITY AREAS OF FOCUS BASED ON THE IDENTIFIED NEEDS INCLUDE: ACCESS TO HEALTH CARE, SUBSTANCE USE, ORAL HEALTH, CHRONIC HEALTH ISSUES, MATERNAL AND CHILD HEALTH, AND SOCIAL DETERMINANTS OF HEALTH (ECONOMIC OPPORTUNITIES, HOMELESSNESS AND FOOD INSECURITY). IMPROVED ACCESS TO CARE, INCLUDING ENHANCEMENT OF GEOGRAPHIC ACCESS FOR MEDICAL AND HEALTHY FAMILIES AND THE PROVISION OF PRIMARY CARE CLINICS TO SERVE THE RURAL AREAS OF CALAVERAS COUNTY. ACCESS TO CARE IN THE COUNTY IS FURTHER SUPPORTED BY FIVE HOSPITAL MEDICAL CENTERS LOCATED IN ARNOLD, ANGELS CAMP, COPPEROPOLIS, SAN ANDREAS, AND VALLEY SPRINGS. ADDITIONALLY, THE HOSPITAL NOW ALSO OPERATES THREE SPECIALTY CARE CENTERS: IN ANGELS CAMP FOR ORTHOPEDICS AND IN SAN ANDREAS ON THE MEDICAL CENTER CAMPUS FOR CANCER AND INFUSION THERAPY, AND SURGICAL SPECIALTY CARE. PREVENTIVE SERVICES INCLUDING THE FIVE PRIMARY CARE CLINICS AS WELL AS THE ENGAGEMENT IN COMMUNITY HEALTH FAIRS, WILL OFFER CHOLESTEROL SCREENING, BLOOD PRESSURE CHECKS, BONE DENSITY STUDIES, HEALTH EDUCATION AND INFORMATION ABOUT OTHER RELEVANT SERVICES AVAILABLE IN THE COMMUNITY. TO ADDRESS TWO OF THE MORE PREVALENT CHRONIC CARE NEEDS OF THE COMMUNITY, MTMC WILL CONTINUE TO FOCUS ON PROVIDING EDUCATION AND INSTRUCTION FOR THE CONGESTIVE HEART FAILURE/CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND DIABETES EDUCATION PROGRAMS. THE GOAL OF THESE PROGRAMS IS TO IMPROVE QUALITY OF LIFE FOR PARTICIPANTS BY INCREASING THEIR SELF-EFFICACY AND AVOIDING HOSPITAL ADMISSIONS. MARK TWAIN MEDICAL CENTER IS ACTIVELY RECRUITING PHYSICIANS, BUT IT IS UNABLE AT THIS TIME TO ADDRESS THE NEEDS FOR MENTAL HEALTH PROFESSIONALS, OBSTETRICAL AND SPECIALTY CARE SERVICES DUE TO THE PHYSICIAN AND HEALTH PROFESSIONS SHORTAGE IN THE SERVICE AREA. AT THIS TIME, PATIENTS ARE REFERRED OUTSIDE THE COUNTY TO ACCESS OBSTETRICAL AND GYNECOLOGICAL SERVICES. THE ESTABLISHED PROGRAMS AND SERVICES WILL INDIRECTLY ADDRESS ISSUES RELATED TO OBESITY, BUT OTHER PROGRAMS OFFERED WITHIN THE COMMUNITY, INCLUDING THE SCHOOL DISTRICT, WILL ADDRESS THE ISSUES OF CHILDHOOD OBESITY MORE DIRECTLY. INFORMATION GAPS THAT LIMIT THE ABILITY OF THIS CHNA TO ASSESS THE COMMUNITYS HEALTH NEEDS INCLUDE LIMITED SECONDARY DATA ON SOME OF THE HEALTH NEEDS. SUCH LIMITATIONS INCLUDED LACK OF DATA FOR MATERNAL AND CHILD HEALTH, HEALTH STATUS OF SENIORS, HEALTH EDUCATION AND SEXUAL HEALTH. SCHEDULE H, PART V, SECTION B, LINES 16A THROUGH 16C https://www.dignityhealth.org/central-california/locations/marktwainmedica l/patients-and-visitors/patients/billing-information/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 FINANICAL ASSISTANCE POLICY. CONTACT INFORMATION CAN ALSO BE FOUND ON EACH FACILITYS WEB PAGE.ExplanationTxt
FieldValueIRS element (for citing)
Facility5FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
Valley Springs Family Medical Center
1919 VISTA DEL LAGO DRIVEVALLEY SPRINGSCA95252OUTPATIENT CLINIC
Angels Camp Familly Medical Center
222 SOUTH MAIN STREETANGELS CAMPCA95222OUTPATIENT CLINIC
Arnold Family Medical Center
2182 Highway 4ArnoldCA95223Outpatient Clinic
San Andreas Clinic
704 Mt Ranch Road Suite 103San AndreasCA95249Outpatient Clinic
Copperopolis Family Medical Center
3505 Spangler Lane Suite 400CopperopolisCA95228Outpatient Clinic

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 7MARK TWAIN MEDICAL CENTER (MTMC) FOLLOWS THE METHOD USED BY DIGNITY HEALTH. FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, MTMC USES A COST ACCOUNTING SYSTEM THAT COMBINES RELATIVE VALUE UNITS (RVU) AND COST TO CHARGE RATIOS (CCR) TO ALLOCATE COSTS TO THE PATIENT LEVEL. THE COST ACCOUNTING SYSTEM ALGORITHM ALLOCATES TOTAL OPERATING EXPENSES TO THE PROCEDURE CHARGE CODE LEVEL BASED UPON AN RVU FOR PROCEDURES THAT HAVE BEEN STUDIED AND ASSIGNED AN RVU, OR BASED UPON A CCR FOR UNSTUDIED PROCEDURES THAT DO NOT HAVE AN RVU ASSIGNED. WHEN A CCR IS USED, THE SYSTEM CALCULATES THAT CCR ON A DEPARTMENTAL SPECIFIC BASIS AT EACH INDIVIDUAL FACILITY WHERE THE SERVICES WERE PROVIDED. THE CALCULATION IS SIMILAR TO THE WORKSHEET 2 OF SCHEDULE H, RATIO OF PATIENT CARE COST TO CHARGES, EXCEPT IT IS CALCULATED ON A DEPARTMENTAL SPECIFIC BASIS, NOT IN THE AGGREGATE. THE ALLOCATED PROCEDURE CHARGE CODE LEVEL COSTS ARE THEN ROLLED UP TO THE PATIENT LEVEL BASED UPON THE BILLED PROCEDURE CHARGE CODES ASSOCIATED WITH THOSE SERVICES PROVIDED TO EACH SPECIFIC PATIENT. THIS IS DONE FOR ALL PATIENT SEGMENTS INCLUDING INPATIENT, OUTPATIENT, EMERGENCY DEPARTMENT, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED AND SELF-PAY. THE COST ACCOUNTING SYSTEM IS UTILIZED TO DETERMINE THE UNREIMBURSED COST OF MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS. THE COST OF CHARITY CARE IS CALCULATED BY APPLYING THE CCR DERIVED FROM THE COST ACCOUNTING SYSTEM ON A PER FACILITY BASIS, TO THE CHARGES INCURRED ON PATIENTS THAT QUALIFY FOR CHARITY CARE AT THE RESPECTIVE FACILITY. THE ACTUAL COST IS REPORTED FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS AND CASH AND IN-KIND DONATIONS. SCHEDULE H, PART I, LINE 7, 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. MTMC RECOGNIZED FEE-FOR-SERVICE SUPPLEMENTAL PAYMENTS OF $1.49 MILLION DURING THE YEAR REFLECTED UNDER THE MEDICAID PROGRAM AS DIRECT OFFSETTING REVENUE (PART I, LINE 7B, COLUMN D). SCHEDULE H, PART I, LINE 7I THE CALIFORNIA HOSPITAL ASSOCIATION CREATED A PRIVATE PROGRAM, THE CALIFORNIA HEALTH FOUNDATION AND TRUST ("CHFT"), ESTABLISHED FOR SEVERAL PURPOSES, INCLUDING AGGREGATING AND DISTRIBUTING FINANCIAL RESOURCES TO SUPPORT CHARITABLE ACTIVITIES AT VARIOUS HOSPITALS AND HEALTH SYSTEMS IN CALIFORNIA. DURING THE YEAR, MTMC RECORDED A PLEDGE TO A GRANT FUND ESTABLISHED BY CHFT IN THE AMOUNT $0.05 MILLION. THE GRANT IS REPORTED UNDER OTHER BENEFITS (PART I, LINE 7I, COLUMN C), AS CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS.
Schedule H, Part II - Community Building ActivitiesPHYSICAL IMPROVEMENTS AND HOUSING - MTMC donates to Habitat for Humanity to support construction of housing for people in need, and the local Rotary and other organizations for community building projects.
SCHEDULE H, PART III, LINE 2THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE CCR (SEE ABOVE) TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER FINANCIAL ASSISTANCE, AND ARE OTHERWISE UNINSURED. ANY PORTION OF A PATIENT BILL REMAINING AFTER APPLYING FINANCIAL, UNINSURED OR OTHER DISCOUNTS OR PAYMENTS RECEIVED ON THE ACCOUNT THAT ARE ULTIMATELY DETERMINED TO BE UNCOLLECTIBLE ARE WRITTEN OFF TO BAD DEBT. MTMC 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. MTMC 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 MTMC MAKES EVERY EFFORT IN DETERMINING IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. MTMC 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 PAYMENT 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, DIGNITY HEALTH DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT 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, 2017, RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCES FOR CHARITY AND DOUBTFUL ACCOUNTS: PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE ARE REPORTED AT THE NET REALIZABLE AMOUNT FROM PATIENTS, THIRD-PARTY PAYERS, AND OTHERS FOR SERVICES RENDERED. MTMC 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 MTMC PREPARES MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1, 2150FF AND PRM 15-2, 1000FF. AS SUCH, THE FOLLOWING LANGUAGE PER THE PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR TO BE CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. DIGNITY HEALTH BELIEVES THAT THE ENTIRE MEDICARE SHORTFALL OF $1,197 MILLION, AS REPORTED BELOW IN PART VI, LINE 6, CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY MTMC 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 $5 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 MTMC. SCHEDULE H, PART III, LINE 9B MTMC ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. MTMC ALSO FOLLOWS DIGNITY HEALTH'S COLLECTION POLICY. DIGNITY HEALTH'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHOM THE ORGANIZATION KNOWS QUALIFY FOR CHARITY CARE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF MTMC OR BILLING COMPANY RETAINED BY DIGNITY HEALTH IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED FINANCIAL ASSISTANCE OR FOR ASSISTANCE UNDER DIGNITY HEALTH'S FINANCIAL ASISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, MTMC 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 MTMC. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, MTMC REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT.
Schedule H, Part VI, Line 2 - Needs AssessmentHOSPITAL LEADERSHIP OVERSEES COMMUNITY BENEFIT ACTIVITIES FOR THE HOSPITAL AS IT STRIVES TO MEET THE HEALTH AND WELLNESS NEEDS OF THE LOCAL COMMUNITY. SEVERAL MEMBERS OF MARK TWAIN'S SENIOR AND MIDDLE MANAGEMENT TEAM SERVE THE COMMUNITY ON A VARIETY OF COMMUNITY-BASED NOT-FOR-PROFIT BOARDS, OTHER SERVICE CLUBS, LOCAL CHURCHES AND CHAMBER OF COMMERCE, TO NAME A FEW, AND PROVIDE INSIGHT INTO THE UNIQUE NEEDS OF THE COMMUNITY THAT MAY NOT BE APPARENT IN A SECONDARY DATA BASE. COMMUNITY BENEFIT LEADERSHIP OF MARK TWAIN MEDICAL CENTER OVERSAW THE PROCESS OF THE NEEDS ASSESSMENT, WHICH WAS CONDUCTED BY APPLIED SURVEY RESEARCH. MTMC BOARD OF DIRECTORS, MANY OF WHOM ARE RECOGNIZED COMMUNITY LEADERS, ALSO REPRESENTED THE MEDICAL COMMUNITY. AS REPRESENTATIVES OF THE COMMUNITY, THESE LEADERS AND BOARD MEMBERS PROVIDED INSIGHT INTO THE NEEDS ASSESSMENT THROUGH DISCUSSION AT MEETINGS. THEY ALSO REVIEWED AND APPROVED OF THE ASSESSMENT THROUGH WRITTEN CORRESPONDENCE AND BOARD ROOM DISCUSSION OF CONTENT AND TO ESTABLISH PRIORITIES FOR THE HOSPITAL, WITH A FOCUS ON VULNERABLE POPULATIONS, PARTICULARLY THOSE LIVING WITH CHRONIC CONDITIONS. ONE OF THE AREAS IDENTIFIED IS THE LACK OF ACCESS TO HEALTHCARE IN THE WEST POINT/RAILROAD FLAT AREA OF THE COUNTY. THE HOSPITAL IS WORKING WITH THE HEALTH CARE DISTRICT TO CONSIDER THE PURCHASE OF A MOBILE VAN THAT COULD FILL THE GAP. ACCESS TO CARE IN THE COUNTY IS FURTHER SUPPORTED BY FIVE MTMC'S MEDICAL CENTERS LOCATED IN ARNOLD, ANGELS CAMP, COPPEROPOLIS, SAN ANDREAS, AND VALLEY SPRINGS. SERVICES AT THESE AMBULATORY CENTERS INCLUDE IMMEDIATE CARE, PRIMARY CARE, BEHAVIORAL HEALTH, OCCUPATIONAL HEALTH, PEDIATRICS, LABORATORY DRAWS AND HEALTH EDUCATION. ADDITIONALLY, MTMC NOW ALSO OPERATES THREE SPECIALTY CARE CENTERS: IN ANGELS CAMP FOR ORTHOPEDICS AND IN SAN ANDREAS ON THE MEDICAL CENTER CAMPUS FOR CANCER AND INFUSION THERAPY, AND SURGICAL SPECIALTY CARE. IN THE RURAL ENVIRONMENT OF OUR COMMUNITY, SMALL BUSINESS, AGENCIES AND THE HOSPITAL PARTNER TO PROVIDE VARIOUS EVENTS THROUGHOUT THE YEAR THAT ARE FOCUSED ON PROMOTING THE HEALTH OF THE COMMUNITY, ENHANCING QUALITY OF LIFE FOR THE RESIDENTS AND SHOWCASING THE UNIQUE HISTORY AND NATURAL WONDERS OF OUR ENVIRONMENT. BASED ON THE PRIORITIZED HEALTH NEED OF THE COMMUNITY, A SPECIFIC FOCUS HAS BEEN ON WOMEN'S HEALTH ISSUES AND PRIMARY CARE AND PREVENTION. A COMMUNITY NEEDS ASSESSMENT WAS CONDUCTED IN 2017 IN SUPPORT OF OUR STATED MISSION - TO IMPROVE THE HEALTH OF OUR GREATER COMMUNITY. THE GOAL OF THE ASSESSMENT IS TO CONTINUALLY IMPROVE THE QUALITY OF HEALTH AND HEALTH CARE FOR COUNTY RESIDENTS BY PROVIDING ACCURATE AND RELIABLE INFORMATION TO COMMUNITY MEMBERS AND HEALTH CARE PROVIDERS; RAISING AWARENESS OF HEALTH NEEDS, CHANGING TRENDS, EMERGING ISSUES, AND COMMUNITY CHALLENGES; AND PROVIDING RESEARCH-BASED DATA FOR THE HOSPITAL AND THE COMMUNITY TO CONTINUE STRATEGIC PLANNING EFFORTS. THE FOCUS OF THE ASSESSMENT IS ON HEALTH AND THE MAJOR FACTORS THAT IMPACT HEALTH SUCH AS THE ECONOMY, PUBLIC SAFETY AND THE NATURAL ENVIRONMENT. THE LACK OF ACCESS TO HEALTH CARE PROVIDERS WAS REPEATEDLY MENTIONED AS A DRIVER OR BARRIER THAT CONTRIBUTES TO HEALTH NEEDS. OTHER DRIVERS/BARRIERS MENTIONED INCLUDED STIGMA AROUND MENTAL HEALTH ISSUES, LACK OF TRANSPORTATION, POVERTY, SUBSTANCE USE, LACK OF HEALTH EDUCATION, AND LACK OF ACCESS TO PREVENTIVE CARE. TO ADDRESS TWO OF THE MORE PREVALENT CHRONIC CARE NEEDS OF THE COMMUNITY, MTMC WILL CONTINUE TO FOCUS ON PROVIDING EDUCATION AND INSTRUCTION FOR THE CONGESTIVE HEART FAILURE/CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND DIABETES EDUCATION PROGRAMS. THE GOAL OF THESE PROGRAMS IS TO IMPROVE QUALITY OF LIFE FOR PARTICIPANTS BY INCREASING THEIR SELF-EFFICACY AND AVOIDING HOSPITAL ADMISSIONS. PRIORITIZING THE COORDINATION OF CARE, PARTICULARLY FOR PATIENTS WITH MENTAL HEALTH NEEDS WITH OTHER COMMUNITY ORGANIZATIONS FOR THOSE THAT SEEK CARE IN OUR EMERGENCY ROOM WILL ALSO BE A FOCUS FOR 2018. ASR FACILITATED CONVERSATIONS WITH KEY COMMUNITY MEMBERS THAT RESULTED IN THE LIST OF PRIORITIZED COMMUNITY HEALTH NEEDS LISTED BELOW. UNMET HEALTH NEEDS INCLUDED ACCESS TO HEALTH CARE, SUBSTANCE USE, ORAL HEALTH, CHRONIC HEALTH ISSUES, MATERNAL AND CHILD HEALTH, AND SOCIAL DETERMINANTS OF HEALTH (ECONOMIC OPPORTUNITIES, HOMELESSNESS AND FOOD INSECURITY). SPECIFIC POPULATIONS IDENTIFIED AS HAVING GREATER NEED INCLUDED YOUTH WITH EMOTIONAL ISSUES OR SUBSTANCE USE DISORDERS, WOMEN, CHILDREN IN LOW-INCOME HOUSEHOLDS, AND ISOLATED SENIORS. RURAL PARTS OF THE COUNTY WERE IDENTIFIED AS HAVING GREATER HEALTH NEEDS. DURING FISCAL YEAR 2017, THERE WERE OVER 26,000 PERSON-VISITS THAT BENEFITED FROM OUR COMMUNITY HEALTH PROGRAMS. THE ECONOMIC VALUE OF COMMUNITY BENEFIT PROVIDED BY MARK TWAIN MEDICAL CENTER IN FY17 WAS $9,188,482 EXCLUDING UNPAID COSTS OF MEDICARE IN THE AMOUNT OF $6,198,628.
Schedule H, Part VI, Line 3 - Patient Education of Eligibility forASSISTANCE COMMUNICATION OF THE FINANCIAL ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC: INFORMATION ABOUT PATIENT FINANCIAL ASSISTANCE IS AVAILABLE AT MTMC AND ALL OF ITS COMMUNITY LOCATIONS AND WEBSITES, INCLUDING A CONTACT NUMBER FOR PATIENTS TO CALL FOR INFORMATION AND ASSISTANCE. THE INFORMATION IS DISSEMINATED BY MTMC BY VARIOUS MEANS TO INCLUDE NOTICES ON PATIENT BILLS, BROCHURES AT ALL REGISTRATION DESKS AND IN ALL WAITING ROOMS, AND NOTICES POSTED IN THE EMERGENCY DEPARTMENT. SUCH INFORMATION IS PROVIDED IN ENGLISH AND SPANISH. AT THE POINT OF REGISTRATION, ALL PATIENTS RECEIVE BROCHURES EXPLAINING THE FACILITY'S financial assistance PROGRAM AND THE AVAILABILITY OF GOVERNMENT SPONSORED PROGRAMS. UNINSURED PATIENTS RECEIVE COPIES OF THE financial assistance AND MEDICAID APPLICATIONS 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 THEY MAY BE ELIGIBLE FOR A GOVERNMENT SPONSORED PROGRAM OR FACILITY FUNDED financial assistance, INSTRUCTIONS ON HOW TO APPLY FOR A GOVERNMENT PROGRAM OR CHARITY CARE AND THE PROVISION OF SUCH APPLICATIONS. ANY MEMBER OF MTMC STAFF OR MEDICAL STAFF MAY REFER A PATIENT FOR FINANCIAL ASSISTANCE. THE PATIENT, A FAMILY MEMBER, A CLOSE FRIEND OR AN ASSOCIATE OF THE PATIENT MAY ALSO MAKE A REQUEST FOR FINANCIAL ASSISTANCE.
Schedule H, Part VI, Line 4 - Community InformationTHE HOSPITAL SERVES CALAVERAS COUNTY, APPROXIMATELY 130 MILES EAST OF SAN FRANCISCO, 60 MILES SOUTHEAST OF SACRAMENTO, AND 50 MILES EAST OF STOCKTON. THE RURAL COUNTYS GEOGRAPHY BEGINS NEAR SEA-LEVEL IN THE WEST AND CULMINATES NEAR 8,200 FEET IN THE EASTERN PART OF THE COUNTY, IN THE SIERRA NEVADA RANGE. CALAVERAS COUNTY IS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AND PORTIONS OF THE COUNTY ARE MEDICALLY UNDERSERVED AREAS (MUA). BESIDES MARK TWAIN MEDICAL CENTER AND ITS FIVE AMBULATORY CARE CENTERS, AND FOUR SPECIALTY CARE CENTERS, THE FOLLOWING FACILITIES AND RESOURCES ARE AVAILABLE: -CONVALESCENT HOSPITAL -ASSISTED LIVING -COMMUNITY CLINICS -CHILDREN SERVICES -HOME HEALTH CARE -HOSPICE -MENTAL HEALTH -DRUG & ALCOHOL ABUSE SERVICES -SUPPORT GROUPS & SERVICES -TRANSPORTATION THE COUNTY HAS A RELATIVELY MATURE POPULATION WITH THE MEDIAN AGE OF 50.7 YEARS. ADDITIONALLY, 56% OF HOUSEHOLDS HAVE ONE OR MORE PERSON AGED 60 YEARS OR OLDER. THE UNEMPLOYMENT RATE IN CALAVERAS COUNTY AND THROUGHOUT THE COUNTRY HAS STEADILY DECLINED SINCE 2010, FOLLOWING A TEN-YEAR HIGH. THE UNEMPLOYMENT RATE WAS 9% FOR THE COUNTY DURING 2016. IN 2012, 20% OF CALAVERAS COUNTY RESIDENTS HAD VERY HIGH HOUSING COSTS. TOTAL POPULATION: 44,668, DOWN FROM A HIGH OF 44,932 IN 2013 VETERAN POPULATION: 4,808 (13%) RACE: 81.4% WHITE, 11.8% HISPANIC, 1.6% ASIAN, 0.9% BLACK/AFRICAN AMERICAN, 4.3% OTHER MEDIAN AGE: 50.7 POPULATION OVER 60: 15,270 (34%) MEDIAN INCOME: $59,869 UNEMPLOYMENT: 6.5% NO HS DIPLOMA: 7.5% UNINSURED POPULATION: 5.4% MEDICAID PATIENTS: 25% OF THE POPULATION OTHER AREA HOSPITALS: 0
Schedule H, Part VI, Line 5 - Promotion of Community HealthHOSPITAL LEADERSHIP OVERSEES COMMUNITY BENEFIT ACTIVITIES FOR THE HOSPITAL AS IT MEETS THE HEALTH AND WELLNESS NEEDS OF THE LOCAL COMMUNITY. SEVERAL MEMBERS OF MARK TWAIN MEDICAL CENTER'S SENIOR AND MIDDLE MANAGEMENT TEAM SERVE THE COMMUNITY ON A VARIETY OF COMMUNITY BASED NOT FOR PROFIT BOARDS, SUCH AS , SOROPTOMISTS INTERNATIONAL, AMADOR CALAVERAS HOSPICE ,CHAMBER OF COMMERCE AND CALAVERAS RECOVERS, TO NAME A FEW. THE HOSPITAL IS GOVERNED BY A BOARD OF TRUSTEES, THE MAJORITY OF WHOM RESIDE WITHIN ITS PRIMARY SERVICE AREA AND WHO ARE NOT EMPLOYEES, CONTRACTORS OR FAMILY MEMBERS THEREOF. ACCESS TO CARE IN THE COUNTY IS SUPPORTED BY FIVE MTMC'S MEDICAL CENTERS LOCATED IN ARNOLD, ANGELS CAMP, COPPEROPOLIS, SAN ANDREAS, AND VALLEY SPRINGS. SERVICES AT THESE AMBULATORY CENTERS INCLUDE IMMEDIATE CARE, PRIMARY CARE, BEHAVIORAL HEALTH, OCCUPATIONAL HEALTH, PEDIATRICS, GENERAL X-RAY, LABORATORY DRAWS AND HEALTH EDUCATION. ADDITIONALLY, MTMC NOW ALSO OPERATES THREE SPECIALTY CARE CENTERS: IN ANGELS CAMP FOR ORTHOPEDICS AND IN SAN ANDREAS ON THE MEDICAL CENTER CAMPUS FOR CANCER AND INFUSION THERAPY, AND GASTROENTEROLOGY SPECIALTY CARE. IN THE RURAL ENVIRONMENT OF OUR COMMUNITY, SMALL BUSINESS, AGENCIES AND THE HOSPITAL PARTNER TO PROVIDE VARIOUS EVENTS THROUGHOUT THE YEAR THAT ARE FOCUSED ON PROMOTING THE HEALTH OF THE COMMUNITY, ENHANCING QUALITY OF LIFE FOR THE RESIDENTS AND SHOWCASING THE UNIQUE HISTORY AND NATURAL WONDERS OF OUR ENVIRONMENT. BASED ON THE PRIORITIZED HEALTH NEED OF THE COMMUNITY, A SPECIFIC FOCUS HAS BEEN ON WOMEN'S HEALTH ISSUES AND PRIMARY CARE AND PREVENTION. TO ADDRESS TWO OF THE MORE PREVALENT CHRONIC CARE NEEDS OF THE COMMUNITY, MTMC'S WILL CONTINUE TO FOCUS ON PROVIDING EDUCATION AND INSTRUCTION FOR THE CONGESTIVE HEART FAILURE/CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND DIABETES EDUCATION PROGRAMS. THE GOAL OF THESE PROGRAMS IS TO IMPROVE QUALITY OF LIFE FOR PARTICIPANTS BY INCREASING THEIR SELF-EFFICACY AND AVOIDING HOSPITAL ADMISSIONS. THROUGHOUT THE COMMUNITY ARE IMPORTANT RESOURCES THAT EVERYONE CAN BENEFIT IN TIMES OF NEED. MARK TWAIN MEDICAL CENTER PUBLISHED A COMMUNITY RESOURCES BROCHURE FOR RESIDENTS TO KEEP HANDY AT HOME AND IN THE CAR. THE ORGANIZATIONS IN THIS BROCHURE WORK WITH US TO PROVIDE COMMUNITY RESOURCES THAT CAN MAKE A DIFFERENCE. IN ADDITION, MOST EMPLOYEES HAVE LINKAGES TO VARIOUS SERVICE ORGANIZATIONS THROUGHOUT THE COMMUNITIES. COMMUNITY INVOLVEMENT IS EVIDENCED BY PARTICIPATION OF LOCAL BUSINESS AND COMMUNITY LEADERS IN THE HOSPITAL'S GOVERNING BOARDS, FINANCE COMMITTEE, ETHICS COMMITTEE AND OUR PATIENT ADVISORY COMMITTEE. MTMC EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN AND OUTSIDE ITS COMMUNITY WHO REQUEST SAID PRIVILEGES. ALL SURPLUS FUNDS GENERATED BY MTMC ARE REINVESTED BACK INTO THE ORGANIZATION TO IMPROVE PATIENT CARE AND PROVIDE HEALTH CARE SERVICES TO ITS COMMUNITY.
Schedule H, Part VI, Line 6 - Affiliated Health Care SystemMTMC 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, 2017, IS AS FOLLOWS: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 88,031 98,807,000 0.8% Unpaid Costs of Medicaid/Medi-Cal 1,656,712 1,074,093,000 8.3% Other Means-tested Programs 305,907 9,812,000 0.1% Community Services: Community Health Services 351,566 38,258,000 0.3% Health Professions Education 48 177,000 0.0% Subsidized Health Services 352,535 55,272,000 0.4% Donations 111,409 23,470,000 0.2% Community Building Activities 2,233 2,064,000 0.0% Community Benefit Operations 1,732 9,012,000 0.1% Total Community Services for the poor 819,523 128,253,000 1.0% Total Benefits for the Poor 2,870,173 1,310,965,000 10.2% Benefits for the Broader Community: Community Services: Community Health Services 312,585 14,413,000 0.1% Health Professions Education 34,107 67,391,000 0.5% Subsidized Health Services 2,780 1,486,000 0.0% Research 703 8,804,000 0.1% Donations 22,184 8,543,000 0.1% Community Building Activities 20,730 2,429,000 0.0% Community Benefit Operations 54 1,180,000 0.0% Total Benefits for the Broader Community 393,143 104,246,000 0.8% Total Community Benefits 3,263,316 1,415,211,000 11.0% Unpaid Costs of Medicare 1,384,961 1,196,946,000 9.3% Total Community Benefits including Unpaid Cost of Medicare 4,648,277 2,612,157,000 20.3%

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtValuation Method UsedValuationMethodUsedDescNon Cash AssistanceNonCashAssistanceDescPurpose Of GrantPurposeOfGrantTxt
Mark Twain Medical Center Foundation
768 Mountain Ranch RoadSan AndreasCA95249680023507501(c)(3)$287,395N/AN/AFoundation Support
California Health Foundation and Trust
1215 K Street Suite 800SacramentoCA95814941498697501(c)(3)$52,800N/AN/ACommunity Health
FieldValueIRS element (for citing)
Total501c3 Org2Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 1FormAndLineReferenceDesc
ExplanationAS A 501(C)(3) ORGANIZATION, WE PROVIDE ASSISTANCE TO VARIOUS CHARITABLE ORGANIZATIONS TO PROMOTE MTMC'S MISSION. A DESIGNATED COMMITTEE CONSISTING PRIMARILY OF THE EXECUTIVE TEAM ESTABLISHES AND EVALUATES PRIORITIES AND ALLOCATION OF FUNDS WITH EMPHASIS ON PROMOTION OF HEALTHY COMMUNITIES AND COMMUNITY COLLABORATION. WE DO NOT MONITOR AND REPORT PROGRAM OUTCOMES. SPENDING IS TRACKED ON AN ONGOING BASIS TO ENSURE THAT IT IS GENERALLY WITHIN THE BUDGETED AMOUNT.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Cindy Holst
Board Member (thru 4/25/17)$0$232,861$0$68,187$0$5,020$0$31,699$0$29,191$0$366,958$0$0
Charles Kassis
Board Member$0$328,109$0$334,195$0$12,202$0$59,698$0$47,934$0$782,138$0$0
Katherine A Medeiros
Secretary (Thru 6/27/17)$0$297,039$0$151,748$0$16,028$0$38,704$0$41,225$0$544,744$0$0
Robert Diehl
President & CEO$0$136,020$0$0$0$76,134$0$10,611$0$10,574$0$233,339$0$0
Chris L Roberts
VP & CFO$185,061$0$35,726$0$11,396$0$21,947$0$29,368$0$283,498$0$0$0
Robert Allen
VP Clinics$329,041$0$64,244$0$1,131$0$36,154$0$19,234$0$449,804$0$0$0
Katherine Mc Coy
VP & CNE$180,580$0$22,594$0$8,852$0$15,848$0$17,079$0$244,953$0$0$0
John D Anderson MD
Physician$260,706$0$0$0$887$0$20,339$0$15,485$0$297,417$0$0$0
Richard Gonzales MD
Family Practice Physician$230,955$0$400$0$1,367$0$18,049$0$42,363$0$293,134$0$0$0
Jill Ortiz
Director of Pharmacy$191,121$0$27,641$0$11,202$0$23,120$0$44,506$0$297,590$0$0$0
Sanaz Parsa MD
Physician$240,004$0$200$0$632$0$24,818$0$15,385$0$281,039$0$0$0
Mohamad A Parsa MD
Physician$330,404$0$200$0$556$0$28,733$0$28,689$0$388,582$0$0$0
Lawrence A Phillip
Former Officer$0$147,332$0$0$0$0$0$11,492$0$0$0$158,824$0$0
Craig Marks
Former Officer$0$0$0$0$0$576,984$0$0$0$0$0$576,984$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3Although the organization employs personnel, the Organization relied on a related organization, Dignity Health, that used one or more of the methods described in Schedule J, Part I, Line 3, to establish the Organization's top management official's compensation. See Schedule O disclosure for Form 990, Part VI, Section B, Line 15a for additional information.
PART I, LINE 4aTHE ORGANIZATION'S KEY EMPLOYEES AND ITS HIGHEST COMPENSATED EMPLOYEES PARTICIPATE IN A SEVERANCE PLAN THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 6 MONTHS TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE PLAN. A PAYMENT WAS MADE TO ONE FORMER OFFICER DURING 2016 PURSUANT TO THIS PLAN INCLUDE C. MARKS; $576,984.
PART I, LINE 4bCERTAIN 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 WERE MADE UNDER THIS PLAN DURING 2016. 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)).
PART II - SUPPLEMENTAL DISCLOSURESTHE ORGANIZATION'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE DIGNITY HEALTH 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 IT SERVES, PROMOTING PATIENT AND EMPLOYEE SATISFACTION, AND ENSURING FINANCIAL STABILITY. A SUBSTANTIAL PORTION OF EXECUTIVE COMPENSATION IS PERFORMANCE BASED AND IS LINKED TO ORGANIZATIONAL GOALS APPROVED IN ADVANCE BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND THE ORGANIZATION'S COMMITMENT TO SERVING THE POOR AND DISENFRANCHISED IN THE COMMUNITIES IT SERVES. 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 2016.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonSILVER OAK MEDICAL OFFICE INCPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionD. KELAITA, BOD HAS GREATER THAN 35% OWNERSHIPRelationshipDescriptionTxt
Transaction$301,685TransactionAmt
TransactionMEDICAL SERVICES AGREEMENTTransactionDesc
Sharing Of RevenuesfalseSharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PARTS VI, VII and XIIFORM 990, PART VI, SECTION A, LINE 6 THE MARK TWAIN MEDICAL CENTER IS JOINTLY OWNED BY DIGNITY HEALTH, A 501(C)(3) EXEMPT ORGANIZATION AND MARK TWAIN HEALTHCARE DISTRICT (THE DISTRICT). FORM 990, PART VI, SECTION A, LINE 7A DIGNITY HEALTH AND THE DISTRICT, AS THE CORPORATE MEMBERS, RATIFY THE SELECTION OF MEMBERS AND APPROVE NEW BOARD MEMBERS OF THE ORGANIZATION. EACH OWNER DESIGNATES TWO BOARD MEMBERS, AND EACH PAIR OF DESIGNATED BOARD MEMBERS SELECTS A COUNTY RESIDENT; THESE SIX SELECT THE SEVENTH VOTING MEMBER, WHO MUST ALSO BE A COUNTY RESIDENT. THE EIGHTH VOTING MEMBER IS ELECTED AND IS THE CHIEF OF STAFF OF MARK TWAIN MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B RESERVED RIGHTS OF THE CORPORATE MEMBERS (DIGNITY HEALTH AND THE DISTRICT) INCLUDE ADOPTION OF MISSION AND PHILOSOPHY STATEMENTS, AMENDMENT OR RESTATEMENT OF ARTICLES OF INCORPORATION AND BYLAWS, DISSOLUTION OF THE CORPORATION, ACQUISITION OF ANOTHER CORPORATION, CREATION OF A NEW SUBSIDIARY, MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION, PARTICIPATION AS A GENERAL OR LIMITED PARTNER IN ANY VENTURE, INCURRING LONG-TERM INDEBTEDNESS IN EXCESS OF NORMAL OPERATING REQUIREMENTS, RATIFICATION OF BOARD MEMBER APPOINTMENTS AND DISMISSALS, SELECTION AND REMOVAL OF INDEPENDENT AUDITORS, AND TRANSACTIONS OUTSIDE THE ORDINARY COURSE OF BUSINESS. FORM 990, PART VI, SECTION B, LINE 11A MANAGEMENT PRESENTED THE DRAFT OF THE FORM 990 TO THE BOARD BEFORE FILING THE FORM WITH THE INTERNAL REVENUE SERVICE. THE BOARD'S REVIEW INCLUDED ALL INFORMATION REPORTED ON THE FORM 990 WITH THE EXCEPTION OF INDIVIDUALS' COMPENSATION AMOUNTS REPORTED WHICH WERE DIRECTLY REVIEWED BY THE VICE PRESIDENT OF HUMAN RESOURCES. IN THE PROCESS OF ITS PREPARATION, THE FORM 990 WAS REVIEWED AT VARIOUS LEVELS OF FINANCE AND ACCOUNTING (REGIONAL DIGNITY HEALTH MANAGEMENT AND CORPORATE TAX DEPARTMENT), AS WELL AS REVIEWED BY MARK TWAIN'S FINANCE MANAGER AND CFO (WHO SIGNS THE FORM) AND BY AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. THE ORGANIZATION'S BOARD IS CHARGED WITH MONITORING PROPOSED OR ONGOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND ADDRESSING ANY POTENTIAL OR ACTUAL CONFLICTS. PURSUANT TO THESE POLICIES, THE EVP/GENERAL COUNSEL IS RESPONSIBLE FOR COLLECTING, REVIEWING AND VALIDATING ANNUAL DISCLOSURES OF ALL COVERED PERSONS (I.E., BOARD AND BOARD COMMITTEE MEMBERS, OFFICERS AND EXECUTIVE LEADERSHIP, KEY EMPLOYEES, MANAGEMENT PERSONNEL AT THE VICE PRESIDENT LEVEL AND ABOVE, AND ANY OTHER PERSONNEL AT HIS OR HER DISCRETION). ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS ARISING FROM THE BUSINESS, FINANCIAL AND PERSONAL INTERESTS HELD BY SUCH COVERED PERSONS OR THEIR FAMILY MEMBERS. COVERED PERSONS ARE REQUIRED TO DISCLOSE TO THEIR SUPERIORS AND TO RELEVANT DECISION MAKERS ANY INTEREST THAT MAY PRESENT A CONFLICT, 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, AND ANNUALLY THEREAFTER. EACH COVERED PERSON IS REQUIRED TO CERTIFY AT LEAST ANNUALLY THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE POLICY APPLICABLE TO HIS/HER POSITION; (2) HAS READ THE POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE POLICY, INCLUDING COMPLETING THE CONFLICTS OF INTEREST DISCLOSURE STATEMENT AS REQUIRED BY THE POLICY. THE PRESIDENT/CEO AND EVP/GENERAL COUNSEL PREPARE ANNUAL REPORTS OF REPORTED CONFLICTS OF INTEREST, WHICH ARE PROVIDED TO THE BOARD OF DIRECTORS, COMMITTEE CHAIRS, AND KEY LEADERS OF THE ORGANIZATION TO ENABLE RESPONSIBLE INDIVIDUALS TO MONITOR AND MANAGE DISCLOSED CONFLICTS OF INTEREST AND ASSURE DECISIONS ARE MADE IN THE ORGANIZATION'S BEST INTERESTS. THE PROCEDURES FOR ADDRESSING A CONFLICT OF INTEREST RELATED TO A PROPOSED TRANSACTION INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: (1) THE CONFLICTING INTEREST IS FULLY DISCLOSED TO THE BOARD OF DIRECTORS; (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 IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION; (4) IF WARRANTED, ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED, AND COMPETITIVE BIDS OR COMPARABLE VALUATIONS ARE OBTAINED; (5) THE TRANSACTION OR ACTION IS APPROVED BY A MAJORITY OF DISINTERESTED PERSONS, CONSISTENT WITH ANY REQUIREMENTS OF BYLAWS OR POLICIES; AND (6) ANY CONFLICTING ISSUES ARISING DURING THE COURSE OF A BOARD MEETING WHICH CANNOT BE RESOLVED MAY BE REFERRED TO AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS. 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 TOP MANAGEMENT OFFICIAL IS COMPENSATED BY DIGNITY HEALTH. FOR 2016 COMPENSATION, DIGNITY HEALTH'S 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 EMPLOYEES. 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 THE HOSPITAL RELIED ON A RELATED ORGANIZATION, DIGNITY HEALTH, THAT USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART I, LINE 3, TO ESTABLISH THE CHIEF FINANCIAL OFFICER'S COMPENSATION. COMPENSATION OF OTHER HIGHLY PAID KEY EMPLOYEES IS BASED ON A COMPREHENSIVE EVALUATION FOCUSING ON ALL ASPECTS OF THE INCUMBENT'S ASSIGNED DUTIES AND ASSESSED PERFORMANCE IN CARRYING OUT THE PHILOSOPHY AND MISSION OF MTMC. ADDITIONALLY, COMPARATIVE DATA AND MARKET SURVEYS REGARDING COMPENSATION IN THE SURROUNDING MARKETPLACE ARE CONSIDERED. FORM 990, PART VI, SECTION C, LINE 19 FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION MAKES ITS FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION A DR. WILLIAM GRIFFIN AND DR. DEAN KELAITA'S COMPENSATION IS FOR PHYSICIAN SERVICES PROVIDED TO THE ORGANIZATION. FORM 990, PART XI, LINE 8 PRIOR YEAR ADJUSTMENTS, GRANT EXPENSE PREVIOUSLY RECOGNIZED; $109,137 FORM 990, PART XI, LINE 9 INTEREST IN NET ASSETS OF UNCONSOLIDATED FOUNDATION; $121,785 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.
FORM 990 PART IX LINE 11GDESCRIPTION:REVENUE CYCLE SERVICES TOTAL FEES:681451
FORM 990 PART IX LINE 11GDESCRIPTION:PHYSICIAN/MEDICAL SERVICES TOTAL FEES:5582684
FORM 990 PART IX LINE 11GDESCRIPTION:ADMINISTRATIVE SERVICES TOTAL FEES:3509116
FORM 990 PART IX LINE 11GDESCRIPTION:BUILDING SERVICES TOTAL FEES:2333710
FORM 990 PART IX LINE 11GDESCRIPTION:PROFESSIONAL SERVICES TOTAL FEES:141741
FORM 990 PART IX LINE 11GDESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:316046

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1Dignity HealthBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1185 Berry StreetAddressLine1Txt
CitySan FranciscoCityNm
State AbbreviationCAStateAbbreviationCd
ZIP94107ZIPCd
FieldValueIRS element (for citing)
EIN941196203EIN
Primary ActivitiesHospitalPrimaryActivitiesTxt
Legal Domicile StateCALegalDomicileStateCd
Exempt Code Section501(c)(3)ExemptCodeSectionTxt
Public Charity Status3PublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1NONEBusinessNameLine1Txt

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