MARK TWAIN MEDICAL CENTER: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MARK TWAIN MEDICAL CENTER (EIN 68-0127677)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-05
- IRS object ID
- 201721259349301147
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-05T13:13:29-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 SECOND STREET SUITE 1400 | AddressLine1Txt |
| City | SAN FRANCISCO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94105 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 680127677 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mark Twain Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % ROBIN AGUILLON ACCOUNTING D | InCareOfNm |
| Business Name Control | MARK | BusinessNameControlTxt |
| Phone | 2097543521 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 185 BERRY STREET SUITE 300 | AddressLine1Txt |
| City | SAN FRANCISCO | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94107 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHRIS ROBERTS | PersonNm |
| Person Title | VP & CFO | PersonTitleTxt |
| Phone | 2097542614 | PhoneNum |
| Signature | 2017-04-20 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | VALERIE J BALL | PreparerPersonNm |
| PTIN | P00178114 | PTIN |
| Phone | 4159635100 | PhoneNum |
| Preparation | 2017-05-01 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHRIS ROBERTS CFO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 768 MOUNTAIN RANCH ROAD | AddressLine1Txt |
| City | SAN ANDREAS | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95249 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $75,489,375 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.marktwainmedicalcenter.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1987 | FormationYr |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Activity Or Mission | To continuously improve the health status of our community. of our community. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 374 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $70,139 | PYContributionsGrantsAmt |
| CY Contributions Grants | $450,500 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $65,519,873 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $63,162,045 | CYProgramServiceRevenueAmt |
| PY Investment Income | $857,830 | PYInvestmentIncomeAmt |
| CY Investment Income | $634,694 | CYInvestmentIncomeAmt |
| PY Other Revenue | $239,856 | PYOtherRevenueAmt |
| CY Other Revenue | $533,928 | CYOtherRevenueAmt |
| PY Total Revenue | $66,687,698 | PYTotalRevenueAmt |
| CY Total Revenue | $64,781,167 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $446,057 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $370,085 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $34,497,563 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $35,747,681 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $31,693,247 | PYOtherExpensesAmt |
| CY Other Expenses | $32,790,987 | CYOtherExpensesAmt |
| PY Total Expenses | $66,636,867 | PYTotalExpensesAmt |
| CY Total Expenses | $68,908,753 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $50,831 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$4,127,586 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $52,220,266 | TotalAssetsBOYAmt |
| Total Assets EOY | $46,290,454 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,495,856 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,034,710 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $41,724,410 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $37,255,744 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO CONTINUOUSLY IMPROVE THE HEALTH STATUS OF OUR COMMUNITY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $54,866,388 | ExpenseAmt |
| Grant | $370,085 | GrantAmt |
| Revenue | $63,162,045 | RevenueAmt |
| Desc | THE HOSPITAL PROVIDES ROUTINE PATIENT CARE IN PRIVATE AND SEMI-PRIVATE ROOMS AS WELL AS VARIOUS INPATIENT AND OUTPATIENT ANCILLARY SERVICES SUCH AS X-RAY, LAB, EMERGENCY ROOM, ETC. DURING THE FISCAL YEAR 2016, 1,033 PATIENTS WERE ADMITTED TO THE FACILITY AND 80,504 OUTPATIENT VISITS WERE RECORDED INCLUDING VISITS AT OUR 5 RURAL HEALTH CLINICS. | Desc |
| Total Program Service Expenses | $54,866,388 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (true) | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 105 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 374 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | CA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBIN AGUILLON ACCOUNTING D | PersonNm |
| Phone | 9166313337 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10901 GOLD CENTER DRIVE 3RD FLOOR | AddressLine1Txt |
| City | RANCHO CORDOVA | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95670 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Cindy Holst | |||||||||
| Board Member | 4.0 | 40.0 | Yes (X) | $0 | $391,219 | $64,850 | |||
| Dean Kelaita MD | |||||||||
| Board Member | 4.0 | 0.0 | Yes (X) | $4,500 | $0 | $0 | |||
| Ken McInturf | |||||||||
| Board Member | 4.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| Lin Reed | |||||||||
| Board Member | 4.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| William Griffin MD | |||||||||
| Chairman | 4.0 | 0.0 | Yes (X) | $22,500 | $0 | $0 | Yes (X) | ||
| Katherine Medeiros | |||||||||
| Secretary | 4.0 | 40.0 | Yes (X) | $0 | $518,947 | $80,837 | Yes (X) | ||
| David Woodhams DDS | |||||||||
| Treasurer | 4.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| Robert Diehl | |||||||||
| President & CEO (start 6/13/16 | 40.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |||
| Craig Marks | |||||||||
| President & CEO (to 12/14/15 | 40.0 | 0.0 | $0 | $535,410 | $95,522 | Yes (X) | |||
| Lawrence A Phillip | |||||||||
| Interim Pres & CEO (to 6/12/16 | 40.0 | 0.0 | $0 | $26,586 | $1,941 | Yes (X) | |||
| Chris L Roberts | |||||||||
| VP & CFO | 40.0 | 0.0 | $0 | $163,113 | $35,411 | Yes (X) | |||
| Robert Allen | |||||||||
| VP Clinics | 40.0 | 0.0 | $230,380 | $0 | $27,924 | Yes (X) | |||
| Sean Anderson MD | |||||||||
| VP CMO (thru 4/15/16) | 20.0 | 0.0 | $216,974 | $0 | $47,983 | Yes (X) | |||
| Larry Cornish | |||||||||
| VP & COO (thru 11/19/15) | 40.0 | 0.0 | $191,000 | $0 | $43,259 | Yes (X) | |||
| Kelly Fobia | |||||||||
| Interim VP & CNE (to 2/29/16) | 40.0 | 0.0 | $204,934 | $0 | $53,886 | Yes (X) | |||
| Joanne Jeffords | |||||||||
| VP & CNE | 40.0 | 0.0 | $101,243 | $0 | $35,362 | Yes (X) | |||
| John D Anderson MD | |||||||||
| Physician | 40.0 | 0.0 | $234,845 | $0 | $32,087 | Yes (X) | |||
| Richard Gonzales MD | |||||||||
| Family Practice Physician | 40.0 | 0.0 | $235,950 | $0 | $58,186 | Yes (X) | |||
| Sanaz Kalantarzadeh MD | |||||||||
| Physician | 40.0 | 0.0 | $249,273 | $0 | $33,699 | Yes (X) | |||
| Jill Ortiz | |||||||||
| Director of Pharmacy | 40.0 | 0.0 | $247,117 | $0 | $67,308 | Yes (X) | |||
| Mohamad A Parsa MD | |||||||||
| Physician | 40.0 | 0.0 | $340,531 | $0 | $53,198 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,279,247 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,635,275 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $731,453 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 93 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| INPATIENT SERVICE OF CALIFORNIA INC | |||||
| 7032 COLLECTION CTR DR | CHICAGO | IL | 60693 | Medical Services | $1,070,432 |
| TRIMEDX LLC | |||||
| 5451 LAKEVIEW PKWY S DR | INDIANAPOLIS | IN | 46268 | Management services | $697,593 |
| COURTNEY R VIRGILIO MD INC | |||||
| 931 PENNSYLVANIA GULTCH RD | MURPHYS | CA | 95247 | Medical Services | $681,548 |
| RODGER ORMAN MD INC | |||||
| PO BOX 2189 | MURPHYS | CA | 95247 | Medical Services | $669,612 |
| NORIDIAN ADMINS SERVICES LLC | |||||
| PO BOX 6730 | FARGO | ND | 581086730 | admin Services | $629,219 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 27 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $450,000 | RelatedOrganizationsAmt |
| All Other Contributions | $500 | AllOtherContributionsAmt |
| Total Contributions | $450,500 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT NET OF CHARITY AND BAD DEBT | 900099 | $34,669,235 | $34,669,235 |
| MEDICARE/MEDICAID PAYMENTS | 900099 | $28,195,071 | $28,195,071 |
| MEANINGFUL USE INCENTIVES | 900099 | $250,359 | $250,359 |
| MEDICAL OFFICE BLDG | 900099 | $19,373 | $19,373 |
| HEALTH FAIR | 900099 | $15,885 | $15,885 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,122 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,122 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $63,162,045 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $286,518 | TotalRevenueColumnAmt |
| Exclusion | $286,518 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $11,056,384 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $10,708,208 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $348,176 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $348,176 | TotalRevenueColumnAmt |
| Exclusion | $348,176 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| SETTLEMENT FOR WILD FIRE | 900099 | $214,903 | $214,903 |
| CAFETERIA | 561000 | $112,166 | $112,166 |
| TENANT SERVICES | 561000 | $99,545 | $99,545 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $107,314 | TotalRevenueColumnAmt |
| Exclusion | $107,314 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $533,928 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $64,781,167 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $63,162,045 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $1,168,622 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $370,085 | TotalAmt |
| Program Services | $370,085 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,100,064 | TotalAmt |
| Program Services | $999,290 | ProgramServicesAmt |
| Management And General | $100,774 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $433,957 | TotalAmt |
| Program Services | $433,957 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,632,689 | TotalAmt |
| Program Services | $23,286,282 | ProgramServicesAmt |
| Management And General | $2,346,407 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,041,929 | TotalAmt |
| Program Services | $962,350 | ProgramServicesAmt |
| Management And General | $79,579 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,784,779 | TotalAmt |
| Program Services | $5,340,563 | ProgramServicesAmt |
| Management And General | $444,216 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,754,263 | TotalAmt |
| Program Services | $1,619,486 | ProgramServicesAmt |
| Management And General | $134,777 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $262,086 | TotalAmt |
| Management And General | $262,086 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,770 | TotalAmt |
| Management And General | $20,770 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,774 | TotalAmt |
| Management And General | $19,774 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,508 | TotalAmt |
| Management And General | $74,508 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,109,122 | TotalAmt |
| Program Services | $9,195,860 | ProgramServicesAmt |
| Management And General | $4,913,262 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $704,029 | TotalAmt |
| Program Services | $19,834 | ProgramServicesAmt |
| Management And General | $684,195 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,550,280 | TotalAmt |
| Program Services | $981,446 | ProgramServicesAmt |
| Management And General | $568,834 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,046,857 | TotalAmt |
| Program Services | $314,778 | ProgramServicesAmt |
| Management And General | $3,732,079 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $955,571 | TotalAmt |
| Program Services | $633,238 | ProgramServicesAmt |
| Management And General | $322,333 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,398 | TotalAmt |
| Program Services | $66,524 | ProgramServicesAmt |
| Management And General | $25,874 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,997 | TotalAmt |
| Program Services | $47,684 | ProgramServicesAmt |
| Management And General | $42,313 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $143,600 | TotalAmt |
| Program Services | $143,600 | ProgramServicesAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,205,309 | TotalAmt |
| Program Services | $2,134,860 | ProgramServicesAmt |
| Management And General | $70,449 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,137,980 | TotalAmt |
| Program Services | $1,137,980 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES | $6,820,296 | $6,820,271 | $25 | $0 |
| FOOD/INVENTORY EXPENSE | $298,077 | $233,560 | $64,517 | $0 |
| DUES AND SUBSCRIPTION | $91,781 | $28,079 | $63,702 | $0 |
| LICENSES AND TAXES | $79,321 | $41,761 | $37,560 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,231 | TotalAmt |
| Program Services | $54,900 | ProgramServicesAmt |
| Management And General | $34,331 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,908,753 | TotalAmt |
| Program Services | $54,866,388 | ProgramServicesAmt |
| Management And General | $14,042,365 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,706 | BOYAmt |
| EOY | $2,700 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,982,771 | BOYAmt |
| EOY | $352,882 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,688,350 | BOYAmt |
| EOY | $9,526,512 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $429,176 | BOYAmt |
| EOY | $485,877 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,191,087 | BOYAmt |
| EOY | $1,141,878 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,024,094 | BOYAmt |
| EOY | $3,076,117 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $41,260,580 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $27,044,023 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,089,602 | BOYAmt |
| EOY | $14,216,557 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,794,051 | BOYAmt |
| EOY | $6,267,902 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,616,169 | BOYAmt |
| EOY | $8,055,149 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,094,215 | BOYAmt |
| EOY | $2,657,311 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $308,045 | BOYAmt |
| EOY | $507,569 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,220,266 | BOYAmt |
| EOY | $46,290,454 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,714,771 | BOYAmt |
| EOY | $6,285,532 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $162,186 | BOYAmt |
| EOY | $109,137 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,618,899 | BOYAmt |
| EOY | $2,640,041 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,495,856 | BOYAmt |
| EOY | $9,034,710 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $39,630,195 | BOYAmt |
| EOY | $34,598,433 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,094,215 | BOYAmt |
| EOY | $2,657,311 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,724,410 | BOYAmt |
| EOY | $37,255,744 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,220,266 | BOYAmt |
| EOY | $46,290,454 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$4,127,586 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$957,226 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | $53,050 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $563,096 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $19,774 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $19,774 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II - B, Line 1i | FormAndLineReferenceDesc |
| Explanation | Lobbying expenditures paid directly by the filing organization for annual membership dues: American College of Physicians $ 46 ----- SUBTOTAL $ 46 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 $ 997 CHA/HASC/Hospital Council $ 3,508 Catholic Health Association $ 341 California Hospital Association $14,811 340B Health $ 71 ------ SUBTOTAL $ 19,728 ------- TOTAL $ 19,774 ======= | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $0 | OtherCostOrOtherBasisAmt |
| Book Value | $0 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $18,410,400 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,059,774 | DepreciationAmt |
| Book Value | $7,350,626 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $3,250,956 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,768,523 | DepreciationAmt |
| Book Value | $482,433 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $16,829,857 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,476,097 | DepreciationAmt |
| Book Value | $4,353,760 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $2,769,367 | OtherCostOrOtherBasisAmt |
| Depreciation | $739,629 | DepreciationAmt |
| Book Value | $2,029,738 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,216,557 | TotalBookValueLandBuildingsAmt |
| Financial Derivatives | FinancialDerivativesGrp | |
| Closely Held Equity Interests | CloselyHeldEquityInterestsGrp |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | POOLED INVESTMENTS | Desc |
| Book Value | $8,055,149 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $8,055,149 | TotalBookValueSecuritiesAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INVSTMNT IN UNCONSOLIDATED FND | Desc |
| Book Value | $2,657,311 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $2,657,311 | TotalBookValueProgramRltdAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO RELATED PARTIES | $2,328,056 |
| PENSION PAYABLE | $3,885 |
| OTHER NON-CURRENT LIABILITIES | $308,100 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,640,041 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Sched D, Part X, Line 2 - FIN 48 (ASC 740) FOOTNOTE | FormAndLineReferenceDesc |
| Explanation | DIGNITY 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 500. | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 842 | PersonsServedCnt |
| Total Community Benefit Expns | $193,422 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $193,422 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00280 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 28081 | PersonsServedCnt |
| Total Community Benefit Expns | $18,900,983 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,203,600 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,697,383 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12620 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 28923 | PersonsServedCnt |
| Total Community Benefit Expns | $19,094,405 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,203,600 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,890,805 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12900 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Persons Served | 886 | PersonsServedCnt |
| Total Community Benefit Expns | $444,607 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $444,607 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00650 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 6 | ActivitiesOrProgramsCnt |
| Persons Served | 451 | PersonsServedCnt |
| Total Community Benefit Expns | $410,838 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $410,838 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00600 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 14 | ActivitiesOrProgramsCnt |
| Persons Served | 1337 | PersonsServedCnt |
| Total Community Benefit Expns | $855,445 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $855,445 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01250 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 14 | ActivitiesOrProgramsCnt |
| Persons Served | 30260 | PersonsServedCnt |
| Total Community Benefit Expns | $19,949,850 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,203,600 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $9,746,250 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14150 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $670 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $670 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,622,529 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $17,412,637 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $23,433,498 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$6,020,861 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mark Twain Medical Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 768 Mountain Ranch Road | AddressLine1Txt |
| City | San Andreas | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 95249 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | dignityhealth.org/marktwainmedical/ | WebsiteAddressTxt |
| State License | 030000058 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Mark Twain Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | dignityhealth.org/marktwainmedical/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 500. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE H, PART V, SECTION B, LINE 5 | FormAndLineReferenceDesc |
| Explanation | A COMMUNITY HEALTH NEEDS ASSESSMENT WAS LAST CONDUCTED IN FISCAL YEAR 2014, AS REQUIRED BY STATE LAW (SB 697). IT WAS A COLLABORATIVE EFFORT INVOLVING THE MARK TWAIN MEDICAL CENTER BOARD OF DIRECTORS, THE CALAVERAS COUNTY DEPARTMENT OF PUBLIC HEALTH, PRACTICING PHYSICIANS, VARIOUS COMMUNITY MEMBERS AND THE CALAVERAS COUNTY SUPERINTENDENT OF SCHOOLS AND VARIOUS BOARD MEMBERS. THE NEEDS ASSESSMENT WAS A PRIMARY TOOL USED BY THE HOSPITAL TO DETERMINE ITS COMMUNITY BENEFIT PLAN, WHICH OUTLINED HOW THE HOSPITAL GAVE BACK TO THE COMMUNITY IN THE FORM OF HEALTH CARE AND OTHER COMMUNITY SERVICES TO ADDRESS UNMET COMMUNITY HEALTH NEEDS. THIS ASSESSMENT INCORPORATED COMPONENTS OF PRIMARY DATA COLLECTION AND SECONDARY DATA ANALYSIS THAT FOCUSED ON THE HEALTH AND SOCIAL NEEDS OF THE MTMC SERVICE AREA. THE PRIMARY SERVICE AREA ENCOMPASSED THE CITIES, TOWNS AND COMMUNITIES OF CALAVERAS COUNTY THAT INCLUDE 20 ZIP CODE AREAS. TARGETED INTERVIEWS WERE USED TO GATHER PRIMARY DATA COLLECTION INFORMATION AND OPINIONS FROM MEMBERS OF THE MTMC COMMUNITY. FOR THE INTERVIEWS, COMMUNITY LEADERS WERE CONTACTED AND ASKED TO PARTICIPATE IN THE NEEDS ASSESSMENT. 80% OF THOSE CONTACTED AGREED TO PARTICIPATE. SECONDARY DATA WERE COLLECTED BY OBTAINING AND ANALYZING A VARIETY OF LOCAL, COUNTY AND STATE SOURCES TO PRESENT A COMMUNITY PROFILE, BIRTH AND DEATH CHARACTERISTICS, ACCESS TO HEALTH CARE, CHRONIC DISEASES, SOCIAL ISSUES, AND SCHOOL AND STUDENT CHARACTERISTICS. SCHEDULE H, PART V, SECTION B, LINE 6b CALAVERAS UNIFIED SCHOOL DISTRICT, MARK TWAIN HEALTH CARE DISTRICT, CALAVERAS COUNTY OFFICE OF EDUCATION, THE RESOURCE CONNECTION FOOD BANK, CALAVERAS COUNTY SHERIFFS OFFICE, FIRST 5, CALAVERAS HEALTH AND HUMAN SERVICES AGENCY, CALAVERAS COUNTY ASSISTANT DISTRICT ATTORNEY SCHEDULE H, PART V, SECTION B, LINE 7A http://www.dignityhealth.org/marktwainmedical/community-benefits 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: IMPROVED ACCESS TO CARE, PREVENTIVE SERVICES, AND CHRONIC DISEASE MANAGEMENT. 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 GASTROENTEROLOGY 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. SCHEDULE H, PART V, SECTION B, LINES 16A THROUGH 16C http://www.dignityhealth.org/marktwainmedical/patients-and-visitors/patien ts/billing-information/payment-assistance SCHEDULE H, PART V, SECTION B, LINE 16I 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. LINE 22D UNINSURED PATIENTS WHO ARE APPLYING FOR FINANCIAL ASSISTANCE WHOSE HOUSEHOLD INCOME IS AT OR BELOW 350% OF THE FPL ARE ELIGIBLE TO RECEIVE SERVICES AT THE HIGHEST AVERAGE PAYMENT RATE THE HOSPITAL WOULD RECEIVE FOR PROVIDING SERVICES FROM MEDICARE, MEDICAID, OR ANY OTHER GOVERNMENT SPONSORED HEALTH PROGRAM OR HEALTH BENEFIT IN WHICH THE HOSPITAL PARTICIPATES. THE MAXIMUM CHARGE THAT MAY BE BILLED TO A PATIENT WHO IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THIS FINANCIAL ASSISTANCE POLICY IS KNOWN AS THE AMOUNT GENERALLY BILLED (AGB). NO PATIENT ELIGIBLE FOR FINANCIAL ASSISTANCE WILL BE CHARGED MORE THAN THE AGB FOR THE ELIGIBLE SERVICE(S) PROVIDED TO THE PATIENT. DIGNITY HEALTH CALCULATES THE AGB ON A FACILITY-BY-FACILITY BASIS USING THE "LOOKBACK" METHOD BY MULTIPLYING THE "GROSS CHARGES" FOR ANY ELIGIBLE SERVICE THAT IT PROVIDES BY AGB PERCENTAGES WHICH ARE BASED UPON PAST CLAIMS ALLOWED UNDER MEDICARE AND PRIVATE INSURANCE AS SET FORTH IN FEDERAL LAW. | ExplanationTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Valley Springs Family Medical Center | ||||
| 1919 VISTA DEL LAGO DRIVE | VALLEY SPRINGS | CA | 95252 | OUTPATIENT CLINIC |
| Angels Camp Familly Medical Center | ||||
| 222 SOUTH MAIN STREET | ANGELS CAMP | CA | 95222 | OUTPATIENT CLINIC |
| Arnold Family Medical Center | ||||
| 2182 Highway 4 | Arnold | CA | 95223 | Outpatient Clinic |
| San Andreas Clinic | ||||
| 704 Mt Ranch Road Suite 103 | San Andreas | CA | 95249 | Outpatient Clinic |
| Copperopolis Family Medical Center | ||||
| 3505 Spangler Lane Suite 400 | Copperopolis | CA | 95228 | Outpatient Clinic |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7 | MARK 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 $2.81 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 $0.06 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 Activities | COMMUNITY BUILDING - ADVOCACY FOR COMMUNITY HEALTH IMPROVEMENT MTMC ADVOCATES ON BEHALF OF THE POOR AND DISENFRANCHISED, PARTICULARLY FOR IMPROVED ACCESS TO HEALTH CARE SERVICES. MTMCS LEADERSHIP OVERSEES THE DEVELOPMENT OF THE COMMUNITY BENEFIT IMPLEMENTATION PLAN FOR THE HOSPITAL AS IT STRIVES TO MEET THE HEALTH AND WELLNESS NEEDS OF THE LOCAL COMMUNITY. COMMUNITY INVOLVEMENT IS EVIDENCED BY PARTICIPATION OF LOCAL BUSINESS AND COMMUNITY LEADERS IN THE HOSPITALS GOVERNING BOARDS, FINANCE COMMITTEE, ETHICS COMMITTEE AND PATIENT ADVISORY COMMITTEE. BELOW ARE JUST A FEW SPECIFIC PROGRAMS OFFERED BY MTMC. HEALTH FAIRS (FREE ADMISSION) - THROUGHOUT THE YEAR, MTMC IS INVOLVED WITH MANY HEALTH FAIRS. COMMUNITY SERVICE ORGANIZATIONS ATTEND THE HEALTH FAIR AND PROVIDE COMMUNITY EDUCATION AND SERVICE TO THOSE IN ATTENDANCE. CHOLESTEROL SCREENING, BLOOD PRESSURE CHECKS, BONE DENSITY STUDIES AND HEALTH EDUCATION ARE JUST A FEW OF THE SERVICES PROVIDED. SUMMER HEALTH FAIR (FREE ADMISSION) - AS A RESULT OF THE SUCCESS AT THE FALL AND SPRING HEALTH FAIRS, AND THE NEED TO PROVIDE THE SERVICES TO THE NORTH-WEST COMMUNITIES, MTMC NOW OFFERS AN ANNUAL SUMMER HEALTH FAIR IN VALLEY SPRINGS IN JUNE. MINI-HEALTH FAIRS - A SERIES OF MINI-HEALTH FAIRS WERE CONDUCTED IN THE COMMUNITY. PARTNERSHIPS WITH THE MUSIC IN THE PARKS, SPONSORED BY THE CALAVERAS COUNTY ARTS COUNCIL; THE FARMER'S MARKET, SPONSORED BY THE ANGELS CAMP BUSINESS ASSOCIATION; AND THE FIRST FRIDAY CONCERTS, HOSTED BY THE MURPHY'S COMMUNITY CLUB, ALL PROVIDED VENUES FOR THE FAIRS. THE FAIRS INCLUDE HEALTH INFORMATION, BLOOD PRESSURE CHECKS, STRENGTH TESTING, ADVICE FROM NURSE/MID-LEVEL, ETC. WE ALSO PARTICIPATED IN AN EMPLOYEE HEALTH FAIR AT BLACK OAK CASINO IN NEIGHBORING TUOLUMNE COUNTY TO PROVIDE HEALTH INFORMATION TO THEIR 400+ EMPLOYEES. IN ADDITION, MTMC PARTNERS WITH OTHERS IN THE COMMUNITY TO OFFER THE FOLLOWING: COMMUNITY HEALTH EDUCATION SUBSTANCE ABUSE - COLLABORATIVE BETWEEN THE CALAVERAS COUNTY HEALTH SERVICES AGENCY, MARK TWAIN MEDICAL CENTER AND THE CALAVERAS COUNTY OFFICE OF EDUCATION. THE VISION IS TO HAVE A COMMUNITY FREE FROM SUBSTANCE ABUSE THROUGH BETTER EDUCATION. CALAVERAS COUNTY CHRONIC DISEASE SELF-MANAGEMENT PROGRAM - COLLABORATIVE BETWEEN THE CALAVERAS COUNTY HEALTH SERVICES AGENCY, MARK TWAIN MEDICAL CENTER, AND VARIOUS AGENCIES. BOTH THE WALK AND THE SIX-WEEK WORKSHOP ARE PROJECTS FUNDED THROUGH THE CENTER FOR DISEASE CONTROL AND PREVENTION AS PART OF THE COMMUNITY TRANSFORMATION INITIATIVE. CALAVERAS COUNTY WAS ONE OF 12 RURAL CALIFORNIA COUNTIES TO RECEIVE GRANT FUNDING TO IMPROVE RURAL HEALTH DISPARITIES IN KEY PREVENTATIVE AREAS - REDUCING EXPOSURE TO SECOND-HAND SMOKE, FACILITATING HEALTHY COMMUNITIES THROUGH REDUCED CONSUMPTION OF SUGARY-SWEETENED BEVERAGES AND SAFE WALKING ROUTES AND THE PROVISION OF INCREASED CLINICAL AND COMMUNITY PREVENTIVE SERVICES. CHILDREN AND FAMILIES MASTER PLAN - THE GOAL IS TO TRAIN COMMUNITY ADVOCATES FOR THE UNDERSERVED CHILDREN OF OUR COMMUNITIES. MARK TWAIN MEDICAL CENTERS - FIVE FEDERALLY-QUALIFIED RURAL HEALTH CLINICS (RHC) STRATEGICALLY LOCATED IN REMOTE COMMUNITIES OF CALAVERAS COUNTY. VISITORS TO THESE CENTERS ARE PROVIDED PRIMARY HEALTHCARE SERVICES AND PROVIDE US WITH INFORMATION ABOUT THE ADDITIONAL NEEDS AND SERVICES THAT ARE IMPORTANT TO THEIR COMMUNITY. WOMEN'S HEALTH RESOURCE CENTER - AS PART OF OUR STRATEGIC PLAN FOR FY2016, WE FIRST IDENTIFIED WOMEN'S HEALTH AS A MAJOR NEED FOR SERVICES. IN THE YEARS SINCE, OUR STRATEGIC PLAN CONTINUES TO IDENTIFY A WOMEN'S RESOURCE CENTER AS A GOAL. A COMMUNITY ADVISORY GROUP WAS IDENTIFIED AND PROVIDED VALUABLE INPUT INTO THE CENTER'S PROGRAMS. THE CENTER, PLANNED TO OPEN IN THE NEXT FEW YEARS, WILL BE PART OF THE NEW MEDICAL CENTER IN ANGELS CAMP, PROVIDING EDUCATION, SUPPORT, AND SERVICES FOR OUR COMMUNITIES. |
| SCHEDULE H, PART III, LINE 2 | THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE CCR (SEE ABOVE) TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER FINANCIAL ASSISTANCE, AND ARE OTHERWISE UNINSURED. ANY PORTION OF A PATIENT BILL REMAINING AFTER APPLYING FINANCIAL, UNINSURED OR OTHER DISCOUNTS OR PAYMENTS RECEIVED ON THE ACCOUNT THAT ARE ULTIMATELY DETERMINED TO BE UNCOLLECTIBLE ARE WRITTEN OFF TO BAD DEBT. 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 A 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 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, 2016, 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 $895 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 $6 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 Assessment | HOSPITAL 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, SUCH AS CHILDREN AND FAMILIES COMMISSION, HABITAT FOR HUMANITY, SOROPTIMISTS INTERNATIONAL, ECONOMIC DEVELOPMENT CORPORATION, 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, 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. A COMMUNITY NEEDS ASSESSMENT WAS CONDUCTED IN fiscal year 2014 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. AS COMPARED TO THE STATE AND THE NATION, COMMUNITY ISSUES IDENTIFIED IN THE ASSESSMENT INCLUDE A HIGHER PERCENTAGE OF CALAVERAS COUNTY CHILDREN IN CALAVERAS COUNTY WHO ARE OBESE, RATES OF CHILD IMMUNIZATIONS ARE LOWER, AND MOTOR VEHICLE ACCIDENTS WHICH ARE HIGHER THAN THE STATE AVERAGES. 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. DURING FISCAL YEAR 2016, THERE WERE OVER 30,000 PERSON-VISITS THAT BENEFITED FROM OUR COMMUNITY HEALTH PROGRAMS. HIGHLIGHTS INCLUDED $9,322,250 NET BENEFIT FOR PROGRAMS AND SERVICES FOR THE VULNERABLE AND $424,000 FOR THE BROADER COMMUNITY, WITH A TOTAL HOSPITAL EXPENDITURE OF OVER $51 MILLION. THE TOTAL VALUE OF COMMUNITY BENEFIT FOR FY2016 IS $9,746,000 AT COST. INCLUDING THE SHORTFALL FROM MEDICARE, THE TOTAL EXPENSE FOR COMMUNITY BENEFITS WAS $16,216,000. QUANTIFIABLE BENEFITS INCLUDED TRADITIONAL CHARITY CARE, UNPAID COSTS OF MEDI-CAL AND MEDICARE, COMMUNITY SERVICE DONATIONS, COMMUNITY HEALTH SERVICES AND EDUCATION, AND COMMUNITY BUILDING ACTIVITIES. THE COMMUNITY NEEDS ASSESSMENT IDENTIFIED THE FOLLOWING SIZEABLE AND SEVERE NEEDS: HEALTH ISSUES - 33% OF CALAVERAS COUNTY STUDENTS WERE OVERWEIGHT OR OBESE IN 2010, SLIGHTLY LOWER THAN CALIFORNIA OVERALL AT 38%. -THE PERCENTAGE OF ADULTS WITH DIABETES IS 7.8% AND 8.4% IN THE REST OF THE STATE. -ONE-THIRD OF RESIDENTS REPORTED THAT THEY HAD BEEN DIAGNOSED WITH HIGH BLOOD PRESSURE. -19% OF INDIVIDUALS IN CALAVERAS COUNTY FROM AGES 5 TO17 HAVE A DISABILITY, COMPARED TO THE STATE LEVEL OF 10%. -LIMITED SERVICES AND SERVICE PROVIDERS MAKE IT DIFFICULT TO ACCESS MENTAL HEALTH, OBSTETRICAL AND SPECIALTY CARE SERVICES. -THE PERCENTAGES OF CALAVERAS COUNTY KINDERGARTNERS WITH ALL REQUIRED IMMUNIZATIONS WERE 78% IN 2012-2013 COMPARED TO THE 90% STATE AVERAGE. -THERE IS A LACK OF MENTAL HEALTH SERVICES IN THE COUNTY. -SUICIDES ARE INCREASING AT 25.2% OVER THE STATE AVERAGE OF 10.2% PER 100,000 POPULATION. SOCIAL DEMOGRAPHIC ISSUES -THE AREA REFLECTS AN AGING POPULATION WITH APPROXIMATELY 63% OF THE POPULATION OVER THE AGE OF 40, MUCH HIGHER THAN IN THE STATE AT 44%. -A DECLINING ECONOMY IS IMPACTING THE COMMUNITY BY INCREASED JOBLESSNESS, DECREASES IN EMPLOYER-BASED HEALTH INSURANCE, HIGHER COSTS FOR TRANSPORTATION AND DECREASED AVAILABILITY OF AFFORDABLE HOUSING. -THE MEDIAN HOUSEHOLD INCOME IS $54,971 COMPARED TO THE STATE MEDIAN INCOME OF $60,883. -PERSONS BELOW THE FEDERAL POVERTY LEVEL ARE 10%. -HOME OWNERSHIP RATE IS 51.0%. -A LACK OF PROVIDERS IN CALAVERAS COUNTY (PRIMARY CARE, MENTAL HEALTH, SPECIALISTS) NEGATIVELY IMPACTS ACCESS TO CARE AND REQUIRES RESIDENTS TO TRAVEL OUTSIDE OF THE COUNTY TO OBTAIN SERVICES. -1 IN 558 HOUSES IN CALAVERAS COUNTY WAS IN FORECLOSURE IN DECEMBER 2013. -LESS THAN ONE-THIRD OF WORKING PARENTS HAVE ACCESS TO CHILD CARE IN CALAVERAS. -SMOKING AMONG ADULTS AND TEENS IS A CONCERN. 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. The Countys Resource Connection and the Mark Twain Health Care District have reviewed the assessment and have developed their own strategies to effect change, in addition to the hospitals Community Benefit plan. In this way, the CHNA report is a countywide resource. |
| Schedule H, Part VI, Line 3 - Patient Education of Eligibility for | ASSISTANCE 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 Information | THE 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 County Demographics: Total Population: 44,668 Race/Ethnicity: White - Non-Hispanic 81.4%; Black/African American - Non-Hispanic 0.9%; Hispanic or Latino 11.8%; Asian/Pacific Islander 1.6%; All Others 4.3% Median Income: $59,869 Unemployment: 6.5% No High School Diploma: 7.5% Medicaid: 24.8% Uninsured: 5.4% OTHER AREA HOSPITALS: 0 |
| Schedule H, Part VI, Line 5 - Promotion of Community Health | HOSPITAL LEADERSHIP OVERSEES COMMUNITY BENEFIT ACTIVITIES FOR THE HOSPITAL AS IT MEETS THE HEALTH AND WELLNESS NEEDS OF THE LOCAL COMMUNITY. SEVERAL MEMBERS OF MARK TWAIN MEDICAL CENTER'S SENIOR AND MIDDLE MANAGEMENT TEAM SERVE THE COMMUNITY ON A VARIETY OF COMMUNITY BASED NOT FOR PROFIT BOARDS, SUCH AS CHILDREN AND FAMILIES COMMISSION, HABITAT FOR HUMANITY, CALAVERAS COUNTY BUSINESS COUNCIL, SOROPTOMISTS INTERNATIONAL, CHAMBER OF COMMERCE AND UNITED WAY, TO NAME A FEW. THE HOSPITAL IS GOVERNED BY A BOARD OF TRUSTEES, THE MAJORITY OF WHOM RESIDE WITHIN ITS PRIMARY SERVICE AREA AND WHO ARE NOT EMPLOYEES, CONTRACTORS OR FAMILY MEMBERS THEREOF. IN ADDITION, MOST EMPLOYEES HAVE LINKAGES TO VARIOUS SERVICE ORGANIZATIONS THROUGHOUT THE COMMUNITIES. COMMUNITY INVOLVEMENT IS EVIDENCED BY PARTICIPATION OF LOCAL BUSINESS AND COMMUNITY LEADERS IN THE HOSPITAL'S GOVERNING BOARDS, FINANCE COMMITTEE, ETHICS COMMITTEE AND OUR PARISH NURSE ADVISORY COMMITTEE. 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 System | MTMC 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, 2016, IS AS FOLLOWS: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 140,490 96,453,000 0.8% Unpaid Costs of Medicaid/Medi-Cal 1,623,229 927,750,000 7.3% Other Means-tested Programs 275,647 7,027,000 0.1% Community Services: Community Health Services 371,669 44,816,000 0.4% Health Professions Education 84 48,000 0.0% Subsidized Health Services 321,882 47,172,000 0.4% Donations 108,977 22,245,000 0.2% Community Building Activities 6,090 1,679,000 0.0% Community Benefit Operations 65 8,030,000 0.1% Total Community Services for the poor 808,767 123,990,000 1.1% Total Benefits for the Poor 2,848,133 1,155,220,000 9.3% Benefits for the Broader Community: Community Services: Community Health Services 307,874 13,768,000 0.1% Health Professions Education 24,127 70,327,000 0.6% Subsidized Health Services 5,215 1,147,000 0.0% Research 565 7,370,000 0.1% Donations 36,410 6,544,000 0.1% Community Building Activities 16,623 2,724,000 0.0% Community Benefit Operations 28 1,318,000 0.0% Total Benefits for the Broader Community 390,842 103,198,000 0.8% Total Community Benefits 3,238,975 1,258,418,000 10.1% Unpaid Costs of Medicare 1,098,561 895,491,000 7.1% Total Community Benefits including Cost of Medicare 4,337,536 2,153,909,000 17.2% |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|---|---|
| Mark Twain Medical Center Foundation | ||||||||||
| 768 Mountain Ranch Road | San Andreas | CA | 95249 | 680023507 | 501(c)(3) | $270,700 | $0 | N/A | N/A | Foundation Support |
| California Health Foundation and Trust | ||||||||||
| 1215 K Street Suite 800 | Sacramento | CA | 95814 | 941498697 | 501(c)(3) | $56,625 | $0 | N/A | N/A | Community Health |
| Resource Connection Food Bank | ||||||||||
| PO Box 919 | San Andreas | CA | 95249 | 942705790 | 501(C)(3) | $7,000 | $0 | N/A | N/A | COMMUNITY SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1 | FormAndLineReferenceDesc |
| Explanation | AS 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Cindy Holst | ||||||||||||||
| Board Member | $0 | $253,282 | $0 | $129,755 | $0 | $8,182 | $0 | $36,579 | $0 | $28,271 | $0 | $456,069 | $0 | $0 |
| Katherine Medeiros | ||||||||||||||
| Secretary | $0 | $296,172 | $0 | $207,397 | $0 | $15,378 | $0 | $42,233 | $0 | $38,604 | $0 | $599,784 | $0 | $0 |
| Craig Marks | ||||||||||||||
| President & CEO (to 12/14/15 | $0 | $251,933 | $0 | $225,028 | $0 | $58,449 | $0 | $41,848 | $0 | $53,674 | $0 | $630,932 | $0 | $0 |
| Chris L Roberts | ||||||||||||||
| VP & CFO | $0 | $162,103 | $0 | $0 | $0 | $1,010 | $0 | $11,895 | $0 | $23,516 | $0 | $198,524 | $0 | $0 |
| Robert Allen | ||||||||||||||
| VP Clinics | $206,731 | $0 | $13,718 | $0 | $9,931 | $0 | $16,275 | $0 | $11,649 | $0 | $258,304 | $0 | $0 | $0 |
| Sean Anderson MD | ||||||||||||||
| VP CMO (thru 4/15/16) | $167,899 | $0 | $48,552 | $0 | $523 | $0 | $21,169 | $0 | $26,814 | $0 | $264,957 | $0 | $0 | $0 |
| Larry Cornish | ||||||||||||||
| VP & COO (thru 11/19/15) | $120,948 | $0 | $38,747 | $0 | $31,305 | $0 | $17,388 | $0 | $25,871 | $0 | $234,259 | $0 | $0 | $0 |
| Kelly Fobia | ||||||||||||||
| Interim VP & CNE (to 2/29/16) | $145,656 | $0 | $47,816 | $0 | $11,462 | $0 | $17,095 | $0 | $36,791 | $0 | $258,820 | $0 | $0 | $0 |
| John D Anderson MD | ||||||||||||||
| Physician | $233,958 | $0 | $0 | $0 | $887 | $0 | $17,082 | $0 | $15,005 | $0 | $266,932 | $0 | $0 | $0 |
| Richard Gonzales MD | ||||||||||||||
| Family Practice Physician | $234,583 | $0 | $0 | $0 | $1,367 | $0 | $17,128 | $0 | $41,058 | $0 | $294,136 | $0 | $0 | $0 |
| Sanaz Kalantarzadeh MD | ||||||||||||||
| Physician | $248,665 | $0 | $0 | $0 | $608 | $0 | $18,791 | $0 | $14,908 | $0 | $282,972 | $0 | $0 | $0 |
| Jill Ortiz | ||||||||||||||
| Director of Pharmacy | $193,850 | $0 | $42,762 | $0 | $10,505 | $0 | $24,622 | $0 | $42,686 | $0 | $314,425 | $0 | $0 | $0 |
| Mohamad A Parsa MD | ||||||||||||||
| Physician | $330,037 | $0 | $10,000 | $0 | $494 | $0 | $25,440 | $0 | $27,758 | $0 | $393,729 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | Although the organization employs personnel, the Organization relied on a related organization, Dignity Health, that used one or more of the methods described in Schedule J, Part I, Line 3, to establish the Organization's top management official's compensation. See Schedule O disclosure for Form 990, Part VI, Section B, Line 15a for additional information. |
| PART I, LINE 4a | The organization's key employees and its highest compensated employees participate in a severance plan that provides market-standard compensation, ranging from payments of 6 months to 2 years of base compensation, depending on the executive's position, in the event of a position elimination or other involuntary termination, in accordance with the guidelines of the plan. No payments were made to any listed persons during 2015 pursuant to this plan. |
| PART I, LINE 4b | Certain listed persons are eligible to participate in one of two 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 2015. 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 DISCLOSURES | The 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. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SILVER OAK MEDICAL OFFICE INC | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | D Kelaita, BOD | RelationshipDescriptionTxt |
| Transaction | $433,957 | TransactionAmt |
| Transaction | MEDICAL SERVICES AGREEMENT | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part IV, column b | FormAndLineReferenceDesc |
| Explanation | D. KELAITA, BOD HAS GREATER THAN 35% OWNERSHIP. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PARTS VI, VII and XII | FORM 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 real 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 the 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 2015 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 9 INTEREST IN NET ASSETS OF UNCONSOLIDATED FOUNDATION; $563,096. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MEDICAL SERVICES TOTAL FEES:5885056 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ADMINISTRATIVE SERVICES TOTAL FEES:3700062 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:BUILDING SERVICES TOTAL FEES:2016863 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PROFESSIONAL FEES TOTAL FEES:969708 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PURCHASED FEES TOTAL FEES:830293 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:REVENUE CYCLE SERVICES TOTAL FEES:707140 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Dignity Health | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 185 Berry Street | AddressLine1Txt |
| City | San Francisco | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 94107 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 941196203 | EIN |
| Primary Activities | Hospital | PrimaryActivitiesTxt |
| Legal Domicile State | CA | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 3 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NONE | BusinessNameLine1Txt |
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