2017-05-05T13:13:29-05:00 2016-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2015-07-01 680127677 Mark Twain Medical Center % ROBIN AGUILLON ACCOUNTING D MARK 2097543521 185 BERRY STREET SUITE 300 SAN FRANCISCO CA 94107 CHRIS ROBERTS VP & CFO 2097542614 2017-04-20 true VALERIE J BALL P00178114 4159635100 2017-05-01 2015 2021-01-29 14:40:06Z CHRIS ROBERTS CFO 768 MOUNTAIN RANCH ROAD SAN ANDREAS CA 95249 75489375 false X www.marktwainmedicalcenter.org X 1987 CA To continuously improve the health status of our community. of our community. 7 3 374 25 0 70139 450500 65519873 63162045 857830 634694 239856 533928 66687698 64781167 446057 370085 0 0 34497563 35747681 0 0 0 31693247 32790987 66636867 68908753 50831 -4127586 52220266 46290454 10495856 9034710 41724410 37255744 TO CONTINUOUSLY IMPROVE THE HEALTH STATUS OF OUR COMMUNITY. false false 54866388 370085 63162045 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. 54866388 true true false true false false false false false false true true true false true true false true false false false false false false false false true true true false true false false false false false false false true false false false false false true false false false true 105 0 true 374 true false false false false false false false false false false X 7 3 false false false false true true true true true false false false true true true true true false false false CA X ROBIN AGUILLON ACCOUNTING D 9166313337 10901 GOLD CENTER DRIVE 3RD FLOOR RANCHO CORDOVA CA 95670 X Cindy Holst Board Member 4.0 40.0 X 0 391219 64850 Dean Kelaita MD Board Member 4.0 0.0 X 4500 0 0 Ken McInturf Board Member 4.0 0.0 X 0 0 0 Lin Reed Board Member 4.0 0.0 X 0 0 0 William Griffin MD Chairman 4.0 0.0 X X 22500 0 0 Katherine Medeiros Secretary 4.0 40.0 X X 0 518947 80837 David Woodhams DDS Treasurer 4.0 0.0 X X 0 0 0 Robert Diehl President & CEO (start 6/13/16 40.0 0.0 X 0 0 0 Craig Marks President & CEO (to 12/14/15 40.0 0.0 X 0 535410 95522 Lawrence A Phillip Interim Pres & CEO (to 6/12/16 40.0 0.0 X 0 26586 1941 Chris L Roberts VP & CFO 40.0 0.0 X 0 163113 35411 Robert Allen VP Clinics 40.0 0.0 X 230380 0 27924 Sean Anderson MD VP CMO (thru 4/15/16) 20.0 0.0 X 216974 0 47983 Larry Cornish VP & COO (thru 11/19/15) 40.0 0.0 X 191000 0 43259 Kelly Fobia Interim VP & CNE (to 2/29/16) 40.0 0.0 X 204934 0 53886 Joanne Jeffords VP & CNE 40.0 0.0 X 101243 0 35362 John D Anderson MD Physician 40.0 0.0 X 234845 0 32087 Richard Gonzales MD Family Practice Physician 40.0 0.0 X 235950 0 58186 Sanaz Kalantarzadeh MD Physician 40.0 0.0 X 249273 0 33699 Jill Ortiz Director of Pharmacy 40.0 0.0 X 247117 0 67308 Mohamad A Parsa MD Physician 40.0 0.0 X 340531 0 53198 2279247 1635275 731453 93 false true false INPATIENT SERVICE OF CALIFORNIA INC 7032 COLLECTION CTR DR CHICAGO IL 60693 Medical Services 1070432 TRIMEDX LLC 5451 LAKEVIEW PKWY S DR INDIANAPOLIS IN 46268 Management services 697593 COURTNEY R VIRGILIO MD INC 931 PENNSYLVANIA GULTCH RD MURPHYS CA 95247 Medical Services 681548 RODGER ORMAN MD INC PO BOX 2189 MURPHYS CA 95247 Medical Services 669612 NORIDIAN ADMINS SERVICES LLC PO BOX 6730 FARGO ND 581086730 admin Services 629219 27 450000 500 450500 PATIENT NET OF CHARITY AND BAD DEBT 900099 34669235 34669235 MEDICARE/MEDICAID PAYMENTS 900099 28195071 28195071 MEANINGFUL USE INCENTIVES 900099 250359 250359 MEDICAL OFFICE BLDG 900099 19373 19373 HEALTH FAIR 900099 15885 15885 12122 12122 63162045 286518 286518 0 0 0 0 0 11056384 10708208 348176 348176 348176 0 0 0 SETTLEMENT FOR WILD FIRE 900099 214903 214903 CAFETERIA 561000 112166 112166 TENANT SERVICES 561000 99545 99545 107314 107314 533928 64781167 63162045 1168622 X 370085 370085 0 0 0 1100064 999290 100774 433957 433957 25632689 23286282 2346407 1041929 962350 79579 5784779 5340563 444216 1754263 1619486 134777 0 262086 262086 20770 20770 19774 19774 0 74508 74508 14109122 9195860 4913262 0 704029 19834 684195 1550280 981446 568834 4046857 314778 3732079 0 955571 633238 322333 92398 66524 25874 0 89997 47684 42313 143600 143600 0 2205309 2134860 70449 1137980 1137980 MEDICAL SUPPLIES 6820296 6820271 25 0 FOOD/INVENTORY EXPENSE 298077 233560 64517 0 DUES AND SUBSCRIPTION 91781 28079 63702 0 LICENSES AND TAXES 79321 41761 37560 0 89231 54900 34331 68908753 54866388 14042365 0 X 2706 2700 3982771 352882 0 0 10688350 9526512 0 0 0 0 429176 485877 1191087 1141878 3024094 3076117 41260580 27044023 13089602 14216557 11794051 6267902 5616169 8055149 2094215 2657311 0 0 308045 507569 52220266 46290454 7714771 6285532 0 0 162186 109137 0 0 0 0 0 0 0 0 0 0 2618899 2640041 10495856 9034710 X 39630195 34598433 2094215 2657311 0 0 41724410 37255744 52220266 46290454 X -4127586 -957226 53050 563096 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 19774 19774 false PART II - B, Line 1i 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 ======= 0 0 0 0 18410400 11059774 7350626 0 3250956 2768523 482433 0 16829857 12476097 4353760 0 2769367 739629 2029738 14216557 POOLED INVESTMENTS 8055149 F 8055149 INVSTMNT IN UNCONSOLIDATED FND 2657311 F 2657311 0 DUE TO RELATED PARTIES 2328056 PENSION PAYABLE 3885 OTHER NON-CURRENT LIABILITIES 308100 2640041 X Sched D, Part X, Line 2 - FIN 48 (ASC 740) FOOTNOTE 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. true true X true X true X 500. true true false true true 842 193422 0 193422 0.00280 28081 18900983 10203600 8697383 0.12620 28923 19094405 10203600 8890805 0.12900 8 886 444607 0 444607 0.00650 6 451 410838 0 410838 0.00600 14 1337 855445 0 855445 0.01250 14 30260 19949850 10203600 9746250 0.14150 1 0 670 0 0 0.00000 1 0 670 0 0 0.00000 true 1622529 0 17412637 23433498 -6020861 X true true 1 1 Mark Twain Medical Center 768 Mountain Ranch Road San Andreas CA 95249 dignityhealth.org/marktwainmedical/ 030000058 X X X X Mark Twain Medical Center 1 false false true X X X X X X X X X 13 true false true true X SEE SECTION C X true 14 true dignityhealth.org/marktwainmedical/ false true X 200. 500. X X X X true true X X X X true X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 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. 5 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 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% true Mark Twain Medical Center Foundation 768 Mountain Ranch Road San Andreas CA 95249 680023507 501(c)(3) 270700 0 N/A N/A Foundation Support California Health Foundation and Trust 1215 K Street Suite 800 Sacramento CA 95814 941498697 501(c)(3) 56625 0 N/A N/A Community Health Resource Connection Food Bank PO Box 919 San Andreas CA 95249 942705790 501(C)(3) 7000 0 N/A N/A COMMUNITY SUPPORT 3 0 PART I, LINE 1 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. false true false false false false false false false Cindy Holst Board Member 0 253282 0 129755 0 8182 0 36579 0 28271 0 456069 0 0 Katherine Medeiros Secretary 0 296172 0 207397 0 15378 0 42233 0 38604 0 599784 0 0 Craig Marks President & CEO (to 12/14/15 0 251933 0 225028 0 58449 0 41848 0 53674 0 630932 0 0 Chris L Roberts VP & CFO 0 162103 0 0 0 1010 0 11895 0 23516 0 198524 0 0 Robert Allen VP Clinics 206731 0 13718 0 9931 0 16275 0 11649 0 258304 0 0 0 Sean Anderson MD VP CMO (thru 4/15/16) 167899 0 48552 0 523 0 21169 0 26814 0 264957 0 0 0 Larry Cornish VP & COO (thru 11/19/15) 120948 0 38747 0 31305 0 17388 0 25871 0 234259 0 0 0 Kelly Fobia Interim VP & CNE (to 2/29/16) 145656 0 47816 0 11462 0 17095 0 36791 0 258820 0 0 0 John D Anderson MD Physician 233958 0 0 0 887 0 17082 0 15005 0 266932 0 0 0 Richard Gonzales MD Family Practice Physician 234583 0 0 0 1367 0 17128 0 41058 0 294136 0 0 0 Sanaz Kalantarzadeh MD Physician 248665 0 0 0 608 0 18791 0 14908 0 282972 0 0 0 Jill Ortiz Director of Pharmacy 193850 0 42762 0 10505 0 24622 0 42686 0 314425 0 0 0 Mohamad A Parsa MD Physician 330037 0 10000 0 494 0 25440 0 27758 0 393729 0 0 0 PART I, LINE 3 Although the organization employs personnel, the Organization relied on a related organization, Dignity Health, that used one or more of the methods described in Schedule J, Part I, Line 3, to establish the Organization's 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. SILVER OAK MEDICAL OFFICE INC D Kelaita, BOD 433957 MEDICAL SERVICES AGREEMENT false Part IV, column b D. KELAITA, BOD HAS GREATER THAN 35% OWNERSHIP. 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 Dignity Health 185 Berry Street San Francisco CA 94107 941196203 Hospital CA 501(c)(3) 3 NA false false false false false true false false false false false true false true true false true false true true NONE