2017-05-12T13:08:25-05:00 2016-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2015-07-01 941156295 Saint Francis Memorial Hospital % LARA HARROW - FINANCE DEPT SAIN 4153536600 185 BERRY STREET SUITE 300 San Francisco CA 94107 MARIA LUISA MENDOZA CONTROLLER 4153536754 2017-05-10 true VALERIE J BALL P00178114 4159635100 2017-05-12 2015 2017-02-10 21:41:12Z CHARLES MCGETTIGAN 900 Hyde Street San Francisco CA 94109 266907114 false X www.dignityhealth.org/saintfrancis X 1938 CA TO PROVIDE COMPASSIONATE, QUALITY, COST EFFECIVE MEDICAL AND HEALTHCARE RELATED SERVICES TO MEET THE NEEDS OF THE COMMUNITIES WE SERVE. 15 10 1274 205 126903 2788325 2617387 225313511 220897316 8571554 7378548 1820678 2129216 238494068 233022467 2524415 1453830 0 0 127675324 135269561 0 0 0 118336193 117751271 248535932 254474662 -10041864 -21452195 376725219 350397806 93257864 105658308 283467355 244739498 X TO PROVIDE COMPASSIONATE, HIGH-QUALITY, AFFORDABLE HEALTH SERVICES FOR OUR SISTERS AND BROTHERS WHO ARE POOR AND DISENFRANCHISED; AND PARTNERING WITH OTHERS IN THE COMMUNITY TO IMPROVE THE QUALITY OF LIFE. false false 216384273 1453830 220897316 SAINT FRANCIS MEMORIAL HOSPITAL'S MISSION IS TO CONTRIBUTE TO THE HEALTH OF THE COMMUNITY THROUGH THE PROVISIONS OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST EFFECTIVE MANNER. THE HOSPITAL HAS 288 BEDS AND SERVICED PATIENTS AS FOLLOWS: OUTPATIENT VISITS OF 123,158; EMERGENCY VISITS OF 33,863; INPATIENT AND OUTPATIENT OPERATING ROOM CASES OF 3,459. INPATIENT SERVICES: ACUTE MEDICAL SURGICAL CARE AND REHAB, INTENSIVE AND BURN CARE, ADULT PSYCH, PHARMACY, CARDIOPULMONARY, SURGERY AND TELEMETRY UNIT. OUTPATIENT SERVICES: EMERGENCY CARE, SPORTS MEDICINE AND OCCUPATIONAL HEALTH CLINICS, PULMONARY REHAB, OUTPATIENT BURN CARE, SPINE AND JOINT/PAIN/MS CLINIC, DIAGNOSTIC IMAGING, RADIATION ONCOLOGY, GASTROINTESTINAL SERVICES AND PHYSICAL THERAPY SERVICES, HYPERBARIC OXYGEN CLINIC. SUPPORT SERVICES: CHAPLAINCY PROGRAM, FAMILY SUPPORT SERVICES, PALLIATIVE CARE, PARKING SERVICES, NURSING EDUCATION SERVICES, HEALTH SCIENCES LIBRARY; AS WELL AS SUPPORT, TIME AND MONEY TO ORGANIZATIONS AND INDIVIDUALS THROUGHOUT THE COMMUNITY. 216384273 true true false true false false false false false true true false true false true true false true false false false false false false false false true true true true true true true false false false false true false true false true false false false false false true false false false true 205 0 true 1274 true true true false false false false false false false false false X 15 10 false false false false true true true true true false false false true true true true true false false true true CA X LARA HARROW - FINANCE DEPT 9168512000 3400 DATA DRIVE 3RD FLOOR RANCHO CORDOVA CA 95670 X N Thomas Ahlberg MD Board Member 3.0 0.0 X 0 0 0 Amy Bossen MD Board Member 3.0 0.0 X 1406 0 0 Carrie Byles Board Member 3.0 0.0 X 0 0 0 Michaela Cassidy Board Member 3.0 0.0 X 0 0 0 Gary Chan MD Board Member 3.0 0.0 X 3806 0 0 David Duong MD Board Member 3.0 0.0 X 0 0 0 Harris Goodman MD Board Member 3.0 0.0 X 0 0 0 Kathleen Jodan MD Board Member 3.0 0.0 X 112663 0 0 Cynthia Kilroy Board Member 3.0 0.0 X 0 0 0 Man Kit Leung Board Member 3.0 0.0 X 16400 0 0 Kimberly MacPherson Board Member 3.0 0.0 X 0 0 0 Victor Prieto MD Board Member 3.0 0.0 X 130321 0 0 Julie Soo JD Board Member 3.0 0.0 X 0 0 0 Richard Spalding Board Member 3.0 0.0 X 0 0 0 Peter Teng MD Board Member 3.0 0.0 X 0 0 0 David J Malone MD Board Chair 3.0 0.0 X X 208 0 0 Charles McGettigan Vice-Chair 3.0 0.0 X X 0 2500 0 Alan Fox CFO/ Treasurer 40.0 0.0 X 309726 0 64626 James Houser Interim President & CEO 40.0 0.0 X 0 845000 61685 Charlene Battaglia Senior Director - Nursing 40.0 0.0 X 207220 0 24990 Jae Chun VP Strategy and Service Line O 40.0 0.0 X 257183 0 56212 Mark Garfield MD Chief Medical Officer 40.0 0.0 X 287440 0 46947 Bradley Grote Senior Director-Nursing Operat 40.0 0.0 X 202363 0 28961 Dennis Kneeppel CNE 40.0 0.0 X 223043 0 17009 Raymond Miller Director, Pharmacy 40.0 0.0 X 212492 0 45733 Tracey Pierce VP, HR 40.0 0.0 X 269465 0 35831 Dallas Ryan Director Materials Management 40.0 0.0 X 201839 0 43285 Jill Welton VP Quality/CNO 40.0 0.0 X 293465 0 61756 Abbie Yant Vice President Comm.Advocacy H 40.0 0.0 X 183114 0 54203 Kevin Causey Foundation President 40.0 0.0 X 299584 0 53064 Frances T L Chee Registered Nurse 40.0 0.0 X 293377 0 48537 Bradford K Moy Medical Director 40.0 0.0 X 305827 0 44662 Isatou E Njie Staff Nurse II 40.0 0.0 X 267765 0 44761 Doris Y Yau Staff Nurse III 40.0 0.0 X 269296 0 40536 Tom Hennessy Former Officer 0.0 0.0 X 508250 0 0 4856253 847500 772798 422 true true false CITY BUILDING INC 212 N SAN MATEO DR SAN MATEO CA 94401 GENERAL CONTRACTOR 5848496 GALEN INPATIENT PHYSICIANS 2100 POWELL ST STE 900 EMERYVILLE CA 946081803 Medical Services 2273750 TRIMEDX LLC 5451 LAKEVIEW PKWY S DR INDIANAPOLIS IN 46268 Management services 2147587 ARAMARK HEALTHCARE 27310 NETWORK PL CHICAGO IL 606731273 Management food/faci 2133138 REHABCARE HRS DIVISION 927G 680 S 4TH ST LOUISVILLE KY 40202 Medical Services 1846667 63 480085 2137302 2617387 PATIENT NET OF CHARITY AND BAD DEBT 900099 217687702 217687702 MEDICAL OFFICE BLDGS 532000 2337913 2337913 PHYSICIAN PROFESSIONAL FEES 900099 765423 765423 RALLY FAMILY VISITATION SERVICES 900099 74291 74291 EDUCATION 446110 14100 14100 17887 17887 220897316 1936286 1936286 0 0 151775 151775 0 151775 151775 39326909 33884647 5442262 5442262 5442262 0 0 0 PARKING LOT FEES 812930 892618 892618 GIFT SHOP 453220 269217 269217 CAFETERIA 722514 248649 248649 566957 126903 440054 1977441 233022467 220897316 126903 9380861 X 1437092 1437092 16738 16738 0 0 3131863 2902460 229403 309021 309021 100163956 93032785 7131171 8840807 8272799 568008 16070516 15061528 1008988 6753398 6319218 434180 0 352238 352238 57600 57600 78080 78080 0 77743 77743 42358780 31474444 10884336 0 1107579 77899 1029680 4776399 3726268 1050131 14709079 1073981 13635098 0 2951283 2882330 68953 365581 204711 160870 0 121134 52320 68814 1055068 1055068 0 8989965 8464882 525083 1509132 1509132 MEDICAL SUPPLIES 20980948 20978488 2460 0 MEDI-CAL PROVIDER FEE 15568177 15568177 0 0 FOOD 937491 748493 188998 0 LICENSES & TAXES 484299 351552 132747 0 1270695 864887 405808 254474662 216384273 38090389 0 X 6460 6310 488105 0 282280 122580 36496104 38683672 24928 5092 0 0 3179271 3532060 3668506 3385803 22544886 22105035 228067833 137175365 82110568 90892468 132727831 101269270 0 0 93120029 83168265 0 0 2076251 7227251 376725219 350397806 50288553 65934554 0 0 52767 58896 10000000 10000000 0 0 0 0 0 624070 0 0 32916544 29040788 93257864 105658308 X 190477325 161591464 62575793 52733797 30414237 30414237 283467355 244739498 376725219 350397806 X -21452195 -8515129 871500 -9632033 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 78080 78080 false PART II - B, Line 1 SCHEDULE C, PART II-B LINE 1 LOBBYING EXPENDITURES PAID BY THE PARENT ORGANIZATION FOR ANNUAL MEMBERSHIP DUES WHERE EXPENSES ARE ALLOCATED TO THE HOSPITAL: CATHOLIC HEALTH ASSOCIATION $ 1,232 AMERICAN HOSPITAL ASSOCIATION $ 2,341 California Hospital Association $ 12,845 CALIFORNIA HOSPITAL COMMITTEE ON ISSUES $ 61,617 340B HEALTH (FORMERLY SAFETY NET HOSPTALS) $ 45 -------- TOTAL $ 78,080 ======== 41498514 -1372418 946000 39180096 41664814 200 970214 1136714 41498514 36767665 94403 4859064 56318 41664814 34688666 27052 3479952 1428005 36767665 36338723 100 -742651 907506 34688666 0.22370 0.77630 0.00000 true false 2094567 2094567 134548329 79605168 54943161 258262 246743 11519 71942755 57323454 14619301 19223920 19223920 90892468 UNCONSOLIDATED FOUNDATION 83148033 F OWNERSHIP IN HEALTH-RELATED 20232 F 83168265 0 DUE TO RELATED PARTIES 26066449 PENSION LIABILITY 2490725 OTHER NON CURRENT LIABILITIES 444582 DEFERRED COMPENSATION 39032 29040788 X Sch D, Part V, Line 4 THE ENDOWMENT FUNDS ARE INTENDED TO BE USED TO SUPPORT THE HOSPITAL'S HEALTHCARE NEEDS AND OTHER HOSPITAL PROGRAM NEEDS. Sch D, Part X, Line 2 - FIN 48 (ASC 740) FOOTNOTE DIGNITY HEALTH REVIEWS ITS TAX POSITIONS 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 4941 3982922 0 3982922 0.01570 12947 62766850 39081559 23685291 0.09310 646 391960 0 391960 0.00150 18534 67141732 39081559 28060173 0.11030 7 1047 420816 0 420816 0.00170 4 0 369841 289633 80208 0.00030 3 1379 1034285 679681 354604 0.00140 5 5195 233349 20325 213024 0.00080 19 7621 2058291 989639 1068652 0.00420 19 26155 69200023 40071198 29128825 0.11450 1 1 4150 0 4150 2 44 15860 0 15860 3 45 20010 0 20010 true 5038064 0 46715209 67671538 -20956329 X true true 1 1 Saint Francis Memorial Hospital 900 Hyde St San Francisco CA 94109 www.saintfrancismemorial.org 220000069 X X X X Saint Francis Memorial Hospital 1 false false true X X X X X X X X X 15 true true true true X SEE SECTION C X HTTP://WWW.SFHIP.ORG/ X true 15 true SEE SECTION C false true X 200. 500. X X X X true true X X X X true X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X true X false X X X X true X false false Schedule H, part V SCHEDULE H, PART V, SECTION B, LINE 5 THE 2016 CHNA TOOK INTO ACCOUNT COMMUNITY INPUT VIA COMMUNITY MEETINGS WITH TARGET RESIDENT POPULATIONS, IN ADDITION TO THE LEADERSHIP AND ACTIVE PARTICIPATION OF THE PUBLIC HEALTH DEPARTMENT AND MANY PUBLIC AND NON-PROFIT AGENCIES. TARGET POPULATIONS FOR THE COMMUNITY MEETINGS WERE SELECTED BASED ON FOUR FACTORS: 1) THE POPULATION HAS KNOWN HEALTH DISPARITIES, 2) LITTLE INFORMATION DESCRIBING THE HEALTH OF THE POPULATION WAS AVAILABLE, 3) THE POPULATION WAS NOT INCLUDED IN A RECENT HEALTH ASSESSMENT, AND 4) THE POPULATION WAS REACHABLE THROUGH AN EXISTING COMMUNITY GROUP. THE MAIN QUESTION ASKED OF MEETING PARTICIPANTS WAS, "WHAT ACTIONS CAN WE TAKE, INCLUDING RESIDENTS, COMMUNITY GROUPS, AND THE SAN FRANCISCO HEALTH IMPROVEMENT PARTNERSHIP, TO IMPROVE HEALTH?" PARTICIPANTS WERE ALSO ASKED ABOUT THE ASSETS AND BARRIERS WHICH EXIST IN THEIR COMMUNITIES REGARDING HEALTH. A TOTAL OF 127 PARTICIPANTS ATTENDED 11 MEETINGS. PARTICIPANTS CAME FROM A VARIETY OF BACKGROUND. THE ETHNIC GROUPS WITH THE LARGEST REPRESENTATION IN THE MEETINGS WERE LATINO (23 PERCENT), BLACK/AFRICAN AMERICAN (15 PERCENT), WHITE (17 PERCENT), AND ASIAN (12 PERCENT). OTHER SELF-REPORTED ETHNICITIES INCLUDED ARAB, FILIPINO, JEWISH, MIDDLE EASTERN, AND NATIVE AMERICAN. THE MAJORITY OF PARTICIPANTS WERE FEMALE (59 PERCENT). SCHEDULE H, PART V, SECTION B, LINE 6A DIGNITY HEALTH ST. MARYS MEDICAL CENTER, SUTTER HEALTH CALIFORNIA PACIFIC MEDICAL CENTER, CHINESE HOSPITAL, KAISER PERMANENTE SAN FRANCISCO, UCSF MEDICAL CENTER SCHEDULE H, PART V, SECTION B, LINE 6B SAN FRANCISCO HEALTH IMPROVEMENT PARTNERSHIP MEMBERS INCLUDING: SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH, CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTES COMMUNITY ENGAGEMENT AND HEALTH POLICY PROGRAM AT UCSF, SAN FRANCISCO UNIFIED SCHOOL DISTRICT, THE OFFICE OF THE MAYOR, THE ASIAN AND PACIFIC ISLANDER HEALTH PARITY COALITION, HUMAN SERVICE NETWORK, CHICANO/LATINO/INDIGENA HEALTH EQUITY COALITION, AFRICAN AMERICAN COMMUNITY HEALTH COUNCIL, COMMUNITY CLINIC CONSORTIUM, 12 OTHER COMMUNITY ENGAGEMENT PARTNERS, AND FAITH BASED AND PHILANTHROPIC PARTNERS. SCHEDULE H, PART V, SECTION B, LINE 7A http://www.dignityhealth.org/saintfrancis/about-us/community-benefit SCHEDULE H, PART V, SECTION B, LINE 10A https://www.dignityhealth.org/bayarea/locations/saintfrancis/about-us/comm unity-benefits SCHEDULE H, PART V, SECTION B, LINE 11 SAINT FRANCIS MEMORIAL HOSPITAL WILL ADDRESS THE FOLLOWING 2016 CHNA IDENTIFIED AND PRIORITIZED HEALTH NEEDS: ACCESS TO CARE; HEALTHY EATING AND PHYSICAL ACTIVITY; AND BEHAVIORAL/PSYCHOSOCIAL HEALTH. THE HOSPITAL IS ADDRESSING THESE NEEDS IN NUMEROUS WAYS DESCRIBED IN DETAIL IN THE IMPLEMENTATION STRATEGY, WHICH IS WIDELY AVAILABLE TO THE PUBLIC ONLINE. PROGRAMS INCLUDE: TENDERLOIN HEALTH IMPROVEMENT PARTNERSHIP (GREEN MOBILE HEALTH EDUCATION KITCHEN, TENDERLOIN SAFE PASSAGE, TENDERLOIN ECONOMIC DEVELOPMENT PROJECT, BOYS AND GIRLS CLUBS OF SAN FRANCISCO, TENDERLOIN INTRAVENOUS DRUG USE WORKGROUP); HEALTHRIGHT 360S TENDERLOIN HEALTH SERVICES, EMERGENCY DEPARTMENT TRANSITIONS PROGRAM AND ADDICTION MEDICINE; HEALTHY SAN FRANCISCO; AND RALLY FAMILY VISITATION SERVICES. THE TENDERLOIN HEALTH IMPROVEMENT PARTNERSHIP IS A MULTI-SECTOR COLLECTIVE IMPACT INITIATIVE COMMITTED TO IMPROVE THE HEALTH, SAFETY AND WELL-BEING OF RESIDENTS IN SAN FRANCISCOS TENDERLOIN NEIGHBORHOOD. IT IS DESIGNED SUPPORT AND ENHANCE COMMUNITY BUILDING CAPACITY NONPROFITS, BUSINESSES, GOVERNMENT AGENCIES, AND FUNDERS OPERATING WITHIN A SINGLE NEIGHBORHOOD, THE TENDERLOIN, TO WORK TOGETHER IN MORE COORDINATED WAYS TO IMPROVE RESIDENTS HEALTH OUTCOMES. THE HOSPITAL WILL NOT DIRECTLY ADDRESS: SAFETY AND VIOLENCE PREVENTION; SUBSTANCE ABUSE; OR HOUSING STABILITY/HOMELESSNESS. THESE NEEDS ARE BEYOND THE HOSPITALS INSTITUTIONAL AND RESOURCE CAPACITY, AND ARE BEING ADDRESSED BY OTHERS IN THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 16A-16C https://www.dignityhealth.org/bayarea/locations/saintfrancis/patients-and- visitors/for-patients/billing-and-payment/financial-assistance SCHEDULE H, PART V, SECTION B, LINE 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 FINANCIAL ASSISTANCE POLICY. CONTACT INFORMATION CAN ALSO BE FOUND ON EACH FACILITYS WEB PAGE. SCHEDULE H, PART V, SECTION B, 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 IN CALIFORNIA, AND IN ARIZONA AND NEVADA THE AMOUNT GENERALLY BILLED. 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 SERVICES THAT IT PROVIDES BY AGB PERCENTAGES WHICH ARE BASED UPON PAST CLAIMS ALLOWED UNDER MEDICARE AND PRIVATE INSURANCE AS SET FORTH IN FEDERAL LAW. 1 SMI Imaging LLC 6740 E Camelback Road Suite 101 Scotsdale AZ 85251 imaging SCHEDULE H, PART I, LINE 7 FOR PURPOSES OF CALCULATING THE AMOUNTS PROVIDED IN THE TABLE, SFMH USES A COST ACCOUNTING SYSTEM THAT COMBINES RELATIVE VALUE UNITS (RVU) AND COST TO CHARGE RATIOS (CCR) TO ALLOCATE COSTS TO THE PATIENT LEVEL. THE COST ACCOUNTING SYSTEM ALGORITHM ALLOCATES TOTAL OPERATING EXPENSES TO THE PROCEDURE CHARGE CODE LEVEL BASED UPON AN RVU FOR PROCEDURES THAT HAVE BEEN STUDIED AND ASSIGNED AN RVU, OR BASED UPON A CCR FOR UNSTUDIED PROCEDURES THAT DO NOT HAVE AN RVU ASSIGNED. WHEN A CCR IS USED, THE SYSTEM CALCULATES THAT CCR ON A DEPARTMENTAL SPECIFIC BASIS AT WHERE THE SERVICES WERE PROVIDED. THE CALCULATION IS SIMILAR TO THE WORKSHEET 2 OF SCHEDULE H, RATIO OF PATIENT CARE COST TO CHARGES, EXCEPT IT IS CALCULATED ON A DEPARTMENTAL SPECIFIC BASIS, NOT IN THE AGGREGATE. THE ALLOCATED PROCEDURE CHARGE CODE LEVEL COSTS ARE THEN ROLLED UP TO THE PATIENT LEVEL BASED UPON THE BILLED PROCEDURE CHARGE CODES ASSOCIATED WITH THOSE SERVICES PROVIDED TO EACH SPECIFIC PATIENT. THIS IS DONE FOR ALL PATIENT SEGMENTS INCLUDING INPATIENT, OUTPATIENT, EMERGENCY DEPARTMENT, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED AND SELF PAY. THE COST ACCOUNTING SYSTEM IS UTILIZED TO DETERMINE THE UNREIMBURSED COST OF MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS. THE COST OF CHARITY CARE IS CALCULATED BY APPLYING THE CCR DERIVED FROM THE COST ACCOUNTING SYSTEM ON A PER FACILITY BASIS, TO THE CHARGES INCURRED ON PATIENTS THAT QUALIFY FOR CHARITY CARE AT THE RESPECTIVE FACILITY. THE ACTUAL COST IS REPORTED FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH AND CASH AND IN-KIND DONATIONS. SCHEDULE H, PART I, LINE 7B, COLUMN (F) BEGINNING IN 2009, THE STATE OF CALIFORNIA ESTABLISHED PROVIDER FEE PROGRAMS. THESE PROGRAMS ARE FUNDED BY QUALITY ASSURANCE FEES PAID BY PARTICIPATING HOSPITALS AND MATCHING FEDERAL FUNDS. SFMH RECOGNIZED QUALITY ASSURANCE FEES DURING THE YEAR OF $15.57 MILLION WHICH ARE INCLUDED IN TOTAL COMMUNITY BENEFIT EXPENSE RELATED TO UNREIMBURSED MEDICAID (PART I, LINE 7B, COLUMN C), AND RECOGNIZED FEE-FOR-SERVICE SUPPLEMENTAL PAYMENTS OF $19.31 MILLION DURING THE YEAR REFLECTED UNDER THE MEDICAID PROGRAM AS DIRECT OFFSETTING REVENUE (PART I, LINE 7B, COLUMN D). THIS NET REDUCTION IN THE COST OF THE MEDICAID PROGRAM IS DRIVING THE DECREASE IN THE OVERALL COST OF COMMUNITY BENEFIT EXPENSE AS A PERCENT OF TOTAL EXPENSES WHEN COMPARED TO PRIOR YEARS. Schedule H, Part II - Community Building Activities COALITION BUILDING - UNDER COALITION BUILDING IS THE SAN FRANCISCO HEP B FREE, WHICH IS A CITYWIDE CAMPAIGN, CREATED TO EDUCATE, TEST, VACCINATE AND TREAT SAN FRANCISCO ASIAN AND PACIFIC ISLANDER (API) RESIDENTS OF HEPATITIS B (HBV). SAINT FRANCIS MEMORIAL HOSPITAL ALONG WITH OTHER COMMUNITY ORGANIZATIONS, HOSPITAL AND THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH ARE COLLABORATING TO PROVIDE CONVENIENT, FREE OR LOW-COST TESTING OPPORTUNITES AT STREET FAIRS AND CLINICS. THE SAN FRANCISCO PALLIATIVE CARE TASK FORCE, A MULTIDISCIPLINARY TASK FORCE JOINED TOGETHER FOR A PERIOD OF THREE MONTHS TO DEVELOP STRATEGIC RECOMMENDATIONS TO MEET SAN FRANCISCO'S CURRENT AND FUTURE PALLIATIVE CARE NEEDS. THE TASK FORCE WAS SUPPORTED BY STAFF FROM THE SF DEPARTMENT OF PUBLIC HEALTH AND THE DEPARTMENT OF AGING AND ADULT SERVICES. SFMH FUNDS CONTRIBUTED TOWARDS THE COSTS OF THE FACILITATOR FOR THE TASK FORCE. OVER THE COURSE OF THE PROJECT FOUR WORKGROUPS WERE FORMED THAT DEVELOPED SHORT AND LONG TERM RECOMMENDATIONS IN THE AREAS OF 1) QUALITY, 2) FINANCE, 3) SYSTEMS AND 4) COMMUNITY ENGAGEMENT. THE RECOMMENDATIONS WERE HEARD AT BOTH THE PUBLIC HEALTH COMMISSION AND COMMISSION AGING. THE MAYOR'S LONG TERM CARE COUNCIL ADOPTED THE PALLIATIVE CARE WORKGROUP WHERE THE WORK CONTINUES. WORKFORCE DEVELOPMENT - UNDER WORK FORCE DEVELOPMENT, WE HAVE CRISTO REY/IMMACULATE CONCEPTION ACADEMY AS PART OF OUR MENTORING PROGRAMS. IMMACULATE CONCEPTION ACADEMY (ICA) IS AN ALL-GIRLS CATHOLIC HIGH SCHOOL, WHICH OFFERS A COLLEGE PREPARATORY EDUCATION IN THE DOMINICAN TRADITION. AS PART OF THE CRISTO REY NETWORK, ICA OPERATES WITH A UNIQUE PROGRAM OF STRONG COLLEGE PREP CURRICULUM PARTNERED WITH A CORPORATE WORK STUDY COMPONENT. MEMBERSHIP IN THE CRISTO REY NETWORK ALLOWS ICA TO OPEN ITS DOORS TO CAPABLE STUDENTS DESIRING A FAITH BASED HIGH SCHOOL EDUCATION BUT WITHOUT ADEQUATE MEANS TO AFFORD IT. SAINT FRANCIS PROVIDES MENTORING OPPORTUNITIES FOR UP TO 4 ICA STUDENTS THROUGHOUT THE ACADEMIC YEAR. Schedule H, Part III - BAD DEBT, MEDICARE & COLLECTION PRACTICES SCHEDULE H, PART III, LINE 2 THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE CCR (SEE SCHEDULE H, PART I, LINE 7) TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER FINANCIAL ASSISTANCE, AND ARE OTHERWISE UNINSURED. ANY PORTION OF A PATIENT BILL REMAINING AFTER APPLYING FINANCIAL, UNINSURED OR OTHER DISCOUNTS OR PAYMENTS RECEIVED ON THE ACCOUNT THAT ARE ULTIMATELY DETERMINED TO BE UNCOLLECTIBLE ARE WRITTEN OFF TO BAD DEBT. AS NOTED IN PART I, LINE 3, SFMH PROVIDES FREE OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS THAT FALL INTO THREE CATEGORIES; UNDER 200%, 201%-350% OR 351%-500% OF THE FEDERAL POVERTY LEVEL. SFMH ALSO PROVIDES PATIENTS OPTIONS FOR PROMPT PAY DISCOUNTS, AND INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS RECEIVE AN AUTOMATIC UNINSURED DISCOUNT OF 30%. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE. SCHEDULE H, PART III, LINE 3 SFMH MAKES EVERY EFFORT IN DETERMINING IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. SFMH FOLLOWS DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY. DIGNITY HEALTH'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. DIGNITY HEALTH ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF 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 FINANCIAL ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT NO SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE WERE REPORTED AS BAD DEBT. AS SUCH, SFMH DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE. SCHEDULE H, PART III, LINE 4 THE FOLLOWING IS AN EXCERPT FROM DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS' CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 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 PAYORS, AND OTHERS FOR SERVICES RENDERED. SFMH MANAGES ITS COLLECTION RISK BY REGULARLY REVIEWING ITS ACCOUNTS AND CONTRACTS AND BY PROVIDING APPROPRIATE ALLOWANCES. RESERVES FOR CHARITY AND UNCOLLECTIBLE AMOUNTS HAVE BEEN ESTABLISHED AND ARE NETTED AGAINST PATIENT ACCOUNTS RECEIVABLE IN THE CONSOLIDATED BALANCE SHEET. SCHEDULE H, PART III, LINE 8 SFMH PREPARES MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1, 2150FF AND PRM 15-2, 1000FF. AS SUCH, THE FOLLOWING LANGUAGE PER THE PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR TO BE CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. DIGNITY HEALTH 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 DIGNITY HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. THIS SHORTFALL INCLUDES $21 MILLION REPORTED ON PART III, SECTION B, LINE 7, PRIMARILY FOR FEE FOR SERVICE MEDICARE PATIENTS, AS WELL AS THE UNREIMBURSED PORTION OF MEDICARE MANAGED CARE AND MEDICARE CAPITATED PROGRAMS FOR SFMH. SCHEDULE H, PART III, LINE 9B SFMH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. SFMH FOLLOWS DIGNITY HEALTH'S BILLING AND COLLECTION POLICY. DIGNITY HEALTH'S COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHOM THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF SFMH OR THE BILLING COMPANY RETAINED BY DIGNITY HEALTH IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED FINANCIAL ASSISTANCE OR FOR ASSISTANCE UNDER DIGNITY HEALTH'S PATIENT FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, SFMH WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. LEGAL ACTION WILL NOT BE PURSUED TO COLLECT DEBTS FROM PATIENTS WHO HAVE QUALIFIED FOR CHARITY OR ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DEBT. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY DIGNITY HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, SFMH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT. Schedule H, Part VI, Line 2 - Needs Assessment SFMH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT WITH COMMUNITY INPUT AT LEAST EVERY THREE YEARS; USING FIVE CORE PRINCIPLES TO GUIDE PLANNING AND PROGRAM DECISIONS; MEASURING AND TRACKING PROGRAM INDICATORS; AND ENGAGING THE COMMUNITY ADVISORY COMMITTEE AND OTHER STAKEHOLDERS IN THE DEVELOPMENT OF THE ANNUAL COMMUNITY BENEFIT PLAN AND TRIENNIAL IMPLEMENTATION STRATEGY. THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT WAS APPROVED BY SFMHS COMMUNITY ADVISORY COMMITTEE ON MAY 20, 2016 AND WAS ADOPTED IN JUNE 2016 BY SFMHS BOARD OF TRUSTEES. SFMH CONDUCTED THE 2016 CHNA IN PARTNERSHIP WITH THE CITY AND COUNTY OF SAN FRANCISCO THROUGH THE SAN FRANCISCO HEALTH IMPROVEMENT PARTNERSHIP (SFHIP), A COLLABORATIVE BODY WHOSE MISSION IS TO IMPROVE COMMUNITY HEALTH AND WELLNESS IN SAN FRANCISCO. SFHIP MEMBERSHIP INCLUDES THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH, SAN FRANCISCOS NON-PROFIT HOSPITALS, UCSF, THE SAN FRANCISCO UNIFIED SCHOOL DISTRICT, THE OFFICE OF THE MAYOR, COMMUNITY REPRESENTATIVES FROM THE ASIAN AND PACIFIC ISLANDER HEALTH PARITY COALITION, HUMAN SERVICE NETWORK, CHICANO/LATINO/INDIGENA HEALTH EQUITY COALITION, AFRICAN AMERICAN COMMUNITY HEALTH COUNCIL, COMMUNITY CLINIC CONSORTIUM, FAITH BASED ORGANIZATIONS, AND PHILANTHROPIC PARTNERS. OVER THE YEARS, A VARIETY OF VALUABLE HEALTH NEEDS ASSESSMENTS HAVE BEEN COMPLETED IN SAN FRANCISCO. TO ENSURE EXISTING KNOWLEDGE WAS INTEGRATED IN THE CHNA, SFHIP CONDUCTED AN ASSESSMENT OF TWENTY ONE HEALTH ASSESSMENTS THAT MET THE FOLLOWING INCLUSION CRITERIA: INCLUDED PRIMARY DATA COLLECTION WITH DATA AVAILABLE FOR SAN FRANCISCO; COLLECTED IN 2010 OR LATER; DATA COLLECTION METHODS WERE IDENTIFIED AND ASSESSMENT TOPICS INCLUDED SOCIAL DETERMINANTS OF HEALTH OR HEALTH OUTCOMES. SFHIP ALSO WORKED WITH COMMUNITY PARTNERS TO ENGAGE WITH COMMUNITY MEMBERS REPRESENTING A BROAD SPECTRUM OF SAN FRANCISCO RESIDENTS. TARGETED RESIDENT POPULATIONS INCLUDED THOSE NOT INCLUDED IN A RECENT HEALTH ASSESSMENT, THOSE THAT WERE REACHABLE THROUGH AN EXISTING COMMUNITY GROUP, AND THOSE KNOWN TO HAVE HEALTH DISPARITIES WITH LITTLE INFORMATION DESCRIBING HEALTH OF THAT POPULATION. ABOUT 121 PARTICIPANTS PARTICIPATED IN 11 MEETINGS THAT FOCUSED ON ACTIONS THAT CAN BE TAKEN TO IMPROVE HEALTH AND ON WHAT ASSETS AND BARRIERS EXIST IN THEIR COMMUNITIES REGARDING HEALTH. TO IDENTIFY THE MOST SIGNIFICANT HEALTH NEEDS IN SAN FRANCISCO, THE SFHIP STEERING COMMITTEE, AND THE SFHIP IMPLEMENTATION PLAN SUBCOMMITTEE MET ON OCTOBER 8, AND NOVEMBER 4TH, 2015. PARTICIPANTS IDENTIFIED HEALTH NEEDS THROUGH A MULTISTEP PROCESS. FIRST PARTICIPANTS REVIEWED DATA AND INFORMATION FROM THE COMMUNITY HEALTH STATUS ASSESSMENT, THE ASSESSMENT OF PRIOR ASSESSMENTS, AND THE COMMUNITY ENGAGEMENT, AS WELL AS THE HEALTH PRIORITIES FROM THE 2013 COMMUNITY HEALTH IMPROVEMENT PLAN. THEN, USING THE TECHNOLOGY OF PARTICIPATION APPROACH TO CONSENSUS DEVELOPMENT, PARTICIPANTS ENGAGED IN SMALL GROUP FOCUSED DISCUSSIONS ABOUT THE DATA. FINALLY, PARTICIPANTS DEVELOPED CONSENSUS ON THE HEALTH NEEDS. THROUGHOUT THE PROCESS NEEDS WERE SCREENED AND PRIORITIZED AND RANKED USING PREESTABLISHED CRITERIA SEVERITY OF THE NEEDS, DISPARITIES IN THE COMMUNITY, PRIORITY TO THE COMMUNITY, AND FEASIBILITY TO AFFECT CHANGE. THROUGH THIS PROCESS TWO FOUNDATIONAL ISSUES AND SEVEN HEALTH NEEDS WERE IDENTIFIED AND PRIORITIZED. FOUNDATIONAL ISSUES ARE NEEDS WHICH AFFECT HEALTH AT EVERY LEVEL AND MUST BE ADDRESSED TO IMPROVE HEALTH IN SAN FRANCISCO. COMMUNITY NEEDS INDEX SFMH ALSO MAKES FULL USE OF THE COMMUNITY NEEDS INDEX (CNI), WHICH ANALYZES THE COMMUNITY NEEDS OF A SPECIFIC GEOGRAPHIC REGION BY MEASURING BARRIERS TO HEALTH CARE INCLUDING INCOME, EDUCATION, CULTURAL/LANGUAGE, INSURANCE, AND HOUSING. A NUMERICAL VALUE IS ASSIGNED TO THOSE AREAS OF HIGHEST TO LOWEST NEEDS. THESE CNI SCORES CORRELATE WITH DATA SHOWING THESE COMMUNITIES ALSO HAVE HIGHER RATES OF HOSPITALIZATION FOR AMBULATORY CARE SENSITIVE CONDITIONS. RESIDENTS IN THE COMMUNITIES WITH SCORES OF "5" ARE MORE THAN TWICE LIKELY TO NEED INPATIENT CARE FOR PREVENTABLE CONDITIONS THAN COMMUNITIES WITH A SCORE OF "1". OF THE SIX IDENTIFIED ZIP CODES IN OUR CATCHMENT AREA, FIVE OF THEM RATE AS "HIGHEST NEEDY." THESE ZIP CODES INCLUDE 94102 (TENDERLOIN), 94103 (SOMA), 94104 (DOWNTOWN), 94108 (CHINATOWN), AND 94133 (NORTH BEACH), WHICH ALLOW FURTHER FOCUS OR REFINEMENT OF OUR COMMUNITY BENEFIT INTERVENTION FOR MAXIMUM AND STRATEGIC IMPACT. THE DIGNITY HEALTH CNI FINDINGS ARE IN ALIGNMENT WITH THE OTHER HEALTH INDICATOR DATA FOUND ON THE SFHIP.ORG WEBSITE. Schedule H, Part VI, Line 3 - Patient Education PATIENT EDUCATION OF ELIGIBILITY FOR COMMUNICATION OF THE FINANCIAL ASSISTANCE PROGRAM TO PATIENTS AND THE PUBLIC: SFMH FOLLOWS DIGNITY HEALTH'S FINANCIAL ASSISTANCE PROGRAM. INFORMATION ABOUT DIGNITY HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF THE SFMH'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS SFMH MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES SFMH SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT ALL UNINSURED PATIENTS RECEIVE AN UNINSURED DISCOUNT OF 30%, AND THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION OR WITH PROMPT PAYMENT. FINANCIAL ASSISTANCE INFORMATION, GOVERNMENT PROGRAM RESOURCE INFORMATION, TOOLS TO ASSIST PATIENTS IN FINDING HEALTH COVERAGE, ANSWERS TO FREQUENTLY ASKED BILLING QUESTIONS, AND OTHER SUCH INFORMATION CAN ALSO BE FOUND ON SFMH'S WEBSITE AT https://www.dignityhealth.org/bayarea/locations/saintfrancis/patients-and- visitors/for-patients/billing-and-payment/financial-assistance AND ALSO ON DIGNITY HEALTH'S WEBSITE AT WWW.DIGNITYHEALTH.ORG. AT THE POINT OF REGISTRATION, BROCHURES ARE MADE AVAILABLE TO ALL PATIENTS EXPLAINING THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND THE AVAILABILITY OF GOVERNMENT SPONSORED PROGRAMS. COPIES OF THE FINANCIAL ASSISTANCE APPLICATION ARE MADE AVAILABLE TO ALL UNINSURED PATIENTS IN ADDITION TO THE BROCHURE UPON ADMISSION TO THE FACILITY. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO UNINSURED PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED, A STATEMENT INFORMING PATIENTS WITHOUT INSURANCE COVERAGE THAT THEY MAY BE ELIGIBLE FOR A GOVERNMENT SPONSORED PROGRAM OR FACILITY FUNDED FINANCIAL ASSISTANCE, INSTRUCTIONS ON HOW TO APPLY FOR A GOVERNMENT PROGRAM OR FINANCIAL ASSISTANCE AND THE PROVISION OF SUCH APPLICATIONS. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF SFMH REQUIRES ALL INITIAL STATEMENTS TO UNINSURED PATIENTS TO INCLUDE VERBIAGE INFORMING PATIENTS OF THE FACILITY'S FINANCIAL ASSISTANCE PROGRAM AND A COPY OF THE FINANCIAL ASSISTANCE APPLICATION. ALSO, ANY MEMBER OF THE SFMH STAFF OR MEDICAL STAFF MAY MAKE REFERRALS OF PATIENTS FOR FINANCIAL ASSISTANCE. THE PATIENT, A FAMILY MEMBER, A CLOSE FRIEND OR AN ASSOCIATE OF THE PATIENT MAY ALSO MAKE A REQUEST FOR FINANCIAL ASSISTANCE. Schedule H, Part VI, Line 4 - Community Information SFMH IS THE ONLY HOSPITAL LOCATED IN DOWNTOWN SAN FRANCISCO. PATIENTS' ACCESSING THE HOSPITAL'S SERVICES ENCOMPASSES BOTH THE CITY'S RICHEST TO POOREST RESIDENTS. THE HOSPITAL PRIMARILY SERVES SAN FRANCISCO, HOWEVER A NUMBER OF SPECIALIZED PROGRAMS DRAW PATIENTS FROM ALL OVER NORTHERN CALIFORNIA AND BEYOND. SAN FRANCISCO IS DENSELY POPULATED AND BOASTS CULTURALLY DIVERSE NEIGHBORHOODS IN WHICH RESIDENTS SPEAK MORE THAN 12 DIFFERENT LANGUAGES. PARTS OF SAN FRANCISCO (47 CENSUS TRACTS) ARE FEDERALLY-DESIGNATED AS MEDICALLY UNDERSERVED AREAS. Total Population: 805,270 Race/Ethnicity: White - Non-Hispanic 40.9%; Black/African American - Non-Hispanic 5.0%; Hispanic or Latino 15.6%; Asian/Pacific Islander 34.4%; All Others 4.1% Median Income: $86,478 Unemployment: 5.1% No High School Diploma: 11.3% Medicaid: 23.0% Uninsured: 5.4% OTHER AREA HOSPITALS: 8 THE TENDERLOIN (94102) The Tenderloin is one of San Franciscos lowest income neighborhoods, where 1 in 3 live in poverty 34% are at or below 100% of FPL and 64% are at or below 200% of FPL. Housing is an important concern in the Tenderloin, with over half of the Citys homeless population living in the neighborhood in 2015: 3,836 homeless individuals compared to 2,850 homeless individuals (San Francisco Homeless Count Survey, 2005 2013). THE TENDERLOIN NEIGHBORHOOD IS THE PRIMARY FOCUS OF THE SFMH COMMUNITY BENEFIT PLAN. IT focuses on the health needs of the Tenderloin WHERE: -The Tenderloin has a slightly older and more ethnically diverse population when compared to San Francisco: 32% White, 10% Black, 18% Latino/a, 33% API, 6% Other and a majority of which are between the ages of 25-44, followed by 45-64 and 65+ (American Community Survey 5-Year Estimates, 2009-2013; American Community Survey 5-Year Estimates, 2010-2014). - The Tenderloin is one of San Franciscos lowest income neighborhoods, where 1 in 3 live in poverty 34% are at or below 100% of FPL and 64% are at or below 200% of FPL. Housing is an important concern in the Tenderloin, with over half of the Citys homeless population living in the neighborhood in 2015: 3,836 homeless individuals compared to 2,850 homeless individuals (San Francisco Homeless Count Survey, 2005 2013). - There is significant momentum to increase healthy food access for all residents of the Tenderloin. The Healthy Retail SF Program has worked to convert 5 corner stores into retailers that sell affordable food and minimize the visibility of alcohol and tobacco products. 57% of retailers accept CalFresh benefits, compared to 40% San Francisco. - The Tenderloin has the highest rate of severe and fatal pedestrian injuries in the City, with 50 per 100 road miles, compared to 8 per 100 road miles San Francisco. Vision Zero SF is refocusing city resources and investment on the streets that have the most severe and fatal traffic injuries so that we can get to zero traffic deaths by 2024. - Crime and safety are important issues in the Tenderloin, with violent crime rate of 260.3 per 1,000 residents compared to 56.5 San Francisco. - The leading causes of death 2011-2015 in the Tenderloin is accidental poisoning and exposure to noxious substances, followed by Ischemic Heart Diseases, Lung Trachea/Bronchial Cancer, Hypertensive Diseases, and Dementias, Alzheimers, and Other Degenerative Diseases of the Nervous System. (CDPH, Death Statistical Master File, 2011 2015). Mental health and substance use disorder are top health issues for Tenderloin residents. Tenderloin residents are hospitalized more often for ambulatory care sensitive chronic diseases, 148.1 hospitalizations-age adjusted rate per 10,000 residents, compared to 60.6 hospitalizations-age adjusted rate per 10,000 residents San Francisco (OSHPD, Hospital Discharge Data, 2012-2014). - The Tenderloin has a high rate of new HIV diagnoses, with 189 new HIV diagnoses per 100,000 compared to 83 new HIV diagnoses per 100,000 San Francisco (SFDPH HIV Epidemiology Report, 2014). - More Tenderloin residents have insurance as a result of the ACA. Healthy SF enrollment dropped by 75-85% between 2010 and 2015, in both the Tenderloin and Citywide, indicating more individuals moved to MediCal or health insurance through the exchange. About 4% of Tenderloin residents were still enrolled in Healthy SF as of December 2015. Schedule H, Part VI, Line 5 - Promotion of Community Health 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. ALL SURPLUS FUNDS GENERATED BY SFMH ARE REINVESTED BACK INTO THE ORGANIZATION TO IMPROVE PATIENT CARE AND PROVIDE HEALTHCARE SERVICES TO ITS COMMUNITY. SFMH HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. IN ADDITION, SFMH FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY BY EXERCISING THE FOLLOWING: - OPERATING AN EMERGENCY ROOM THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY; - PARTNERING WITH GLIDE HEALTH CLINIC, AN FQHC SERVING THE UNDERSERVED IN THE TENDERLOIN NEIGHBORHOOD. - ENGAGING IN THE TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS IN THE TENDERLOIN NEIGHBORHOOD. Schedule H, Part VI, Line 6 - Affiliated Health Care System SFMH IS AFFILIATED WITH DIGNITY HEALTH. AFFILIATES OF DIGNITY HEALTH ALSO PROMOTE THE HEALTH OF ADDITIONAL COMMUNITIES IN BAKERSFIELD, SAN BERNARDINO, SAN FRANCISCO, SAN ANDREAS, AND GRASS VALLEY/NEVADA CITY, CALIFORNIA. THESE AFFILIATES FOLLOW PRACTICES SIMILAR TO THOSE NOTED ABOVE IN DETERMINING THE UNMET HEALTHCARE NEEDS OF THEIR COMMUNITIES. TOTAL UNSPONSORED COMMUNITY BENEFIT EXPENSE FOR DIGNITY HEALTH AND ITS SUBORDINATE CORPORATIONS FOR THE YEAR ENDED JUNE 30, 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 Dignity Health Medical Foundation 3400 Data Drive Sacramento CA 95814 680220314 501(c)(3) 1115239 0 N/A N/A Medical Foundation Support Hospital Council of Northern CA 1215 K Street 800 Sacramento CA 95814 941533644 501(c)(3) 33025 0 N/A N/A Community Health ICA San Francisco Work Study Inc 3625 24th Street San Francisco CA 94110 264450576 501(c)(3) 12000 0 N/A N/A Education Support Hult International Business School Inc 1355 Sansome Street San Francisco CA 94111 043348440 501(c)(3) 15000 0 N/A N/A Education Support Saint Francis Foundation 900 Hyde Street San Francisco CA 94109 942597514 501(c)(3) 251316 0 N/A N/A Community Health 5 0 PROVISION OF FOOD 5159 0 16738 FMV DISCOUNTED MEALS Sched I, Part I, Line 2 AS A 501(C)(3) ORGANIZATION, WE PROVIDE ASSISTANCE TO VARIOUS CHARITABLE ORGANIZATIONS TO PROMOTE DIGNITY HEALTH'S MISSION. A DESIGNATED COMMITTEE ESTABLISHES AND EVALUATES PRIORITIES AND ALLOCATION OF FUNDS WITH EMPHASIS ON PROMOTION OF HEALTHY COMMUNITIES AND COMMUNITY COLLABORATION. WE DO NOT MONITOR AND REPORT PROGRAM OUTCOMES. SPENDING IS TRACKED ON AN ONGOING BASIS TO ENSURE THAT ANNUAL SPENDING IS WITHIN THE BUDGETED AMOUNT. true true false false false false false false false Alan Fox CFO/ Treasurer 286536 0 500 0 22690 0 29494 0 35132 0 374352 0 0 0 James Houser Interim President & CEO 0 845000 0 0 0 61685 0 0 906685 0 0 Charlene Battaglia Senior Director - Nursing 202626 0 500 0 4094 0 21214 0 3776 0 232210 0 0 0 Jae Chun VP Strategy and Service Line O 255690 0 500 0 993 0 20181 0 36031 0 313395 0 0 0 Mark Garfield MD Chief Medical Officer 258388 0 500 0 28552 0 25125 0 21822 0 334387 0 0 0 Bradley Grote Senior Director-Nursing Operat 200952 0 500 0 911 0 15064 0 13897 0 231324 0 0 0 Dennis Kneeppel CNE 37157 0 0 0 185886 0 6408 0 10601 0 240052 0 0 0 Raymond Miller Director, Pharmacy 209706 0 500 0 2286 0 21802 0 23931 0 258225 0 0 0 Tracey Pierce VP, HR 201212 0 68000 0 253 0 19763 0 16068 0 305296 0 0 0 Dallas Ryan Director Materials Management 200392 0 500 0 947 0 19993 0 23292 0 245124 0 0 0 Jill Welton VP Quality/CNO 291850 0 500 0 1115 0 30144 0 31612 0 355221 0 0 0 Abbie Yant Vice President Comm.Advocacy H 178820 0 500 0 3794 0 17307 0 36896 0 237317 0 0 0 Kevin Causey Foundation President 232730 0 65489 0 1365 0 29164 0 23900 0 352648 0 0 0 Frances T L Chee Registered Nurse 288069 0 500 0 4808 0 24400 0 24137 0 341914 0 0 0 Bradford K Moy Medical Director 303466 0 500 0 1861 0 29753 0 14909 0 350489 0 0 0 Isatou E Njie Staff Nurse II 267265 0 500 0 0 22467 0 22294 0 312526 0 0 0 Doris Y Yau Staff Nurse III 235821 0 0 0 33475 0 17404 0 23132 0 309832 0 0 0 Tom Hennessy Former Officer 0 0 0 0 508250 0 0 0 0 0 508250 0 0 0 PART I, LINE 3 Although the organization employs personnel, the Organization relied on a related organization, Dignity Health, that used one or more of the methods described in Schedule J, Part I, Line 3, to establish the Organization's President's compensation. See Schedule O disclosure for Form 990, Part VI, Section B, Line 15a for additional information. PART I, LINE 4a THE LISTED PERSONS PAID BY THE PARENT ORGANIZATION PARTICIPATE IN A SEVERANCE PLAN PROVIDED BY DIGNITY HEALTH THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 6 MONTHS TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE PLAN. PAYMENTS AND DEFERRED COMPENSATION PURSUANT TO THE PLAN ARRANGEMENT OCCURRED DURING 2015 TO A FORMER OFFICER INCLUDE T. HENNESSY, $508,250. THE ORGANIZATION'S NON-CONTRACTUAL EMPLOYEES PARTICIPATE IN A SEVERANCE PLAN PROVIDED BY SAINT FRANCIS MEMORIAL HOSPITAL THAT PROVIDES FAIR COMPENSATION, RANGING FROM PAYMENTS OF 2 WEEKS TO 18 WEEKS OF BASE COMPENSATION, DEPENDING ON THE EMPLOYEE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE PLAN. SEVERANCE FOR EMPLOYEES COVERED BY COLLECTIVE BARGAINING AGREEMENTS VARIES BY AGREEMENT. PAYMENTS WERE MADE TO ONE KEY EMPLOYEE DURING 2015 PURSUANT TO THIS PLAN INCLUDE D KNEEPPEL; $149,819. 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 occurred during 2015 PURSUANT TO THIS PLAN. CERTAIN LISTED PERSONS PARTICIPATE IN THE DIGNITY HEALTH KEY EMPLOYEE SHARE OPTION PLAN (KEYSOP), WHICH WAS FROZEN IN MAY 2002. THE KEYSOP PROGRAM WAS ESTABLISHED IN 2001 WITH THE PURPOSE OF PROVIDING INCOME DEFERRAL OPPORTUNITIES TO EMPLOYEES ELIGIBLE FOR THE COMPANY'S KEY EMPLOYEE RETENTION PROGRAM. NO PAYMENTS WERE MADE TO ANY LISTED PERSONS DURING 2015 PURSUANT TO THIS PLAN. Compensation amounts for the supplemental nonqualified retirement plans discussed above are reported as deferred compensation in the year accrued (Schedule J, Part II, column C) and are reflected again as reportable compensation in the year paid (Schedule J, Part II, column B(iii)). 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 the organization to fulfill its mission of providing high quality healthcare for all persons regardless of their ability to pay for services, improving the quality of life in the communities the organization serves, promoting employee satisfaction, and ensuring financial stability. A substantial portion of executive compensation is performance based and is linked to organizational goals approved in advance by the Compensation and Benefits Committee. These goals include attainment of annual and long-term financial performance, certain healthcare quality standards and the organization's commitment to serving the poor and disenfranchised in the communities it serves. Total compensation, which includes base salary, annual and long-term incentive compensation, is established to approximate the prevailing market conditions for executives of companies of similar size, revenues and complexity. A CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033FYE4 2005-11-10 200000000 SEE PART VI - BOND 1 - CUSIP 13033 false false true A 0 0 10000000 0 0 0 0 0 0 10000000 0 0 2007 false false true true A false true true true true true 0.00100 0.00000 0.00100 false false 0.00000 false true A false false false true true false 0 false 0 true true A true BOND 1 - CUSIP 13033FYE4 SCHEDULE K, PART I, COLUMN (E) THE DIFFERENCE BETWEEN THE ISSUE PRICE IN PART I, COLUMN (E) AND PART II, LINE 3 IS PRIMARILY A RESULT OF THE COMPOSITE BOND ISSUE THAT WAS A POOLED FINANCING ISSUE. THE FULL ISSUE PRICE OF WHICH IS SHOWN IN PART I, COLUMN (E). IN COMPARISON, THE AMOUNT OF PROCEEDS SHOWN IN PART II, LINE 3 REFLECTS ONLY THE PORTION OF THE BOND ISSUE BORROWED BY SAINT FRANCIS MEMORIAL HOSPITAL AND CURRENTLY OUTSTANDING. A SMALL PART OF THE DIFFERENCE BETWEEN THE ISSUE PRICE AND PROCEEDS IS DUE TO INVESTMENT EARNINGS. SCHEDULE K, PART I, COLUMN (F) FINANCE ACQUISITION OF MEDICAL EQUIPMENT AND CONSTRUCTION AND RENOVATION OF HOSPITAL FACILITIES. SCHEDULE K, PART IV, LINE 2C THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFOMED ON 1/28/2015. DR DAVID DUONG BOARD MEMBER HOUSING LOAN X 92250 5092 false true true 5092 DAVID T DUONG MD PHD DAVID DUONG - BM 59896 LEASE PAYMENTS TO SFMH false DAVID T DUONG MD PHD DAVID DUONG - BM 19836 LOAN FORGIVENESS PAYMENTS false DAVID T DUONG MD PHD DAVID DUONG - BM 36940 medical services false ANESTHESIOLOGISTS MEDICAL GROUP SF THOMAS AHLBERG - BM 480000 MEDICAL SERVICES false VICTOR PRIETO MD VICTOR PRIETO - BM 145143 MEDICAL SERVICES false PARAGON PATHOLOGY MEDICAL ASSOCIATE H GOODMAN - BM 538617 MEDICAL SERVICES false KATHLEEN JODAN MD K JODAN - BM 107102 MEDICAL SERVICES false Form 990, PART VI,VII, XI and XII FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS DIGNITY HEALTH, A 501(C)(3) EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A DIGNITY HEALTH, AS THE SOLE CORPORATE MEMBER, RATIFIES THE SELECTION OF MEMBERS AND THE DIGNITY HEALTH BOARD APPROVES NEW BOARD MEMBERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B RESERVED RIGHTS OF THE CORPORATE MEMBER INCLUDE ADOPTION OF MISSION AND PHILOSOPHY STATEMENTS, AMENDMENT OR RESTATEMENT OF ARTICLES OF INCORPORATION AND BYLAWS, DISSOLUTION OF THE CORPORATION, ACQUISITION OF ANOTHER CORPORATION, CREATION OF A NEW SUBSIDIARY, MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION, PARTICIPATION AS A GENERAL OR LIMITED PARTNER IN ANY VENTURE, INCURRING LONG-TERM INDEBTEDNESS IN EXCESS OF NORMAL OPERATING REQUIREMENTS, RATIFICATION OF BOARD MEMBER APPOINTMENTS AND DISMISSALS, SELECTION AND REMOVAL OF INDEPENDENT AUDITORS, AND TRANSACTIONS OUTSIDE THE ORDINARY COURSE OF BUSINESS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS REVIEWED BY FINANCE AND ACCOUNTING (REGIONAL DIGNITY HEALTH MANAGEMENT AND CORPORATE TAX DEPARTMENT), WHICH WORKED CLOSELY WITH AN INDEPENDENT ACCOUNTING FIRM ENGAGED TO REVIEW THE RETURN. THE BOARD OF TRUSTEES HAS DELEGATED THE REVIEW OF THE FORM 990 TO THE FINANCE COMMITTEE. MANAGEMENT PROVIDED THE DRAFT OF THE FORM 990 TO THE FINANCE COMMITTEE BEFORE FILING THE RETURN WITH THE IRS FOR DISCUSSION AT THE COMMITTEE MEETING. THE DRAFT WAS COMPLETE EXCEPT IT EXCLUDED COMPENSATION INFORMATION. SUBSEQUENT TO ITS REVIEW, THE FINANCE COMMITTEE REPORTED BACK TO THE BOARD REGARDING ITS REVIEW AND PROVIDED A DRAFT TO THE BOARD OF TRUSTEES, AGAIN EXCLUDING COMPENSATION. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. Under such policies, the EVP/General Counsel is 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, members of Board Committees with subject matter jurisdiction and any other relevant decision-makers; (2) the interested person responds to factual questions related to the substance of the transaction or arrangement being considered, after which he/she shall leave the meeting; (3) the interested person 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 PRESIDENT IS COMPENSATED BY DIGNITY HEALTH. FOR 2015, DIGNITY HEALTH'S Board of Directors appoints a Human Resources and Compensation Committee, comprised of independent directors, who are accountable for setting reasonable compensation packages for each officer and certain key employees (including the President/CEO). The Human Resources and Compensation Committee approves, consistent with the organization's philosophy and principles, the annual performance goals and criteria to be used in determining merit increases and variable compensation criteria for officers and key executives. The Human Resources and Compensation Committee also engages outside legal counsel as necessary and qualified independent compensation and benefits specialists (independent experts) to review, analyze and provide benchmarking data for the total compensation and benefits packages of officers and key executives. Appropriate comparable data is obtained from the independent experts, (e.g., total economic benefits paid by similarly situated organizations, both taxable and tax-exempt, for similar job responsibilities). Key deliberations of the Committee are documented in meeting minutes which are approved at the next Committee meeting and provided to the Board of Directors. The documentation of the deliberations includes (a) the terms of the transaction approved and the date approved; (b) the members of the Committee who were present during discussion of the approved transaction and those who voted on it; and (c) the comparability data obtained and relied upon by the Committee and how the data was obtained. FORM 990, PART VI, SECTION B, LINE 15B FOR 2015, THE PARENT ORGANIZATION'S HUMAN RESOURCES DEPARTMENT CONDUCTED AN ANNUAL REVIEW AND ANALYSIS TO PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGE OF KEY EXECUTIVES. THE COMPENSATION FOR THESE INDIVIDUALS WAS BASED ON THE QUALIFICATION AND EXPERIENCE OF THE CANDIDATES. COMPENSATION IS ALSO REVIEWED ANNUALLY AS PART OF THE MERIT INCREASE PROCESS. FORM 990, PART VI, SECTION C, LINE 19 FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY BE MADE AVAILABLE FOR PUBLIC INSPECTION. FORM 990 AND THE COPY OF AUDITED FINANCIAL STATEMENTS ATTACHED TO IT ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9 SHARED JOINT VENTURE FUND BALANCE; $ 470,462 INTEREST IN NET ASSETS OF UNCONSOLIDATED FOUNDATION; $(9,841,996) CHANGE IN OWNERSHIP INTERESTS; $ (260,499) FORM 990, PART XII, LINE 3B THE ORGANIZATION'S FEDERAL AWARDS WERE INCLUDED IN DIGNITY HEALTH'S CONSOLIDATED OMB CIRCULAR A-133 AUDITED SCHEDULE OF FEDERAL EXPENDITURES. safe harbor election disclosure Tangible Property Regulation Statement Section 1.263(A)-1(F) de minimis safe harbor election Taxpayer is making the de minimis safe harbor election under Treasury Regulation 1.263(A)-1(F) for all eligible amounts paid or incurred during the taxable year. FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL SERVICES TOTAL FEES:15545383 FORM 990 PART IX LINE 11G DESCRIPTION:REVENUE CYCLE ADMIN SERVICES TOTAL FEES:7719734 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATIVE SERVICES TOTAL FEES:6439516 FORM 990 PART IX LINE 11G DESCRIPTION:REPAIRS/MAINTENANCE TOTAL FEES:5987450 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL COUNSULTING TOTAL FEES:2385792 FORM 990 PART IX LINE 11G DESCRIPTION:PARKING TOTAL FEES:2008526 FORM 990 PART IX LINE 11G DESCRIPTION:JANITORIAL/CLEANING/WASTE/LAUU TOTAL FEES:1822685 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:449694 DIGNITY HEALTH 185 Berry Street San Francisco CA 94107 941196203 Hospital CA 501(c)(3) 3 NA false false true true false false false false false false false false false true false false false false true false NONE