2016-05-12T15:20:15-05:00 2015-06-30 GRANT THORNTON LLP 101 CALIFORNIA STREET SUITE 2700 SAN FRANCISCO CA 94111 990 2014-07-01 912154436 O'Connor Hospital % JACK SPENCER OCON 6509174528 2105 Forest Avenue San Jose CA 95128 Stephen Forney CFO 6509174528 2016-05-09 true BETHANN LONDYNSKY P00847678 4159863900 2014 2016-08-17 19:52:53Z Robert Minkin 2105 Forest Avenue San Jose CA 95128 300897048 false 0928 X www.oconnor.verity.org X 2001 CA See Attachment 1 11 10 1809 183 0 -44011 26251391 1664390 263490092 293194898 10177458 -36048 7200653 5430985 307119594 300254225 17552293 15179609 0 0 187665431 183609489 0 0 0 137962197 150220321 343179921 349009419 -36060327 -48755194 99866603 124965875 169019243 245272573 -69152640 -120306698 X IN THE SPIRIT OF OUR FOUNDERS, ST. VINCENT DE PAUL, ST. LOUISE DE MARILLAC, AND ST. ELIZABETH ANN SETON, THE DAUGHTERS OF CHARITY HEALTH SYSTEM IS COMMITTED TO SERVING THE SICK AND THE POOR. WITH JESUS CHRIST AS OUR MODEL, WE ADVANCE AND STRENGTHEN THE HEALING MISSION OF THE CATHOLIC CHURCH BY PROVIDING COMPREHENSIVE, EXCELLENT HEALTHCARE THAT IS COMPASSIONATE AND ATTENTIVE TO THE WHOLE PERSON: BODY, MIND AND SPIRIT. WE PROMOTE HEALTHY FAMILIES, RESPONSIBLE STEWARDSHIP OF THE ENVIRONMENT, AND A JUST SOCIETY THROUGH VALUE-BASED RELATIONSHIPS AND COMMUNITY-BASED COLLABORATION. false false 286012715 15179609 295441686 O'Connor Hospital, a member of the Daughters of Charity Health System, is a full service acute care hospital serving Santa Clara County, California, with the following key areas of patient services: Emergency and Critical Care Services, Oncology and Radiation Therapy, Breast Health Center, Center for Orthopedics, Arthritis, and Joint Replacement Center for Sports Medicine, Cardiovascular Services, Endovascular and Wound Care Services, Interventional Radiology, Women's and Children's Services, Pediatric Clinic. Additional information about O'Connor Hospital's charitable activities can be found on Schedule O. 286012715 true true false false false false false false false false true false false true true false false true false false false false false false false false true true true false true true false false false false false false false false false false true false false false false true true true false false true 226 0 true 1809 true false false false false false false false false false false X 11 10 false false false false true true true true true false false true true true true true true true true true true CA X JACK SPENCER 6505516650 203 REDWOOD SHORES PKWY SUITE 800 Redwood City CA 94065 X Sr Eileen Kenny DC Board Chair 4.0 0.0 X X 0 0 0 Sr Marion Bill DC Board Member 2.0 7.0 X 0 0 0 Sr Catarina Chu DC Board Member 2.0 0.0 X 0 0 0 Sr William Eileen Dunn DC Board Member 2.0 0.0 X 0 0 0 Sr Margaret Keaveney DC Int. Pres. & CEO/Board Member 20.0 20.0 X X 0 0 0 N Thad Padua MD Vice Chair 2.0 0.0 X X 0 0 0 Mario Cordero MD Treasurer/Secretary 2.0 0.0 X X 0 0 0 Jeffrey Anderson MD Board Member 2.0 0.0 X 0 0 0 Gerry DeYoung Board Member 2.0 0.0 X 0 0 0 Hugh Walsh MD Board Member 2.0 0.0 X 3600 0 0 Robert Issai Board Member 2.0 46.0 X 0 1553079 326419 James Dover President & CEO thru June '15 20.0 22.0 X 0 864646 82939 David Carroll Sr VP-CFO/Bus Dev thru Apr '15 20.0 24.0 X 540052 0 44227 George Block Chief Med Officer thru Apr '15 40.0 0.0 X 482937 0 43066 Ron Yaw Controller thru April 2015 40.0 0.0 X 187659 0 16763 Dawn Goeringer Sr. VP - Chief Clinical Care 40.0 0.0 X 241356 0 12262 Terri Yu Staff Nurse 40.0 0.0 X 387516 0 26669 Robert Souza Jr Interventional Rad Tech Lead 40.0 0.0 X 360609 0 52993 Julie Hatcher VP, Human Resources 20.0 20.0 X 355611 0 26635 Gyu Keun Lee Staff Nurse III 40.0 0.0 X 347843 0 37201 John R Gilchrist Chf Dev Officer thru May 2015 0.0 40.0 X 311998 0 14899 Judy Watland Former Sr. VP - CNO 0.0 0.0 X 142135 0 9675 3361316 2417725 693748 587 true true false OCHG California PC 10 Centimeters Dr MAULDIN SC 29662 Physician Services 1476739 Family Medicine Associates of San J 455 OConnor Drive SAN JOSE CA 95128 Physician Services 1390602 ARUP Laboratories 500 Chipeta Way SALT LAKE CITY UT 84108 Lab Services 727489 Coast Anesthesia Medical Group PO Box 39000 SAN FRANCISCO CA 94139 Physician Services 480055 Sang Hyun Lee MD 2315 Westbridge Lane PLEASANTON CA 94566 Physician Services 463500 27 1664375 15 28259 1664390 NET PATIENT REVENUE 622110 291015254 291015254 MEDICAL OFFICE BUILDING REVENUE 531120 1441709 1441709 EDUCATION REVENUE 900099 37447 37447 ALL OTHER OPERATING REVENUE 900099 700488 700488 293194898 134 134 0 0 1284029 606641 677388 0 677388 677388 36182 -36182 -36182 -36182 0 0 0 0 PHYSICIAN BILLING 900099 2246788 2246788 ELECTRONIC RECORDS INCENTIVE REVENUE 900099 1188579 1188579 CAFETERIA 722210 814376 814376 503854 503854 4753597 300254225 295441686 0 3148149 15179609 15179609 0 0 0 1719948 950617 769331 0 134136395 100602296 33534099 13635535 10226651 3408884 24640430 18480323 6160107 9477181 7107886 2369295 0 635788 635788 0 0 0 0 34548830 29005543 5543287 4261 4261 1874271 1405703 468568 8682251 6511688 2170563 0 5118012 3838509 1279503 31862 23897 7965 0 31760 23820 7940 4177179 4177179 0 10955921 8216941 2738980 4007102 1340794 2666308 MEDICAL SUPPLIES 42259196 42259196 PROVIDER FEES 25144678 25144678 BAD DEBT EXPENSES 7821911 7821911 EQUIPMENT RENTAL 2214659 1660994 553665 2712640 2034480 678160 349009419 286012715 62996704 0 0 0 1398967 13218112 0 0 31788554 28751826 20000 0 0 0 0 0 5096040 4810006 1363295 341278 277088714 236009301 49871064 41079413 0 0 0 0 7860 1237 0 0 10320823 36764003 99866603 124965875 29920932 30177588 0 0 0 0 0 25997164 0 0 0 0 5493030 5328571 0 0 133605281 183769250 169019243 245272573 X -69152640 -120306698 0 0 0 0 -69152640 -120306698 99866603 124965875 X -48755194 -864 -2398000 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 727429 727429 156483673 132902970 23580703 2253524 1896493 357031 115457897 101209838 14248059 2166191 2166191 41079413 OTHER RESTRICTED ASSETS 15996878 PROVIDER FEES RECEIVABLE 9802366 DUE FROM RELATED PARTIES 7677893 DUE FROM GOVERNMENT AGENCIES 2239210 OTHER RECEIVABLES 677165 DEPOSITS 370491 36764003 0 DUE TO RELATED PARTIES 125710284 PENSION OBLIGATION 57393758 DUE TO GOVERNMENT AGENCIES 337205 ASSET RETIREMENT OBLIGATION 169093 DEPOSITS 101866 UNEARNED RENT 57044 183769250 FIN 48 (ASC 740) Footnote Schedule D, Part X, Line 2: Daughters of Charity Health System and its affiliates do not have a liability for uncertain tax positions under FIN 48 (ASC 740) on their consolidated financial statements for the year ended June 30, 2015. As such, there was no FIN 48 (ASC 740) disclosure in the footnotes to the consolidated financial statements of Daughters of Charity Health System. true true X true X true X true true false true true 930 1352588 1326588 0.00400 40468 104727805 64799382 39928423 0.11700 41398 106080393 64799382 41255011 0.12100 3052 4073920 1242647 2831273 0.00830 1924 50433 16895 33538 0.00010 4976 4124353 1259542 2864811 0.00840 46374 110204746 66058924 44119822 0.12940 true 7821911 0 113086096 133384559 -20298463 X true true 1 1 O'Connor Hospital 2105 Forest Ave San Jose CA 95128 www.oconnor.verity.org 070000072 X X X X SEE FORM 990, PAGE 2 O'Connor Hospital false false true X X X X X X X X X 12 true true true true X See Part V, Section C X true 14 true See Part V, Section C false false true X 200. 350. X X X X X true true X X X X true X X X X X true X false X X X X true X false false Part V, Section B, Lines 2, 3j, 7d, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c 21d, 22d, 23, and 24: N/A Part V, Section B, Line 5: See disclosure for Part VI, Question 2: Needs Assessment Part V, Section B, Line 6a: O'Connor Hospital's Community Health Needs Assessment ("CHNA") was conducted in conjunction with the Santa Clara County Community Benefit Coalition, a coalition of eight local non-profit hospitals and other partners. The hospitals included in the coalition are: O'Connor Hospital, El Camino Hospital, Lucile Packard Children's Hospital at Stanford, Stanford Hospitals & Clinics, Kaiser Permanente, and Saint Louise Regional Hospital. Part V, Section B, Line 6b: The non-hospital organizations included in the Santa Clara County Community Benefit Coalition, which O'Connor Hospital ("OCH") worked in conjunction with to complete its CHNA, include the Hospital Council of Northern & Southern California, the Santa Clara County Public Health Department, and the United Way of Silicon Valley. Part V, Section B, Line 7a: The CHNA report can be accessed at: http://oconnor.verity.org/about-us/community-benefit/ Part V, Section B, Line 10a: O'Connor Hospital's most recently adopted implementation strategy is posted on its website via the organization's Community Benefit Report for the fiscal year-ending June 30, 2014, which can be found at http://oconnor.verity.org/about-us/community-benefit/ Part V, Section B, Line 11: OCH is committed to providing quality care to the community we serve. Taking into consideration the magnitude of the need, the Hospital's resources, the Santa Clara County Community Benefit Coalition members' activities and additional community assets, the O'Connor Hospital Community Benefits Committee has identified five priority needs which will be addressed by OCH: 1. Diabetes 2. Obesity 3. Cardiovascular Disease, Heart Disease and Stroke 4. Cancer 5. Access to Health Care Services Diabetes is a health need as marked by relatively high rates of diabetes among adults in Santa Clara County. For example, county-wide, diabetes prevalence is at 8% (no better than the state average), but for the county's Latino population diabetes prevalence is 11%. Drivers of diabetes rates include poor nutrition and lack of exercise, and physical environment such as availability of fresh food and fast food. To address this priority need, OCH has provided education and resources to individuals in the hope that this will help them make healthier choices when it comes to food and exercise. OCH has undertaken many activities to accomplish its objectives of (i) educating associates, physicians and the community on the risks of diabetes, (ii) providing education and resources to targeted populations, and (iii) providing diabetes screenings in the community. These activities include: educating Family Medicine Residents on how to diagnose and care for patients living with diabetes; teaching residents a patient self-care model (which will enable patients to manage their diabetes through self-management and group meetings); present Living Well Community Education Classes on diabetes, nutrition and exercise; and conducting monthly diabetes support group meetings. Obesity is a health need as indicated by high rates of obese youth (24-31%) and adults (21%) in Santa Clara County, and high rates of overweight individuals (14% and 36% respectively). Overall rates miss the Healthy People 2020 targets. Latino and Black/African American residents have the highest overweight and obesity rates. Drivers of obesity are poor nutrition, lack of exercise, and physical environment such as availability of fresh food and fast food. To address this priority need, OCH has provided education and resources to individuals in the hope that this will help them make healthier choices when it comes to food and exercise. OCH has undertaken many activities to accomplish its objectives of (i) educating associates, physicians and the community on the risks of obesity, (ii) providing education and resources to targeted populations, and (iii) providing BMI screenings in the community. These activities include: educating Family Medicine Residents on how to diagnose and care for patients living with obesity; teaching residents a patient self-care model (which will enable patients to manage their obesity through self-management and group meetings); present Living Well Community Education Classes on obesity, nutrition and exercise; conduct BMI screenings at health fairs and provide educational information; promote CalFresh enrollment through its Health Benefits Resource Center; and promote Brown Bag Program for seniors through its Health Benefits Resource Center. Cardiovascular Disease, Heart Disease, and Stroke are a health need, as they are among the top ten deaths in Santa Clara County and California. The overall rate of high cholesterol in the county (29%) is higher than the Healthy People 2020 target (17%), as are the rates for all ethnic populations. Related to poor cardiovascular health are the health behaviors of smoking, drinking, poor nutrition and lack of exercise. To address this priority need, OCH has provided education and screenings to individuals in the hope that they will make lifestyle modifications to lower high blood pressure and cholesterol rates. OCH has undertaken many activities to accomplish its objectives of (i) educating associates and physicians on the risks and warning signs associated with cardiovascular disease, heart disease and stroke, (ii) provide education and resources to targeted populations, and (iii) provide health screenings in the community. These activities include: present Living Well Community Education Classes on cardiovascular diseases, heart attacks, stroke, nutrition and exercise; conduct cholesterol, glucose, BMI and blood pressure screenings at health fairs and provide educational information; offer free weekly blood pressure screenings in its Cardiac Rehabilitation Center; conduct monthly stroke support group meetings; conduct bimonthly implantable cardioverter-defibrillator (ICD) support group meetings; sponsor events that provide education or create awareness; and have associates who are actively involved with community organizations provide education or create awareness. Cancer is a health need; Santa Clara County incidence rates for breast, cervical, liver and prostate cancers are higher than benchmarks/state averages. Certain ethnic subgroups experience difference incidence and mortality rates. For instance, the overall county liver cancer mortality rate (age adjusted mortality incidence per 100,000) is 6.8, compared with 5.6 for the state, and even worse for county Latinos (9.0) and Asian/Pacific Islanders (11.9). Contributing factors to cancer are health behaviors such as smoking and drinking, and lack of screenings. To address this priority need, OCH has provided education and screenings to individuals in an effort to create awareness, improve early detection and assist those living with cancer. OCH has undertaken many activities to accomplish its objectives of (i) educating associates and physicians on the early signs of cancer, (ii) provide education and resources to targeted populations, and (iii) provide health screenings in the community. These activities include: present Living Well Community Education Classes on cancer; conduct hepatitis B screenings; host bimonthly cancer support group meetings; sponsor events that provide education or create awareness; and have associates who are actively involved with community organizations provide education or create awareness. Access to Health Care Services is a health need in Santa Clara County because socioeconomic conditions (poverty, low levels of education, lack of health insurance) as well as factors such as the size of the health care workforce and linguistic and transportation barriers all affect access to care, which negatively impacts health. To address this priority need, OCH has strived to improve access to health care services. OCH has undertaken many activities to accomplish its objectives of (i) providing health care services to all in the community, (ii) improve the health care workforce, (iii) provide health education and resources, and (iv) provide health screenings in the community. These activities include: provide free radiologic examinations to patients from the San Jose RotaCare Clinic; operate the Health Benefits Resource Center; participate in Santa Clara County's Medical Respite Program so homeless individuals have a place to recover from their acute hospital; refer patients to the New Directions Case Management Program so frequent Emergency Room users have case management services; sponsor the San Jose-O'Connor Family Medicine Residency Program, which provides clinical training for 24 family medicine residents and 2 sports medicine fellows; be a clinical teaching site for nursing students, radiological technicians, pharmacy students and clinical lab specialists; and present Living Well Community education Classes on a variety of topics in a variety of languages. Taking into consideration the Coalition members' community benefit investments, additional community assets and OCH's own resources, the OCH Community Benefit Committee identified the following health needs that will not be targeted as actionable for intervention. Violence is a health need because the rate of youth homicide (7.4) in Santa Clara County is higher than Healthy People target. In addition, the county has seen a large increase in homicides in the years 2011 and 2012. Domestic violence and child abuse rates also miss the benchmark for some ethnic subgroups. Drivers of this health need include mental health and social determinants of health such as poverty and unemployment. OCH does not have the expertise or funding resources to impact Violence. There are several community organizations doing great work to address this need. Poor Mental Health is a health need because of self-reported poor mental health (17%) among Santa Clara County residents, higher than the state average. Also, youth of color are disproportionately depressed and suicidal. Community input indicates high concern about stress and depression specifically. OCH does participate in the New Directions Program and sponsors the Medical Respite Program, both coordinated through the Hospital Council of Northern & Central California. These Part I, Line 3c: N/A Part I, Line 6a: O'Connor Hospital prepares an annual Community Benefit Report. It highlights the community's needs and O'Connor's programs and activities that directly respond to the needs. Reports on community benefit activities and outcomes are provided by managers and directors responsible for specific community benefit programs. Quarterly reports are presented to the OCH Board of Directors and Daughters of Charity Health System (DCHS) corporate officers. An annual report is prepared and presented to the OCH Board of Directors for approval. The annual report is made available to hospital leadership, key stakeholders, DCHS, and community organizations and members. The annual report is presented to the California Office of Statewide Planning and Development, in accordance with SB697. O'Connor Hospital's Community Benefit Report is developed using results from the Community Needs Assessment, data and input provided by the managers and directors responsible for specific community benefit programs and feedback from the Community Benefits Committee. O'Connor Hospital's Board of Directors reviews and gives final approval of OCH's Community Benefit Report. Part I, Line 7, Column (f): Form 990, Part IX, line 25, Column A for OCH reflects a bad debt expense of $7,821,911 which is not included in the line 7 calculation. Part I, Line 7: OCH utilizes a cost accounting system that determines costs for providing medical services based on the organizations relationship of costs to charges. Part II: N/A Part III, Line 4: OCH is included in the DCHS Consolidated Audited Financial Statements. The financial statements for FY 2015 do not contain a separate footnote on bad debts. Bad debt expense is estimated by utilizing historical collections data of self-pay patients. In making this estimate, Management also considers business and general economic conditions in its service area. Part III, Line 8: As a not-for-profit hospital it is our mission to improve the health status of all people within our community and provide healthcare to all patients regardless of their ability to pay or their insurance status. OCH accepts Medicare which results in shortfalls in the costs for caring for patients utilizing this program. OCH utilizes a cost accounting system that determines costs for providing medical services based on the organizations relationship of costs to charges. The entire shortfall shown on Part III, Line 7 should be reflected as a community benefit. Part III, Line 9b: OCH follows the collection practices as outlined in DCHS Charity Care and Financial Discount and Financial Assistance operating policies. For patients who qualify for charity care and financial discount, OCH provides the patient with a written notice prior to commencing collection activities. The notice states that nonprofit counseling services may be available in the area and provides information concerning state and federal law requirements for debt collectors. OCH does not pursue legal action for non-payment of bills against any household where the primary wage earner(s) is unemployed or there are not significant income sources. OCH does not assign patients meeting an agreed upon monthly payment plan to a collection agency and does not report the patient to credit bureaus. OCH does not report adverse information to a consumer credit agency or commence civil action for nonpayment of a patient debt prior to 150 days after the initial billing of the patient. OCH does not use wage garnishments or liens on real property as a means of collecting unpaid hospital bills for eligible patients. OCH expects its external collection agencies to not pursue legal action against an eligible patient without prior approval from OCH. OCH expects its external collection agencies to follow Fair Debt and Collection Practices, Assembly Bill AB774 and act in a manner that treats individuals with dignity, respect and compassion. In addition, for patients who qualify for financial assistance, OCH does not pursue legal action for non-payment of bills against any household where the primary wage earner(s) is unemployed, uninsured or there are not significant income sources or assets. OCH does not assign eligible patients meeting an agreed upon monthly payment plan to a collection agency and does not report the patient to credit bureaus. OCH does not use liens on real property as a means of collecting unpaid hospital bills for eligible patients. Part VI, Question 2: In an effort to identify the most critical health care needs in O'Connor Hospital's service area, a Community Needs Assessment is conducted every three years. The most recent assessment was completed in fiscal year 2013 (tax year 2012). The results of the needs assessment are integrated into the planning of current and future hospital programs and activities. METHODOLOGY The fiscal year 2013 Santa Clara County Community Health Needs Assessment was conducted in collaboration with the Santa Clara County Public Health Department and the Community Benefits Coalition of the Hospital Council of Northern and Central California, South Bay Section. Participating organizations included the following: o El Camino Hospital o Hospital Council of Northern and Southern California o Kaiser Permanente o Lucile Packard Children's Hospital o Saint Louise Regional Hospital o Santa Clara Public Health Department o Stanford Hospital and Clinics o United Way Silicon Valley Representatives of this group of organizations met regularly to identify challenges, and opportunities for health care organizations, government agencies, and community organizations to improve the health and quality of life of Santa Clara County residents. Suggestions regarding data questions were discussed and agreed upon. Information discovered and obtained through the community needs process allows the O'Connor Hospital Community Benefit Committee to prioritize needs and initiate new programs that address emerging needs. Every three years, the Community Benefit Committee evaluates OCH's exiting programs and activities to ensure they align with the community's greatest needs and largest health disparities. Part VI, Question 3: Signage is posted in English and Spanish in the Patient Financial Services area and at every point of registration stating that OCH has financial assistance and charitable programs available for qualified low income, uninsured patients who may not have the ability to meet the financial obligation of their hospital services and a contact number to call. Post discharge, this information is reiterated on the reverse of the monthly patient statements mailed to the guarantor's home address. Patients who present to the OCH Emergency Department who identify themselves as uninsured are provided with a charity care application. Part VI, Question 4: OCH is located in the heart of San Jose, the largest city in Santa Clara County. With almost 1.8 million residents, Santa Clara County is the sixth most populated of California's 58 counties and the most populated county in the San Francisco Bay Area. More than half of the county's population lives in San Jose. Santa Clara County's population is expected to grow to more than 2.3 million by 2050. In Santa Clara County, there are 11 hospitals. OCH is one of two hospitals in San Jose that serves all community members regardless of their ability to pay. Additionally, there are several primary care clinics and community organizations that specifically focus on providing health care services to low-income individuals. The population served by OCH resides primarily in San Jose and the surrounding cities of Santa Clara, Campbell, and Milpitas. This area tends to be relatively affluent with the median income slightly above $89,000 per year. More than four in 10 county households have annual incomes of $100,000 or more and nearly half the adults have a bachelor's degree or higher. In stark contrast to the fact that Santa Clara County has one of the highest median incomes and costs of living in the U.S., nearly one in 10 children and one in 12 adults in the county live in poverty. More than one in 5 households in Santa Clara County (22%) live below the Self-Sufficiency Standard. The percentage of uninsured adults in Santa Clara County was 11% in 2013. Santa Clara County's population is diverse: 34% of residents are White, 34% are Asian, 27% are Hispanic, more than 3% are African American, and 2% are other races/ethnicities. The county has a large foreign-born population, with 36% of its residents born outside the U.S. This represents one of the highest proportions of immigrants in any California county. More than 100 languages and dialects are spoken in the county. In 2007, Santa Clara County became one of only 10 counties in the U.S. where half the residents speak a language other than English at home. O'Connor's patient population is equally diverse. The top languages spoken by O'Connor patients are English, Spanish, Vietnamese, Mandarin, Russian, and Farsi/Persian. HEALTH DISPARITIES Overall, Santa Clara County appears to be healthy, but a closer look reveals disparities leaving certain populations at a higher risk for chronic diseases. Disparities are differences in health status defined by characteristics such as race/ethnicity, income or education levels. According to the fiscal year 2013 Santa Clara County Community Health Needs Assessment, obesity and diabetes are two chronic diseases that have a profound impact on our community. The prevalence of overweight and obesity among middle and high school students in Santa Clara County is at 10%. African-American and Hispanic middle and high school students' obesity rates are significantly higher than the overall average. The percentage of adults in Santa Clara County who are overweight or obese (defined as a BMI over 25) was 55% in 2013. Overweight and obesity rates are higher among adults with low incomes. Hispanic adults have the highest rate of overweight and obesity: 68% of Hispanic adults were overweight or obese compared to 55% of County residents overall in 2013. The adult diabetes rate in Santa Clara County has also increased. The percentage of adults who were told by a health professional that they have diabetes was 8% in 2013. A higher proportion of Hispanic adults have been diagnosed with diabetes: 11% of Hispanics were diagnosed with diabetes compared to 7% of Whites and 5% of Asians in 2013. Community Building Activities OCH's Community Building Activities improve the health and well-being of our community. We promote healthy families, responsible stewardship of the environment and a just society through value-based relationships and community-based collaborations. OCH improves access to health services by caring for the underserved. We serve the underinsured and uninsured with community health clinics and programs that provide individuals with basic health services such as immunizations, primary care checkups and treatment for illness and injuries. The OCH Pediatric Center for Life provides low-income children with a full range a medical services for children from infancy through age 18, regardless of financial status. For patients who come to the center uninsured, the staff works with the patients and their families to enroll them on a government sponsored health insurance program. The Pediatric Center for Life was founded 20 years ago in response to a critical community need for a children's health clinic that specifically cares for low-income individuals. OCH continues to subsidize the medical costs associated with caring for uninsured and underinsured children. OCH's leadership and associates undertake a variety of responsibilities to assist an assortment of organizations including Hospice of the Valley, American Heart Association, Junior League, Habitat for Humanity and many more. Part VI, Question 5: OCH is a 358-bed acute care, not-for-profit, community hospital located in the heart of San Jose, California. Established in 1889, O'Connor Hospital was built by area philanthropists, Judge Myles P. O'Connor and his wife, Amanda, and operated by the Daughters of Charity of St. Vincent de Paul. O'Connor Hospital and the Daughters of Charity have served Santa Clara County longer than any other hospital in the region. For more than 120 years, OCH has provided comprehensive, excellent health care that is attentive and compassionate to the whole person: body, mind and spirit. Today, OCH continues to thrive, providing excellent medical care with a special focus on the needs of low-income and underserved populations. OCH sponsors the Stanford-affiliated Family Medicine Residency Program. Key services include cardiology, oncology, mother-baby care, orthopedic services, vascular care, wound care and emergency services. OCH is a Joint Commission certified Center of Excellence for Hip and Knee Replacement, Wound Care and a Primary Stroke Center. Additionally, the hospital is fully accredited by The Joint Commission, the California Department of Public Health and the Center for Medicare and Medicaid Services. Our experienced team of 1,450 employees and 532 medical staff members provide quality health care to the community, welcoming all patients regardless of their financial circumstances. In fiscal year 2015, OCH had 10,816 acute discharges, 6,075 surgical cases, 2,825 births, and 59,396 emergency visits OCH plays a vital role in the health and well-being of Santa Clara County. We provide comprehensive health care services without delay or limitations and without regard to the patient's ability to pay. We are a leader in our community in serving the underserved and marginalized. OCH responds to the needs of our community and adapts to provide care and services in unmet areas. Serving the sick and those living in poverty is what guides us. In addition to providing health care services to all, OCH financially sponsors programs that provide direct services to the homeless and chronically ill. We partner with a variety of community organizations to provide hands-on learning opportunities for physicians, nurses and other health care professionals. We also provide a wide range of free, health education classes and resources for the community. Supporting our programs that serve the underserved and partnering with organizations to enhance the services they provide to the community, allow OCH to take an active role in contributing to the health and well-being of our community. Part VI, Question 6: The Daughters of Charity Health System ("DCHS") is a regional health care system of hospitals and medical centers ("Local Health Ministries") spanning the California coast from the San Francisco Bay Area to Los Angeles. In the spirit of our founders, St. Vincent de Paul, St. Louise de Marillac and St. Elizabeth Ann Seton, the Daughters of Charity Health System is committed to serving the sick and the poor. With Jesus Christ as our model, we advance and strengthen the healing Mission of the Catholic Church by providing comprehensive, excellent health care that is compassionate and attentive to the whole person: body, mind and spirit. We promote healthy families, responsible stewardship of the environment, and a just society through values-based relationships and community based collaboration. Every day in DCHS Local Health Ministries, dedicated associates, physicians and volunteers provide quality, compassionate care. These thousands of people are the hands and hearts of the Daughters of Charity, reaching out to provide comfort and holistic healing - body, mind and spirit - to the people of California, just as the first Daughters did more than 150 years ago. As a member of the Daughters of Charity Health System, OCH continues to uphold its Mission of providing quality medical services to the most vulnerable populations, the sick, the poor, the elderly, and children. OCH is committed to the fulfillment of the Mission of its founding sisters through the delivery of charitable services and care to the community. Part VI, Quesiton 7: OCH annually updates its Community Benefits Report and files a copy of it with the State of California. true DCHS Medical Foundation 400 Race Street San Jose CA 95126 413691852 501(c)(3) 15174609 General support 1 Grants Paid by O'Connor Hospital Schedule I, Part I & II: O'Connor Hospital is part of a related group of tax exempt organizations, which includes DCHS Medical Foundation. Grants are made to support the related tax exempt organization's exempt purpose. false true false false false false false false false Robert Issai Board Member 0 937792 0 0 0 615287 0 303132 0 23287 0 1879498 0 0 James Dover President & CEO thru June '15 0 524243 0 0 0 340403 0 45993 0 36946 0 947585 0 0 David Carroll Sr VP-CFO/Bus Dev thru Apr '15 404744 0 0 0 135308 0 20217 0 24010 0 584279 0 0 0 George Block Chief Med Officer thru Apr '15 403209 0 0 0 79728 0 19056 0 24010 0 526003 0 0 0 Ron Yaw Controller thru April 2015 187303 0 0 0 356 0 8978 0 7785 0 204422 0 0 0 Dawn Goeringer Sr. VP - Chief Clinical Care 234856 0 0 0 6500 0 0 0 12262 0 253618 0 0 0 Judy Watland Former Sr. VP - CNO 84379 0 0 0 57756 0 6817 0 2858 0 151810 0 0 0 Terri Yu Staff Nurse 385615 0 0 0 1901 0 4550 0 22119 0 414185 0 0 0 Robert Souza Jr Interventional Rad Tech Lead 360436 0 0 0 173 0 17550 0 35443 0 413602 0 0 0 Julie Hatcher VP, Human Resources 293249 0 0 0 62362 0 15202 0 11433 0 382246 0 0 0 Gyu Keun Lee Staff Nurse III 347150 0 0 0 693 0 4550 0 32651 0 385044 0 0 0 John R Gilchrist Chf Dev Officer thru May 2015 266998 0 0 0 45000 0 3466 0 11433 0 326897 0 0 0 Questions Regarding Compensation Schedule J, Part I, Line 3: The President & CEO is an employee of Daughters of Charity Health System ("DCHS"). DCHS uses one or more of the following methods to establish top management officials' compensation: independent compensation consultant, compensation survey or study, approval by the board or compensation committee, Form 990 of other organizations, and written employment contracts. Severance Arrangements Schedule J, Part I, Line 4a: Some of the listed individuals have a severance provision as part of their employment arrangement. The severance provisions ranges from 6 months to 2 years. Nonqualified Retirement Plan Schedule J, Part I, Line 4b: The following individuals participated in a supplemental nonqualified retirement plan, which is included in compensation reported on schedule J, Part II, Column C: Robert Issai $104,257 James Dover $16,246 David Carroll $7,867 George Block $6,706 Julie Hatcher $2,852 Explanation of Other Reportable Compensation Schedule J, Part II Certain individuals listed on Schedule J, Part II received a retention payment during the 2014 calendar year, which is reported as "Other Reportable Compensation" on Schedule J, Part II, Column (b)(iii). The payments were made to retain employees whose continuity of employment was essential during the transaction period of solicitation of proposals for the sale of the Daughters of Charity Health System, which includes this filing organization. These payments were approved in advance by the Board of Directors of Daughters of Charity Health System. A CA Statewide Communities Development Authority 680164610 13080SCV4 2014-07-30 110000000 Working Capital false false true B CA Statewide Communities Development Authority 680164610 13080SCX0 2014-08-27 15000000 Working Capital false false true A 0 0 23089000 0 0 0 419800 0 22669200 0 0 0 false false true true B 0 0 3148500 0 0 0 0 0 3148500 0 0 0 false false true true A false false false false 0.00000 0.00000 0.00000 false false false true B false false false false 0.00000 0.00000 0.00000 false false false true A false true false false false false 0 false 0 false true B false true false false false false 0 false 0 false true A true B true Schedule K, Part I, Column (e) The issue price for the bond dated 7/30/2014 is $110,000,000 (as declared on the filed Form 8038); O'Connor Hospital benefited from $23,089,000 of these funds. The issue price for the bond dated 8/27/2014 is $15,000,000 (as declared on the filed Form 8038); O'Connor Hospital benefited from $3,148,500 of these funds. X Medical Equipment 1 28259 Fair Market Value false true false Form 990, Part III, Line 4a: The Daughters of Charity Health System ("DCHS") is a regional health care system of hospitals and medical centers ("Local Health Ministries") spanning the California coast from the San Francisco Bay Area to Los Angeles. In the spirit of our founders, St. Vincent de Paul, St. Louise de Marillac and St. Elizabeth Ann Seton, the Daughters of Charity Health System is committed to serving the sick and the poor. With Jesus Christ as our model, we advance and strengthen the healing mission of the Catholic Church by providing comprehensive, excellent health care that is compassionate and attentive to the whole person: body, mind and spirit. We promote healthy families, responsible stewardship of the environment, and a just society through values-based relationships and community based collaboration. Every day in DCHS Local Health Ministries, dedicated associates, physicians and volunteers provide quality, compassionate care. These thousands of people are the hands and hearts of the Daughters of Charity, reaching out to provide comfort and holistic healing - body, mind and spirit - to the people of California, just as the first Daughters did more than 150 years ago. As a member of the Daughters of Charity Health System, O'Connor Hospital continues to uphold its mission of providing quality medical services to the most vulnerable populations, the sick, the poor, the elderly, and children. O'Connor Hospital is committed to the fulfillment of the mission of its founding sisters through the delivery of charitable services and care to the community. During fiscal year ended June 30, 2015, O'Connor Hospital provided total quantifiable community benefits of $243.6 million. After offsetting direct revenue, O'Connor Hospital provided unsponsored community benefits of $64.4 million, at cost. Total unsponsored community benefits of $64.4 million, at cost, consisted of quantifiable unsponsored benefits for the poor at a cost of $44.1 million, quantifiable unsponsored benefits to the broader community at a cost of $0.1 million, and quantifiable unsponsored benefits to beneficiaries of the Medicare program at a cost of $20.2 million. Form 990 Part IV, Line 12A, and Part XII, Line 2b and 2c: The financial statements of the organization are consolidated by the Daughters of Charity Health System and include each of the affiliated Local Health Ministries, their related fundraising Foundations and other related organizations (as listed on Form 990 Schedule R) in accordance with GAAP and audited by an independent public accounting firm. The Daughters of Charity Health System's Board and Audit Committee of the Board have responsibility for oversight of the audit of the consolidated financial statements and selection of the independent public accounting firm. Form 990 Part VI, Line 6: O'Connor Hospital has only one member, Daughters of Charity Health System, a California nonprofit religious corporation. Form 990 Part VI, Line 7a: The Member's Board of Directors may appoint the organization's directors and officers. Form 990 Part VI, Line 7b: The sole member has broad powers including the power to amend the Bylaws and Articles of Incorporation, and approve, interpret and change any statement of mission, philosophy, role or purpose of O'Connor Hospital. The member has the right to approve any merger, dissolution, consolidation or reorganization of O'Connor Hospital. In addition, the member has the right to approve capital and operating budgets, approve debt incurred or guaranteed, approve the disposition of the assets, and establish policy concerning quality of care, finance and resources. Finally, the member has such other powers and rights as provided by the California Nonprofit Corporation Law. Form 990, Part VI, Line 11b: Grant Thornton LLP and the organization's finance staff work together to gather the required tax information necessary to complete the tax returns. The initial draft return is reviewed by Grant Thornton and the finance staff. After the return is discussed and reviewed, recommended changes are reflected on the return and a draft return is prepared. The draft return is then circulated to the board of directors prior to filing with the Internal Revenue Service. Form 990, Part VI, Line 12c: The Daughters of Charity Health System ("DCHS") has a Conflict of Interest Policy that covers DCHS and all of its affiliates. The policy provides for a systematic and ongoing method of requiring individuals who have decision making responsibility to disclose and address potential and actual conflicts of interest. Covered individuals are required to complete an annual statement disclosing any conflicts of interest and have a duty to update the disclosure for any potential conflicts of interest that arise during the year. The Presidents/CEOs of the health ministries report the conflict of interest findings and resolutions to their respective Board of Directors. This policy is reviewed annually for compliance by the DCHS's Corporate Responsibility Officer. Form 990, Part VI, Line 15a and 15b: The Daughters of Charity Health System ("DCHS") compensation programs cover DCHS and all of its affiliated Local Health Ministries. The CEO of each Local Health Ministry is employed by DCHS. The DCHS compensation programs are designed to recruit, retain, and motivate qualified executives. The programs are designed for positions that have a significant impact on the high-level strategic and policy direction of DCHS and its affiliated Local Health Ministries. All of the Local Health Ministry CEOs are paid directly by DCHS and covered by the DCHS compensation programs. Market data analyses are made of comparable organizations within the industry and within the region. Total compensation is established for all executive positions to target similar total compensation of comparable organization market compensation. Base pay is established for all executive positions to target the median range of comparable organization market compensation. DCHS utilizes a benefits committee to review compensation and benefits. The DCHS Board of Directors reviews and approves compensation recommended by the benefits committee, and documents its conclusion that the proposed compensation is reasonable. In evaluating and finalizing its determination of base pay and total compensation for comparable positions at comparable organizations in comparable markets, DCHS utilizes available market data analyses including the DCHS benefits committee, independent compensation consultant, Form 990 of other organizations, written employment contracts, compensation survey or study, recommendation of the benefits committee and approval by the DCHS Board of Directors. Form 990, Part VI, Line 19: O'Connor Hospital makes its Form 990 available upon request. Form 990, Part XI, Line 9: The other changes in net assets or fund balance consists of the following: Change in Funded Status of Pension Plans $(2,398,000) See Part VII See Part VII See Part VII true false true true true false false false false true false false true true true true true true true O'Connor Hospital Foundation c 1590858 Cost O'Connor Hospital Foundation o 473670 Cost O'Connor Hospital Foundation q 96542 Cost Schedule R, Part II THE FOLLOWING ORGANIZATIONS LISTED BELOW ARE RELATED TO THE FILING ORGANIZATION: DAUGHTERS OF CHARITY MINISTRY SERVICES CORPORATION 26000 ALTAMONT ROAD LOS ALTOS HILLS, CA 94022-4317 EIN: 77-0482943 COL (B): PRIMARY ACTIVITY - MANAGERIAL AND CONSULTING SERVICES IN THE AREAS OF FINANCE, ADMINISTRATION AND FACILITIES TO THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL PROVINCE OF THE WEST MINISTRIES. COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 1 COL (F): DIRECT CONTROLLING ENTITY NAME - DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL PROVINCE OF THE WEST COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO DAUGHTERS OF CHARITY HEALTH SYSTEM 203 REDWOOD SHORES PARKWAY, SUITE 800 REDWOOD CITY, CA 94065 EIN: 91-2145484 COL (B): PRIMARY ACTIVITY - HEALTH SYSTEM LEADERSHIP AND SUPPORT TO HEALTH MINISTRIES. COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 11B COL (F): DIRECT CONTROLLING ENTITY NAME - DAUGHTERS OF CHARITY MINISTRY SERVICES CORPORATION COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO CARITAS BUSINESS SERVICES 203 REDWOOD SHORES PARKWAY, SUITE 800 REDWOOD CITY, CA 94065 EIN: 51-0659139 COL (B): PRIMARY ACTIVITY - PROMOTE AND SUPPORT THE ACTIVITIES OF THE DAUGHTERS OF CHARITY HEALTH SYSTEM AND ITS LOCAL HEALTH MINISTRIES BY PERFORMING ACCOUNTING, BUDGETING AND PATIENT FINANCIAL SERVICES ON A CENTRALIZED BASIS, ALL OF WHICH MUST BE PROVIDED INTERNALLY BY EACH HOSPITAL FOR ITS EXEMPT OPERATIONS IF NOT PROVIDED BY CARITAS BUSINESS SERVICES. COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 11A COL (F): DIRECT CONTROLLING ENTITY NAME - DAUGHTERS OF CHARITY HEALTH SYSTEM COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO HOTEL DIEU, INC. 203 REDWOOD SHORES PARKWAY, SUITE 800 REDWOOD CITY, CA 94065 EIN: 95-475156 COL (B): PRIMARY ACTIVITY - LOW-INCOME RESIDENCE FOR FRAGILE SENIOR CITIZENS COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 9 C COL (F): DIRECT CONTROLLING ENTITY NAME - DAUGHTERS OF CHARITY MINISTRY SERVICES CORPORATION COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO O'CONNOR HOSPITAL FOUNDATION 2105 FOREST AVENUE SAN JOSE, CA 95128 EIN: 77-0006295 COL (B): PRIMARY ACTIVITY - FUNDRAISING COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 11A COL (F): DIRECT CONTROLLING ENTITY NAME - O'CONNOR HOSPITAL COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - YES ROBERT F. KENNEDY MEDICAL CENTER 203 REDWOOD SHORES PARKWAY, SUITE 800 REDWOOD CITY, CA 94065 EIN: 91-2154440 COL (B): PRIMARY ACTIVITY - HOSPITAL - INACTIVE COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 3 COL (F): DIRECT CONTROLLING ENTITY NAME - DAUGHTERS OF CHARITY HEALTH SYSTEM COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO ROBERT F. KENNEDY MEDICAL CENTER FOUNDATION 203 REDWOOD SHORES PARKWAY, SUITE 800 REDWOOD CITY, CA 94065 EIN: 95-3745227 COL (B): PRIMARY ACTIVITY - FUNDRAISING - INACTIVE COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 11A COL (F): DIRECT CONTROLLING ENTITY NAME - ROBERT F. KENNEDY MEDICAL CENTER COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO ST. FRANCIS MEDICAL CENTER 3630 EAST IMPERIAL HIGHWAY LYNWOOD, CA 90262-2636 EIN: 91-2154439 COL (B): PRIMARY ACTIVITY - HOSPITAL COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 3 COL (F): DIRECT CONTROLLING ENTITY NAME - DAUGHTERS OF CHARITY HEALTH SYSTEM COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO ST. FRANCIS MEDICAL CENTER OF LYNWOOD FOUNDATION 3630 EAST IMPERIAL HIGHWAY, SUITE 400 LYNWOOD, CA 90262-2636 EIN: 95-3190773 COL (B): PRIMARY ACTIVITY - FUNDRAISING COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 11A COL (F): DIRECT CONTROLLING ENTITY NAME - ST. FRANCIS MEDICAL CENTER COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO SAINT LOUISE REGIONAL HOSPITAL 9400 NO NAME UNO GILROY, CA 95020 EIN: 91-2154437 COL (B): PRIMARY ACTIVITY - HOSPITAL COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 3 COL (F): DIRECT CONTROLLING ENTITY NAME - DAUGHTERS OF CHARITY HEALTH SYSTEM COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO SAINT LOUISE REGIONAL HOSPITAL FOUNDATION 9400 NO NAME UNO GILROY, CA 95020 EIN: 56-2384735 COL (B): PRIMARY ACTIVITY - FUNDRAISING COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 11A COL (F): DIRECT CONTROLLING ENTITY NAME - SAINT LOUISE REGIONAL HOSPITAL COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO ST. VINCENT MEDICAL CENTER 2131 WEST 3RD STREET LOS ANGELES, CA 90057 EIN: 91-2154438 COL (B): PRIMARY ACTIVITY - HOSPITAL COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 3 COL (F): DIRECT CONTROLLING ENTITY NAME - DAUGHTERS OF CHARITY HEALTH SYSTEM COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO ST. VINCENT DE PAUL ETHICS CORPORATION 3630 EAST IMPERIAL HIGHWAY LYNWOOD, CA 90262 EIN: 95-4426405 COL (B): PRIMARY ACTIVITY - SUPPORTS DCHS MINISTRIES COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 11A COL (F): DIRECT CONTROLLING ENTITY NAME - ST. FRANCIS MEDICAL CENTER COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO ST. VINCENT DIALYSIS CENTER 2131 WEST THIRD STREET LOS ANGELES, CA 90057 EIN: 95-3749293 COL (B): PRIMARY ACTIVITY - HOSPITAL COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 3 COL (F): DIRECT CONTROLLING ENTITY NAME - ST. VINCENT MEDICAL CENTER COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO ST. VINCENT FOUNDATION 2200 WEST THIRD STREET, SUITE 200 LOS ANGELES, CA 90057 EIN: 95-3922511 COL (B): PRIMARY ACTIVITY - FUNDRAISING COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 11A COL (F): DIRECT CONTROLLING ENTITY NAME - ST. VINCENT MEDICAL CENTER COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO ST. VINCENT SENIOR CENTER NUTRITION PROGRAM, INC. 2131 WEST THIRD STREET LOS ANGELES, CA 90057 EIN: 95-3696693 COL (B): PRIMARY ACTIVITY - NUTRITION PROGRAM COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 9 COL (F): DIRECT CONTROLLING ENTITY NAME - DAUGHTERS OF CHARITY MINISTRY SERVICES CORPORATION COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO SETON MEDICAL CENTER 1900 SULLIVAN AVENUE DALY CITY, CA 94015 EIN: 91-2154441 COL (B): PRIMARY ACTIVITY - HOSPITAL COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 3 COL (F): DIRECT CONTROLLING ENTITY NAME - DAUGHTERS OF CHARITY HEALTH SYSTEM COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO SETON MEDICAL CENTER FOUNDATION 1900 SULLIVAN AVENUE DALY CITY, CA 94015 EIN: 94-2824033 COL (B): PRIMARY ACTIVITY - FUNDRAISING COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 11A COL (F): DIRECT CONTROLLING ENTITY NAME - SETON MEDICAL CENTER COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO DCHS MEDICAL FOUNDATION 400 RACE STREET SAN JOSE, CA 95126 EIN: 41-3691852 COL (B): PRIMARY ACTIVITY - MEDICAL FOUNDATION COL (C): LEGAL DOMICILE - CA COL (D): EXEMPT CODE SECTION - 501(C)(3) COL (E): PUBLIC CHARITY STATUS - 9 COL (F): DIRECT CONTROLLING ENTITY NAME - DAUGHTERS OF CHARITY HEALTH SYSTEM COL (G): SECTION 512(B)(13) CONTROLLED ENTITY - NO Schedule R, Part III O'CONNOR HEALTH CENTER 1, A CALIFORNIA LIMITED PARTNERSHIP 1960 THE ALAMEDA, SUITE 20 SAN JOSE, CA 95126 EIN: 77-0419045 COL (B): PRIMARY ACTIVITY - DEVELOPMENT AND RENTAL COL (C): LEGAL DOMICILE - CA COL (D): DIRECT CONTROLLING ENTITY NAME - O'CONNOR HOSPITAL COL (E): PREDOMINANT INCOME - INVESTMENT OR OTHER INCOME EXCLUDED FROM TAX UNDER SECTION 512, 513, OR 514 COL (F): SHARE OF TOTAL INCOME - $677,423 COL (G): SHARE OF END-OF-YEAR ASSETS - $3,433,289 COL (H): DISPROPORTIONATE ALLOCATIONS - NO COL (I): CODE V - UBI AMOUNT IN BOX 20 OF SCHEDULE K-1 (FORM 1065) - $0 COL (J): GENERAL OR MANAGING PARTNER - NO COL (K): PERCENTAGE OF OWNERSHIP - 75% Schedule R, Part IV MARILLAC INSURANCE COMPANY, LTD. C/O AON INSURANCE MANAGERS (CAYMAN), LTD. P.O. BOX 69, GRAND CAYMAN KY1-1102 EIN: 98-0417930 COL (B): PRIMARY ACTIVITY - INSURANCE COL (C): LEGAL DOMICILE - CJ COL (D): DIRECT CONTROLLING ENTITY NAME - N/A COL (E): TYPE OF ENTITY - C CORPORATION COL (F): SHARE OF TOTAL INCOME - N/A COL (G): SHARE OF END-OF-YEAR ASSETS - N/A COL (H): PERCENTAGE OWNERSHIP - N/A COL (I): SECTION 512(b)(13) CONTROLLED ENTITY - N/A