2013-05-07T17:39:57-05:00 2012-06-30 910189318 MOSS ADAMS LLP 3121 WEST MARCH LANE SUITE 100 STOCKTON CA 952192303 990 2011-07-01 941387866 RIDEOUT MEMORIAL HOSPITAL RIDE 5307401920 989 PLUMAS STREET YUBA CITY CA 95991 L WAYNE MILLS 5307401920 2013-04-25 1 TRACY S PAGLIA P00366884 2099556100 2011 2016-02-25 16:41:14Z L WAYNE MILLS 989 PLUMAS STREET YUBA CITY CA 95991 359040960 0 X HTTP://WWW.FRHG.ORG/ X 1955 CA TO PROVIDE COMPASSIONATE AND SUPERIOR HEALTHCARE TO EVERYONE IN OUR COMMUNITY AND REGION, REGARDLESS OF THE ABILITY TO PAY. 13 6 1494 260 0 0 255048 48839 320849701 324580569 17843459 4891498 -266215 190789 338681993 329711695 0 774872 0 0 98770088 103453774 0 0 0 200187299 202413058 298957387 306641704 39724606 23069991 373334321 517935598 80650213 206043041 292684108 311892557 TO PROVIDE COMPASSIONATE AND SUPERIOR HEALTHCARE TO EVERYONE IN OUR COMMUNITY AND REGION, REGARDLESS OF THE ABILITY TO PAY. 0 0 228348896 774872 324580569 RIDEOUT MEMORIAL HOSPITAL CONSISTS OF TWO CAMPUSES: - RIDEOUT MEMORIAL HOSPITAL (RMH) LOCATED IN MARYSVILLE, CA IS A 173-LICENSED-BED ACUTE CARE FACILITY WHICH INCLUDES A TRAUMA LEVEL-3 EMERGENCY DEPARTMENT, A STATE-OF-THE-ART CARDIAC UNIT AND A FREESTANDING CANCER CENTER WHICH IS AN AFFILIATION BETWEEN THE FREMONT RIDEOUT HEALTH GROUP AND UC-DAVIS HEALTH SYSTEM. THE EMERGENCY DEPARTMENT, LOCATED INSIDE RMH IS THE ONLY EMERGENCY ROOM BETWEEN SOUTHERN BUTTE COUNTY AND SACRAMENTO. - FREMONT MEDICAL CENTER (FMC) LOCATED IN YUBA CITY, CA IS A 132-LICENSED-BED ACUTE CARE FACILITY WHICH INCLUDES PERINATAL AND PEDIATRIC CARE. 228348896 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 0 0 1494 1 0 0 0 0 0 0 0 0 0 0 X 13 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X CHRIS ROBERTS 5307401920 614 J STREET MARYSVILLE CA 95901 X RONALD M SWEENEY 5.00 X X 0 0 0 JOHN WRIGHT 5.00 X X 0 1384 0 JOHN WEILER 5.00 X 0 0 0 LISA DEL PERO 5.00 X X 0 24622 0 JANICE S NALL 5.00 X X 0 17151 0 JOHN W CARY 5.00 X X 0 17151 0 RUPINDER BRAR 5.00 X 0 40139 0 FLOYD BURTON 5.00 X 0 0 0 ROBERT CHASON 5.00 X 0 0 0 JAMES KENNEDY 5.00 X 0 0 0 ALEXANDRA REICHMAN 5.00 X 0 17151 0 DAVID TARKE 5.00 X 0 0 0 DAVE VAUGHN 5.00 X 0 0 0 THERESA HAMILTON 40.00 X 0 1384892 19901 L WAYNE MILLS 30.00 X 0 196524 17919 CHANCE WHITE 40.00 X 0 263928 18665 ROBERT BONACCI 40.00 X 219472 0 18093 GLENNA TRENT 40.00 X 189335 0 8536 ART ORTEZA 40.00 X 184113 0 8490 CHRISTINA FERRERO 40.00 X 172313 0 18087 CLIFFORD FUKUMITSU 40.00 X 169171 0 17955 THOMAS HAYES 0.00 X 0 283355 16430 934404 2246297 144076 189 1 1 0 TRUSTAFF PO BOX 73426 CLEVELAND OH 44193 MEDICAL AND HEALTH CARE PAYMENTS 9841203 SUTTER BUTTE ANESTHESIA ASSOCIATION 1190 CIVIC CENTER BLVD YUBA CITY CA 95993 MEDICAL AND HEALTH CARE PAYMENTS 2322662 COBB FRENCH PRASAD NEUROSURGICAL ASSOC 2801 K STREET SUITE 300 SACRAMENTO CA 95816 MEDICAL AND HEALTH CARE PAYMENTS 1549833 KFORCE PO BOX 277997 ATLANTA GA 30384 MEDICAL AND HEALTH CARE PAYMENTS 1508197 YUBA SUTTER HOSPITALIST GROUP PO BOX 1177 YUBA CITY CA 95992 MEDICAL AND HEALTH CARE PAYMENTS 1442204 41 45671 3168 48839 NET PATIENT REVENUE 621400 302314688 302314688 CANCER CENTER REVENUE 621990 20007180 20007180 OTHER PROGRAM REVENUE 900099 2242228 2242228 PROGRAM RELATED RENT 532000 16473 16473 324580569 4883709 4883709 263896 -263896 -263896 -263896 29066908 6250 29046678 18691 20230 -12441 7789 7789 OTHER INCOME 900099 454685 454685 454685 329711695 324580569 0 5082287 774872 774872 130531 130531 80828320 60616034 20212286 922363 691772 230591 15411391 11558543 3852848 6161169 4620877 1540292 24449145 24449145 30250 30250 564176 564176 50493480 36205527 14287953 3004 2720 284 38018719 34551964 3466755 2932335 446693 2485642 180192 124180 56012 2194301 2194301 10282438 10282438 2387251 2387251 HOSPITAL FEE 24998459 24998459 BAD DEBT 20842147 20842147 CANCER CENTER 20007180 20007180 REPAIRS 4301177 2393279 1907898 728804 101680 627124 306641704 228348896 78292808 0 36147201 46368322 41457397 64242668 108226 10769 3775943 3446300 8878635 4271549 281295636 164387263 98391290 116908373 175675143 179807832 8900486 102879785 373334321 517935598 31172547 56718679 14526055 98740 23760417 131550884 11191194 17674738 80650213 206043041 X 292684108 311892557 292684108 311892557 373334321 517935598 X 23069991 -3861542 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12989581 12989581 91032514 69484358 21548156 6906154 2711316 4194838 113846645 92191589 21655056 56520742 56520742 116908373 UNAMORTIZED FINANCING COSTS 825520 FUNDS HELD BY TRUSTEE 95046602 DUE FROM RELATED ENTITIES 7007663 102879785 INTEREST SWAP 11905501 DUE TO RELATED ENTITIES 3972681 MALPRACTICE INSURANCE 1458676 ASBESTOS ABATEMENT 337880 17674738 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: IN THE EVENT THE ASSOCIATION HAD A TAX PROVISION THAT WAS UNCERTAIN OF BEING SUSTAINED, THE GROUP WOULD APPLY THE MINIMUM PROBABILITY THRESHOLD SPECIFIED IN THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES TOPIC OF THE ACCOUNTING STANDARDS CODIFICATION TO DETERMINE WHETHER A FINANCIAL STATEMENT LIABILITY OR BENEFIT SHOULD BE RECOGNIZED. THERE WERE NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2012 AND 2011. 1 1 X 1 X 1 X 1 1 0 1 1 726293 726293 0.00250 62159650 42634325 19525325 0.06830 9523060 5310111 4212949 0.01470 72409003 47944436 24464567 0.08550 157863 185937 -28074 0.00000 182807 12298 170509 0.00060 31077 0 31077 0.00010 371747 198235 173512 0.00070 72780750 48142671 24638079 0.08620 1 5600285 726293 92203619 106604251 -14400632 X 1 1 2 1 RIDEOUT MEMORIAL HOSPITAL

726 4TH STREET MARYSVILLE CA 95901

X X X 2 FREMONT MEDICAL CENTER

970 PLUMAS STREET YUBA CITY CA 95991

X X RIDEOUT MEMORIAL HOSPITAL 1 1 1 200.000000000000 1 350.000000000000 1 X 1 1 X 1 0 1 X 0 1 FREMONT MEDICAL CENTER 2 1 1 200.000000000000 1 350.000000000000 1 X 1 1 X 1 0 1 X 0 1 PART I, LINE 6A: RIDEOUT MEMORIAL HOSPITAL'S COMMUNITY BENEFIT REPORT IS INCLUDED IN THE COMMUNITY BENEFIT REPORT PREPARED BY FREMONT RIDEOUT HEALTH GROUP. THE COMMUNITY BENEFIT REPORT IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST AND CAN ALSO BE REQUESTED THROUGH THE STATE (OSHPD ADDRESS PROVIDED BELOW).OSHPD HEALTHCARE INFORMATION RESOURCE CENTER400 R STREET, ROOM 200; SACRAMENTO, CA 95811TELEPHONE (916) 326-3802FAX (916) 324-9242 PART I, LINE 7: ACTUAL COSTS ARE USED - COST TO CHARGE RATIO METHODOLOGY PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX, LINE 24 ($20,842,147) IS EXCLUDED FOR PURPOSES OF CALCULATING THE PERCENTAGES REPORTED ON SCHEDULE H, PART I, LINE 7, COLUMN (F). PART III, LINE 4: ACTUAL COSTS ARE USED - COST TO CHARGE RATIO METHODOLOGY.THE FINANCIAL COUNSELING DEPARTMENT WILL ASSIST PATIENTS WHO ARE CURRENTLY IN-HOUSE WITH COLLECTION OF ANY INSURANCE DEDUCTIBLES, CO-PAYS, OR SHARE-OF-COSTS AS WELL AS OBTAINING PAYMENT ARRANGEMENTS, ASSISTING WITH MEDI-CAL OR CMSP APPLICATION, AND APPLICATION TO THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM FOR PATIENT WITHOUT ANOTHER PAYMENT SOURCE. FINANCIAL COUNSELORS AND CREDIT & COLLECTION EMPLOYEES WILL PERFORM UNCOMPENSATED CARE FINANCIAL SCREENING AND MEANS TESTING. A PATIENT MAY BE GRANTED EITHER FULL OR PARTIAL FINANCIAL RELIEF DEPENDING UPON THEIR FINANCIAL SITUATION. ALL UNINSURED PATIENTS WHO CANNOT AFFORD TREATMENT WILL BE ASSESSED AT TIME OF ADMISSION/REGISTRATION TO DETERMINE IF THEY HAVE UNEXPLORED INSURANCE BENEFITS OR ARE ELIGIBLE FOR PUBLICLY FUNDED PROGRAMS.FOOTNOTE RELATING TO BAD DEBT EXPENSE: "FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE GROUP RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED (OR ON THE BASIS OF DISCOUNTED RATES, IF NEGOTIATED OR PROVIDED BY POLICY). ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE GROUP'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE GROUP RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED."FOOTNOTE RELATING TO ALLOWANCE FOR DOUBTFUL ACCOUNTS: "PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE GROUP ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE GROUP ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE GROUP RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS." PART III, LINE 8: THE MEDICARE SHORTFALL IS FULLY TREATED AS COMMUNITY BENEFIT IN THE ORGANIZATION'S COMMUNITY BENEFIT REPORT.ACTUAL COSTS ARE USED - COST TO CHARGE RATIO METHODOLOGY PART III, LINE 9B: THE FINANCIAL COUNSELING DEPARTMENT WILL ASSIST PATIENTS WHO ARE CURRENTLY IN-HOUSE WITH COLLECTION OF ANY INSURANCE DEDUCTIBLES, CO-PAYS, OR SHARE-OF-COSTS AS WELL AS OBTAINING PAYMENT ARRANGEMENTS, ASSISTING WITH MEDI-CAL OR CMSP APPLICATION, AND APPLICATION TO THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM FOR PATIENTS WITHOUT ANOTHER PAYMENT SOURCE. RIDEOUT MEMORIAL HOSPITAL PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED THE SAME REGARDLESS OF THEIR ABILITY TO PAY. IF THE PATIENT IS FAP-ELIGIBLE AND COMPLETES THE REQUIRED DOCUMENTATION, THE CHARGES ARE EITHER REDUCED OR WRITTEN-OFF TO CHARITY CARE. FREMONT MEDICAL CENTER PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED THE SAME REGARDLESS OF THEIR ABILITY TO PAY. IF THE PATIENT IS FAP-ELIGIBLE AND COMPLETES THE REQUIRED DOCUMENTATION, THE CHARGES ARE EITHER REDUCED OR WRITTEN-OFF TO CHARITY CARE. PART VI, LINE 2: THE COMMUNITY ACTION COMMITTEE, A CROSS-SECTION OF CLINICAL AND NON-CLINICAL HOSPITAL STAFF, REGULARLY REVIEW HEALTH CARE NEEDS OF THE COMMUNITY. PARTICIPANTS ARE ASKED FOR SUGGESTIONS ON NEW CLASSES, PROGRAMS AND SERVICES. FRHG REPRESENTATIVES ARE ACTIVE IN COMMUNITY GROUPS AND COLLABORATIVES, INCLUDING UNITED WAY, AMERICAN CANCER SOCIETY AND SUTTER AND YUBA COUNTY PUBLIC HEALTH DEPARTMENTS AND UC DAVIS HEALTH SYSTEM. THESE COMMITTEES AND PROGRAMS, ALONG WITH THE BOARD OF DIRECTORS, SET THE PACE FOR ASSESSING THE COMMUNITIES' NEEDS IN REGARD TO HEALTH CARE. PART VI, LINE 3: THE FINANCIAL COUNSELING DEPARTMENT WILL ASSIST PATIENTS WHO ARE CURRENTLY IN-HOUSE WITH COLLECTION OF ANY INSURANCE DEDUCTIBLES, CO-PAYS, OR SHARE-OF-COSTS AS WELL AS OBTAINING PAYMENT ARRANGEMENTS, ASSISTING WITH MEDI-CAL OR CMSP APPLICATION, AND APPLICATION TO THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM FOR PATIENTS WITHOUT ANOTHER PAYMENT SOURCE. FINANCIAL COUNSELORS AND CREDIT & COLLECTION EMPLOYEES WILL PERFORM UNCOMPENSATED CARE FINANCIAL SCREENING AND MEANS TESTING. A PATIENT MAY BE GRANTED EITHER FULL OR PARTIAL FINANCIAL RELIEF DEPENDING UPON THEIR FINANCIAL SITUATION. ALL UNINSURED PATIENTS WHO CANNOT AFFORD TREATMENT WILL BE ASSESSED AT TIME OF ADMISSION/REGISTRATION TO DETERMINE IF THEY HAVE UNEXPLORED INSURANCE BENEFITS OR ARE ELIGIBLE FOR PUBLICLY FUNDED PROGRAMS. PART VI, LINE 4: THE SERVICE AREA OF RIDEOUT MEMORIAL HOSPITAL IS PRIMARILY COMPRISED OF THE NORTHERN CALIFORNIA COUNTIES OF YUBA AND SUTTER, WITH A COMBINED POPULATION OF APPROXIMATELY 167,500. INCOME IN BOTH COUNTIES IS BELOW THE STATEWIDE AVERAGE, AND THE POVERTY RATE IS HIGHER THAN THE STATEWIDE AVERAGE, ACCORDING TO THE FOLLOWING INCOME AND POVERTY STATISTICS FROM THE U.S. CENSUS BUREAU: THE 2011 MEDIAN PER CAPITA INCOME FOR SUTTER COUNTY WAS $22,464; FOR YUBA COUNTY $20,046. THE STATEWIDE MEDIAN PER CAPITA INCOME WAS $29,634. THE 2011 MEDIAN HOUSEHOLD INCOME FOR SUTTER COUNTY WAS $50,010; FOR YUBA COUNTY $46,617. THE STATEWIDE MEDIAN HOUSEHOLD INCOME WAS $61,632. THE 2011 POVERTY RATE IN YUBA COUNTY WAS 20.3 PERCENT, AND IN SUTTER COUNTY 15.2 PERCENT, BOTH ABOVE THE STATEWIDE POVERTY RATE OF 14.4 PERCENT. HIGH UNEMPLOYMENT IS CHRONIC IN YUBA AND SUTTER COUNTIES. IN OCTOBER OF 2011, ACCORDING TO THE UNITED STATES BUREAU OF LABOR STATISTICS, YUBA AND SUTTER COUNTIES' COMBINED UNEMPLOYMENT RATE OF 15.4 PERCENT WAS THE THIRD HIGHEST AMONG THE 370 METROPOLITAN STATISTICAL AREAS DEFINED IN THE UNITED STATES. THE PERCENTAGE OF RESIDENTS WITHOUT HEALTH INSURANCE IS HIGHER IN YUBA AND SUTTER COUNTIES THAN THE NATIONAL AVERAGE, ACCORDING TO THE U.S. CENSUS BUREAU'S SMALL AREA HEALTH INSURANCE ESTIMATES. ACCORDING TO THE CENSUS BUREAU, 21.5 PERCENT OF SUTTER COUNTY RESIDENTS AND 19.1 PERCENT OF YUBA COUNTY RESIDENTS WERE WITHOUT HEALTH INSURANCE FOR ALL 12 MONTHS OF 2009, COMPARED TO THE CALIFORNIA UNINSURED RATE OF 20.1 PERCENT, AND THE NATIONAL UNINSURED RATE OF 16.3 PERCENT. FRHG PROVIDES COMMUNITY BENEFITS TO THE COMMUNITIES WE SERVE - DEMONSTRATING OUR COMMITMENT TO THE HEALTH OF RESIDENTS IN OUR SERVICE AREA. WE CREATE ACCESS TO HEALTH CARE IN OUR REGION FOR INDIVIDUALS AND FAMILIES WHO STRUGGLE AGAINST POVERTY, DISABILITY AND ISOLATION. PART VI, LINE 5: - RIDEOUT MEMORIAL HOSPITAL ADDRESSES THE FOLLOWING COMMUNITY NEEDS: ACCESS TO IN-PATIENT AND OUT-PATIENT CARE FOR INDIVIDUALS WITHOUT A MEDICAL PROVIDER; EDUCATION AND SCREENING PROGRAMS FOR SPECIAL POPULATIONS AND HEALTH CONDITIONS; COMMUNITY FLU VACCINATION CLINICS; SPECIAL SUPPORT SERVICES FOR HOSPICE PATIENTS, FAMILIES AND THE COMMUNITY; SUPPORT OF COMMUNITY NONPROFIT ORGANIZATIONS; EDUCATION AND TRAINING OF HEALTH CARE PROFESSIONALS; AND COLLABORATION WITH LOCAL SCHOOLS THROUGH OUR TEEN LEADERSHIP COUNCIL PROGRAM TO PROMOTE INTEREST IN HEALTH CARE CAREERS.- RIDEOUT MEMORIAL HOSPITAL REGULARLY OFFERS HEALTH SCREENINGS TO THE PUBLIC AT LITTLE OR NO CHARGE THROUGH DIABETES HEALTH FAIRE, BLESS YOUR HEART WALK & FAIRE, AND PROSTRATE SCREENINGS THROUGH THE CANCER CENTER AT RIDEOUT. THE RIDEOUT MEMORIAL HOSPITAL ALSO OFFERS LOW COST MAMMOGRAM PROGRAMS DURING PINK OCTOBER. THESE SCREENINGS MAY INCLUDE: CHOLESTEROL, GLUCOSE, BLOOD PRESSURE, HEIGHT AND WEIGHT WITH BMI (BODY MASS INDEX), PROSTRATE SCREENING, AND LOW COST MAMMOGRAMS.- RIDEOUT MEMORIAL HOSPITAL PROUDLY SUPPORTS MANY LOCAL ORGANIZATIONS, IN COLLABORATION WITH AGENCIES SUCH AS PEACH TREE CLINIC, AMPLA HEALTH CARE, SUTTER COUNTY HEALTH ACS, YUBA COUNTY HEALTH DEPARTMENT TO PROVIDE SERVICES AND SUPPORT GROUPS. - RIDEOUT MEMORIAL HOSPITAL IS ACTIVELY INVOLVED IN THE ECONOMIC DEVELOPMENT COMMITTEE FOR YUBA COUNTY, EXECUTIVE STEERING COMMITTEE FOR THE CITY OF MARYSVILLE, AND REPRESENTATION IN ROTARY SERVICE CLUBS IN BOTH YUBA CITY AND MARYSVILLE.- RIDEOUT MEMORIAL HOSPITAL'S COMMUNITY HEALTH EDUCATION PROGRAM PROVIDES A VARIETY OF CLASSES, SEMINARS, SUPPORT GROUPS AND EVENTS TO HELP THE RESIDENTS OF THE YUBA-SUTTER COMMUNITIES TO IMPROVE AND MAINTAIN THEIR HEALTH AND LIFESTYLE. REPORTS FILED WITH STATES PART VI, LINE 7 CA 1 CITY OF MARYSVILLE 107 9TH STREET MARYSVILLE CA 95901 946000368 CITY OF MARYSVILLE 774872 BOOK FIRE TRUCK PURCHASED NEW FIRE TRUCK FOR CITY OF MARYSVILLE FIRE DEPARTMENT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ONLY GRANT DURING THE YEAR WAS A FIRETRUCK THAT WAS PURCHASED FOR THE MARYSVILLE FIRE DEPARTMENT IN CONNECTION WITH A CONTRACTUAL AGREEMENT WITH THE CITY TO MEET PATIENT SAFETY NEEDS ASSOCIATED WITH THE CONSTRUCTION OF A NEW SIX-STORY HOSPITAL. 0 1 0 0 0 0 0 0 0 THERESA HAMILTON 0 331968 0 256139 0 796785 0 3471 0 16430 0 1404793 0 0 L WAYNE MILLS 0 175366 0 16426 0 4732 0 1489 0 16430 0 214443 0 0 CHANCE WHITE 0 211299 0 31503 0 21126 0 2235 0 16430 0 282593 0 0 ROBERT BONACCI 134516 0 1149 0 83807 0 1663 0 16430 0 237565 0 0 0 GLENNA TRENT 88727 0 4697 0 95911 0 1168 0 7368 0 197871 0 0 0 ART ORTEZA 87672 0 4979 0 91462 0 1122 0 7368 0 192603 0 0 0 CHRISTINA FERRERO 161429 0 8084 0 2800 0 1657 0 16430 0 190400 0 0 0 CLIFFORD FUKUMITSU 140012 0 3997 0 25162 0 1525 0 16430 0 187126 0 0 0 THOMAS HAYES 0 283355 0 0 0 0 0 0 0 16430 0 299785 0 0 PART I, LINE 3 THE ORGANIZATION RELIED ON A RELATED ORGANIZATION THAT USED ONE OR MORE OF THE METHODS DESCRIBED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. PART I, LINE 4B THERESA HAMILTON, CEO, AS PART OF HER EXECUTIVE COMPENSATION PACKAGE, PARTICIPATES IN THE FRHG EXECUTIVE DEFERRED COMPENSATION PLAN - 457 (F) AND THE FRHG SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP), WHICH IS PAID BY THE ORGANIZATION. SUPPLEMENTAL INFORMATION PART III ADDITIONAL INFORMATION: THE INCENTIVE PAY PROGRAM IS AVAILABLE FOR ALL EMPLOYEES. PAYMENTS ARE BASED ON ACTUAL PERFORMANCE EXCEEDING PRE-DEFINED FINANCIAL AND QUALITY TARGETS FOR THE FISCAL YEAR. CITY OF MARYSVILLE CALIFORNIA 941387866 574340AA3 2003-12-04 13625000 CALL 1992 BONDS 0 0 0 CITY OF MARYSVILLE CALIFORNIA 946000368 574374AN4 2011-11-15 111067641 CONSTRUCTION, IMPROVEMENT, EXPANSION, AND EQUIPPING OF A NEW TOWER 0 0 0 13625000 272500 297121 1 0 1 1 111148410 90259237 3629356 1066710 1392359 16192176 0 0 0 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 0 0 0 0 0 0 X SCHEDULE K, PART II, LINE 3: THE DIFFERENCE BETWEEN THE ISSUE PRICE REPORTED IN PART I, COLUMN (E) AND THE TOTAL PROCEEDS REPORTED ON PART II, LINE 3 IS DUE TO INTEREST EARNED. NORTH VALLEY GI ENDOSCOPY CENTER PARTNERSHIP MORE THAN 5% OWNED BY FLOYD BURTON, DIRECTOR 326400 PHYSICAN COVERAGE 0 ANN WEILER WIFE OF JOHN WEILER, DIRECTOR 130531 EMPLOYMENT 0 FEATHER RIVER PATHOLOGY MEDICAL GROUP PARTNERSHIP MORE THAN 5% OWNED BY ALEXANDRA REICHMAN, DIRECTOR 1144227 PHYSICAN SERVICES 0 FEATHER RIVER CARDIOVASCULAR INSTITUTE PARTNERSHIP MORE THAN 5% OWNED BY RUPINDER BRAR, DIRECTOR 189039 PHYSICIAN SERVICES 0 FORM 990, PART VI, SECTION A, LINE 6 ORGANIZATION HAS ONE MEMBER WITH RESERVED POWERS. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE ORGANIZATION HAS THE POWER TO ELECT AND REMOVE DIRECTORS AND APPOINT THE CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER OF THE ORGANIZATION HAS THE POWER TO: (A) APPROVE THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THE ORGANIZATION, AS WELL AS ALL PURCHASES, BORROWINGS OR FINANCINGS IN ANY AMOUNT IN EXCESS OF A DOLLAR AMOUNT ESTABLISHED BY THE MEMBER (B) APPROVE THE PURCHASE, SALE, LEASE, DISPOSITION, HYPOTHECATION, EXCHANGE, GIFT, PLEDGE OR ENCUMBRANCE OF ANY REAL OR PERSONAL PROPERTY INTEREST (C) APPROVE ANY ARTICLE OR BYLAW CHANGES ORGANIZATION, DISSOLUTION, AFFILIATION, JOINT VENTURE ACTIVITY OR ALLIANCE BETWEEN THIS ORGANIZATION AND ANY OTHER ENTITY, (E) APPROVE THE FORMATION BY THIS ORGANIZATION OF ANY NEW CORPORATION, OR ITS PARTICIPATION IN ANY OTHER CORPORATION OR ENTITY AS A SHAREHOLDER, MEMBER, PARTNER OR JOINT VENTURER (F) REVIEW, APPROVE OR DISAPPROVE ANY PROPOSED TRANSACTION OF THIS ORGANIZATION WHICH INVOLVES SIGNIFICANT QUESTIONS OF POLICY OR WHICH WOULD HAVE SUBSTANTIAL IMPACT, FINANCIAL OR OTHERWISE, UPON THE ORGANIZATION OR THE MEMBER, AND (G) APPROVE ANY TRANSACTION IN WHICH A DIRECTOR OR OFFICER OF THIS ORGANIZATION HAS A MATERIAL FINANCIAL INTEREST. FORM 990, PART VI, SECTION B, LINE 11 THE AUDIT COMMITTEE WILL PERFORM A DETAILED REVIEW AND BE PART OF THE PRESENTATION BY THE PREPARER (MOSS ADAMS LLP). THE AUDIT COMMITTEE WILL THEN MAKE A RECOMMENDATION TO THE FULL BOARD. A FULL COPY OF THE FORM 990 WILL BE MADE AVAILABLE TO THE FULL BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. IN-HOUSE LEGAL COLLECTS AND REVIEWS THE CONFLICT OF INTEREST STATEMENTS FOR ALL BOARD MEMBERS AND KEY EMPLOYEES. BOARD MEMBERS ARE EXCUSED FROM ANY PORTION OF THE MEETINGS WHERE THEIR PERSONAL INTEREST WOULD CREATE A CONFLICT ON AN ISSUE OR INFLUENCE A VOTE. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNANCE COMMITTEE DEVELOPS THE COMPENSATION POLICY AND STRATEGY TO BE FOLLOWED IN ESTABLISHING THE CEO'S COMPENSATION AND FOR THE CEO TO FOLLOW IN ESTABLISHING COMPENSATION FOR OTHER KEY EMPLOYEES. THE PRIMARY STRATEGY IS TO UTILIZE AN OUTSIDE FIRM TO PROVIDE EXECUTIVE SALARY MARKET DATA WITHIN THE HEALTH CARE INDUSTRY FOR COMPARABILITY WHEN SETTING EXECUTIVE COMPENSATION LEVELS. THE CEO THEN REPORTS SALARY DECISIONS FOR KEY EMPLOYEES UTILIZING THIS DATA TO THE GOVERNANCE COMMITTEE. ANNUALLY THE GOVERNANCE COMMITTEE REPORTS A SUMMARY OF ITS ACTIONS AND ESTABLISHED COMPENSATION PHILOSOPHY TO THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST DURING NORMAL BUSINESS HOURS. CONFLICT OF INTEREST POLICY IS NOT MADE AVAILABLE TO THE PUBLIC. HOURS DEVOTED TO RELATED ORGANIZATIONS: FORM 990, PART VII THERESA HAMILTON SPENDS A TOTAL AVERAGE OF 70 HOURS PER WEEK PERFORMING CEO SERVICES FOR THE FREMONT-RIDEOUT HEALTH GROUP AND AFFILIATES, WHICH INCLUDES RIDEOUT MEMORIAL HOSPITAL. L. WAYNE MILLS SPENDS A TOTAL AVERAGE OF 60 HOURS PER WEEK PERFORMING CFO SERVICES FOR THE FREMONT RIDEOUT-HEALTH GROUP AND AFFILIATES, WHICH INCLUDES RIDEOUT MEMORIAL HOSPITAL. THOMAS HAYES IS THE FORMER CEO OF FREMONT-RIDEOUT HEALTH GROUP AND AFFILIATES, AND IS CONTRACTUALLY OBLIGATED TO PROVIDE SERVICES TO THE GROUP FOR AN AVERAGE OF AT LEAST 8 HOURS PER WEEK. CHANCE WHITE SPENDS A TOTAL OF 60 HOURS PER WEEK PERFORMING SR. VP/CHIEF CLINICAL OFFICER FOR THE FREMONT-RIDEOUT HEALTH GROUP (10 HOURS), UNITED COM-SERVE (10 HOURS), AND RIDEOUT MEMORIAL HOSPITAL (40 HOURS). EACH DIRECTOR DEVOTES HIS/HER TIME AS FOLLOWS: - 2 HOURS PER WEEK TO UNITED COM-SERVE - 5 HOURS PER WEEK TO FREMONT RIDEOUT HEALTH GROUP CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 88,803. INTEREST SWAP -3,950,345. TOTAL TO FORM 990, PART XI, LINE 5: -3,861,542. 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