SIERRA NEVADA MEMORIAL-MINERS HOSPITAL: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: SIERRA NEVADA MEMORIAL-MINERS HOSPITAL (EIN 94-1439787)
Tax period: 2010-07-01 to 2011-06-30
Filed: 2012-05-01
IRS object ID: 201201229349301310
Schema version: 2010v3.7
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule K
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-05-01T19:07:12-05:00	Timestamp
Tax Period End Date	2011-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	KPMG LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	55 SECOND STREET SUITE 1400	AddressLine1
City	SAN FRANCISCO	City
State	CA	State
ZIP Code	94105	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2010-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	941439787	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Sierra Nevada Memorial - Miners Hospital Inc	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	SIER	NameControl
Phone	5302746099	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO Box 1029	AddressLine1
Address Line2	155 Glasson Way	AddressLine2
City	Grass Valley	City
State	CA	State
ZIP Code	95945	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	CAROLYN CANADY	Name
Title	CFO	Title
Date Signed	2012-04-30	DateSigned

Preparer Preparer

Field	Value	IRS element (for citing)
Phone	4159635100	Phone

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Carolyn Canady	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	155 Glasson Way	AddressLine1
City	Grass Valley	City
State	CA	State
ZIP Code	95945	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	298740459	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.SNMH.Org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1934	YearFormation
State Legal Domicile	CA	StateLegalDomicile
Activity Or Mission Description	TO CONTRIBUTE TO THE WELLNESS OF OUR COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	10	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	7	NbrIndependentVotingMembers
Total Nbr Employees	944	TotalNbrEmployees
Total Gross UBI	27731	TotalGrossUBI
Contributions Grants Prior Year	1197514	ContributionsGrantsPriorYear
Contributions Grants Current Year	1138647	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	123645134	ProgramServiceRevenuePriorYear
Program Service Revenue CY	127596279	ProgramServiceRevenueCY
Investment Income Prior Year	6329667	InvestmentIncomePriorYear
Investment Income Current Year	9171689	InvestmentIncomeCurrentYear
Other Revenue Prior Year	868215	OtherRevenuePriorYear
Other Revenue Current Year	602982	OtherRevenueCurrentYear
Total Revenue Prior Year	132040530	TotalRevenuePriorYear
Total Revenue Current Year	138509597	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	1507610	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	3862062	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	78074108	SalariesEtcPriorYear
Salaries Etc Current Year	80557536	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	43352357	OtherExpensePriorYear
Other Expenses Current Year	45951627	OtherExpensesCurrentYear
Total Expenses Prior Year	122934075	TotalExpensesPriorYear
Total Expenses Current Year	130371225	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	9106455	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	8138372	RevenuesLessExpensesCY
Total Assets BOY	184366081	TotalAssetsBOY
Total Assets EOY	213524629	TotalAssetsEOY
Total Liabilities BOY	30481264	TotalLiabilitiesBOY
Total Liabilities EOY	36297739	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	153884817	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	177226890	NetAssetsOrFundBalancesEOY
Mission Description	TO CONTRIBUTE TO THE WELLNESS OF OUR COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	119185837	Expense
Grants	3862062	Grants
Revenue	127579287	Revenue
Description	Sierra Nevada Memorial Hospital's mission is to contribute to the wellness of our community through the provision of quality services delivered in a compassionate and cost-effective manner, collaborating with others in the community to improve the quality of life. The hospital offers a wide range of services and specialties to accommodate the growing needs of Western Nevada County. As the sole acute care provider in our service area, Sierra Nevada Memorial Hospital treats all patients regardless of their ability to pay. Sierra Nevada Memorial Hospital is licensed with 104 acute beds and 17 skilled nursing facility beds and service patients as follows: outpatient visits of 156,019; emergency visits of 30,964; and inpatient and outpatient operating room cases of 2,906. Sierra Nevada Memorial Hospital's list of inpatient, outpatient and support services is quite exhaustive, including: inpatient services: acute medical/surgical care; intensive care; pharmacy; surgery; transitional care unit and women & infant care unit. Outpatient services: ambulatory treatment center; cardiac rehabilitation; cardiopulmonary; diagnostic imaging; laboratory; outpatient surgery center; rehabilitation services; wound care center; ambulance; cancer center; and emergency.	Description
Total Program Service Expense	119185837	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	true	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	true	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	true	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	true	TaxExemptBonds
Invest Tax Exempt Bonds	true	InvestTaxExemptBonds
Escrow Account	false	EscrowAccount
On Behalf Of Issuer	false	OnBehalfOfIssuer
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	true	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	151	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	944	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	true	UnrelatedBusinessIncome
Form990-T Filed	true	Form990-TFiled
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	10	NbrVotingGoverningBodyMembers
Number Independent Voting Members	7	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	true	MembersOrStockholders
Election Of Board Members	true	ElectionOfBoardMembers
Decisions Subject To Approval	true	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	false	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	CA	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	LARA HARROWFINANCE DEPARTMENT	NamePerson
Telephone Number	9168512104	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	3400 DATA DRIVE	AddressLine1
City	rancho cordova	City
State	CA	State
ZIP Code	95670	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
Gerald Angove
Board Member	2.0	X	0	0	0
Dr Joseph Britton
Board Member	2.0	X	0	0	0
Barry Burrows
Board Member	2.0	X	0	0	0
Tom Cross
Board Member	2.0	X	0	0	0
Robbert Liddle
Board Member	2.0	X	0	0	0
Dr Robert Lowe
Board Member	2.0	X	313	0	0
Karl Silberstein
Board Member	2.0	X	0	668603	80378
Dr Sarah Woerner
Board Member	2.0	X	28600	0	0
Don Coots
Secretary	2.0	X	0	0	0	X
Leo Granucci
Vice-Chairman	2.0	X	0	0	0	X
Katherine A Medeiros
CEO/ Service Area Leader	40.0	X	0	503521	69531	X
Caroline Crin Stanford
Chairman	1.0	X	0	0	0	X
Carolyn Canady
CFO/Board Treasurer	40.0		215493	0	31081	X
Mary Gish
CNO	40.0		224775	0	40114		X
Sandra L Cummings
Director of Emergency	40.0		197413	0	13418			X
James E Heard
VP of Prof Servc	40.0		184484	0	47645			X
Gregory T Smith
Registered Nurse	40.0		177767	0	37462			X
Jonathan D Stone
Director of Pharmacy	40.0		194996	0	38180			X
Tzvetan I Tzvetanov
Physicist	40.0		261772	0	28185			X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1485613	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	1172124	TotalReportableCompFrmRltdOrgs
Total Other Compensation	385994	TotalOtherCompensation
Number Individuals GT100 K	147	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
SIERRA NEVADA ANESTHESIA
970 E MAIN ST SUITE 100	GRASS VALLEY	CA	95945	Medical Services	1010335
E PAUL REID MD PC
170 SOUTHPORT DR	MORRISVILLE	NC	27560	Physician Services	980369
GOLD COUNTRY HOSPITALISTS
2036 NEVADA CITY HWY SUITE 307	GRASS VALLEY	CA	95945	Medical Services	500580
HAROLD E NUTTER SON INC
3017 DOUGLAS BLVD SUITE 200	ROSEVILLE	CA	95661	Electrical Contracti	327233
AFFILIATED COMPUTER SERVICES
PO BOX 201322	DALLAS	TX	753201322	IT Services	308227

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	25	NumberOfContractorsGT100K
Related Organizations	621147	RelatedOrganizations
Government Grants	140089	GovernmentGrants
All Other Contributions	377411	AllOtherContributions
Total Contributions	1138647	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT REV/CHARITY CARE	900099	62251642	62251642
MEDICARE/MEDICAID PAYMENTS	900099	64297836	64297836
MED OFFICE BLDG	621300	355470	355470
EHR	900099	132927	132927
MANAGEMENT SERVICES	541610	63622	63622

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	494782	TotalRevenueColumn
Related Or Exempt Function Income	477790	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	16992	UnrelatedBusinessRevenue

Field	Value	IRS element (for citing)
Total Program Service Revenue	127596279	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	3748192	TotalRevenueColumn
Exclusion	$3,748,192	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	12700	Real
Personal	1068	Personal

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	12700	Real
Personal	1068	Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	13768	TotalRevenueColumn
Exclusion	$13,768	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	165653198	Securities
Other	1161	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	160230785	Securities
Other	77	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	5422413	Securities
Other	1084	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	5423497	TotalRevenueColumn
Exclusion	$5,423,497	ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount	Unrelated Business RevenueUnrelatedBusinessRevenue
GIFT SHOPS	453220	187735	$187,735
CAFETERIA/CATERING	722320	198101	$187,362	10739
FINANCE CHARGES	900099	46176	$46,176

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	157202	TotalRevenueColumn
Exclusion	$157,202	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	589214	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	138509597	TotalRevenueColumn
Related Or Exempt Function Income	127579287	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	27731	UnrelatedBusinessRevenue
Exclusion	$9,763,932	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	3858062	Total
Program Services	3858062	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	4000	Total
Program Services	4000	ProgramServices

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	514377	Total
Program Services	481605	ProgramServices
Management And General	32772	ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	180686	Total
Program Services	180686	ProgramServices

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	58350953	Total
Program Services	54431963	ProgramServices
Management And General	3918990	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	3893807	Total
Program Services	3630957	ProgramServices
Management And General	262850	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	13345902	Total
Program Services	12444992	ProgramServices
Management And General	900910	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	4271811	Total
Program Services	3983444	ProgramServices
Management And General	288367	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	189926	Total
Management And General	189926	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	43411	Total
Management And General	43411	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	11648	Total
Management And General	11648	ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	536631	Total
Management And General	536631	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	14145629	Total
Program Services	10098470	ProgramServices
Management And General	4047159	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	103289	Total
Program Services	5746	ProgramServices
Management And General	97543	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	3613812	Total
Program Services	3476735	ProgramServices
Management And General	137077	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	1407967	Total
Program Services	1368997	ProgramServices
Management And General	38970	ManagementAndGeneral

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	1858179	Total
Program Services	1665844	ProgramServices
Management And General	192335	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	171461	Total
Program Services	143289	ProgramServices
Management And General	28172	ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	52149	Total
Program Services	40802	ProgramServices
Management And General	11347	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	952039	Total
Program Services	951562	ProgramServices
Management And General	477	ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	3651670	Total
Program Services	3617156	ProgramServices
Management And General	34514	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	619392	Total
Program Services	619392	ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
MEDICAL SUPPLIES	11914037	11892558	21479
BAD DEBT	5355706	5355706
LICENSES & TAXES	176239	124507	51732
DUES & SUBSCRIPTIONS	177616	42090	135526
OVERHEAD CORPORATE ALLOCATION	25050		25050

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	945776	Total
Program Services	767274	ProgramServices
Management And General	178502	ManagementAndGeneral
Fundraising	0	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	130371225	Total
Program Services	119185837	ProgramServices
Management And General	11185388	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	5626	BOY
EOY	83004	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	12022860	BOY
EOY	11982596	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	11790045	BOY
EOY	13350273	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	612241	BOY
EOY	191116	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	1574086	BOY
EOY	1510539	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	708940	BOY
EOY	622701	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	103417321	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	67630771	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	33129990	BOY
EOY	35786550	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	97266428	BOY
EOY	116871317	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	23181908	BOY
EOY	26245231	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	4017695	BOY
EOY	6844204	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	56262	BOY
EOY	37098	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	184366081	BOY
EOY	213524629	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	11912990	BOY
EOY	15000302	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	151276	BOY
EOY	3240359	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	4000000	BOY
EOY	4000000	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	14416998	BOY
EOY	14057078	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	30481264	BOY
EOY	36297739	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	149764682	BOY
EOY	172295314	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	2887408	BOY
EOY	3331832	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	1232727	BOY
EOY	1599744	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	153884817	BOY
EOY	177226890	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	184366081	BOY
EOY	213524629	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	8138372	ReconcilationRevenueExpenses
Reconcilation Other Changes	15203701	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	true	FederalGrantAuditRequired
Federal Grant Audit Performed	true	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbying
Total Direct Lobbying		TotalDirectLobbying
Total Lobbying Expenditures		TotalLobbyingExpenditures
Other Exempt Purpose Expenditures		OtherExemptPurposeExpenditures
Total Exempt Purpose Expenditures		TotalExemptPurposeExpenditures
Lobbying Nontaxable		LobbyingNontaxableAmount
Grassroots Nontaxable		GrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non Tx		TotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying Nontx		TotLobbyExpendMnsLobbyingNontx
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$11,648	OtherActivitiesAmount
Total Lobbying Expenditures IIB	11648	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	PART II-B, LINE 1i	Identifier
Explanation	Lobbying expenditures paid directly by the filing organization for annual membership dues: American College of Healthcare Executives $ 3 Health Physics Society $ 7 Society of Human Resources $ 14 American Organization Nurses $ 22 Lobbying expenditures paid by the Parent organization for annual membership dues where expenses are allocated to the hospital: American Hospital Association $ 859 Catholic Health Association $ 877 California Hospital Association $ 9,866 --------- TOTAL EXPENDITURES PAID TO ORGANIZATIONS $ 11,648 =========	Explanation

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amts		ArtPublicExhibitionAmts
Held Works Of Art Amts		HeldWorksOfArtAmts

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	2423093	BeginningOfYearBalance
Contributions	57110	Contributions
Investment Earnings Or Losses	350441	InvestmentEarningsOrLosses
Other Expenditures	18141	OtherExpenditures
End Of Year Balance	2812503	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	1178093	BeginningOfYearBalance
Contributions	1252000	Contributions
Investment Earnings Or Losses	-7000	InvestmentEarningsOrLosses
End Of Year Balance	2423093	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	1130227	BeginningOfYearBalance
Contributions	47866	Contributions
End Of Year Balance	1178093	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	0.43000	BoardDesignatedEOYBalance
Permanent Endowment EOY Balance	0.57000	PermanentEndowmentEOYBalance
Term Endowment EOY Balance	0.00000	TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs	false	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	true	EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R	true	AreRelatedOrgsListedScheduleR

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1140154	OtherCostOrOtherBasis
Book Value	1140154	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	57896489	OtherCostOrOtherBasis
Depreciation	34292459	Depreciation
Book Value	23604030	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	289591	OtherCostOrOtherBasis
Depreciation	214259	Depreciation
Book Value	75332	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	35796294	OtherCostOrOtherBasis
Depreciation	30597568	Depreciation
Book Value	5198726	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	8294793	OtherCostOrOtherBasis
Depreciation	2526485	Depreciation
Book Value	5768308	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	35786550	TotalOfBookValueLandBuildings
Financial Derivatives		FinancialDerivatives
Closely Held Equity Interests		CloselyHeldEquityInterests

Other Securities OtherSecurities

Field	Value	IRS element (for citing)
Description	POOLED INVESTMENTS	Description
Book Value	26245231	BookValue
Method Of Valuation	F	MethodOfValuation

Field	Value	IRS element (for citing)
Total Of Book Value Securities	26245231	TotalOfBookValueSecurities
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescription	AmountAmount
DUE TO RELATED PARTIES	$12,469,144
PENSION PAYABLE	$1,542,934
DUE TO FOUNDATION & ANNUITANT	$45,000

Field	Value	IRS element (for citing)
Total Of Amounts	14057078	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	Sch D, PART V, LINE 4	Identifier
Explanation	The endowment funds are intended to be used to support Alzheimer's research, the Cancer Center, the Cardiac program and other hospital program needs.	Explanation

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	true	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare

Discounted Other DiscountedOther

Field	Value	IRS element (for citing)
Other	X	Other
Discounted Other Percentage	500.	DiscountedOtherPercentage

Field	Value	IRS element (for citing)
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	false	ExpensesExceededBudget
Annual Community Benefit Report	true	AnnualCommunityBenefitReport
Report Publically Available	true	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Persons Served	5981	PersonsServed
Total Community Benefit Expense	1676906	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	1676906	NetCommunityBenefitExpense
Percent Of Total Expense	0.01340	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Persons Served	21021	PersonsServed
Total Community Benefit Expense	16029380	TotalCommunityBenefitExpense
Direct Offsetting Revenue	15857537	DirectOffsettingRevenue
Net Community Benefit Expense	171843	NetCommunityBenefitExpense
Percent Of Total Expense	0.00140	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Persons Served	4399	PersonsServed
Total Community Benefit Expense	2936402	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1338387	DirectOffsettingRevenue
Net Community Benefit Expense	1598015	NetCommunityBenefitExpense
Percent Of Total Expense	0.01280	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Persons Served	31401	PersonsServed
Total Community Benefit Expense	20642688	TotalCommunityBenefitExpense
Direct Offsetting Revenue	17195924	DirectOffsettingRevenue
Net Community Benefit Expense	3446764	NetCommunityBenefitExpense
Percent Of Total Expense	0.02760	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Persons Served	4935	PersonsServed
Total Community Benefit Expense	469242	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	469242	NetCommunityBenefitExpense
Percent Of Total Expense	0.00380	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Persons Served	62	PersonsServed
Total Community Benefit Expense	27044	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2000	DirectOffsettingRevenue
Net Community Benefit Expense	25044	NetCommunityBenefitExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Persons Served	0	PersonsServed
Total Community Benefit Expense	7976	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	7976	NetCommunityBenefitExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Persons Served	700	PersonsServed
Total Community Benefit Expense	1217345	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	1217345	NetCommunityBenefitExpense
Percent Of Total Expense	0.00970	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Persons Served	5697	PersonsServed
Total Community Benefit Expense	1721607	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2000	DirectOffsettingRevenue
Net Community Benefit Expense	1719607	NetCommunityBenefitExpense
Percent Of Total Expense	0.01380	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Persons Served	37098	PersonsServed
Total Community Benefit Expense	22364295	TotalCommunityBenefitExpense
Direct Offsetting Revenue	17197924	DirectOffsettingRevenue
Net Community Benefit Expense	5166371	NetCommunityBenefitExpense
Percent Of Total Expense	0.04140	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	2	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Building Expense	17567	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	17567	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	2	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Building Expense	17567	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	17567	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$1,525,975	BadDebtExpenseAmount
Amount Attributable To	0	AmountAttributableTo
Amount Reimbursed By Medicare	38287782	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	56866381	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-18578599	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

Field	Value	IRS element (for citing)
Business Name Line1	GRASS VALLEY OUTPATI	BusinessNameLine1

Field	Value	IRS element (for citing)
Description Ent Primary Activity	AMBULATORY SURGERY CENTER	DescriptionEntPrimaryActivity
Organization Profit Or Ownership	0.22800	OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership	0.00000	OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership	0.31590	PhysicansProfitOrOwnership

Field	Value	IRS element (for citing)
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Sierra Nevada Memorial Miner's Hospital	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	155 Glasson Way	AddressLine1
City	Grass Valley	City
State	CA	State
ZIP Code	95945	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Sierra Nevada Memorial Miner's Hospital	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	1	NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	GRASS VALLEY SURGERY CENTER	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	408 Sierra Colleg Drive	AddressLine1
City	GRASS VALLEY	City
State	CA	State
ZIP Code	95945	ZIPCode

Field	Value	IRS element (for citing)
Facility Type	OUTPATIENT SURGERY CENTER	FacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
SCH H, Part I, Line 7, column (f)	The amount of bad debt expense included on Form 990, Part IX, line 25, column (A) is $5,355,706 and has been subtracted for purposes of calculating the percentages in column (f).
SCH H, PART I, LINE 7	For purposes of calculating the amounts provided in the table, SNMMH uses a cost accounting system that combines relative value units (RVU) and cost to charge ratios (CCR) to allocate costs to the patient level. The cost accounting system algorithm allocates total operating expenses to the procedure charge code level based upon an RVU for procedures that have been studied and assigned an RVU, or based upon a CCR for unstudied procedures that do not have an RVU assigned. When a CCR is used, the system calculates that CCR on a departmental specific basis at each individual hospital 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.
SCH H, PART II - COMMUNITY BUILDING ACTIVITIES	Advocacy to improve the health status of the underserved and the quality of life for residents in Nevada County is a priority. Sierra Nevada Memorial Hospital is involved in various organizations to represent the needs of the underserved, develop initiatives for healthier communities, and enhance the overall economy of the community. Significant volunteer time is spent serving the community in this capacity on the boards of organizations that include: Miners/Western Sierra Clinic Grass Valley Chamber of Commerce Community Recovery Resources Rotary of Grass Valley Rotary of Nevada County South The Friendship Club Eldercare Providers Economic Resource Council The hospital also participates in fundraising events to support meaningful health improvement programs and services by community based nonprofit organizations.
SCH H, PART III, LINE 4	The amount of the organization's bad debt at cost is determined by applying the CCR (see above) to patient charges that are deemed to be uncollectible. This amount represents the cost of services provided to patients who are unable or refuse to pay their bills and do not qualify for free or discounted care, government sponsored programs or other financial assistance, and are otherwise uninsured. Any portion of a patient bill remaining after applying financial, uninsured or other discounts or payments received on the account that are ultimately determined to be uncollectible are written off to bad debt. As noted in Part I, Line 3b, SNMMH provides free or discounted care to uninsured or under-insured individuals at or below 500% of the Federal Poverty Level. SNMMH also provides patients options for prompt pay discounts, discounts for the medically indigent, 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 25% for patients seen at California facilities. The expected patient payment amount on the patient's bill reflects this discount. SNMMH makes every effort in determining if a patient qualifies for charity care upon admission. SNMMH follows CHW's financial assistance policy. This 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 and is provided upon billing if eligibility is not previously determined. Eligibility is reevaluated as needed and amounts are classified as financial assistance as soon as eligibility is known. SNMMH also utilizes a Payment Assistance Rank Ordering (PARO) scoring system to assist in determining if a patient may qualify for financial 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 socio-economic 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 charity are reported as bad debt. As such, SNMMH does not believe that any amounts included in Part III, Line 2, are attributable to patients eligible under the organization's financial assistance policy. The following is an excerpt from CHW and its subordinate corporations' consolidated annual audited financial statements for the year ended June 30, 2011, 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. SNMMH 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.
SCH H, PART III, LINE 8	SNMMH prepares Medicare cost reports in a manner that comports with Provider Reimbursement Manual (PRM) 15-1, 2150ff and PRM 15-2, 1000ff. As such, the following language per the PRM 15-1 describes the computation of costs per the Medicare Cost Report: Total allowable costs of a provider are apportioned between program beneficiaries and other patients so that the share borne by the program is based upon actual services received by program beneficiaries. The ratio of covered beneficiary charges to total patient charges for the services of each ancillary department is applied to the cost of the department. Added to this amount is the cost of routine services for program beneficiaries, determined on the basis of a separate average cost per diem for all patients for general routine patient care areas. Another factor to be considered is a separate average cost per diem for each intensive care unit, coronary care unit, and other special care inpatient hospital units. CHW believes that the entire Medicare shortfall of $429.3 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 CHW 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 $18.6 million reported on Part III, Section B, Line 8, primarily for fee for service Medicare patients, as well as the unreimbursed portion of Medicare Managed Care and Medicare Capitated programs for SNMMH.
SCH H, PART III, LINE 9B	SNMMH ensures that patient accounts are processed fairly and consistently. SNMMH's collection policy contains provisions that prohibit the collection of amounts due from patients who the organization knows qualify for financial assistance. Accounts with incorrect or incomplete demographic information are assigned to a collection agency if the SNMMH or billing company retained by SNMMH 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 SNMMH's Patient Payment Assistance Policy, or where the patient is attempting in good faith to settle an outstanding bill with the facility via payment plans, SNMMH 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. SNMMH does not impose wage garnishments or liens on primary residences. 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 hospital patient financial assistance department. Upon assignment of such a patient account to a collection agency, SNMMH requires the agency to comply with the Fair Debt Collection Practices Act.
Sch H, Part VI, Line 2 - Needs Assessment	The hospital is addressing priority needs identified in the needs assessment, focusing on access to care as a priority need and by implementing a chronic disease self-management program. Needs are also assessed each year working with community organizations during our Community Grants program. Sierra Nevada Memorial Hospital participated with United Way on the earlier needs assessment to determine priority health issues. As a hospital in a rural community, the hospital has not previously conducted its own needs assessment, but has initiated the formal process in 2011. The new assessment will be complete in 2012, and will include both quantitative and qualitative data. Active in the community, the hospital determines community health needs in various other ways; working collaboratively with nonprofit community clinics and organizations, and examining demographics and most prevalent needs of patients.
Sch H, Part VI, Line 3- Patient Education of Eligibility for	Communication of the Financial Assistance Program to Patients and the Public: Information about patient financial assistance available from SNMMH, including a contact number, IS disseminated by the hospital by various means, including the publication of notices in patient bills and by posting notices in the Emergency and Admitting Departments, central lobbies, and waiting rooms. Such information IS provided in the primary languages spoken by the populations served by the hospital. In addition, payment discussions are held with patients at the time of registration and again when discharged. The Patient is given a brochure at these times. Financial Advisors are also available during the patient's visit. If financial assistance eligibility is not determined prior to billing, initial billing statements to uninsured patients include a request to the patient to provide any insurance information that was valid for the dates of service billed, a statement informing patients without insurance coverage they may be eligible for a government sponsored program or facility funded financial assistance, instructions on how to apply for a government program or financial assistance and the provision of such applications. Additionally, contract terms with collection vendors working on behalf of the hospital require all initial statements to uninsured patients include verbiage informing patients of the facility's financial assistance program and a copy of the financial assistance application. Any member of SNMMH's staff or medical staff may make referral of patients for financial assistance. The patient or a family member, a close friend or associate of the patient may also make a request for financial assistance.	Assistance
Sch H, Part VI Line 4: - Community Information	Primary Service Area: Sierra Nevada Memorial Hospital is in Nevada County encompassing four zip codes in the communities of Grass Valley, Penn Valley and Nevada City. Population: Population within Sierra Nevada Memorial Hospital's primary service area is 71,468, and is projected to grow to 73,769 by 2015. Within the hospital's primary service area, people between the ages of 35 and 64 make up the largest percentage of the population (40%). Over 25.6% of the population is between 18 and 34 years of age. Children age 17 and younger make up 17% of the population, and seniors 65 years and older account for nearly 21% of the population. Growth in the senior population is anticipated in the future. Over half of the population is female. Ethnicity: The majority of the population in Sierra Nevada Memorial Hospital's primary service area is Caucasian (88%). Some growth is expected in the Hispanic community. In the 2009 OSHPD data, 9% of its residents live below the poverty line. 19.71% receive Medicare, 10.95% receive MediCal, 16.71% are uninsured and 52.62% are self-paid (12.97% risk and 39.64% non-risk). Sierra Nevada Memorial Hospital is the community's sole healthcare provider. The nearest hospital is Sutter Auburn Faith which is 22 miles away. TPrimary Care and Mental Health services have been Federally designated as Medically Underserved Areas.
Sch H, Part VI, Line 5 - Promotion of Community Health	Sierra Nevada Memorial Hospital offers medical staff privileges to any qualifying physicians. The hospital's Community Board serves in an oversight role to ensure that community benefit practices and programs are aligned with and support the mission, policy and priorities of the region and the organization. The majority of the organization's governing body resides in the primary service area and is not employed by nor contractored with the organization. SNMMH utilizes a Community Needs Assessment process that results in a document describing the health care needs of the surrounding population. In addition a companion document listing Community Health Assets is prepared and then compared to the Needs Assessment. Unmet needs are identified and used in planning for physician recruitment, adding new services and programs, and offering community education. Sierra Nevada Memorial Hospital specifically sponsors and takes an active role in programs that address priorities within its service area such as: - CHAMP (Congestive Heart Active Management Program) that provides a vital medical link to heart failure patients when they leave the hospital to improve their understanding and ability to manage this chronic disease, and reduce their risk of readmission. Free or discounted cardiac rehab programs to those who are unable to pay as a complementary program to CHAMP. - Wellness Education Program that offers a wide variety of free or discounted classes addressing health issues including diabetes, chronic disease self management, smoking cessation, aging, healthy cooking, and prenatal care. - Free nutritional counseling by a registered dietician for those that are uninsured or can't afford to pay. - Free or low cost lab testing for all in the community, with an emphasis on poor and vulnerable. - Assistance to Alzheimer's patients and their caregivers/families by the Hospital's Home Care Department. - Cancer screenings and cancer support groups. - Traumatic brain injury, stroke and other support groups. - Educational training for those entering the professional and medical health field. Sierra Nevada Memorial Hospital also provides assistance to uninsured patients for enrollment in government sponsored health insurance programs, and free transportation to those in need.
Sch H, Part VI, Line 6 - Affiliated Health Care System	SNMMH is affiliated with CHW. Affiliates of CHW 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 CHW and its subordinate corporations for the year ended June 30, 2011, is as follows: Persons Net Comm % of Served Benefit Exp excl Bad Debt Benefits for the Poor: Traditional Charity Care 97,422 152,563,579 1.6% Unpaid Costs of Medicaid/Medi-Cal 1,035,601 444,972,896 4.7% Other Means-tested Programs 253,140 63,978,237 0.7% Community Services: Community Health Services 552,089 49,285,673 0.5% Health Professions Education 21,637 10,998,382 0.1% Subsidized Health Services 219,756 37,388,406 0.4% Donations 233,077 37,415,522 0.4% Community Building Activities 15,081 1,642,251 0.0% Community Benefit Operations 19,210 6,983,659 0.1% Total Community Services for the poor 1,060,850 143,713,893 1.5% Total Benefits for the Poor 2,447,013 805,228,605 8.5% Benefits for the Broader Community: Community Services: Community Health Services 2,004,902 23,003,029 0.2% Health Professions Education 52,255 65,128,468 0.7% Subsidized Health Services 124,290 11,026,699 0.1% Research 5,057 24,166,007 0.3% Donations 202,417 7,914,381 0.1% Community Building Activities 63,555 8,148,278 0.1% Community Benefit Operations 937 2,883,276 0.0% Total Benefits for the Broader Community 2,453,413 142,270,138 1.5% Total Community Benefits 3,562,475 571,626,794 10.0% Unpaid Costs of Medicare 1,109,062 429,356,656 4.5% Total Community Benefits including Cost of Medicare 6,009,488 1,376,855,399 14.5%
Schedule H, Part I, line 7b, column (f)	In January 2010, the State of California enacted legislation that provided for supplemental Medi-Cal payments to certain hospitals funded by a quality assurance fee paid by participating hospitals and matching federal funds ("the 2010 Hospital Fee Program"). The legislation covered the period of April 1, 2009 through December 31, 2010. The Centers for Medicare & Medicaid Services approved the 2010 Hospital Fee Program in its entirety in December 2010, and therefore all activity of the program was recognized during the year ended June 30, 2011. Fee-for-service supplemental payments of $6.5 million recognized during the year are 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 a large decrease in the overall cost of community benefit expense as a percent of total expenses when compared to prior years which was 7.97%. The California Hospital Association created a private program, the California Health Foundation and Trust ("CHFT"), established for several purposes, including aggregating and distributing financial resources to support charitable activities at various hospitals and health systems in California. Upon approval of the legislation noted above in December 2010, SNMMH recorded a pledge to a grant fund established by CHFT in the amount $0.7 million. The grant is reported under other benefits (Part I, line 7i, column c), as cash and in-kind contributions to community groups.
STATE FILING OF COMMUNITY BENEFIT REPORT	CA,	990 SCHEDULE H, PART VI

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	true	RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Method Of ValuationMethodOfValuation	Description Of Non Cash AssistanceDescriptionOfNonCashAssistance	Purpose Of GrantPurposeOfGrant
California Health Foundation and Trust
1215 K Street Suite 800	Sacramento	CA	95814	941498697	501(c)(3)	659288	N/A	N/A	Improve access through electronic health records
CHW Medical Foundation
3400 Data Drive	Rancho Cordova	CA	95670	680220314	501(c)(3)	2759975	N/A	N/A	Medical Fnd Support
Sierra Nevada Hospital Foundation
140 Litton Drive	Grass Valley	CA	95945	680005939	501(c)(3)	437955	N/A	N/A	Foundation Support

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	3	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	0	TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	Part I, line 2	Identifier
Explanation	The organization's CFO reviews financial information monthly and approves the grant payment based on that review. The grants to the foundation are based on actual expenses, not to exceed the approved budget.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	true	SeverancePayment
Supplemental Nonqual Retire Plan	true	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Karl Silberstein
0	412362	0	242230	0	14011	0	44108	0	36270	0	748981	0	0
Katherine A Medeiros
0	276565	0	214735	0	12221	0	34951	0	34580	0	573052	0	0
Carolyn Canady
170275	0	45218	0	0	0	22969	0	8112	0	246574	0	0	0
Mary Gish
177638	0	47137	0	0	0	29002	0	11112	0	264889	0	0	0
Sandra L Cummings
92544	0	28857	0	76012	0	13418	0	0	0	210831	0	0	0
James E Heard
146105	0	38379	0	0	0	28431	0	19214	0	232129	0	0	0
Gregory T Smith
176353	0	1414	0	0	0	12621	0	24841	0	215229	0	0	0
Jonathan D Stone
159586	0	35410	0	0	0	18966	0	19214	0	233176	0	0	0
Tzvetan I Tzvetanov
242792	0	18980	0	0	0	28023	0	162	0	289957	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)

IdentifierIdentifier	ExplanationExplanation
PART I, LINE 3	Although the organization employs personnel, the Organization relied on a related organization, Catholic Healthcare West, that used one or more of the methods described in Schedule J, Part I, Line 3, to establish the Organization's Service Area Leader's compensation. See Schedule O disclosure for Form 990, Part VI, Section B, Line 15a for additional information.
PART I, LINE 4a	The organization's key employees, certain officers and highly compensated employees participate in a severance plan that provides market-standard compensation, ranging from payments of 6 months to 2 years of base compensation, depending on the executive's position, in the event of a position elimination or other involuntary termination, in accordance with the guidelines of the plan. Payments pursuant to the plan arrangement for one highly compensated employee occurred during 2010; S. Cummings $65,031.
PART I, LINE 4b	CHW's key employees and certain officers and highly compensated employees hired prior to June 30, 2006 are eligible to participate in the 2007 CHW Executive Deferred Compensation Plan that is subject to substantial risk of forfeiture, as required by the IRS. The 2007 Executive Deferred Compensation Plan is a nonqualified 457(f) plan which is intended bridge the difference, if any, between the benefit provided under the CHW 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. No benefit under this formula will vest under this 457(f) plan before the attainment of age 62 or the completion of 15 years of service. No payments were made under this plan during 2010. Certain officers and key employees participate in the CHW Excess Benefit Plan, a nonqualified supplemental benefit plan limited to participants in the CHW retirement plan whose benefits are affected by the limitations imposed by Sections 401(a)(17) and 415 of the Internal Revenue Code. Benefit service under this plan was frozen as of January 1, 2008. No payments were made to any listed persons during 2010 pursuant to this plan. Certain listed persons participate in the CHW 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 2010 pursuant to this plan.
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.
Part VII - Schedule J-2, Part I	SNMMH does not compensate directors, SARAH WOERNER AND ROBERT LOWE, for their services as board members. All compensation and benefits reported for directors represent compensation as medical director of SNMMH.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEIN	CUSIP NumberCUSIPNumber	Date IssuedDateIssued	Issue PriceIssuePrice	Description Of PurposeDescriptionOfPurpose	DefeasedDefeased	On Behalf Of IssuerOnBehalfOfIssuer	Pool FinancingPoolFinancing
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITHY
521598225	13033FTN0	2004-05-19	150000000	NEW MONEY TO FUND VAR PROJECTS & M	false	false	false
CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITHY
521643828	13033FYE4	2005-11-10	200000000	NEW MONEY TO FINANCE CAPITAL E	false	false	false

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetired	Amount Bond DefeasedAmountBondDefeased	Total ProceedsTotalProceeds	Amount In Reserve FundAmountInReserveFund	Capitalized InterestCapitalizedInterest	Refunding EscrowRefundingEscrow	Issuance Costs From ProceedsIssuanceCostsFromProceeds	Credit EnhancementCreditEnhancement	Working Capital ExpendituresWorkingCapitalExpenditures	Capital ExpendituresCapitalExpenditures	Other Spent ProceedsOtherSpentProceeds	Amount UnspentAmountUnspent	Year Of Subst CompletionYearOfSubstCompletion	Current RefundingCurrentRefunding	Advance RefundingAdvanceRefunding	Final Allocation MadeFinalAllocationMade	Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
0	0	2004283	0	0	0	0	0	0	2004283	0	0	2005	false	false	true	true
0	0	2022246	0	0	0	0	0	0	2022246	0	0	2008	false	false	true	true

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedProperty	Any Lease ArrangementsAnyLeaseArrangements	Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty	Any Research AgreementsAnyResearchAgreements	Bond Counsel Routinely EngagedBondCounselRoutinelyEngaged	Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers	Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI	Total Private Business UseTotalPrivateBusinessUse	Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
false	true	true	true	true	0.01408	0.00850	0.02258	true
false	true	true	true	true	0.00000	0.00000	0.00000	true

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiled	Variable Rate IssueVariableRateIssue	Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds	Gross Proceeds Invested In GICGrossProceedsInvestedInGIC	Gross Proceeds InvestedGrossProceedsInvested	Exception To RebateExceptionToRebate
false	true	false	false	true	false
true	true	false	false	true	false

Form990 Schedule K Part V Form990ScheduleKPartV

Field	Value	IRS element (for citing)
Identifier	Sch K, Part V	Identifier
Explanation	Bond A: CUSIP 13033FTN0 Part I, Column (e) The difference between the issue price in Part I, column (e) and Part II, Line 3 is due to investment earnings. Sierra Nevada Miners Hospital, as a separate entity, received $2 million of the $150 million of the CHFFA 2004JK pool bonds. Part III, Line 3a Although there are management or service contracts that may generate private use, we have policies and procedures in place that require such contract be in compliance with Revenue Procedure 97-13. Part III, Line 3b Although there are research agreements which may result in private use, we have policies and procedures in place that require such contract be in compliance with Revenue Procedure 2007-47. Part IV, Line 1 Arbitrage calculations were performed by our arbitrage consultant. Such consultant determined that there was no rebatable arbitrage liability; accordingly, no form 8038-T was required to be filed. Bond A: CUSIP 13033FYE4 Part I, Column (e) The difference between the issue price in Part I, column (e) and Part II, Line 3 is due to investment earnings. Sierra Nevada Miners Hospital, as a separate entity, received $2 million of the $200 million of the CHFFA 2005HI pool bonds. Part III, Line 3a Although there are management or service contracts that may generate private use, we have policies and procedures in place that require such contract be in compliance with Revenue Procedure 97-13. Part III, Line 3b Although there are research agreements which may result in private use, we have policies and procedures in place that require such contract be in compliance with Revenue Procedure 2007-47.	Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Field	Value	IRS element (for citing)
Name Person	Burrows Security Force	NamePerson

Field	Value	IRS element (for citing)
Relationship	see supplemental info	Relationship
Amount Of Transaction	180686	AmountOfTransaction
Description Of Transaction	Payment for Security Services	DescriptionOfTransaction
Sharing Of Revenues	false	SharingOfRevenues

Form990 Schedule L Part V Form990ScheduleLPartV

Field	Value	IRS element (for citing)
Identifier	Sch L, Part IV, column (b)	Identifier
Explanation	Barry Burrows, a board member during fiscal year 2011, is an officer of Burrows Security Force and a greater than 35% owner of Burrows Security Force.	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
FORM 990, PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE	SECTION A, LINE 6: The organization has a sole corporate member, Catholic Healthcare West, a 501(c)(3) exempt organization. SECTION A, LINE 7A: THE CORPORATE MEMBER CAN ELECT ONE MEMBER AND APPOINT TWO OTHER MEMBERS IF NOMINATED BY THE BOARD. 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. SECTION B, LINE 11a: The organization's CFO reviewed the Form 990. In addition, in the process of preparation, the form 990 was reviewed by Finance and Accounting (Regional CHW management and Corporate Tax Department), which worked closely with AN INDEPENDENT accounting firm engaged to review the return. Management presented the draft of the Form 990 to the Board. The draft was complete except it excluded compensation information for directors who are also key executives of Catholic Healthcare West, the filing organization's sole member. Compensation by Catholic Healthcare West to those directors has been reviewed by the Compensation and Benefits Committee of the Catholic Healthcare West Board of Directors. SECTION B, LINE 12C: The Organization has adopted CHW's Conflicts of Interest Policy. The Organization's Board is charged with monitoring proposed or ongoing transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to the conflicts of interest policy, an annual conflict of interest disclosure statement, aimed at determining any family and business relationships and transactions, or other transactions that may pose a potential conflict, is distributed to all covered persons (e.g., board members, officers and executive leadership, key employees and all management personnel whose responsibilities include business decisions which may give rise to conflicts of interest). Covered persons are also required to disclose real or potential conflicts at the time such conflicts arise. When an individual becomes a covered person and annually thereafter, each covered person is required to submit an updated disclosure statement and to sign a statement affirming that he/she: (1) has received a copy of the conflicts of interest policy; (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. The completed questionnaires are reviewed by CHW's Legal Department and any persons with actual or potential conflicts are informed via written communication. The procedures for addressing any 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; (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 person with the conflict of interest 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) any conflicting issues arising during the course of a board meeting which cannot be resolved are to be referred to an independent committee of the Board of Directors; and (6) the transaction or action must be approved by a majority of disinterested persons. All conflicts of interest, whether resolved or unresolved, are reported in the Organization's Form 990. SECTION B, LINE 15A: Although the organization employs personnel, the Service Area Leader is compensated by Catholic Healthcare West (CHW). FOR 2010, CHW's Compensation and Benefits department conductED an annual review and analysis to provide benchmarking data for the total compensation and benefits package of the Service Area Leader. Appropriate comparability data for similar jobs in peer companies (both taxable and tax-exempt) WAS obtained from independent third-party survey sources. SECTION B, LINE 15B: Compensation of other highly paid key employees is based on a COMPREHENSIVE EVALUATION FOCUSING ON ALL ASPECTS OF THE INCUMBENT'S ASSIGNED duties and assessed performance in carrying out the philosophy and mission of CHW and its sponsoring congregations. Additionally, comparative data and market surveys regarding compensation in the surrounding marketplace are considered. SECTION C, LINE 19: Federal tax laws do not mandate that the organization's governing documents, conflict of interest policy and financial statements be made available for public inspection. Financial statements are made available on CHW's website and upon request.
FORM 990, PART XI, Line 5 - RECONCILIATION OF NET ASSETS	Change in unrealized gains/(losses); $14,392,262. Interest in net assets of an unconsolidated Foundation; $709,185. To include Sierra Nevada Auxiliary Income and Expense for tax purposes- Auxiliary operates under the hospital's 501(c)(3); $102,255.
FORM 990, PART XII, Line 3 - FINANCIAL STATEMENTS REPORTING	The organization's federal awards were included in CHW's consolidated OMB Circular A-133 audited Schedule of Federal Expenditures.
HOURS DEVOTED FOR RELATED ORGANIZATION	NAME:Karl Silberstein TITLE:Board Member HOURS:40	FORM 990 PART VII

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1
Sierra Nevada Memorial Hospital Fdtn
PO Box 1810	Grass Valley	CA	95945	680005939	Fundraising	CA	501(c)(3)	11;TYPE I	NA
Catholic Healthcare West
185 Berry Street	San Francisco	CA	94107	941196203	Hospital	CA	501(c)(3)	3	NA

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	true	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	true	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	false	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	false	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	false	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	false	PerformOfServicesByOtherOrgs
Sharing Of Facilities	false	SharingOfFacilities
Sharing Of Paid Employees	false	SharingOfPaidEmployees
Reimbursement Paid To Other Org	true	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	false	OtherTransferToOtherOrg
Other Transfer From Other Org	true	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

Field	Value	IRS element (for citing)
Business Name Line1	NA	BusinessNameLine1