2012-05-01T19:07:12-05:00 2011-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2010-07-01 941439787 Sierra Nevada Memorial - Miners Hospital Inc SIER 5302746099 PO Box 1029 155 Glasson Way Grass Valley CA 95945 CAROLYN CANADY 2012-04-30 4159635100 2010 2016-02-24 21:20:13Z Carolyn Canady 155 Glasson Way Grass Valley CA 95945 298740459 false X www.SNMH.Org X 1934 CA TO CONTRIBUTE TO THE WELLNESS OF OUR COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER. 10 7 944 27731 1197514 1138647 123645134 127596279 6329667 9171689 868215 602982 132040530 138509597 1507610 3862062 0 0 78074108 80557536 0 0 0 43352357 45951627 122934075 130371225 9106455 8138372 184366081 213524629 30481264 36297739 153884817 177226890 TO CONTRIBUTE TO THE WELLNESS OF OUR COMMUNITY THROUGH THE PROVISION OF QUALITY SERVICES DELIVERED IN A COMPASSIONATE AND COST-EFFECTIVE MANNER. false false 119185837 3862062 127579287 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. 119185837 true true false true false false false false true true true false false true false false true false false false false false false false false true true true false true true true false false false false false false false false true false false false false false true false false false false true 151 0 true 944 true true true false false false false false false false false false X 10 7 false false false false true true true true true false false false true true true true true false false false CA X LARA HARROWFINANCE DEPARTMENT 9168512104 3400 DATA DRIVE rancho cordova CA 95670 X Gerald Angove 2.0 X 0 0 0 Dr Joseph Britton 2.0 X 0 0 0 Barry Burrows 2.0 X 0 0 0 Tom Cross 2.0 X 0 0 0 Robbert Liddle 2.0 X 0 0 0 Dr Robert Lowe 2.0 X 313 0 0 Karl Silberstein 2.0 X 0 668603 80378 Dr Sarah Woerner 2.0 X 28600 0 0 Don Coots 2.0 X X 0 0 0 Leo Granucci 2.0 X X 0 0 0 Katherine A Medeiros 40.0 X X 0 503521 69531 Caroline Crin Stanford 1.0 X X 0 0 0 Carolyn Canady 40.0 X 215493 0 31081 Mary Gish 40.0 X 224775 0 40114 Sandra L Cummings 40.0 X 197413 0 13418 James E Heard 40.0 X 184484 0 47645 Gregory T Smith 40.0 X 177767 0 37462 Jonathan D Stone 40.0 X 194996 0 38180 Tzvetan I Tzvetanov 40.0 X 261772 0 28185 1485613 1172124 385994 147 false true false 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 25 621147 140089 377411 1138647 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 494782 477790 16992 127596279 3748192 3748192 0 0 12700 1068 12700 1068 13768 13768 165653198 1161 160230785 77 5422413 1084 5423497 5423497 0 0 0 GIFT SHOPS 453220 187735 187735 CAFETERIA/CATERING 722320 198101 10739 187362 FINANCE CHARGES 900099 46176 46176 157202 157202 589214 138509597 127579287 27731 9763932 3858062 3858062 4000 4000 0 0 514377 481605 32772 180686 180686 58350953 54431963 3918990 3893807 3630957 262850 13345902 12444992 900910 4271811 3983444 288367 0 189926 189926 43411 43411 11648 11648 0 536631 536631 14145629 10098470 4047159 103289 5746 97543 3613812 3476735 137077 1407967 1368997 38970 0 1858179 1665844 192335 171461 143289 28172 0 52149 40802 11347 952039 951562 477 0 3651670 3617156 34514 619392 619392 MEDICAL SUPPLIES 11914037 11892558 21479 BAD DEBT 5355706 5355706 LICENSES & TAXES 176239 124507 51732 DUES & SUBSCRIPTIONS 177616 42090 135526 OVERHEAD CORPORATE ALLOCATION 25050 25050 945776 767274 178502 0 130371225 119185837 11185388 0 5626 83004 12022860 11982596 11790045 13350273 612241 191116 1574086 1510539 708940 622701 103417321 67630771 33129990 35786550 97266428 116871317 23181908 26245231 4017695 6844204 56262 37098 184366081 213524629 11912990 15000302 151276 3240359 4000000 4000000 14416998 14057078 30481264 36297739 X 149764682 172295314 2887408 3331832 1232727 1599744 153884817 177226890 184366081 213524629 X 8138372 15203701 X X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 11648 11648 false PART II-B, LINE 1i 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 ========= 2423093 57110 350441 18141 2812503 1178093 1252000 -7000 2423093 1130227 47866 1178093 0.43000 0.57000 0.00000 false true true 1140154 1140154 57896489 34292459 23604030 289591 214259 75332 35796294 30597568 5198726 8294793 2526485 5768308 35786550 POOLED INVESTMENTS 26245231 F 26245231 0 DUE TO RELATED PARTIES 12469144 PENSION PAYABLE 1542934 DUE TO FOUNDATION & ANNUITANT 45000 14057078 Sch D, PART V, LINE 4 The endowment funds are intended to be used to support Alzheimer's research, the Cancer Center, the Cardiac program and other hospital program needs. true true X true X true X 500. true true false true true 5981 1676906 0 1676906 0.01340 21021 16029380 15857537 171843 0.00140 4399 2936402 1338387 1598015 0.01280 31401 20642688 17195924 3446764 0.02760 4935 469242 0 469242 0.00380 62 27044 2000 25044 0.00020 0 7976 0 7976 0.00010 700 1217345 0 1217345 0.00970 5697 1721607 2000 1719607 0.01380 37098 22364295 17197924 5166371 0.04140 2 0 17567 0 17567 0.00010 2 0 17567 0 17567 0.00010 true 1525975 0 38287782 56866381 -18578599 X true true GRASS VALLEY OUTPATI AMBULATORY SURGERY CENTER 0.22800 0.00000 0.31590 1 1 Sierra Nevada Memorial Miner's Hospital

155 Glasson Way Grass Valley CA 95945

X X X Sierra Nevada Memorial Miner's Hospital 1 1 GRASS VALLEY SURGERY CENTER

408 Sierra Colleg Drive GRASS VALLEY CA 95945

OUTPATIENT SURGERY CENTER 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 Assistance 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. 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 990 SCHEDULE H, PART VI CA, true 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 3 0 Part I, line 2 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. true true false false false false false false false 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 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. 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 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 false true true true true 0.01408 0.00850 0.02258 true false true true true true 0.00000 0.00000 0.00000 true false true false false true false true true false false true false Sch K, Part V 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. Burrows Security Force see supplemental info 180686 Payment for Security Services false Sch L, Part IV, column (b) 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. 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 FORM 990 PART VII NAME:Karl Silberstein TITLE:Board Member HOURS:40 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 false true true false false false false false false false false false false false true false false true NA