2012-05-11T15:34:57-05:00 2011-06-30 990 2010-07-01 941437713 SAINT AGNES MEDICAL CENTER SAIN 5594503559 1303 EAST HERNDON AVENUE FRESNO CA 93720 CHRISTINE SARRICO 5594503559 2012-05-11 2010 2016-02-24 21:20:13Z NANCY HOLLINGSWORTH 1303 EAST HERNDON AVENUE FRESNO CA 93720 488737961 0 0928 X WWW.SAMC.COM X 1958 CA HEALTH CARE SERVICES 14 10 3114 981 404043 209370 882841 2078166 424477624 466010640 8409952 14483684 5160715 5018686 438931132 487591176 957577 1274179 0 0 213942968 224482133 5000 0 952029 215941603 255806192 430847148 481562504 8083984 6028672 598002848 614100925 154974461 152483867 443028387 461617058 HEALTH CARE SERVICES 0 0 390216777 1274179 468356218 SAINT AGNES MEDICAL CENTER (THE HOSPITAL), A CALIFORNIA NOT-FOR-PROFIT CORPORATION, OWNS AND OPERATES AN ACUTE-CARE HOSPITAL IN FRESNO, CALIFORNIA. THE HOSPITAL PROVIDES HEALTH SERVICES TO INDIVIDUALS WHO RESIDE PRIMARILY IN THE LOCAL GEOGRAPHIC REGION. THE HOSPITAL IS A MEMBER OF TRINITY HEALTH, AN INDIANA NOT-FOR-PROFIT CORPORATION, SPONSORED BY CATHOLIC HEALTH MINISTRIES, A PUBLIC JURIDIC PERSON OF THE HOLY ROMAN CATHOLIC CHURCH. FOR MORE INFORMATION ABOUT SERVICES PROVIDED,SEE SAINT AGNES MEDICAL CENTER'S WEBSITE AT WWW.SAMC.COM MISSIONTHE MISSION STATEMENT OF THE HOSPITAL IS AS FOLLOWS:WE SERVE TOGETHER IN TRINITY HEALTHIN THE SPIRIT OF THE GOSPELTO HEAL BODY, MIND, AND SPIRITTO IMPROVE THE HEALTH OF OUR COMMUNITIESAND TO STEWARD THE RESOURCES ENTRUSTED TO US. 390216777 1 1 0 1 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 1 1 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 1 413 1 1 3114 1 1 1 0 0 0 0 1 1 0 0 0 0 X 14 10 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 CA X STEPHEN KALOMIRIS CONTROLLER & CAO 5594503559 1111 E SPRUCE AVENUE FRESNO CA 93720 X CRAIG SALADINO 2.00 X X 0 0 0 MICHAEL MARTINEZ 2.00 X X 0 0 0 NANCY HOLLINGSWORTH 50.00 X X 0 360570 78074 JAMES LEONARD 50.00 X X 0 287157 12901 THOMAS ANDERSON 50.00 X X 0 614242 49360 SR MARY CORITA HEID RSM 2.00 X 0 0 0 LEE JAY KOLLIGIAN ESQ 2.00 X 0 0 0 DIANNE NURY 2.00 X 0 0 0 PHILLIP SANCHEZ 2.00 X 0 0 0 WILLIAM OWEN MD 2.00 X 0 0 0 WILLIAM HADCOCK MD 2.00 X 88274 0 0 EARL SMITTCAMP 2.00 X 0 0 0 DEBORAH IKEDA 2.00 X 0 0 0 NEIL KOENIG 2.00 X 0 0 0 SR KATHLEEN MORONEY CSC 2.00 X 0 0 0 YRMA RICO 2.00 X 0 0 0 SR VERONIQUE WIEDOWER CSC 2.00 X 0 0 0 DANIEL HALE ESQ 2.00 X 0 789942 220882 CHRISTINE SARRICO 50.00 X 0 0 0 JARRELL E WILLIAMSON ESQ 50.00 X 96004 62806 23384 JEFF ROONEY TATUM LLC 50.00 X 444000 0 0 MARK BATEMAN 50.00 X 0 0 0 JOSEPH SWEDISH 2.00 X 0 2853932 791453 KEDRICK ADKINS 2.00 X 0 1160870 198248 MICHAEL SLUBOWSKI 2.00 X 0 1153164 271732 J RICHARD O'CONNELL 2.00 X 0 761373 137960 MICHAEL MURPHY 2.00 X 0 539823 68542 DANIEL CAMP 50.00 X 0 306052 44272 STEPHEN SOLDO MD 50.00 X 0 372133 39200 STACY VAILLANCOURT 50.00 X 0 216356 25733 TONI KAZARIAN 50.00 X 223063 0 87147 GERALD MARGOSIAN 50.00 X 285077 0 69425 GREGORY WALAITIS 50.00 X 0 255116 31678 SIMONE HUGHES 50.00 X 241909 0 63807 SABINUS EKEH 50.00 X 219162 0 41457 BARBARA LENAHAN 50.00 X 201345 0 62284 KATHLEEN CAIN 0.00 X 0 281795 9536 Y MARIE PARATTO ESQ 0.00 X 0 224877 99091 PATRICK MARABELLA 0.00 X 0 283764 13598 1798834 10523972 2439764 466 1 1 1 SEALSBIEHLE GENERAL CONTRACTORS PO BOX 7749 VISALIA CA 93290 CONSTRUCTION SERVICES 4321962 STANFORD HOSPITAL AND CLINICS 300 PASTEUR DR FALK BLDG MC STANFORD CA 94305 MEDICAL PROFESSIONAL SERVICES 3307463 DAVITA DIALYSIS GHENT PO BOX 403008 ATLANTA GA 30384 DIALYSIS SERVICES 1790825 ANGELICA CORPORATION DEPT 6777 LOS ANGELES CA 90084 LAUNDRY SERVICES 1440111 ARAMARK CORPORATION 24863 NETWORK PLACE CHICAGO IL 60673 MANAGEMENT SERVICES 1201580 69 432192 40542 1605432 238524 2078166 ACUTE INPATIENT SVCS 900099 331507909 331507909 ACUTE OUTPATIENT SVCS 900099 134502731 134224897 277834 466010640 4951048 4951048 652453 315575 336878 336878 336878 9401609 644835 513808 9401609 131027 9532636 9532636 72477 432192 274579 -202102 -202102 63260 42823 20437 20437 OTHER REVENUE 900099 2749621 2623412 126209 CAFETERIA REVENUE 900099 2113852 2113852 4863473 487591176 468356218 404043 16752749 1199730 1199730 74449 74449 3690884 3690884 712773 245460 467313 170750676 156840327 13443078 467271 14290701 13081421 1170349 38931 22341270 20245790 2035188 60292 12695829 11137550 1523003 35276 940682 940682 3571353 3571353 26871208 16532769 10315324 23115 666913 590 657814 8509 6264009 4622264 1589850 51895 17380829 421978 16945471 13380 6244155 5685770 558385 538033 343262 173639 21132 3994285 3994285 26936936 10121744 16806531 8661 2920158 2920158 MEDICAL SUPPLIES 68653153 68653153 HOSPITAL PROVIDER TAX 44917264 44917264 BAD DEBT 19484767 19484767 EQUIPMENT MAINTENANCE 8517859 7698703 809105 10051 UBI TAXES 59903 59903 17844685 3974819 13656350 213516 481562504 390216777 90393698 952029 94960 631160 421596 189347 2340654 2601918 60006576 64898751 29545 496254 6620988 6019820 2865187 2798665 482733087 268434564 218913479 214298523 190793543 144040830 91193695 153593752 24226371 25028159 598002848 614100925 38722122 38749573 525009 649626 115727330 113084668 154974461 152483867 X 430326721 446469811 3608065 4464689 9093601 10682558 443028387 461617058 598002848 614100925 X 6028672 12559999 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 65696 1 3131 0 0 68827 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: SAINT AGNES MEDICAL CENTER HAS HAD DIRECT CONTACT WITH AND SENT MAILINGS TO LEGISLATORS DURING THE YEAR. THIS CONTACT INCLUDED DISCUSSIONS OF HEALTH CARE AND MEDICARE ISSUES. SAINT AGNES MEDICAL CENTER HAS ALSO MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. SOME OF THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED SAINT AGNES MEDICAL CENTER WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. SAINT AGNES MEDICAL CENTER MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 11889721 30096 2028501 13948318 11022433 19842 902081 54635 11889721 13058503 403895 -2439965 11022433 0.23410 0.76590 0 0 1369459 5093934 6463393 272348163 125665454 146682709 186816610 142769110 44047500 17104921 17104921 214298523 ABSOLUTE RETURN STRATEGY FUNDS 71108219 F COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 19910301 F BOND FUND 62575232 F 153593752 INTERCOMPANY ACCOUNTS PAYABLE 4819211 ASSET RETIREMENT OBLIGATION (FIN 47) 1308351 INTERCOMPANY NOTES PAYABLE 106033458 OTHER DEFERRED LIABILITIES 923648 113084668 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: SAINT AGNES MEDICAL CENTER HAS ENDOWMENT FUNDS (BOARD DESIGNATED AND PERMANENTLY RESTRICTED) WHERE THE GOAL IS TO BUILD THE OVERALL ENDOWMENT FUNDS TO $25 MILLION. UPON REACHING THIS GOAL, INVESTMENT INCOME FROM THE FUNDS WILL BE USED BY SAINT AGNES MEDICAL CENTER TO PURCHASE EQUIPMENT AND TO OFFSET OPERATING EXPENDITURES. AS OF JUNE 30, 2011, THE BOARD DESIGNATED ENDOWMENT FUND WAS $3.3 MILLION AND THE PERMANENTLY RESTRICTED ENDOWMENT FUND WAS $10.2 MILLION. SAINT AGNES MEDICAL CENTER HAS ANOTHER PERMANENTLY RESTRICTED ENDOWMENT FUND WHICH IS USED FOR GRANTING SCHOLARSHIPS TO INDIVIDUALS ENROLLED IN NURSING PROGRAMS. AS OF JUNE 30, 2011, THIS PERMANENTLY RESTRICTED ENDOWMENT FUND WAS $491,000. SUMMER SIZZLE 200012 177612 22400 27521 18733 58516 BMW GOLF 153382 119741 33641 16077 9584 35111 2 151275 134839 16436 15225 13890 18224 61698 504669 432192 72477 31302 41411 46541 155325 274579 -202102 63260 1750 33900 7173 1 0.10000 63260 1750 33900 7173 42823 20437 CA 0 ORGANIZATION IS EXEMPT AND DOES NOT REQUIRE A LICENSE. 0 0 0 1.00000 MARISELA ROMO 1111 E SPRUCE AVENUE FRESNO CA 93720 0 GREGORY WALAITIS 2551 THE GAMING ACTIVITIES AT SAINT AGNES MEDICAL CENTER PRIMARILY RELATE TO RAFFLE TICKET SALES AT FUNDRAISING EVENTS. GREGORY WALAITIS, VP - FOUNDATION, MANAGES THE OVERALL GAMING ACTIVITIES INCLUDING THE RECORDKEEPING, HIRING AND FIRING OF WORKERS, AND MAKING THE BANK DEPOSITS FOR THE GAMING ACTIVITIES. GREGORY WALAITIS' COMPENSATION ALLOCATED TO GAMING ACTIVITIES IS APPROXIMATELY $2,551. X 0 1 1 X 1 X 1 X 1 1 0 1 1 1 5738 6046223 6046223 0.01310 1 64341 116630108 97721000 18909108 0.04090 2 70079 122676331 97721000 24955331 0.05400 9 10307 1186633 9427 1177206 0.00250 3 302 361215 361215 0.00080 12 10609 1547848 9427 1538421 0.00330 14 80688 124224179 97730427 26493752 0.05730 1 40730 513754 513754 0.00110 1 40730 513754 513754 0.00110 0 4733460 0 157345432 168582770 -11237338 X 1 1 1 1 SAINT AGNES MEDICAL CENTER

1303 E HERNDON AVE FRESNO CA 93720

X X X NOT REQUIRED 1 9 SAINT AGNES ADULT DAY HEALTH CENTER

1163 E WARNER AVE FRESNO CA 93720

DAY CARE CENTER FOR SENIORS SAINT AGNES PEACHWOOD LABORATORY

275 W HERNDON AVE CLOVIS CA 93612

LAB SAINT AGNES NORTHWEST LABORATORY

4770 W HERNDON AVE FRESNO CA 93722

LAB SAINT AGNES LAB AT KEISHO PLAZA

568 E HERNDON AVE FRESNO CA 93720

LAB SAINT AGNES OAKHURST LABORATORY

40232 JUNCTION DRIVE OAKHURST CA 93644

LAB SAINT AGNES CENTRAL FRESNO LABORATORY

1300 N FRESNO ST FRESNO CA 93703

LAB SAINT AGNES

1377 E HERNDON AVE FRESNO CA 93720

EMERGENCY DEPT. ADMIN. HOLY CROSS CENTER FOR WOMEN

421 F STREET FRESNO CA 93720

MEDICAL SERVICES FOR THE INDIGENT THE HOLY CROSS CLINIC AT POVERELLO HOUSE

412 F STREET FRESNO CA 93720

MEDICAL/DENTAL FOR THE INDIGENT PART I, LINE 6A: SAINT AGNES MEDICAL CENTER REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH IN ITS ANNUAL REPORT, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, SAINT AGNES MEDICAL CENTER INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, L7 COL(F): THE FOLLOWING NUMBER, $19,484,767, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART II: COMMUNITY BUILDING ACTIVITIES - SAINT AGNES MEDICAL CENTER ENGAGES IN A WIDE RANGE OF COMMUNITY BUILDING ACTIVITIES. A SAMPLING IS INCLUDED HERE. ESTABLISHED IN 1984 BY SAINT AGNES MEDICAL CENTER AND THE SISTERS OF THE HOLY CROSS, SAINT AGNES HOLY CROSS CENTER FOR WOMEN (HCCW) SERVES AS A DAYTIME REFUGE FOR POOR AND HOMELESS WOMEN AND THEIR CHILDREN. AN AVERAGE OF 126 WOMEN AND 21 CHILDREN VISIT THE CENTER EACH DAY FOR A NAP, A WARM MEAL, TO BATHE, WASH THEIR CLOTHES OR SIMPLY WATCH TELEVISION. LOCATED ACROSS THE STREET FROM POVERELLO HOUSE IN DOWNTOWN FRESNO, HOLY CROSS CENTER FOR WOMEN IS EASILY ACCESSIBLE TO THOSE IN NEED. IT PROVIDES WOMEN OF ALL AGES AND THEIR CHILDREN A PEACEFUL RESPITE FROM THE COLD REALITIES OF THE STREETS. THEY CAN ALSO TAKE ADVANTAGE OF COUNSELING, REFERRAL SERVICES, EDUCATIONAL AND SKILLS TRAINING, AND RECREATIONAL ACTIVITIES.THOSE WHO COME TO THE CENTER ARE PREDOMINANTLY YOUNG, MINORITY, IMPOVERISHED WOMEN WITH CHILDREN WHOSE LIVES ARE CHALLENGED BY UNEMPLOYMENT, POVERTY, ADDICTION, RACISM, FEAR, LACK OF EDUCATION, LOW SELF-ESTEEM AND HOMELESSNESS. SOME COME BACK DAY AFTER DAY; OTHERS COME TO FILL A TEMPORARY NEED. ON A MONTHLY BASIS, HCCW PROVIDES:- GENTLY USED CLOTHING TO MORE THAN 543 INDIVIDUALS AND FAMILIES - WARM SHOWERS TO 948 HOMELESS WOMEN - WASHERS AND DRYERS TO ACCOMMODATE 421 LOADS OF LAUNDRY IN ADDITION TO REFUGE AND REST, HCCW PROVIDES WOMEN WITH OPPORTUNITIES TO LEARN NECESSARY SKILLS THAT ENABLE THEM TO BECOME SELF-SUFFICIENT SO THEY MAY EVENTUALLY BREAK THE CYCLE THEY ARE IN. THIS INCLUDES:- ENGLISH AS A SECOND LANGUAGE CLASSES- SELF-ESTEEM AND PARENTING CLASSES- SEWING INSTRUCTION- ARTS AND CRAFTS- PRAYER GROUPS- PSYCHOLOGIST COUNSELINGTHANKS TO THE COMMUNITY VOLUNTEERS WHO DONATE THEIR TIME TO LEAD THESE CLASSES AND ACTIVITIES, AND THE SUPPORTIVE STAFF AT HCCW, MANY CLIENTS HAVE SUCCESSFULLY TURNED THEIR LIVES AROUND AND BECOME PRODUCTIVE, CONTRIBUTING MEMBERS OF THE COMMUNITY.THE POVERELLO HOUSE, LOCATED ACROSS THE STREET FROM HOLY CROSS CENTER FOR WOMEN, PROVIDES FREE MEALS TO HUNDREDS OF HOMELESS INDIVIDUALS AND LOW-INCOME FAMILIES EVERY DAY. BESIDES NEEDING FOOD AND CLOTHING, MANY VISITORS LACK BASIC MEDICAL CARE. TO ADDRESS THIS NEED, THE SISTERS OF THE HOLY CROSS AND SAINT AGNES MEDICAL CENTER ESTABLISHED THE HOLY CROSS CLINIC AT POVERELLO HOUSE IN 1982. SAINT AGNES STAFF AND MEDICAL PROFESSIONAL VOLUNTEERS - INCLUDING SPECIALISTS, DENTISTS, NURSES, AND OTHER PARAMEDICAL PERSONNEL - PROVIDE FREE BASIC MEDICAL AND DENTAL CARE TO OUR VALLEY'S GROWING NUMBERS OF UNINSURED AND UNDERINSURED. LAST YEAR ALONE, HOLY CROSS CLINIC RECEIVED MORE THAN 7,510 VISITS FOR MEDICAL SERVICES AND 802 VISITS FOR DENTAL CARE. THE VALUE OF DONATED SERVICES TOTALED MORE THAN $819,400. HEALTH EDUCATION IS ALSO PROVIDED BY THE CLINIC TO TEACH INDIVIDUALS WHO SUFFER FROM CHRONIC CONDITIONS LIKE DIABETES AND ASTHMA HOW TO MANAGE THEIR DISEASE, PREVENT COMPLICATIONS AND EXPERIENCE A HEALTHIER, MORE PRODUCTIVE LIFESTYLE. FURTHER, THE CLINIC COLLABORATES WITH NUMEROUS COMMUNITY GROUPS AND SERVICE PROVIDERS TO REACH OUT TO THOSE CLIENTS WHO - IN ADDITION TO MEDICAL OR DENTAL SERVICES - MAY NEED HELP FINDING SHELTER OR OTHER SUPPORT SERVICES. PART III, LINE 4: SAINT AGNES MEDICAL CENTER IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM THOSE STATEMENTS: "SUBSTANTIALLY ALL OF THE CORPORATION'S RECEIVABLES ARE RELATED TO PROVIDING HEALTHCARE SERVICES TO PATIENTS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR AMOUNTS THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE. THE CORPORATION'S ESTIMATE FOR ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS BY PAYOR."COSTING METHODOLOGY FOR LINES 2 AND 3: AMOUNTS ARE CALCULATED ON LINE 2 USING A COST TO CHARGE RATIO METHODOLOGY.ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS.BALANCES THAT ARE ELIGIBLE TO BE ADJUSTED OFF UNDER OUR CHARITY/FINANCIAL ASSISTANCE PROGRAM ARE NOT ADVANCED AS A BAD DEBT WRITE-OFF. PART III, LINE 8: SAINT AGNES MEDICAL CENTER DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CHA RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTHCARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: IN ACCORDANCE WITH CA AB774, PATIENTS/ACCOUNTS WHO MEET ELIGIBILITY CRITERIA WILL NOT BE HELD RESPONSIBLE FOR MORE THAN THE HIGHEST GOVERNMENT REIMBURSEMENT RATE. WHEN UNINSURED (SELF PAY) ACCOUNT BALANCES REMAIN UNPAID AFTER 150 DAYS, THEY MAY BE REFERRED TO A CREDIT BUREAU, USUALLY AFTER COLLECTION ATTEMPTS BY A COLLECTION AGENCY, WHOSE BILLING DUNNING NOTICE WILL INCLUDE INFORMATION REGARDING THE PATIENTS' RIGHTS UNDER THE ROSENTHAL FAIR DEBT COLLECTION PRACTICE ACT. ADDITIONALLY, WRITTEN NOTICES TO THE PATIENT WILL ENCOURAGE HIM/HER TO CONSIDER ASSISTANCE FROM A NON-PROFIT CREDIT COUNSELING AGENCY WHICH MAY BE AVAILABLE WITHIN OUR COMMUNITY.IF OTHER AVENUES OF FINANCIAL SUPPORT ARE BEING PURSUED, SAINT AGNES MEDICAL CENTER AND/OR THE APPLICANT SHOULD COMMUNICATE WITH EACH OTHER REGARDING THE PROCESS AND EXPECTED TIMELINE FOR DETERMINATION. SAINT AGNES MEDICAL CENTER WILL DELAY COLLECTION EFFORTS FOR A REASONABLE TIME PERIOD WHILE A DETERMINATION IS BEING MADE. IF A PATIENT IS ATTEMPTING TO QUALIFY FOR ELIGIBILITY UNDER SAINT AGNES MEDICAL CENTER'S CHARITY CARE OR DISCOUNT PAYMENT POLICY AND IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH SAINT AGNES MEDICAL CENTER BY NEGOTIATING A REASONABLE AMOUNT, SAINT AGNES MEDICAL CENTER SHALL NOT ADVANCE THE UNPAID BILL TO A COLLECTION AGENCY. WHEN THE BALANCE ON AN ACCOUNT IS DETERMINED TO BE A PATIENT/GUARANTOR OBLIGATION, SAINT AGNES MEDICAL CENTER WILL BILL THE PATIENT/GUARANTOR AT REGULAR INTERVALS. UNDER THE OVERSIGHT OF THE PATIENT FINANCIAL SERVICES MANAGEMENT TEAM, SELF PAY BALANCES WHICH ARE PAST DUE, (IN EXCESS OF 150 DAYS OF INITIAL BILLING, OR 90 TO 150 DAYS IN EXCESS OF ANY OTHER ACTIVITY DATE PROMPTED BY A FINANCIALLY QUALIFIED PATIENT), MAY BE ADVANCED TO A CREDIT BUREAU (FOLLOWING A MINIMUM OF 150 DAYS FROM INITIAL BILLING). FOR ALL CA AB774 FINANCIALLY QUALIFIED ACCOUNT BALANCES, WHERE THE PATIENT HAS BEEN DETERMINED BY SAINT AGNES MEDICAL CENTER TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE WITH A RESULTING SHARE OF COST FROM THE PATIENT, SAINT AGNES MEDICAL CENTER, OR BILLING VENDOR, WILL ARRANGE, UPON REQUEST OF THE PATIENT, REASONABLE PAYMENT PLANS WHICH WILL REMAIN INTEREST FREE UNTIL THE ACCOUNT BALANCE HAS BEEN PAID IN FULL. THE PATIENT MAY NEGOTIATE THE TERMS OF A REASONABLE PAYMENT PLAN. IN THE EVENT THE PATIENT/GUARANTOR IS DELINQUENT IN PAYING, RENEGOTIATING, OR CONTACTING SAINT AGNES MEDICAL CENTER, OR A BILLING VENDOR, REGARDING HIS/HER OUTSTANDING PAYMENT PLAN BALANCE FOR A MINIMUM PERIOD OF 90 DAYS, ONLY THEN CAN THE CA AB774 SHARE OF COST BALANCE BE REPORTED TO A CREDIT BUREAU, PROVIDED THE MINIMUM PERIOD OF 150 DAYS FROM INITIAL BILLING BY SAINT AGNES MEDICAL CENTER HAS PASSED. UNDERSTANDABLY, THE HOSPITAL DOES FIND IT NECESSARY TO APPLY REASONABLE STANDARDS TO THE LENGTH OF A MONTHLY PAYMENT PLAN. GUIDELINES FOR LEVELS OF AUTHORIZATION AND THE NUMBER OF MONTHS AN AMOUNT CAN BE EXTENDED ARE AS FOLLOWS:- BALANCES UNDER $100 WILL BE PAID WITHIN A MAXIMUM THREE MONTHS- BALANCES OF $100 TO $600 WILL BE PAID WITHIN A MAXIMUM SIX MONTHS- BALANCES OF $600 TO $1,200 WILL BE PAID WITHIN A MAXIMUM TWELVE MONTHS- BALANCES GREATER THAN $1,200 WILL BE PAID WITHIN A MAXIMUM TWENTY-FOUR MONTHS PART VI, LINE 2: NEEDS ASSESSMENT - EVERY THREE YEARS, SAINT AGNES MEDICAL CENTER CONDUCTS A COMMUNITY NEEDS ASSESSMENT TO MEASURE THE HEALTH AND WELL BEING OF THE COMMUNITY AT THAT SPECIFIC POINT IN TIME. THIS ASSESSMENT SERVES AS THE BASIS FOR STRATEGIC AND SUBSEQUENT ACTION PLANNING TO DEVELOP HEALTH POLICY, ALLOCATE RESOURCES, IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS AND COLLABORATE WITH OTHER COMMUNITY HEALTH CARE PROVIDERS. IT ALSO ESTABLISHES A BENCHMARK FOR MEASURING OUR PROGRESS TOWARD ESTABLISHED COMMUNITY HEALTH OBJECTIVES DURING FUTURE ASSESSMENTS.SAINT AGNES MEDICAL CENTER'S COMMUNITY NEEDS ASSESSMENT PROVIDES THE OPPORTUNITY TO:- GAIN INSIGHTS INTO THE NEEDS AND ASSETS OF THE COMMUNITIES SERVED - IDENTIFY AND ADDRESS THE NEEDS OF VULNERABLE POPULATIONS WITHIN THE COMMUNITY- ENHANCE HOSPITAL/COMMUNITY RELATIONSHIPS AND THE OPPORTUNITY FOR COLLABORATIVE COMMUNITY ACTION, INCLUDING INVOLVEMENT WITH COALITIONS, PARTNERSHIPS, BOARDS, COMMITTEES, COMMISSIONS, ADVISORY GROUPS AND PANELS- COLLECT THE INFORMATION REQUIRED FOR COMMUNITY OUTREACH PLANNINGTHE COMMUNITY NEEDS ASSESSMENT PROCESS INVOLVES GATHERING TWO TYPES OF DATA: QUANTITATIVE (DEMOGRAPHICS, HEALTH INDICATORS, ETC.) AND QUALITATIVE (PUBLIC SURVEYS, FORUMS, FOCUS GROUPS). THE DATA HELPS TO SUPPORT SHORT- AND LONG-TERM DECISIONS ABOUT THE ALLOCATION OF COMMUNITY HUMAN AND CAPITAL RESOURCES. IN 2011, SAINT AGNES MEDICAL CENTER, ALONG WITH OTHER COMMUNITY HOSPITALS SERVING A FOUR-COUNTY REGION (FRESNO, MADERA, TULARE AND KINGS), CAME TOGETHER THROUGH THE HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA, TO DEFINE AND PLAN A REGIONAL NEEDS ASSESSMENT PROCESS FOR ALL HOSPITALS TO USE AS THE "CORE" OF THEIR RESPECTIVE COMMUNITY BENEFITS WORK. THE HOSPITAL COUNCIL CONTRACTED WITH THE CENTRAL VALLEY HEALTH POLICY INSTITUTE (CVHPI), CALIFORNIA STATE UNIVERSITY, FRESNO (CSUF) TO CONDUCT AND COMPILE THE REGIONAL NEEDS ASSESSMENT. BOTH QUANTITATIVE AND QUALITATIVE DATA WAS RELIED UPON TO ENSURE THE MOST COMPLETE PICTURE OF COMMUNITY NEEDS, THE TARGET AUDIENCE AS WELL AS THE STRENGTHS, CHALLENGES AND OPPORTUNITIES FACING THE FOUR-COUNTY AREA. DATA FOR THE FOUR-COUNTY AREA WAS ALSO COMPARED TO THE EIGHT COUNTIES OF THE SAN JOAQUIN VALLEY AND TO THE STATE OF CALIFORNIA AS A WHOLE, WHENEVER POSSIBLE. QUANTITATIVEOVER THE LAST SIX YEARS, CVHPI HAS DEVELOPED AND MAINTAINED AN EXTENSIVE DATA WAREHOUSE ON A WIDE RANGE OF HEALTH, SOCIOECONOMIC AND DEMOGRAPHIC INDICATORS. THIS DATA WAREHOUSE SERVED AS THE BASIS FOR THE NEEDS ASSESSMENT, INCLUDING:- ANALYSIS OF BIRTH, DEATH AND HOSPITALIZATION DATA FOR THE SERVICE AREA.- POPULATION-ADJUSTED RATES OF RECEIPT OF APPROPRIATE PRENATAL CARE, LOW BIRTH WEIGHT, AND PRETERM BIRTHS FOR EACH ZIP CODE IN THE SERVICE AREA AND OVERALL.- POPULATION-ADJUSTED RATES FOR HOSPITALIZATIONS FOR SELECTED ACUTE AND CHRONIC CONDITIONS.- A COMPOSITE MEASURE OF PRIMARY CARE-SENSITIVE/AVOIDABLE HOSPITALIZATIONS, PREMATURE DEATHS, AND PREMATURE DEATHS FOR SPECIFIC CONDITIONS ARE DESCRIBED FOR EACH ZIP CODE IN THE SERVICE AREA AND OVERALL.- USING AVAILABLE CALIFORNIA HEALTH INTERVIEW SURVEY (CHIS) DATA, SCHOOL FITNESS TESTING, REPORTABLE HEALTH EVENTS, AND OTHER DATA SOURCES, ESTIMATES OF CHRONIC DISEASE AND HIGH-RISK HEALTH BEHAVIORS FOR THE SERVICE AREA OR THE MOST ACCURATE AVAILABLE GEOGRAPHIC AREAS WITHIN THE SERVICE AREA.- MOST RECENT AVAILABLE ESTIMATES OF DEMOGRAPHIC, EDUCATIONAL ATTAINMENT, AND ECONOMIC OPPORTUNITY INFORMATION FOR THE SERVICE AREA, INCLUDING DATA FROM THE COMMUNITY HEALTH INDICATORS NATIONAL COUNTY HEALTH RANKING. QUALITATIVEFOCUS GROUPS COMPRISING A CROSS-SECTION OF KEY STAKEHOLDERS (E.G., PUBLIC HEALTH, HEALTH CARE PROVIDERS, SCHOOL DISTRICTS, NONPROFIT ORGANIZATIONS, AND FUNDERS) WERE CONDUCTED IN EACH COUNTY. FACILITATED BY CVHPI STAFF, THE FOCUS GROUPS FOLLOWED THE SAME AGENDA AND FORMAT IN EACH COUNTY, COLLECTING INPUT FROM PARTICIPANTS ON FIVE AREAS RELEVANT TO COMMUNITY HEALTH AND WELL-BEING:1. PRIMARY CARE, ACCESS TO CARE, UNINSURED/INDIGENT CARE, IMPLEMENTATION OF FEDERAL HEALTH CARE REFORM2. HOSPITAL/EMERGENCY SERVICES 3. CHRONIC DISEASE MANAGEMENT4. PREVENTION (SERVICES, POLICIES, PHYSICAL ENVIRONMENTS, AIR/WATER QUALITY, PUBLIC SAFETY, MENTAL HEALTH, HOUSING) 5. COMMUNITY INFRASTRUCTURE (TRANSPORTATION, COMMUNITY DEVELOPMENT, ECONOMIC DEVELOPMENT, SCHOOLS AND SOCIAL SERVICES FOR CHILDREN, YOUTH AND FAMILIES, SAFE PLACES TO PLAY, ACCESS TO HEALTHY FOOD)PARTICIPANTS WERE ASKED TO IDENTIFY BOTH THE CONDITIONS AND OPPORTUNITIES IN EACH COUNTY THAT SUPPORT COMMUNITY HEALTH AND WELL-BEING AND POLICIES NEEDED TO SUSTAIN THESE EFFORTS, AS WELL AS THOSE CONDITIONS AND OPPORTUNITIES THAT INHIBIT COMMUNITY HEALTH AND WELL-BEING AND POLICY CHANGES REQUIRED TO MITIGATE THESE. FINALLY, PARTICIPANTS WERE ASKED TO RANK THEIR PRIORITIES FOR ACTION. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - SAINT AGNES MEDICAL CENTER IS COMMITTED TO:- PROVIDING ACCESS TO QUALITY HEALTH CARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR ALL THOSE WE SERVE, PARTICULARLY OUR COMMUNITY'S POOR AND UNDERSERVED; - CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY; - ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE SERVICES/CARE PROVIDED;- BALANCING NEEDED PATIENT FINANCIAL ASSISTANCE WITH THE ORGANIZATION'S BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE. IN ACCORDANCE WITH AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, SAINT AGNES MEDICAL CENTER HAS ADOPTED THESE PRINCIPLES FOR HANDLING PATIENT BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS: - PROACTIVELY COMMUNICATE WITH PATIENTS REGARDING THEIR HOSPITAL BILLS;- MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS;- OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS;- IMPLEMENT CONSISTENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS; - IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PAYMENT OBLIGATIONS.SAINT AGNES MEDICAL CENTER PROACTIVELY COMMUNICATES WITH PATIENTS REGARDING THEIR PAYMENT OBLIGATIONS AND OFFERS FINANCIAL COUNSELING TO HELP PATIENTS UNDERSTAND THEIR HOSPITAL BILLS AND FINANCIAL OBLIGATIONS, AS WELL AS ADDRESS ANY FINANCIAL QUESTIONS OR CONCERNS THEY MAY HAVE. DURING THE PRE-REGISTRATION AND ADMITTING PROCESS, AND/OR THROUGH COMMUNICATION WITH PATIENTS SEEKING FINANCIAL ASSISTANCE, SAINT AGNES MEDICAL CENTER PROVIDES PATIENTS WITH INFORMATION ABOUT HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SPECIFIC SERVICES.THE SAINT AGNES MEDICAL CENTER REGISTRARS GIVE FINANCIAL ASSISTANCE APPLICATIONS TO EVERY PATIENT WHO EXPRESSES A FINANCIAL CONCERN AND THEN REFER THE PATIENT TO A HOSPITAL FINANCIAL COUNSELOR FOR FURTHER ASSISTANCE. THE HOSPITAL ALSO CONTRACTS WITH AN ELIGIBILITY VENDOR WHO ASSISTS PATIENTS WITH THEIR MEDICAID APPLICATIONS AND ELIGIBILITY. THE VENDOR HELPS PATIENTS GATHER THE APPROPRIATE DOCUMENTS REQUIRED TO APPLY FOR MEDI-CAL OR MEDICARE DISABILITY; TRANSLATES AS NEEDED; AND PROVIDES TRANSPORTATION TO THE LOCAL WELFARE OFFICE, IF REQUIRED.FINANCIAL COUNSELORS HELP PATIENTS OBTAIN AND PAY FOR NEEDED HEALTH CARE SERVICES BY IDENTIFYING AND HELPING THEM APPLY FOR THOSE PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY. SAINT AGNES MEDICAL CENTER ALSO ASSISTS PATIENTS BY PAYING THEIR COBRA BENEFITS SO THAT THE PATIENT WILL HAVE HEALTH CARE COVERAGE WHILE OBTAINING SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE.SAINT AGNES MEDICAL CENTER ALSO OFFERS FINANCIAL ASSISTANCE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE, BUT WHO HAVE LIMITED MEANS. DETAILS AND CONTACT INFORMATION FOR OBTAINING FINANCIAL ASSISTANCE IS MADE AVAILABLE AT ALL REGISTRATION SITES ON AND OFF CAMPUS. THIS INCLUDES A COMPREHENSIVE FINANCIAL ASSISTANCE PROGRAM BROCHURE GIVEN TO PATIENTS. INFORMATION ABOUT THE FINANCIAL ASSISTANCE PROGRAM IS ALSO NOTED IN THE CONDITIONS OF ADMISSION AND ON THE PATIENT BILL. IT IS ALSO MADE AVAILABLE IN THE SAINT AGNES MEDICAL CENTER PATIENT FINANCIAL SERVICES OFFICE. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO THE PUBLIC, PHYSICIANS, FRESNO METRO MINISTRIES, HOLY CROSS CENTER FOR WOMEN AND HOLY CROSS CLINIC AT POVERELLO HOUSE. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE AS PART OF THE ADMISSION PACKET, ON THE PUBLIC SAINT AGNES MEDICAL CENTER WEB SITE, AND AT EACH REGISTRATION AREA. IN ADDITION TO ENGLISH, THIS INFORMATION IS AVAILABLE IN SPANISH AND HMONG.SAINT AGNES MEDICAL CENTER HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND FINANCIAL SUPPORT OF PATIENTS AND PATIENT PAYMENT OBLIGATIONS. THE MEDICAL CENTER MAKES EVERY EFFORT TO ADHERE TO THE POLICY AS PART OF ITS COMMITMENT TO ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. TO ENSURE THAT ALL PATIENTS ARE TREATED WITH DIGNITY AND RESPECT, REGARDLESS OF THEIR INSURANCE STATUS OR ABILITY TO PAY FOR SERVICES, SAINT AGNES MEDICAL CENTER EDUCATES ITS EMPLOYEES - PARTICULARLY THOSE WORKING IN FINANCIAL ASSISTANCE, REGISTRATION, AND BILLING AND COLLECTION - ABOUT ITS FINANCIAL POLICY. SAINT AGNES MEDICAL CENTER ALSO INCLUDES THE VENDOR AND COLLECTION AGENCIES IN THIS EDUCATION. PART VI, LINE 4: COMMUNITY INFORMATION - SAINT AGNES MEDICAL CENTER'S PRIMARY SERVICE AREA INCLUDES THE MAJORITY OF FRESNO AND PORTIONS OF MADERA COUNTIES. THE REMAINDER OF FRESNO AND MADERA COUNTIES COMPRISES THE SECONDARY SERVICE AREA. COMBINED, SAINT AGNES MEDICAL CENTER'S SERVICE AREA ENCOMPASSES A POPULATION IN EXCESS OF 1 MILLION.DESPITE A NATIONAL ECONOMIC DOWNTURN, THE SAN JOAQUIN VALLEY AND THE STATE OF CALIFORNIA CONTINUE TO EXPERIENCE POPULATION GROWTH. ACCORDING TO THE U.S. CENSUS BUREAU, THE POPULATION OF FRESNO COUNTY ROSE BY 16.4% BETWEEN 2000 AND 2010, WHILE THE STATE OF CALIFORNIA'S POPULATION ROSE BY 10% DURING THE SAME TIME PERIOD. IN 2010, THE POPULATION FOR FRESNO COUNTY WAS ESTIMATED AT 930,450. A GROWING POPULATION REQUIRES INCREASED INFRASTRUCTURE. HOWEVER, THE COMBINED 2010-2011 & 2011-2012 DEFICITS CREATED A $25.4 BILLION BUDGET GAP FOR CALIFORNIA WHICH HAS SLOWED INFRASTRUCTURE DEVELOPMENT AND HAS ACTUALLY DECREASED THE SERVICES THAT RESPOND TO THE NEEDS OF CALIFORNIANS. IT HAS AFFECTED THE POOR AND UNDERSERVED IN PARTICULAR, ESPECIALLY THOSE IN NEED OF MENTAL HEALTH SERVICES.FRESNO COUNTY IS AN AREA OF IMMENSE NEED, WITH FEWER HEALTH RESOURCES THAN THE REST OF THE STATE. IT IS A REGION OF GREAT DIVERSITY, WITH BOTH URBAN AND RURAL POPULATIONS, MANY IMMIGRANTS WITH LIMITED ENGLISH PROFICIENCY, AND A LOW INCOME POPULATION THAT IS HIGHER THAN THE STATE AVERAGE. ALTHOUGH FRESNO COUNTY'S $5.3 BILLION AGRICULTURAL INDUSTRY IS THE LARGEST IN THE UNITED STATES, THE COUNTY IS SUSCEPTIBLE TO THE VAGARIES OF ADVERSE WEATHER, WORKER SHORTAGES AND INTERNATIONAL COMPETITION. OF 58 COUNTIES IN CALIFORNIA, FRESNO HAS ONE OF THE HIGHEST RATES FOR TEEN PREGNANCY, LOW BIRTH-WEIGHT, INFANT DEATHS, ASTHMA, AND DEATHS DUE TO DIABETES. SOME OF THE CAUSES OF POOR HEALTH IN FRESNO COUNTY INCLUDE HIGH POVERTY, LACK OF HEALTH INSURANCE, POPULATION DIVERSITY, AND LACK OF MEDICAL INFRASTRUCTURE.ETHNIC, CULTURAL AND LINGUISTIC DIVERSITY CONTINUES TO INCREASE IN THE SAN JOAQUIN VALLEY, WHICH HAS A SIGNIFICANT POPULATION OF IMMIGRANTS AND REFUGEES, MANY OF WHOM ARE AGRICULTURAL WORKERS. THE 2010 U.S. CENSUS ESTIMATED THAT FRESNO COUNTY'S TOTAL POPULATION IS 50.3% HISPANIC OR LATINO, 32.7% WHITE, 9.8% ASIAN AND PACIFIC ISLANDER, 5.3% AFRICAN-AMERICAN AND 1.7% NATIVE AMERICAN. THE ASIAN AND PACIFIC ISLANDER GROUP ALONE COMPRISES 11 DIFFERENT ETHNIC POPULATIONS. FORTY-TWO PERCENT OF THE POPULATION SPEAKS A LANGUAGE OTHER THAN ENGLISH IN THEIR HOMES. FRESNO COUNTY RANKS FIRST IN POVERTY OF 58 COUNTIES IN CALIFORNIA, WITH AN UNEMPLOYMENT RATE OF 15.7%, AS OF NOVEMBER 2011.AGRICULTURAL WORKERS SUFFER FROM HIGHER RATES OF HIGH SERUM CHOLESTEROL, HIGH BLOOD PRESSURE AND OBESITY THAN THE GENERAL POPULATION. MANY MEN AND WOMEN WHO ARE HARVESTING CROPS DO NOT SPEAK ENGLISH, AND HAVE NO HEALTH INSURANCE. FOR AGRICULTURE TO SURVIVE IN CALIFORNIA, A STABLE AND HEALTHY WORK FORCE IS CRUCIAL. TO THAT END, A COALITION HAS BEEN ESTABLISHED TO WORK WITH THE CALIFORNIA LEGISLATURE IN FINDING COMPREHENSIVE SOLUTIONS FOR FARM WORKER HEALTH COVERAGE.ACCORDING TO THE AMERICAN LUNG ASSOCIATION, FRESNO-MADERA RANKS NO. 3 ON THE LIST OF THE TOP TEN MOST POLLUTED CITIES IN THE UNITED STATES. ASTHMA, CHRONIC BRONCHITIS, EMPHYSEMA AND CARDIOVASCULAR DISEASE HAVE A SIGNIFICANT IMPACT ON THE HEALTH OF THE PEOPLE OF FRESNO. PART VI, LINE 6: OTHER INFORMATION - SAINT AGNES MEDICAL CENTER'S CONTINUING MEDICAL EDUCATION (CME) PROGRAM STRIVES TO IMPROVE PATIENT CARE BY PROVIDING HIGH QUALITY EDUCATIONAL ACTIVITIES THAT ENHANCE PHYSICIAN KNOWLEDGE AND SKILLS AND PROMOTE LIFELONG LEARNING. PHYSICIANS WHO ATTEND SAINT AGNES MEDICAL CENTER'S CME ACTIVITIES EARN CREDITS TO SUPPORT THEIR STATE LICENSES AND BOARD CERTIFICATIONS.THE CLINICAL RESEARCH CENTER CONDUCTS PHARMACEUTICAL AND DEVICE STUDIES IN A WIDE RANGE OF THERAPEUTIC AREAS. CLINICAL TRIALS OF INVESTIGATIONAL DRUGS AND DEVICES, WHICH ARE SUPPORTED BY THE INDUSTRY, PROVIDE PATIENTS ACCESS TO INVESTIGATIONAL TREATMENTS AND SERVICES USUALLY AT NO ADDITIONAL COST. CLINICAL RESEARCH IS ALSO RESPONSIBLE FOR THE ADMINISTRATION OF THE INSTITUTIONAL REVIEW BOARD (IRB), WHICH ENSURES THAT THE RIGHTS AND WELFARE OF ALL HUMAN SUBJECTS INVOLVED IN CLINICAL RESEARCH ARE PROTECTED. IN FY 2011, THE IRB REVIEWED AND APPROVED SEVERAL STUDIES AND CONTINUED ITS ACTIVE REVIEW OF MANY OTHERS ALREADY UNDERWAY. APPROXIMATELY 900 VOLUNTEERS GENEROUSLY PROVIDE CARE AND SERVICE TO SAINT AGNES MEDICAL CENTER'S PATIENTS, STAFF, PHYSICIANS AND GUESTS. IN ADDITION TO SUPPORTING VARIOUS DEPARTMENTS AND PROGRAMS WITHIN THE HOSPITAL, MANY OF THESE INDIVIDUALS REPRESENT SAINT AGNES MEDICAL CENTER WITHIN THE COMMUNITY, VOLUNTEERING THEIR TIME TO SUCH COMMUNITY PROJECTS AS READING TO THE BLIND, MENTORING ELEMENTARY SCHOOL CHILDREN, COORDINATING BLOOD DRIVES, SUPPORTING THE COMMUNITY FOOD BANK, AND SUPPORTING THE AMERICAN CANCER SOCIETY, HABITAT FOR HUMANITY, SPCA AND THE "BABY TRACKING" INFANT IMMUNIZATION PROGRAM. PART VI, LINE 7: SAINT AGNES MEDICAL CENTER IS A MEMBER ORGANIZATION OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE SYSTEMS IN THE COUNTRY. BASED IN NOVI, MICHIGAN, TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEVELOP, AND ARE HELD ACCOUNTABLE FOR ACHIEVING COMMUNITY BENEFIT GOALS THAT INCLUDE DEVELOPING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS AIMED AT SERVING THE POOR AND UNINSURED, MANAGING CHRONIC CONDITIONS LIKE DIABETES, INITIATING HEALTH EDUCATION AND PROMOTION, AND REACHING OUT TO THE ELDERLY. IN FISCAL YEAR 2011, TRINITY HEALTH INVESTED NEARLY $453 MILLION IN SUCH COMMUNITY BENEFITS AND CHARITY CARE. THEREFORE, TRINITY HEALTH TAKES A SYSTEMS APPROACH IN ITS COMMUNITY BENEFIT PLANNING AND IMPLEMENTATION, AND IS CONSEQUENTLY ABLE TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ARE HELPING TO PROMOTE AND ADDRESS THE HEALTH NEEDS OF THEIR RESPECTIVE COMMUNITIES. FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. 1 AMERICAN HEART ASSOCIATION (WESTERN STATES AFFILIATE) 7425 N PALM BLUFF AVE STE 101 FRESNO CA 93711 135613797 501(C)(3) 11250 SPONSORSHIP CATHOLIC CHARITIES OF THE DIOCESE OF FRESNO 149 N FULTON ST FRESNO CA 93701 941678938 501(C)(3) 16600 SPONSORSHIP CENTRAL CALIFORNIA WOMEN'S CONFERENCE C/O 1991 NORTH GATEWAY FRESNO CA 93727 770178140 501(C)(3) 15000 SPONSORSHIP FRESNO CITY AND COUNTY HISTORICAL SOCIETY 7160 W KEARNEY BLVD FRESNO CA 93706 941531568 501(C)(3) 5000 SPONSORSHIP MARCH OF DIMES 1530 E SHAW STE 102 FRESNO CA 93710 941322184 501(C)(3) 12500 SPONSORSHIP UNITED WAY OF FRESNO COUNTY 4949 EAST KINGS CANYON RD FRESNO CA 93727 941156514 501(C)(3) 23333 SPONSORSHIP MEDICAL MINISTRIES INTERNATIONAL 680 N TROUT LAKE DRIVE TIVY VALLEY CA 93657 770498274 501(C)(3) 838516 NBV MEDICAL SUPPLIES AND EQUIPMENT MEDICAL SERVICES FOR THE IMPOVERISHED 7 0 TRANSPORTATION SERVICES 43 8837 COST MEDICAL TRANSPORT/PUBLIC TRANSPORTATION TEMPORARY HOUSING & IN-HOME ASSISTANCE 93 12234 COST TEMPORARY HOUSING & IN-HOME ASSISTANCE PHARMACEUTICALS 68 17912 COST PHARMACEUTICALS FUNERAL EXPENSES 7 2892 COST FUNERAL EXPENSES MEDICAL EQUIPMENT & SUPPLIES 21 13561 COST MEDICAL EQUIPMENT & SUPPLIES HEALTH INSURANCE/COBRA 12 12006 COST HEALTH INSURANCE/COBRA EDUCATION AND MISCELLANEOUS 105 5658 COST EDUCATION, CHRISTMAS GIFTS FOR HOMELESS CHILDREN, AND BOOKS FOOD AND CLOTHING 3 1349 COST FOOD AND CLOTHING PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DONATIONS MADE BY SAINT AGNES MEDICAL CENTER TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE AND ARE CONSIDERED UNRESTRICTED WITH REGARD TO THE USE OF THE FUNDS. X X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 NANCY HOLLINGSWORTH 0 275061 0 67956 0 17553 0 60002 0 18072 0 438644 0 0 JAMES LEONARD 0 187042 0 50000 0 50115 0 8332 0 4569 0 300058 0 0 THOMAS ANDERSON 0 406466 0 149099 0 58677 0 32445 0 16915 0 663602 0 0 DANIEL HALE ESQ 0 451341 0 207437 0 131164 0 201869 0 19013 0 1010824 0 52144 JARRELL E WILLIAMSON ESQ 95377 62700 0 0 627 106 5708 0 12433 5243 114145 68049 0 0 JEFF ROONEY TATUM LLC 444000 0 0 0 0 0 0 0 0 0 444000 0 0 0 JOSEPH SWEDISH 0 1240774 0 645161 0 967997 0 763945 0 27508 0 3645385 0 690161 KEDRICK ADKINS 0 717356 0 326029 0 117485 0 184461 0 13787 0 1359118 0 0 MICHAEL SLUBOWSKI 0 701008 0 291561 0 160595 0 246925 0 24807 0 1424896 0 42832 J RICHARD O'CONNELL 0 533392 0 113794 0 114187 0 116680 0 21280 0 899333 0 0 MICHAEL MURPHY 0 343184 0 68618 0 128021 0 47238 0 21304 0 608365 0 0 DANIEL CAMP 0 240482 0 58429 0 7141 0 34117 0 10155 0 350324 0 0 STEPHEN SOLDO MD 0 368812 0 0 0 3321 0 23817 0 15383 0 411333 0 0 STACY VAILLANCOURT 0 173337 0 42473 0 546 0 14612 0 11121 0 242089 0 0 TONI KAZARIAN 197613 0 0 0 25450 0 79791 0 7356 0 310210 0 0 0 GERALD MARGOSIAN 265031 0 0 0 20046 0 46238 0 23187 0 354502 0 0 0 GREGORY WALAITIS 0 204212 0 50242 0 662 0 14936 0 16742 0 286794 0 0 SIMONE HUGHES 229474 0 0 0 12435 0 42776 0 21031 0 305716 0 0 0 SABINUS EKEH 218269 0 0 0 893 0 20951 0 20506 0 260619 0 0 0 BARBARA LENAHAN 193985 0 0 0 7360 0 48373 0 13911 0 263629 0 0 0 KATHLEEN CAIN 0 0 0 0 0 281795 0 0 0 9536 0 291331 0 0 Y MARIE PARATTO ESQ 0 85002 0 0 0 139875 0 88763 0 10328 0 323968 0 0 PATRICK MARABELLA 0 0 0 0 0 283764 0 0 0 13598 0 297362 0 274827 PART I, LINE 1A DURING CALENDAR 2010, SAINT AGNES MEDICAL CENTER PAID THE FOLLOWING AMOUNT FOR TEMPORARY HOUSING. THIS AMOUNT WAS INCLUDED AS TAXABLE INCOME IN MR. ANDERSON'S FORM W-2 AND IS INCLUDED IN COLUMN B(III): THOMAS ANDERSON - $14,752 PART I, LINE 1A: DURING CALENDAR 2010, SAINT AGNES MEDICAL CENTER PAID THE FOLLOWING COUNTRY CLUB DUES: THOMAS ANDERSON - $3,609 JAMES LEONARD - $1,354 GREGORY WALAITIS - $5,406 NONE OF THE CLUB DUES WERE INCLUDED IN TAXABLE INCOME AS THE COUNTRY CLUBS WERE USED BY THESE INDIVIDUALS FOR BUSINESS PURPOSES ONLY. PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2010. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III): KATHLEEN CAIN - $280,147 PATRICK MARABELLA - $284,356 Y. MARIE PARATTO - $125,121 IN ADDITION, COLUMN (C) OF SCHEDULE J, PART II INCLUDES $88,763 OF SEVERANCE FOR Y. MARIE PARATTO WHICH WAS UNPAID AS OF 12/31/10. THE $88,763 WAS PAID AND INCLUDED IN Y. MARIE PARATTO'S TAXABLE INCOME IN 2011. PART I, LINE 4B: THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH PENSION RESTORATION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($245,000 FOR 2010). THE FOLLOWING ACCRUALS FOR 2010 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $113,498 DANIEL HALE - $155,414 MICHAEL MURPHY - $26,316 J. RICHARD O'CONNELL - $83,058 MICHAEL SLUBOWSKI - $136,445 JOSEPH SWEDISH - $223,342 PART I, LINE 4B: THE FOLLOWING ARE PARTICIPANTS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING SERP ACCRUALS FOR 2010 ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $49,977 MICHAEL SLUBOWSKI - $77,185 JOSEPH SWEDISH - $511,613 SUPPLEMENTAL INFORMATION PART III PART II: JEFF ROONEY - THE AMOUNT LISTED IN COLUMN B(I) OF SCHEDULE J, PART II REPRESENTS THE AMOUNT PAID BY SAINT AGNES MEDICAL CENTER IN CALENDAR 2010 TO TATUM, LLC FOR MR. ROONEY'S SERVICES AS INTERIM CFO. SAINT AGNES MEDICAL CENTER DOES NOT KNOW HOW MUCH MR. ROONEY RECEIVED AS WAGES FROM TATUM, LLC IN CALENDAR 2010. BRITTANY HOLLINGSWORTH FAMILY MEMBER OF NANCY HOLLINGSWORTH, OFFICER 31825 EMPLOYMENT ARRANGEMENT 0 KAULANA L CORPUZ FAMILY MEMBER OF KATHLEEN CAIN, FORMER OFFICER 49755 EMPLOYMENT ARRANGEMENT 0 ALEXANDER SANCHEZ FAMILY MEMBER OF PHILLIP SANCHEZ, TRUSTEE 132829 EMPLOYMENT ARRANGEMENT 0 AMANDA CORPUZ FAMILY MEMBER OF KATHLEEN CAIN, FORMER OFFICER 27624 EMPLOYMENT ARRANGEMENT 0 X 11 4300 DONOR VALUED X 8604 DONOR VALUED X 1 1064 SHARE PRICE AT GIFT DATE X AUCTION ITEMS 452 224106 DONOR VALUED X EQUIPMENT 1 450 DONOR VALUED 0 0 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): SAINT AGNES MEDICAL CENTER RECEIVES GIFT-IN-KIND DONATIONS IN SUPPORT OF FUNDRAISING EVENTS. THESE DONATIONS ARE PRIMARILY AUCTION ITEMS, AND THE REVENUE FOR THESE ITEMS IS NOT RECORDED UNLESS THE ITEMS ARE SOLD DURING THE AUCTION. ITEMS THAT DO NOT SELL AT THE AUCTION ARE RETURNED TO THE DONOR. DONATED SUPPLIES ARE ALSO RECEIVED FOR THE FUNDRAISING EVENTS AND ARE RECORDED AT FAIR MARKET VALUE. FORM 990, PART VI, SECTION A, LINE 2 MS. DIANNE NURY - SAMC TRUSTEE, AND MR. CRAIG SALADINO - SAMC OFFICER, HAVE A BUSINESS RELATIONSHIP. MR. NEIL KOENIG - SAMC TRUSTEE, AND MR. CRAIG SALADINO - SAMC OFFICER, HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 SAINT AGNES MEDICAL CENTER CONTRACTED WITH THE FOLLOWING COMPANIES FOR THE PROVISION OF INTERIM EXECUTIVE SERVICES: -TATUM, LLC, FOR INTERIM CFO SERVICES UNTIL 3/11 -B.E. SMITH, INC., FOR INTERIM COO SERVICES, AS OF 3/11 -INTERIM HEALTH INNOVATIONS, LLC, FOR INTERIM CNO SERVICES, AS OF 5/11 SEE SCHEDULE J, PART III FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF SAINT AGNES MEDICAL CENTER IS TRINITY HEALTH CORPORATION. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A TRINITY HEALTH CORPORATION IS THE SOLE MEMBER OF SAINT AGNES MEDICAL CENTER. TRINITY HEALTH CORPORATION HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF TRUSTEES OF SAINT AGNES MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, TRINITY HEALTH CORPORATION MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. TRINITY HEALTH CORPORATION MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, A MATERIAL CHANGE IN MISSION, AND MODIFICATIONS TO GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING, THE FORM 990 FOR SAINT AGNES MEDICAL CENTER IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE BOARD OF TRUSTEES. THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C SAINT AGNES MEDICAL CENTER HAS ADOPTED A CONFLICT OF INTEREST POLICY WHICH CONTAINS THE ELEMENTS IN THE MODEL CONFLICT OF INTEREST POLICY ISSUED BY THE IRS. IT APPLIES TO ALL "INTERESTED PERSONS" OF SAINT AGNES MEDICAL CENTER, WHICH INCLUDES TRUSTEES, PRINCIPAL OFFICERS AND EXECUTIVES, AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. INTERESTED PERSONS ARE REQUIRED TO ACT AT ALL TIMES IN A MANNER CONSISTENT WITH SAINT AGNES MEDICAL CENTER'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO SAINT AGNES MEDICAL CENTER OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE BOARD OF TRUSTEES OF SAINT AGNES MEDICAL CENTER IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO SAINT AGNES MEDICAL CENTER. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE REVIEWED WITH THE BOARD OF TRUSTEES OF SAINT AGNES MEDICAL CENTER ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF SAINT AGNES MEDICAL CENTER ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 SAINT AGNES MEDICAL CENTER IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE ANNUAL REPORT (WHICH INCLUDES COMMUNITY BENEFIT MINISTRY INFORMATION) AND CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, SAINT AGNES MEDICAL CENTER INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. ESTIMATE OF THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, LINE 1, COLUMN B: THE HOURS LISTED IN COLUMN B OF PART VII, SECTION A, LINE 1 REFLECT ONLY THE INDIVIDUALS' AVERAGE WEEKLY HOURS SPENT DIRECTLY ON THE ACTIVITIES OF THE REPORTING ORGANIZATION. IN ADDITION, THESE ARE THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: KEDRICK ADKINS - 53 HOURS DANIEL HALE - 53 HOURS MICHAEL MURPHY - 53 HOURS J. RICHARD O'CONNELL - 53 HOURS MICHAEL SLUBOWSKI - 53 HOURS JOSEPH SWEDISH - 53 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 21,773,717. EQUITY TRANSFERS TO AFFILIATES: -8,981,046. EQUITY LOSS IN UNCONSOLIDATED AFFILIATES: -232,672. TOTAL TO FORM 990, PART XI, LINE 5: 12,559,999. FORM 990, PART XII, LINE 2: SAINT AGNES MEDICAL CENTER'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY11 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTHCARE SERVICES MI 501(C)(3) 9 TRINITY HEALTH-MICHIGAN 0 AMICARE HOSPICE SERVICES INC 27870 CABOT DRIVE NOVI MI 483772920 382949053 PROVIDE HOSPICE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC 0 AUXILIARY OF HOLY ROSARY HOSPITAL 351 SW 9TH STREET ONTARIO OR 97914 943059469 SUPPORTS SERVICES OF RELATED HOSPITAL OR 501(C)(3) 9 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 0 BATTLE CREEK HEALTH SYSTEM 300 NORTH AVENUE BATTLE CREEK MI 49016 382776791 HEALTHCARE SERVICES MI 501(C)(3) 3 TRINITY HEALTH - MICHIGAN 0 BATTLE CREEK HEALTH SYSTEM AUXILIARY 300 NORTH AVENUE BATTLE CREEK MI 49016 383355520 SUPPORT OF TAX EXEMPT HEALTH ORGANIZATION MI 501(C)(3) 11, TYPE I BATTLE CREEK HEALTH SYSTEM 0 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 ACUTE/AMBULATORY HEALTHCARE SERVICES IA 501(C)(3) 3 MERCY HEALTH SERVICES-IOWA CORP 0 BAUM HARMON MERCY HOSPITAL & CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I BAUM HARMON MERCY HOSPITAL 0 CAPITAL PARK FAMILY HEALTH CENTER INC 6150 EAST BROAD STREET COLUMBUS OH 43213 311387838 OPERATION OF A FEDERALLY QUALIFIED HEALTH CENTER (FORMERLY) OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM 0 CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR MI 48106 382507173 FURTHER TRINITY HEALTH ACTIVITIES, ORGANIZE AND DEVELOP MEDICAL SERVICES MI 501(C)(3) 11, TYPE II TRINITY HEALTH-MICHIGAN 0 COMMUNITY HEALTH PARTNERS OF SOUTH BEND PO BOX 3998 SOUTH BEND IN 46619 263051440 HEALTHCARE SERVICES IN 501(C)(3) 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC 0 CRANBROOK HOSPICE CARE 281 ENTERPRISE COURT BLOOMFIELD HILLS MI 48302 383320699 PROVIDE HOSPICE HEALTH SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC 0 DILEY RIDGE MEDICAL CENTER 6150 EAST BROAD STREET COLUMBUS OH 43213 342032340 HOSPITAL CAMPUS IN FAIRFIELD COUNTY OHIO OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM 0 DUBUQUE MERCY HEALTH FOUNDATION INC 250 MERCY DRIVE DUBUQUE IA 52001 262227941 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I MERCY HEALTH SERVICES-IOWA CORP 0 DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE IA 52040 205383271 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I MERCY HEALTH SERVICES-IOWA CORP 0 HACKLEY HOSPITAL 1700 CLINTON ST PO BOX 3302 MUSKEGON MI 494433302 381358196 HEALTHCARE SERVICES MI 501(C)(3) 3 MERCY HEALTH PARTNERS 0 HACKLEY HOSPITAL SELF INSURANCE PROFESSIONAL LIABILITY TRUST PO BOX 3302 MUSKEGON MI 494433302 382299878 SELF INSURANCE FOR GENERAL AND MALPRACTICE LIABILITY MI 501(C)(3) 11, TYPE III-FI MERCY HEALTH PARTNERS 0 HACKLEY LIFE COUNSELING 1352 TERRACE ST MUSKEGON MI 494423545 381386362 COUNSELING, EDUCATION, AND SUPPORT MI 501(C)(3) 9 MERCY HEALTH PARTNERS 0 HACKLEY VISITING NURSE SERVICES AND HOSPICE INC 888 TERRACE ST MUSKEGON MI 49440 381359598 PROVIDE HOME HEALTH CARE SERVICES MI 501(C)(3) 7 MERCY HEALTH PARTNERS 0 HOLY CROSS CARENET INC PO BOX 9184 FARMINGTON HILLS MI 48333 521945054 LONG-TERM CARE AND REHABILITATION FOR THE ELDERLY MD 501(C)(3) 9 TRINITY CONTINUING CARE SERVICES 0 HOLY CROSS HOSPITAL FOUNDATION INC 11801 TECH ROAD SILVER SPRING MD 20904 208428450 CHARITABLE FUNDRAISING MD 501(C)(3) 11, TYPE I HOLY CROSS HOSPITAL OF SILVER SPRING INC 0 HOLY CROSS HOSPITAL OF SILVER SPRING INC 1500 FOREST GLEN RD SILVER SPRING MD 209101484 520738041 HEALTHCARE SERVICES MD 501(C)(3) 3 TRINITY HEALTH CORPORATION 0 HOLY CROSS MEDICAL CENTER 27870 CABOT DRIVE NOVI MI 483772920 951985442 HEALTHCARE SERVICES (FORMERLY) CA 501(C)(3) 3 TRINITY HEALTH CORPORATION 0 HOLY ROSARY MEDICAL CENTER FOUNDATION 351 SW 9TH STREET ONTARIO OR 97914 202683560 SUPPORT THE SERVICES OF RELATED HOSPITAL OR 501(C)(3) 11, TYPE I SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 0 HOSPICE OF NORTH IOWA 232 SECOND STREET SE MASON CITY IA 504016208 421173708 HOSPICE HEALTH CARE SERVICES IA 501(C)(3) 7 MERCY HEALTH SERVICES-IOWA CORP 0 HOSPICE OF WASHTENAW II 806 AIRPORT BLVD ANN ARBOR MI 48108 383320707 HOSPICE HEALTH CARE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HEALTH-MICHIGAN 0 HPCN 1675 LEAHY STREET MUSKEGON MI 49442 300207909 HEALTHCARE SERVICES MI 501(C)(3) 11, TYPE II MERCY HEALTH PARTNERS 0 IHA HEALTH SERVICES CORPORATION 24 FRANK LLOYD WRIGHT DR LOBBY J ANN ARBOR MI 48106 383316559 PROVIDES OFFICE-BASED MEDICAL CARE MI 501(C)(3) 9 TRINITY HEALTH-MICHIGAN 0 LAKESHORE COMMUNITY HOSPITAL INC 72 S STATE STREET SHELBY MI 494551228 382549295 ACUTE HEALTHCARE SERVICES MI 501(C)(3) 3 MERCY HEALTH PARTNERS 0 LIFESPAN INC 166 EAST GOODALE AVE BATTLE CREEK MI 490372728 383298476 PROVIDE HOSPICE HEALTH SERVICES MI 501(C)(3) 9 BATTLE CREEK HEALTH SYSTEM 0 MARIAN HOME HEALTHCARE 801 5TH STREET SIOUX CITY IA 51101 383320705 PROVIDE HOME HEALTH CARE SERVICES IA 501(C)(3) 11, TYPE I MERCY HEALTH SERVICES-IOWA CORP 0 MCAULEY CLINIC CORPORATION PO BOX 992 ANN ARBOR MI 48106 382561013 HEALTHCARE SERVICES (FORMERLY) MI 501(C)(3) 3 CATHERINE MCAULEY HEALTH SERVICES CORP 0 MERCY AMICARE HOME HEALTHCARE OAKLAND 281 ENTERPRISE COURT BLOOMFIELD HILLS MI 483020312 383320698 PROVIDE HOME HEALTH CARE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC 0 MERCY AMICARE HOME HEALTHCARE PORT HURON 505 HURON AVENUE PORT HURON MI 48060 383320701 PROVIDE HOME HEALTH CARE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC 0 MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE 684 HARVEY STREET MUSKEGON MI 49442 383321856 PROVIDE HOME HEALTH CARE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC 0 MERCY HEALTH PARTNERS 1415 LEAHY STREET MUSKEGON MI 49442 382589966 HEALTHCARE SYSTEM SUPPORT MI 501(C)(3) 11, TYPE I TRINITY HEALTH-MICHIGAN 0 MERCY HEALTH SERVICES - IOWA CORP 1000 4TH STREET SW MASON CITY IA 50401 311373080 HEALTHCARE SERVICES DE 501(C)(3) 3 TRINITY HEALTH-MICHIGAN 0 MERCY HEALTHCARE FOUNDATION 1410 N 4TH ST CLINTON IA 52732 421316126 FUNDRAISING AND FINANCIAL ASSISTANCE FOR HOSPITAL CHARITABLE SERVICES IA 501(C)(3) 11, TYPE I MERCY MEDICAL CENTER-CLINTON 0 MERCY HOSP & HEALTH SERVICES OF DETROITMARSHALL PARK HEALTH SERVICES INC 27870 CABOT DRIVE NOVI MI 483772920 381562325 SUPPORTS MALPRACTICE CONTINGENCIES OF CLOSED HOSPITAL MI 501(C)(3) 11, TYPE I TRINITY HEALTH-MICHIGAN 0 MERCY HOSPITAL CADILLAC FOUNDATION 400 HOBART CADILLAC MI 496012331 203357131 SUPPORT THE SERVICES OF RELATED HOSPITAL MI 501(C)(3) 11, TYPE I TRINITY HEALTH-MICHIGAN 0 MERCY HOSPITAL GIFT SHOP 2601 ELECTRIC AVE PORT HURON MI 48060 381630480 VOLUNTEER SERVICE AUXILIARY MI 501(C)(3) 11, TYPE I TRINITY HEALTH-MICHIGAN 0 MERCY MEDICAL CENTER - CLINTON INC 1410 NORTH 4TH ST CLINTON IA 527322940 421336618 TO PROVIDE QUALITY HEALTH CARE DE 501(C)(3) 3 MERCY HEALTH SERVICES-IOWA CORP 0 MERCY MEDICAL CENTER - SIOUX CITY FOUNDATION 801 5TH STREET SIOUX CITY IA 51102 141880022 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 7 MERCY HEALTH SERVICES-IOWA CORP 0 MERCY MEDICAL CENTER FOUNDATION - NORTH IOWA 1000 4TH STREET SW MASON CITY IA 504012800 421229151 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE III-FI MERCY HEALTH SERVICES-IOWA CORP 0 MERCY MEDICAL CENTER FOUNDATION INC 1512 12TH AVENUE ROAD NAMPA ID 83686 261737256 SUPPORT THE SERVICES OF RELATED HOSPITAL ID 501(C)(3) 7 SAINT ALPHONSUS MEDICAL CENTER-NAMPA 0 MERCY NORTH HOMECARE AND HOSPICE 7985 MACKINAW TRAIL CADILLAC MI 49601 383313897 HOME HEALTH AND HOSPICE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC 0 MERCY PAVILION OF BATTLE CREEK 300 NORTH AVENUE BATTLE CREEK MI 49016 382783350 PROVIDES LONG-TERM CARE FOR THE ELDERLY MI 501(C)(3) 9 BATTLE CREEK HEALTH SYSTEM 0 MERCY PHYSICIAN GROUP INC 1512 12TH AVENUE ROAD NAMPA ID 83686 208192593 TO PROVIDE QUALITY HEALTH CARE ID 501(C)(3) 9 SAINT ALPHONSUS MEDICAL CENTER-NAMPA 0 MERCY SERVICES FOR AGING NON-PROFIT HOUSING CORPORATION PO BOX 9184 FARMINGTON HILLS MI 483339184 382719605 PROVIDES LONG-TERM CARE FOR THE ELDERLY MI 501(C)(3) 11, TYPE II TRINITY CONTINUING CARE SERVICES INC 0 MIDWEST MEDFLIGHT 1300 VICTORS WAY ANN ARBOR MI 48108 382684671 AEROMEDICAL TRANSPORT MI 501(C)(3) 9 TRINITY HEALTH-MICHIGAN 0 MOUNT CARMEL CARE CONTINUUM SERVICES CORP 793 WEST STATE STREET COLUMBUS OH 43222 311126211 COOPERATIVE HOSPITAL SERVICE ORGANIZATION OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM 0 MOUNT CARMEL COLLEGE OF NURSING 6150 EAST BROAD STREET COLUMBUS OH 43213 311308555 COLLEGE OF NURSING OH 501(C)(3) 2 MOUNT CARMEL HEALTH 0 MOUNT CARMEL HEALTH 6150 EAST BROAD STREET COLUMBUS OH 43213 314379602 HEALTHCARE SERVICES OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM 0 MOUNT CARMEL HEALTH INSURANCE COMPANY 6150 EAST BROAD STREET COLUMBUS OH 43213 251912781 HEALTH INSURANCE OH 501(C)(4) N/A MOUNT CARMEL HEALTH SYSTEM 0 MOUNT CARMEL HEALTH PLAN INC 6150 EAST BROAD STREET COLUMBUS OH 43213 311471229 MEDICARE HMO FOR SENIORS OH 501(C)(4) N/A MOUNT CARMEL HEALTH SYSTEM 0 MOUNT CARMEL HEALTH SYSTEM 6150 EAST BROAD STREET COLUMBUS OH 43213 311439334 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT OH 501(C)(3) 11, TYPE I TRINITY HEALTH CORPORATION 0 MOUNT CARMEL HEALTH SYSTEM FOUNDATION 6150 EAST BROAD STREET COLUMBUS OH 43213 311113966 SUPPORT THE SERVICES OF RELATED HOSPITAL OH 501(C)(3) 11, TYPE I MOUNT CARMEL HEALTH SYSTEM 0 MOUNT CARMEL HOME CARE LLC 1144 DUBLIN ROAD SUITE B COLUMBUS OH 43215 262729300 PROVIDE HOME HEALTH CARE SERVICES OH 501(C)(3) 9 TRINITY HOME HEALTH SERVICES INC 0 MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL 7333 SMITHS MILL RD NEW ALBANY OH 43054 870790288 HEALTHCARE SERVICES OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM 0 MRI MOBILE SERVICES OF WEST MICHIGAN 1820 - 44TH STREET KENTWOOD MI 49508 383073745 OPERATE MAGNETIC IMAGING RESONANCE (FORMERLY) MI 501(C)(3) 9 TRINITY HEALTH-MICHIGAN 0 MUSKEGON COMMUNITY HEALTH PROJECT 565 W WESTERN AVENUE MUSKEGON MI 49440 911932918 FACILITATE AND COORDINATE HEALTHCARE AND RELATED SERVICES MI 501(C)(3) 7 MERCY HEALTH PARTNERS 0 OAKLAND MERCY HOSPITAL 601 EAST 2ND STREET OAKLAND NE 68045 208072234 HEALTHCARE SERVICES NE 501(C)(3) 3 MERCY HEALTH SERVICES-IOWA CORP 0 OAKLAND MERCY HOSPITAL FOUNDATION 601 E 2ND STREET OAKLAND NE 68045 311678345 SUPPORTS SERVICES OF RELATED HOSPITAL NE 501(C)(3) 11, TYPE III-FI OAKLAND MERCY HOSPITAL 0 PORT HURON MERCY FAMILY CARE INC 2601 ELECTRIC AVE PORT HURON MI 48060 201855647 HEALTHCARE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HEALTH-MICHIGAN 0 PROFESSIONAL MED TEAM 965 FORK STREET MUSKEGON MI 494423257 382638284 MEDICAL CARE, TRANSPORTATION AND EDUCATION MI 501(C)(3) 9 TRINITY HEALTH-MICHIGAN 0 PROFESSIONAL OFFICE CORPORATION 1303 EAST HERNDON AVE FRESNO CA 93720 942839324 HEALTHCARE SERVICES CA 501(C)(3) 11, TYPE I SAINT AGNES MEDICAL CENTER 1 SAINT AGNES MEDICAL CENTER 1303 EAST HERNDON AVE FRESNO CA 93720 941437713 HEALTHCARE SERVICES CA 501(C)(3) 3 TRINITY HEALTH CORPORATION 1 SAINT ALPHONSUS BUILDING COMPANY INC 1055 NORTH CURTIS RD BOISE ID 83706 820401011 SUPPORTS SERVICES OF RELATED HOSPITAL ID 501(C)(3) 11, TYPE I SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC 0 SAINT ALPHONSUS DIVERSIFIED CARE INC 1055 NORTH CURTIS RD BOISE ID 83706 943028978 SUPPORTS SERVICES OF RELATED HOSPITAL ID 501(C)(3) 11, TYPE I SAINT ALPHONSUS REGIONAL MEDICAL CENTER INC 0 SAINT ALPHONSUS HEALTH SYSTEM INC 1055 N CURTIS ROAD BOISE ID 83706 271929502 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT ID 501(C)(3) 11, TYPE I TRINITY HEALTH CORPORATION 0 SAINT ALPHONSUS MEDICAL CENTER-BAKER CITY 3325 POCAHONTAS ROAD BAKER CITY OR 97814 271790052 TO PROVIDE QUALITY HEALTH CARE OR 501(C)(3) 3 SAINT ALPHONSUS HEALTH SYSTEM INC 0 SAINT ALPHONSUS MEDICAL CENTER-NAMPA 1512 12TH AVENUE ROAD NAMPA ID 83686 820200896 TO PROVIDE QUALITY HEALTH CARE ID 501(C)(3) 3 SAINT ALPHONSUS HEALTH SYSTEM INC 0 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 351 SW 9TH STREET ONTARIO OR 97914 271789847 TO PROVIDE QUALITY HEALTH CARE OR 501(C)(3) 3 SAINT ALPHONSUS HEALTH SYSTEM INC 0 SAINT ALPHONSUS REGIONAL MEDICAL CENTER 1055 NORTH CURTIS RD BOISE ID 83706 820200895 HEALTHCARE SERVICES ID 501(C)(3) 3 SAINT ALPHONSUS HEALTH SYSTEM INC 0 SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC 1915 LAKE AVENUE PO BOX 670 PLYMOUTH IN 46563 351142669 HEALTHCARE SERVICES IN 501(C)(3) 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC 0 SAINT JOSEPH REGIONAL MEDICAL CENTER - SOUTH BEND CAMPUS INC PO BOX 1935 SOUTH BEND IN 466341935 350868157 HEALTHCARE SERVICES IN 501(C)(3) 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC 0 SAINT JOSEPH REGIONAL MEDICAL CENTER INC 801 EAST LASALLE AVE SOUTH BEND IN 46617 351568821 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT IN 501(C)(3) 11, TYPE I TRINITY HEALTH CORPORATION 0 SAINT JOSEPH'S AUXILIARY OF MARSHALL COUNTY 1915 LAKE AVENUE PLYMOUTH IN 46563 356043563 HOSPITAL SERVICE AUXILIARY IN 501(C)(3) 11, TYPE II SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH CAMPUS INC 0 SAINT JOSEPH'S TOWER INC PO BOX 9184 FARMINGTON HILLS MI 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