2012-04-30T13:09:34-05:00 2011-06-30 KPMG LLP 55 SECOND STREET SUITE 1400 SAN FRANCISCO CA 94105 990 2010-07-01 680127677 Mark Twain St Joseph's Healthcare Corporation MARK 2097543521 768 Mountain Ranch Road San Andreas CA 95249 JACOB LEWIS 2012-04-25 4159635100 2010 2016-02-24 21:20:13Z JACOB LEWIS CFO 768 MOUNTAIN RANCH ROAD SAN ANDREAS CA 95249 75736334 false X www.chwhealth.org X 1987 CA To continuously improve the health status of our community. 6 4 366 68 0 0 1151100 368501 50209449 51421244 758526 1239637 232682 312068 52351757 53341450 162512 451057 0 0 25677183 27204408 0 0 323745 20724666 23068280 46564361 50723745 5787396 2617705 44752898 47454837 11708232 9679791 33044666 37775046 TO CONTINUOUSLY IMPROVE THE HEALTH STATUS OF OUR COMMUNITY. false false 44316409 451057 51431314 The hospital provides routine patient care in private and semi-private rooms as well as various inpatient and outpatient ancillary services such as x-ray, lab, emergency room, etc. During the fiscal year 2011, 1,365 patients were admitted to the facility and 37,999 patient visits were recorded at our 5 rural health clinics. 44316409 true true false true false false false false false true true false false true false false true false false false false false false false false true true true false true false false false true false false true false true false false false false true true true false false true 153 0 true 366 true false false false false false false false false false false X 6 4 false false false false true true true true true false false false true true true true true false false false CA X CRYSTAL CARRASCO FINANCE DEPT 9168512106 3400 DATA DRIVE RANCHO CORDOVA CA 95670 X Dr Dean Kelaita 4.0 X 15100 0 0 Ken McInturf 4.0 X 0 0 0 Colleen Smart thru 22011 4.0 X 0 0 0 Lewis Steele 4.0 X 0 0 0 Donald Wiley 4.0 X 0 651183 81121 Robert Campana 4.0 X X 0 0 0 Tracy Church thru 52011 4.0 X X 0 483918 69554 David Woodhams DDS 4.0 X X 0 0 0 Feliciano Jiron 40.0 X 0 304671 47460 Jacob Lewis 40.0 X 0 191197 29599 Melissa M Cuevas 40.0 X 189535 0 53201 Anthony C Halat 40.0 X 262947 0 40725 Maria Michnowski 40.0 X 240600 0 42217 Jill Ortiz 40.0 X 194945 0 59591 Joann Rosenfeld 40.0 X 275977 0 43975 Tran C Thuy 40.0 X 227071 0 31693 1406175 1630969 499136 61 false true false RODGER ORMAN MD INC PO BOX 2189 MURPHYS CA 95247 Medical Services 684214 ALLIANCE HEALTHCARE SERVICES FILE 55826 LOS ANGELES CA 900745826 Diagnostic Imaging S 523257 EMERGENCY PHYSICIAN MED GROUP PO BOX 79345 CITY OF INDUSTRY CA 917169345 Medical Services 260966 SILVER OAK MEDICAL OFFICE INC PO BOX 636 SAN ANDREAS CA 95249 Medical Services 243990 AIRE SERV OF THE GOLD COUNTRY PO BOX 533 VALLEY SPRINGS CA 95252 Maintenance Services 232183 14 146712 221789 221789 368501 PATIENT REV/CHARITY CARE 900099 25771927 25771927 MED OFFICE BLDG 900099 55633 55633 MEDICARE / MEDICAID PAYMENTS 900099 25547121 25547121 OTHER RELATED/EXEMPT INCOME 900099 46563 46563 51421244 484143 484143 0 0 22925146 225232 22173095 221789 752051 3443 755494 755494 0 0 0 ADMIN SERVICES FOR MOB TENANTS 561000 64493 0 64493 CAFETERIA 900099 64389 64389 MEDICAL RECORDS SALES 900099 10070 10070 173116 0 173116 312068 53341450 51431314 0 1541635 451057 451057 0 0 0 239482 219432 18237 1813 105974 105974 21289805 19400090 1718796 170919 1087075 990585 87763 8727 3004498 2737813 242565 24120 1477574 1346423 119289 11862 0 96731 14763 81968 17493 17493 5523 5523 0 74404 74404 7014580 4513154 2501232 194 260027 5370 254657 1300270 1107492 191882 896 1858165 1827115 31050 0 946145 506161 338410 101574 101029 79360 21669 0 66671 25070 41601 337007 337007 0 1915831 1877360 38471 362861 362861 BAD DEBT 4627460 4627460 MEDICAL SUPPLIES 3604199 3603772 427 FOOD SUPPLIES 175290 132388 42902 RECRUITING 111599 111599 DUES & SUBSCRIPTIONS 75722 11517 64205 117273 34185 79448 3640 50723745 44316409 6083591 323745 1658 1260 5222815 0 6546873 11392797 67965 49705 78459 541999 953585 983299 171159 324345 31874690 17742106 14436950 14132584 13481408 15817415 3229988 3570518 222585 333101 339453 307814 44752898 47454837 5706599 2057037 904583 6001633 6718171 11708232 9679791 X 32822082 37441946 138815 249331 83769 83769 33044666 37775046 44752898 47454837 X 2617705 2112675 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5523 5523 false PART II - B, Line 1i Lobbying expenditures paid directly by the filing organization for annual membership dues: Natl Rural Health Assoc $22 AMER Dietetic Association $19 ----- SUBTOTAL $41 Lobbying expenditures paid by the Parent organization for annual membership dues where expenses are allocated to the hospital: American Hospital Association $ 576 Catholic Health Association $ 363 Hospital Association of So. Cal $4,543 ------ SUBTOTAL $5,482 ------ TOTAL $5,523 ====== 15637430 8145878 7491552 3077059 1864164 1212895 11618762 7054296 4564466 1541439 677768 863671 14132584 POOLED INVESTMENTS 3570518 F 3570518 0 DEFERRED COMPENSATION 42381 DUE TO RELATED PARTIES 6496371 PENSION PAYABLE 152000 OTHER NON-CURRENT LIABILITIES 27419 6718171 true true X true X true X 500. true true false true true 601 194117 0 194117 0.00420 18910 7355895 8030621 -674726 0.01460 4610 2372614 1626572 746042 0.01620 24121 9922626 9657193 265433 0.00580 15093 55536 450 55086 0.00120 12776 266733 0 266733 0.00580 27869 322269 450 321819 0.00700 51990 10244895 9657643 587252 0.01280 1 0 4208 0 4208 0.00010 1 140 1986 0 1986 2 64 1221 0 1221 4 204 7415 0 7415 0.00010 true 1726262 0 11472558 23526490 -12053932 X true true 1 1 Mark Twain St Joseph's Healthcare Corp

768 Mountain Ranch Rd San Andreas CA 95249

X X X Mark Twain St Joseph's Healthcare Corp 1 5 Angels Camp Family Medical Center

Angels Towne Center 222 S Main St Angels Camp CA 95222

HEALTH CENTER Valley Springs Family Medical Center

1919 Vista Del Lago Drive Valley Springs CA 95222

health center San Andreas Clinic

704 Mt Ranch Road Suite 103 San Andreas CA 95249

HEALTH CENTER Arnold Family Medical Center

Meadowmont Center 2182 Highway 4 ARNOLD CA 95223

HEALTH CENTER Copperopolis Family Medical Center

3505 Spangler Lane 400 Copperopolis CA 95228

HEALTH CENTER Schedule H, Part I, Line 7, column (f) The amount of bad debt expense included on Form 990, Part IX, line 25, column (A) is $4,627,460 and has been subtracted for purposes of calculating the percentages in column (f). Schedule H, Part I, Line 7 MTSJHC follows the method used by CHW. For purposes of calculating the amounts provided in the table, MTSJHC 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 facility 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 and cash and in-kind donations. Schedule H, Part II - Community Building Activities Mark Twain St. Joseph's Hospital has formed many relationships with community organizations to improve community health, improve access to health care, provide health education and in other ways that benefit our residents. In the area of Physical Improvements and Housing, the hospital supports the Resource Connection new Community Garden and continues to work with the local chapter of Habitat for Humanity by providing resources including the recyclable furniture from hospital renovations. We also partner with the Hospital Foundation on "Pink in the Night" activities which light up several communities during Breast Cancer Awareness Month. In the area of Leadership Development and Training for Members of the Community, the hospital organized the 5th Annual Summer Health Career Camp for high school seniors and juniors who are interested in a future health career. The hospital also participated in various Career Day activities at local high schools. We continue to participate in the Chamber of Commerce's Leadership Calaveras program and provide education about local health care access. In the area of Local Community Organizing, Mark Twain St. Joseph's Hospital provides transportation services to persons who have scheduled appointments for radiation therapy outside the local community. This transportation is also available to other patients if schedule permits. We work closely on developing community-wide plans for disaster preparedness and provide respirator fit testing for all first responders in the community. Schedule 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 3, MTSJHC provides free or discounted care to uninsured or under-insured individuals at or below 500% of the Federal Poverty Level. MTSJH 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. The expected patient payment amount on the patient's bill reflects this discount. MTSJHC makes every effort in determining if a patient qualifies for charity care upon admission. MTSJHC follows CHW's financial assistance policy. CHW's 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 charity as soon as eligibility is known. CHW also utilizes a Payment Assistance Rank Ordering (PARO) scoring system to assist in determining if a patient may qualify for charity care 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, MTSJHC does not believe that any amounts included in Part III, Line 2, are attributable to patients eligible under the organization's charity care 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 payers, and others for services rendered. MTSJHC 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. Schedule H, Part III, Line 8 MTSJHC 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 MTSJHC 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 $12.0 million reported on Part III, Section B, Line 7, primarily for fee for service Medicare patients, as well as the unreimbursed portion of Medicare Managed Care and Medicare Capitated programs for MTSJHC. Schedule H, Part III, Line 9b MTSJHC ensures that patient accounts are processed fairly and consistently. MTSJHC also follows CHW's collection policy. CHW's collection policy contains provisions that prohibit the collection of amounts due from patients who the organization knows qualify for charity care. Accounts with incorrect or incomplete demographic information are assigned to a collection agency if MTSJHC or billing company retained by CHW 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 CHW'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, MTSJHC 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. MTSJHC 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 MTSJHC'S patient financial assistance department. Upon assignment of such a patient account to a collection agency, MTSJHC requires the agency to comply with the Fair Debt Collection Practices Act. Schedule H, Part VI, Line 2 - Needs Assessment A Community Health Needs Assessment was last conducted in 2008, as required by State law (SB 697). It was a collaborative effort involving the Mark Twain St. Joseph's Health Care District Board of Directors, The Calaveras County Department of Public Health, practicing physicians, various community members and the Calaveras County Superintendent of Schools and various Board members. The needs assessment WAS a primary tool used by the hospital to determine its community benefit plan, which outlined how the hospital GAVE back to the community in the form of health care and other community services to address unmet community health needs. This assessment incorporated components of primary data collection and secondary data analysis that focused on the health and social needs of the MTSJH Service Area. The primary Service Area encompassed the cities, towns and communities of Calaveras County that include 20 zip code areas. Targeted interviews were used to gather primary data collection information and opinions from members of the MTSJH community. For the interviews, community leaders were contacted and asked to participate in the needs assessment. 80% of those contacted agreed to participate. Secondary data were collected by obtaining and analyzing a variety of local, county and state sources to present a community profile, birth and death characteristics, access to health care, chronic diseases, social issues, and school and student characteristics. The Community Needs Assessment identified the following sizeable and severe needs: Health Issues -Residents have high rates of death from cancer, lung disease and heart disease. -A large percentage of youth (17.9%) suffer from asthma. -Disease rates of arthritis, asthma, cancer, heart disease and hypertension are high in the County. -The area has high rates of skin, cervical and colon cancer. -Limited services and service providers make it difficult to access mental health, obstetrical and specialty care services. -Females suffer from diabetes at higher rates than men in the County. -An increase in preventive care is needed, including flu shots, Pap smears, mammograms and other recommended routine screening tests. -There is inadequate attention given to preventive care, healthy lifestyles, nutrition and exercise. Social/Demographic Issues -The area reflects an aging population with a median age of 44.6 years. The population of seniors is 18.2%. -A declining economy is impacting the community by increased joblessness, decreases in employer-based health insurance, higher costs for transportation and decreased availability of affordable housing. -A lack of providers in the County (primary care, mental health, specialists) negatively impacts access to care and requires residents to travel outside of the County to obtain services. -Large numbers of youth and adults are overweight and obese. -Smoking among adults and teens is a concern. -ER usage increases among the County's poorest residents. Schedule 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 is available at MTSJHC and all of its community locations, including a contact number for patients to call for information and assistance. The information is disseminated by MTSJHC by various means to include notices on patient bills, brochures at all registration desks and in all waiting rooms, and notices posted in the emergency department. Such information is provided in English and Spanish. At the point of registration, all patients receive brochures explaining the facility's charity care program and the availability of government sponsored programs. Uninsured patients receive copies of the charity care and Medicaid applications in addition to the brochure upon admission to the facility. It is MTSJHC's policy that at the time of patient billing, MTSJHC provides to all uninsured patients the same billing information concerning services and charges provided to all other patients who receive care at MTSJHC. 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 charity care, instructions on how to apply for a government program or charity care and the provision of such applications. Additionally, MTSJHC, in partnership with Calaveras County, provides County Social Workers to assist patients in obtaining governmental assistance in the Valley Springs and Arnold Rural Health Clinics. Any member of MTSJHC staff or medical staff may refer a patient for financial assistance. The patient, a family member, a close friend or an associate of the patient may also make a request for financial assistance. Schedule H, Part VI, Line 4 - Community Information Calaveras County is approximately 130 miles east of San Francisco, 60 miles southeast of Sacramento and 50 miles east of Stockton. The total population is about 43,000 with an area of 1,008 square miles. Our only incorporated city, the City of Angels has a population of about 3,200. Calaveras County has been designated by the Health Resources & Services Administration, Department of Health & Human Services as a health professional shortage area (HPSA). Mark Twain St. Joseph's Hospital is the sole community hospital in Calaveras County. Mark Twain St. Joseph's Hospital's Family Medical Centers include five Federally-qualified Rural Health Clinics strategically located in remote communities of Calaveras County. Geographic Area and Target Population: The population (2010) of Calaveras County by ethnic group is 86.5% White, 10.3% Hispanic, 1.2% Asian, .8% Black and 1.2% Native American. Our top ten admitting diagnoses for FY 2010 were Major Joint Replacement; Esophagitis, Gastroent & Misc. Digestive Disorders; Septicemia; Heart Failure; Chronic Obstructive Pulmonary Disease; Pneumonia; Cellulitis; Cardiac Arrhythmia; Kidney/Urinary Infection; and CVA. Mark Twain's patient population (gross charges) consists of 48.3% Medicare, 15.0% Medi-Cal, 27.7% Commercial and 9.0% other. Catholic Healthcare West developed a Community Needs Index (CNI) that considers in aggregate the socio-economic barriers residents face. Each geographic service area, determined by 80% or more of hospital discharges, was considered. The higher the score, the greater risk residents of the zip code have in needing health services. CHW's community benefit efforts have a primary focus on the areas with disproportionate unmet health-related needs. Primary Service Area CNI Score 95252 2.4 95249 3.8 95222 3.8 95247 3.0 95223 2.4 95246 3.0 95245 3.2 95228 2.8 Total 2.9 Schedule H, Part VI, Line 5 - Promotion of Community Health Hospital Leadership oversees community benefit activities for the hospital as it meets the health and wellness needs of the local community. Several members of Mark Twain's senior and middle management team serve the community on a variety of community based not for profit Boards, such as Children and Families Commission, Habitat for Humanity, Calaveras County Business Council, Soroptomists International, Chamber of Commerce and United Way, to name a few. The Hospital is governed by a Board of Trustees, the majority of whom reside within its primary service area and who are not employees, contractors or family members thereof. In addition, most employees have linkages to various service organizations throughout the communities. Community involvement is evidenced by participation of local business and community leaders in the Hospital's Governing Boards, Finance Committee, Ethics Committee and our Parish Nurse Advisory Committee. MTSJHC extends medical staff privileges to all qualified physicians in and outside its community who request said privileges. All surplus funds generated by MTSJHC are reinvested back into the organization to improve patient care and provide health care services to its community. Schedule H, Part VI, Line 6 - Affiliated Health Care System MTSJHC is affiliated with CHW. Affiliates of CHW also 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 $2.1 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 year which was 7.11%. 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, MTSJHC recorded a pledge to a grant fund established by CHFT in the amount $0.2 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 Mark Twain Foundation 768 Mountain Ranch Rd San Andreas CA 95249 680023507 501(c)(3) 220995 0 N/A N/A Foundation Support California Health Foundation and Trust 1215 K Street Ste 800 Sacramento CA 95814 941498697 501(c)(3) 218800 0 N/A N/A Improve access to and betterment of healthcare 2 0 PART I, LINE 2 As a 501(C)(3) organization, we provide assistance to various charitable ORGANIzATiONS TO PROMOTE CHW'S MISSION. A DESIGNATED COMMITTEE consisting primarily of the executive team, establishes and evaluates priorities and allocation of funds with emphasis on promotion of healthy communities and community collaboration. We do not monitor and report program outcomes. Spending is tracked on an ongoing basis to ensure that it is generally within the budgeted amount. false true false false false false false false false Donald Wiley 0 382627 0 253945 0 14611 0 43411 0 37710 0 732304 0 0 Tracy Church thru 52011 0 300691 0 181373 0 1854 0 34514 0 35040 0 553472 0 0 Feliciano Jiron 0 192207 0 104903 0 7561 0 16904 0 30556 0 352131 0 0 Jacob Lewis 0 148572 0 39536 0 3089 0 17112 0 12487 0 220796 0 0 Melissa M Cuevas 155612 0 32849 0 1074 0 25647 0 27554 0 242736 0 0 0 Anthony C Halat 252861 0 150 0 9936 0 16339 0 24386 0 303672 0 0 0 Maria Michnowski 238987 0 150 0 1463 0 13614 0 28603 0 282817 0 0 0 Jill Ortiz 166111 0 21338 0 7496 0 32023 0 27568 0 254536 0 0 0 Joann Rosenfeld 274263 0 450 0 1264 0 23072 0 20903 0 319952 0 0 0 Tran C Thuy 226350 0 450 0 271 0 19513 0 12180 0 258764 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 top management official'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 and its highest 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. No payments were made to any listed persons during 2010 pursuant to this plan. PART I, LINE 4b 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 hired prior to June 30, 2006 are eligible to participate in the 2007 CHW Executive Deferred Compensation Plan, a nonqualified 457(f) plan that is subject to substantial risk of forfeiture, as required by the IRS. The 2007 CHW Executive Deferred Compensation Plan is intended to to 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 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 under this plan during 2010. PART II - SUPPLEMENTAL DISCLOSURES The organization's executive compensation philosophy is designed tto 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 patient and 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 Human Resources and Compensation 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 III - Supplemental Disclosures Dr. Dean Kelaita'S COMPENSATION IS FOR PHYSICIAN SERVICES PROVIDED TO THE ORGANIZATION. Dr Anthony Halat physician loan X 35191 27638 true false true DR Jo Ann Rosenfeld physician loan X 43956 15116 false false true DR Tran C Thuy physician loan X 20000 6951 false false true 49705 Randall Smart SON OF BOD, C SMART 28206 MEDICAL STAFF PAYMENTS false LORI SKEVINGTON DAUGHTER OF BOD, C SMART 77768 COMPENSATION false X 221789 Resale value 0 false true false FORM 990, PART VI - GOVERNANCE, MANAGEMENT, DISCLOSURE FORM 990, PART VI, SECTION A, LINE 6: The hospital is jointly owned by Catholic Healthcare West (CHW), a 501(c)(3) exempt organization and Mark Twain Healthcare District (the district). FORM 990, PART VI, SECTION A, LINE 7a: CHW and the District, as the corporate members, ratify the selection of members and approve new Board members of the organization. Each owner designates two Board members, and each pair of designated Board members selects a county resident; these six select the seventh voting member, who must also be a county resident. FORM 990, PART VI, SECTION A, LINE 7b: Reserved rights of the corporate members (CHW and the District) 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. FORM 990, PART VI, SECTION B, LINE 11A: Management presented the draft of the Form 990 to the Board before filing the form with the Internal Revenue Service. The Board's review included all information reported on the Form 990 with the exception of individuals' compensation amounts reported which were directly reviewed by the Vice President of Human Resources. In the process of its preparation, the 990 was reviewed at various levels of Finance and Accounting (Regional CHW management and Corporate Tax Department), as well as reviewed by Mark Twain's Finance Manager and CFO (who signs the form) and by AN INDEPENDENT accounting firm engaged to review the return before filing. FORM 990, PART VI, 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 questionnaire, 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). Covered persons are required to disclose real or potential conflicts at the time such conflicts arise. When someone becomes a covered person and annually thereafter, each covered person is required 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 questionnaire. 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 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) alternatives to the proposed transaction are investigated, competitive bids or comparable valuations are obtained; (5) any conflicting issues during the course of a Board meeting which cannot be resolved is referred to the Governance Committee; 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. FORM 990, PART VI, SECTION B, LINE 15a: Although the organization employs personnel, the top management official is compensated by Catholic Healthcare West (CHW). FOR 2010 COMPENSATION, 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 top management official. Appropriate comparability data for similar jobs in peer companies (both taxable and tax-exempt) WAS obtained from independent third-party survey sources. FORM 990, PART VI, SECTION B, LINE 15b: The Hospital 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 Chief Financial Officer's compensation. 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. FORM 990, PART VI, 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. The organization makes its financial statements available upon request. FORM 990, PART XI, LINE 5 Change in unrealized gains/(losses); $2,002,158. Interest in net assets of unconsolidated Foundation; $110,517. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Donald Wiley TITLE:Board Member HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Tracy Church (thru 5/2011) TITLE:Secretary HOURS:40 Catholic Healthcare West 185 Berry Street San Francisco CA 94107 941196203 Hospital CA 501(c)(3) 3 NA Mark Twain St Joseph Hospital Auxiliary 788 Mountain Ranch Rd San Andreas CA 95249 942340081 Volunteer ser CA 501(c)(3) 11d NA false false false false true false false false false false true true true true true false true false NONE