Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2010 and ending 12-31-2010
BCheck if applicable:
CName of organization
SUTTER WEST BAY HOSPITALS
 
Doing Business As
CALIFORNIA PACIFIC MEDICAL CENTER
 
Number and street (or P.O. box if mail is not delivered to street address)
PO BOX 7999
 
Room/suite
City or town, state or country, and ZIP + 4
SAN FRANCISCO, CA94120
D Employer identification number

94-0562680
E Telephone number

G Gross receipts $ 1,646,129,191
F Name and address of principal officer:
MARTIN BROTMAN MD
PO BOX 7999
SAN FRANCISCO,CA94120
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.SUTTERHEALTH.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1854
M State of legal domicile: CA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 35
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 29
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 8,786
6 Total number of volunteers (estimate if necessary) .... 6 1,291
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 2,067,119
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 45,464,974 33,710,172
9 Program service revenue (Part VIII, line 2g) ......... 1,194,089,890 1,542,831,482
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -2,270,393 9,541,135
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 8,565,541 6,728,834
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 1,245,850,012 1,592,811,623
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,658,071 1,836,582
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 606,222,788 736,482,501
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet344,988    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 478,846,674 665,272,592
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,086,727,533 1,403,591,675
19 Revenue less expenses. Subtract line 18 from line 12...... 159,122,479 189,219,948
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 1,452,243,769 1,510,104,441
21 Total liabilities (Part X, line 26)............ 562,074,957 574,175,255
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 890,168,812 935,929,186
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: SEE SCHEDULE O
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 1,315,021,288 including grants of $ 1,836,582 ) (Revenue $ 1,542,831,482 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 1,315,021,288
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part IClick to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II.......... Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
 
No
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
Yes
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
1,201
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
8,786
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
35
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
29
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
HENRY YU
PO BOX 7999
SAN FRANCISCO,CA94120
(415) 600-7310
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) RT REV MARC ANDRUS
DIRECTOR
 1.0 X           0 0 0
(2) DAMIAN AUGUSTYN MD
DIRECTOR
 1.0 X           0 0 0
(3) MARTIN BROTMAN MD
REGIONAL PRESIDENT, WEST BAY
 40.0 X   X       0 2,535,924 1,751,747
(4) BILL BRUNETTI
DIRECTOR
 1.0 X           0 0 0
(5) THEODORE DEIKEL
DIRECTOR
 1.0 X           0 0 0
(6) THOMAS JOHN DIETZ PHD
DIRECTOR
 1.0 X           0 0 0
(7) ROY EISENHARDT
DIRECTOR
 1.0 X           0 0 0
(8) PETER FULCHIRON
VICE CHAIR/DIRECTOR
 1.0 X   X       0 0 0
(9) PAT FRY
PRESIDENT & CEO, SUTTER HEALTH
 1.0 X           0 2,699,636 2,088,912
(10) FRANK HERRINGER
DIRECTOR
 1.0 X           0 0 0
(11) JORDAN HOROWITZ MD
DIRECTOR
 1.0 X           17,063 0 0
(12) PETER JACOBI
DIRECTOR
 1.0 X           0 0 0
(13) JOAN C KAHR
DIRECTOR
 1.0 X           0 0 0
(14) RON KAUFMAN
DIRECTOR
 1.0 X           0 0 0
(15) KURT KUNZEL MD
DIRECTOR
 1.0 X           27,500 0 0
(16) STEVEN LEVENBERG DO
DIRECTOR
 1.0 X           0 0 0
(17) TOM LINCOLN
DIRECTOR
 1.0 X           0 0 0
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) ALASTAIR MACTAGGART
DIRECTOR
 1.0 X           0 0 0
(19) ANTHONY MILES
DIRECTOR
 1.0 X           0 0 0
(20) SCOTT MINICK
DIRECTOR
 1.0 X           0 0 0
(21) TIM MURPHY MD
DIRECTOR
 1.0 X           1,500 0 0
(22) CYNTHIA NESTLE
DIRECTOR
 1.0 X           0 0 0
(23) DENNIS O'CONNELL
DIRECTOR
 1.0 X           0 0 0
(24) STEVEN OLIVER
DIRECTOR
 1.0 X           0 0 0
(25) ROBERT OSORIO MD
DIRECTOR
 1.0 X           0 0 0
(26) JAMES PALLESCHI MD
DIRECTOR
 1.0 X           0 0 0
(27) DIANE PEGE MD
DIRECTOR
 1.0 X           0 0 0
(28) ROBERT A ROSENFELD
DIRECTOR
 1.0 X           0 0 0
(29) TERRI SLAGLE MD
DIRECTOR
 1.0 X           14,950 0 0
(30) LEO SOONG
FINANCE CHAIR/DIRECTOR
 1.0 X   X       0 0 0
(31) ROSS E STROMBERG JD
DIRECTOR
 1.0 X           0 0 0
(32) ROBERT M TOMASELLO
CHAIR/DIRECTOR
 1.0 X   X       0 0 0
(33) MICHAEL VALAN MD
DIRECTOR
 1.0 X           0 0 0
(34) ANTHONY G WAGNER
DIRECTOR
 1.0 X           0 0 0
(35) DEBORAH WYATT MD
DIRECTOR
 1.0 X           0 0 0
(36) MICHAEL DUNCHEON
VP, REGIONAL COUNSEL WBR
 40.0     X       0 265,434 86,707
(37) JOHN GATES
REGIONAL VP FINANCE, WEST BAY
 40.0     X X     0 728,158 399,937
(38) JACK BAILEY
EXECUTIVE VP/ADMINISTRATOR
 40.0       X     897,884 0 20,662
(39) TONI BRAYER MD
REGIONAL VP & CMO, WEST BAY
 40.0       X     0 576,844 174,182
(40) WARREN BROWNER MD
CEO, SAN FRANCISCO HOSPITALS
 40.0       X     0 770,292 442,862
(41) GRANT DAVIES
EXEC VP, CPMC & CAO, WB
 40.0       X     0 624,392 185,409
(42) LINDA ISAACS
REG. VP, HR, WEST BAY
 40.0         X   0 402,932 119,116
(43) ALLAN PONT MD
VP MEDICAL AFFAIRS
 40.0         X   0 518,746 98,866
(44) CHRISTOPHER WILLRICH
REG. VP, STRATEGY&BUS DEV, WB
 40.0         X   0 423,286 130,385
(45) SEAN TOWNSEND
VP QUALITY
 40.0         X   751,941 0 16,989
(46) STEVEN CUMMINGS
DIRECTOR CRCLE
 40.0         X   492,352 0 26,921
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,203,190 9,545,644 5,542,695
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet1,705
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
ARAMARK
2500 WARRENVILLE ROAD
DOWNERS GROVE,IL60515 		MANAGEMENT SERVICES 17,957,405
PACIFIC INPATIENT MEDICAL GROUP INC
PO BOX 1230
SUISUN CITY,CA94585 		UTILIZATION SERVICES 6,536,985
ANESTHESIA AND ANALGESIA MEDICAL GR
837 5TH STREET 2ND FLOOR
SANTA ROSA,CA95404 		ANESTHESIA SERVICES 5,327,013
AUXILIO
27401 LOS ALTOS SUITE 100
MISSION VIEJO,CA92691 		PRINTER SVC MGMT 3,402,364
D KELLY CONSTRUCTION INC
55 LAFAYETTE STREET
SAN FRANCISCO,CA94103 		CONSTRUCTION 3,389,544
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet152
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 17,709
d Related organizations...1d 12,104,776
e Government grants (contributions)1e 19,827,158
f All other contributions, gifts, grants, and
similar amounts not included above1f 		1,760,529
g Noncash contributions included in lines 1a-1f:$ 13,500
h Total. Add lines 1a-1f.......MediumBullet 33,710,172
Program Service Revenue Business Code
2a PATIENT SERVICE REVENUE 622,110 1,531,134,571 1,531,134,571    
b CA PACIFIC ADVANCED IMAGING 621,512 1,848,651 1,848,651    
c SAN FRAN ENDOSCOPY CTR 621,498 3,921,699 3,921,699    
d PRESIDIO SURGERY CENTER LLC 621,493 5,926,561 5,926,561    
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 1,542,831,482
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 7,737,288     7,737,288
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents 14,688,714  
b Less: rental expenses 13,304,731  
c Rental income or (loss) 1,383,983  
d Net rental income or (loss).......MediumBullet 1,383,983     1,383,983
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 41,511,487 287,333
b Less: cost or other basis and sales expenses 39,787,244 207,729
c Gain or (loss) 1,724,243 79,604
d Net gain or (loss)..........MediumBullet 1,803,847     1,803,847
8a Gross income from fundraising events (not including
$ 17,709
of contributions reported on line 1c). See Part IV, line 18 ...
a 33,211
b Less: direct expenses ...b 15,364
c Net income or (loss) from fundraising events..MediumBullet 17,847   17,847
9a Gross income from gaming activities.
See Part IV, line 19 ...
a 5,150
b Less: direct expenses ...b 2,500
c Net income or (loss) from gaming activities...MediumBullet 2,650     2,650
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a UBI - LABORATORY 621,500 262,955   262,955  
b UBI - PARKING 812,930 1,804,164   1,804,164  
c CAFETERIA 900,099 3,257,235     3,257,235
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 5,324,354
12 Total revenue. See Instructions....MediumBullet 1,592,811,623 1,542,831,482 2,067,119 14,202,850
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 1,836,332 1,836,332
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 250 250
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0 0
4 Benefits paid to or for members 0 0
5 Compensation of current officers, directors, trustees, and key employees .... 958,897 0 958,897 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0 0 0 0
7 Other salaries and wages 494,080,367 474,082,824 19,827,597 169,946
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 38,828,902 37,282,569 1,531,782 14,551
9 Other employee benefits ....... 162,361,713 150,280,877 12,027,066 53,770
10 Payroll taxes ........... 40,252,622 38,802,782 1,434,264 15,576
11 Fees for services (non-employees):        
a Management ...... 6,644,313 5,179,545 1,403,669 61,099
b Legal ......... 2,037,309 242,660 1,794,649 0
c Accounting ........... 84,700 14,657 70,043 0
d Lobbying ........... 0 0 0 0
e Professional fundraising. See Part IV, line 17.. 0 0
f Investment management fees ...... 627,644 0 627,644 0
g Other .......... 16,127,146 15,686,545 440,601 0
12 Advertising and promotion .... 409,487 409,477 0 10
13 Office expenses ....... 169,492,396 169,077,587 408,628 6,181
14 Information technology ...... 16,353,620 0 16,353,620 0
15 Royalties .. 0 0 0 0
16 Occupancy ........... 13,707,380 13,490,418 216,962 0
17 Travel ............ 1,403,422 1,086,412 313,697 3,313
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0 0 0 0
19 Conferences, conventions, and meetings .... 692,123 600,939 91,184 0
20 Interest ........... 23,691,234 23,691,234 0 0
21 Payments to affiliates ....... 0 0 0 0
22 Depreciation, depletion, and amortization ..... 80,368,655 80,349,571 19,084 0
23 Insurance .............. 9,963,392 9,956,233 7,159 0
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a PURCHASED SERVICES 99,296,049 93,695,803 5,586,853 13,393
b PROFESSIONAL FEES-PHYSICIANS 67,435,409 63,991,559 3,443,850 0
c BAD DEBT 37,350,972 37,350,972 0 0
d REPAIRS & MAINTENANCE 22,166,975 21,697,388 469,587 0
e SYSTEM ALLOCATION FEES 21,104,996 0 21,104,996 0
f All other expenses 76,315,370 76,214,654 93,567 7,149
25 Total functional expenses. Add lines 1 through 24f 1,403,591,675 1,315,021,288 88,225,399 344,988
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ..........   1  
2 Savings and temporary cash investments ....... 56,566,852 2 82,045,309
3 Pledges and grants receivable, net ......... 200,601 3 399,739
4 Accounts receivable, net ......... 208,647,222 4 197,248,328
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 13,871,713 8 14,589,638
9 Prepaid expenses and deferred charges ............ 3,261,305 9 4,035,606
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,692,573,826
b Less: accumulated depreciation. ..... 10b 741,495,660 908,941,346 10c 951,078,166
11 Investments—publicly traded securities .......... 185,836,527 11 183,970,682
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 .. 5,186,655 13 5,320,918
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 69,731,548 15 71,416,055
16 Total assets. Add lines 1 through 15 (must equal line 34)... 1,452,243,769 16 1,510,104,441
Liabilities 17 Accounts payable and accrued expenses . 186,550,786 17 189,729,837
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities .......... 335,260,418 20 334,770,632
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 40,263,753 25 49,674,786
26 Total liabilities. Add lines 17 through 25..... 562,074,957 26 574,175,255
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 869,058,127 27 913,463,129
28 Temporarily restricted net assets ..... 21,110,685 28 22,466,057
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 890,168,812 33 935,929,186
34 Total liabilities and net assets/fund balances ..... 1,452,243,769 34 1,510,104,441
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
1,592,811,623
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
1,403,591,675
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
189,219,948
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
890,168,812
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-143,459,574
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
935,929,186
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
SUTTER WEST BAY HOSPITALS
  		Employer identification number

94-0562680
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
SUTTER WEST BAY HOSPITALS
  		Employer identification number

94-0562680
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
SUTTER WEST BAY HOSPITALS
  		Employer identification number

94-0562680
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....      
b Contributions ........      
c Investment earnings or losses ...      
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses ....      
g End of year balance ......      
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   169,781,890 169,781,890
b Buildings ................   722,837,820 393,973,431 328,864,389
c Leasehold improvements ............   44,243,267 24,833,953 19,409,314
d Equipment ................   426,833,039 319,644,402 107,188,637
e Other .................   328,877,810 3,043,874 325,833,936
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 951,078,166
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
INSURANCE LIABILITIES 22,154,794
3RD PARTY SETTLEMENTS 7,141,520
OTHER LIABILITIES 20,378,472






Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 49,674,786
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
ASC 740 (FIN48) FOOTNOTE FROM AUDIT PART X, LINE 2 THIS ORGANIZATION WAS PART OF A CONSOLIDATED FINANCIAL SYSTEM AUDIT. THE ASC 740 AUDIT FOOTNOTE DISCLOSURE FOR THE SUTTER SYSTEM IS AS FOLLOWS: DEFERRED INCOME TAX ASSETS, WHICH AS OF DECEMBER 31, 2010 AND 2009 WERE FULLY RESERVED, REFLECT THE NET TAX EFFECT OF TEMPORARY DIFFERENCES BETWEEN THE CARRYING AMOUNTS OF ASSETS AND THE LIABILITIES FOR FINANCIAL REPORTING AND THE AMOUNTS USED FOR INCOME TAX PURPOSES. AS OF DECEMBER 31, 2010 AND 2009, SUTTER HAD DEFERRED TAX ASSETS OF $13 (MILLION) RELATING PRINCIPALLY TO NET OPERATING LOSS CARRYOVERS. AS OF DECEMBER 31, 2010 AND 2009, SUCH DEFERRED TAX ASSETS WERE OFFSET BY A VALUATION ALLOWANCE OF $13 (MILLION). THE VALUATION ALLOWANCE DID NOT CHANGE IN 2010 OR 2009. FEDERAL NET OPERATING LOSS CARRYOVERS TOTALED $32 (MILLION) AT DECEMBER 31, 2010 AND WILL EXPIRE BETWEEN 2015 AND 2030.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE G
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

GOLF TOURNAMENT
(event type) 		(b) Event #2

TREE OF LIGHTS
(event type) 		(c) Other Events

0
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 43,065 7,855   50,920
2 Less: Charitable
contributions . . . 		17,709     17,709
3 Gross income (line 1
minus line 2) . . . 		25,356 7,855   33,211
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . .        
6 Rent/facility costs . . 6,120     6,120
7 Food and beverages . . 5,035     5,035
8 Entertainment . . .        
9 Other direct expenses . 2,659 1,550   4,209
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 15,364
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow 17,847
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ...........................
Schedule G (Form 990 or 990-EZ) 2010
Schedule G (Form 990 or 990-EZ) 2010
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2010
Additional Data


Software ID:  
Software Version:  
SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
 
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    20,427,264 0 20,427,264 1.460 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    197,425,628 166,032,789 31,392,839 2.240 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....     12,096,943 5,617,437 6,479,506 0.460 %
dTotal Charity Care and
Means-Tested Government Programs ..... 		    229,949,835 171,650,226 58,299,609 4.160 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    5,765,954 18,436 5,747,518 0.410 %
f Health professions education
(from Worksheet 5) .. 		    41,891,519 4,792,612 37,098,907 2.640 %
g Subsidized health services
(from Worksheet 6) .. 		    11,320,006 7,842,238 3,477,768 0.250 %
h Research (from Worksheet 7)     22,740,306 0 22,740,306 1.620 %
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    3,187,241 0 3,187,241 0.230 %
jTotal Other Benefits ...     84,905,026 12,653,286 72,251,740 5.150 %
kTotal. Add lines 7d and 7j. ..     314,854,861 184,303,512 130,551,349 9.310 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     17,730 0 17,730 0 %
4 Environmental improvements            
5 Leadership development and training for community members     3,600 0 3,600 0 %
6 Coalition building     61,206 0 61,206 0 %
7 Community health improvement advocacy     19,075 0 19,075 0 %
8 Workforce development     46,503 0 46,503 0 %
9 Other            
10 Total     148,114 0 148,114 0.010 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense (at cost).....
2
9,673,901
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
 
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
314,411,867
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
377,034,527
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-62,622,660
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?8
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 CPMC-PACIFIC CAMPUS HOSPITAL
2333 BUCHANAN STREET
SAN FRANCISCO,CA94115 		X X         X    
2 CPMC-CALIFORNIA WEST CAMPUS HOSPITAL
3700 CALIFORNIA STREET
SAN FRANCISCO,CA94118 		X X              
3 CPMC-CALIFORNIA EAST CAMPUS HOSPITAL
3698 CALIFORNIA STREET
SAN FRANCISCO,CA94118 		X X              
4 CPMC-DAVIES CAMPUS HOSPITAL
45 CASTRO STREET
SAN FRANCISCO,CA94114 		X X         X    
5 CPMC-ST LUKE'S CAMPUS HOSPITAL
3555 CESAR CHAVEZ STREET
SAN FRANCISCO,CA94110 		X X         X    
6 SUTTER MEDICAL CENTER SANTA ROSA
3325 CHANATE ROAD
SANTA ROSA,CA95404 		X X         X    
7 SUTTER LAKESIDE HOSPITAL
5176 HILL ROAD EAST
LAKEPORT,CA95463 		X X     X   X    
8 NOVATO COMMUNITY HOSPITAL
180 ROWLAND WAY
NOVATO,CA94945 		X X         X    
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:CPMC-PACIFIC CAMPUS HOSPITAL
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:CPMC-CALIFORNIA WEST CAMPUS HOSPITAL
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:CPMC-CALIFORNIA EAST CAMPUS HOSPITAL
Line Number of Hospital Facility (from Schedule H, Part V, Section A):3

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:CPMC-DAVIES CAMPUS HOSPITAL
Line Number of Hospital Facility (from Schedule H, Part V, Section A):4

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:CPMC-ST LUKE'S CAMPUS HOSPITAL
Line Number of Hospital Facility (from Schedule H, Part V, Section A):5

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:SUTTER MEDICAL CENTER SANTA ROSA
Line Number of Hospital Facility (from Schedule H, Part V, Section A):6

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:SUTTER LAKESIDE HOSPITAL
Line Number of Hospital Facility (from Schedule H, Part V, Section A):7

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:NOVATO COMMUNITY HOSPITAL
Line Number of Hospital Facility (from Schedule H, Part V, Section A):8

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?23
Name and address Type of Facility (Describe)
1 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
2 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
3 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
4 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
5 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
6 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
7 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
8 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
9 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
10 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
11 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
12 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
13 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
14 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
15 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
16 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
17 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
18 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
19 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
20 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
21 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
22 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
23 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
PART I, QUESTION 3C   TO BE ELIGIBLE FOR FREE CARE THE ORGANIZATION USES THE FEDERAL POVERTY GUIDELINES (FPG) FOR FAMILY INCOMES THAT ARE AT OR BELOW 400% OF FPG. IN ADDITION, THE FOLLOWING DISCOUNTS APPLY TO UNINSURED PATIENTS: - SPECIAL CIRCUMSTANCES CHARITY CARE: FOR UNINSURED PATIENTS WHO DO NOT MEET THE FINANCIAL ASSISTANCE CRITERIA SET FORTH BY THE ORGANIZATION, A COMPLETE OR PARTIAL WRITE-OFF IN CIRCUMSTANCES INCLUDING BUT NOT LIMITED TO BANKRUPTCY, HOMELESSNESS, DECEASED, ELIGIBLE FOR MEDICARE/MEDI-CAL, OR IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING THE ORGANIZATION'S CHARITY CARE ELIGIBILITY CRITERIA. - CATASTROPHIC CHARITY CARE: PARTIAL WRITE-OFF WHEN THE FINANCIAL RESPONSIBILITY EXCEEDS 30% OF THE PATIENT'S FAMILY INCOME. PATIENTS THAT MEET THE CRITERIA WILL RECEIVE A FULL WRITE-OFF OF UNDISCOUNTED CHARGES THAT EXCEED 30% OF THEIR FAMILY INCOME. - HIGH MEDICAL COST CHARITY CARE (FOR INSURED PATIENTS): PARTIAL WRITE-OFF OF THE HOSPITAL'S UNDISCOUNTED CHARGES FOR PATIENTS WHOSE FAMILY INCOME IS LESS THAN 350% OF FPG, MEDICAL EXPENSES EXCEED 10% OF THE PATIENT'S FAMILY INCOME, AND THE PATIENT'S INSURER HAS NOT PROVIDED A DISCOUNT. - UNINSURED PATIENT DISCOUNT: A WRITE-OFF OF A PORTION OF COVERED SERVICES NO GREATER THAN THE CURRENT AVERAGE COMMERCIAL FEE-FOR-SERVICE DISCOUNT WITH MANAGED CARE PAYERS FOR PATIENTS WHOSE BENEFITS UNDER INSURANCE OR A GOVERNMENT PROGRAM HAVE BEEN EXHAUSTED PRIOR TO ADMISSION. - PROMPT PAYMENT DISCOUNT: PARTIAL WRITE-OFF AVAILABLE TO UNINSURED PATIENTS WHO PAY PROMPTLY, CONSISTING OF AT LEAST A 10% DISCOUNT FOR THOSE WHO PAY WITHIN 30 DAYS OF FINAL BILLING, OR A 20% DISCOUNT IF 50% OF THE ESTIMATED BILL IS PAID PRIOR TO DISCHARGE.
PART I, QUESTION 7   COSTING METHODOLOGY USED: COST TO CHARGE RATIO UTILIZING WORKSHEET 2 METHODOLOGY.
PART II   COMMUNITY BUILDING ACTIVITIES - COMMUNITY SUPPORT (F3) - DONATION OF MEETING SPACE FOR LOCAL NON-PROFITS @ SUTTER LAKESIDE HOSPITAL - ENABLING PATIENTS TO VOTE PROGRAM - COALITION BUILDING (F6) - PROJECT HOMELESS CONNECT - UNIVERSITY OF SAN FRANCISCO, BOARD OF TRUSTEES PARTICIPATION - COMMUNITY HEALTH IMPROVEMENT ADVOCACY (F7) - AUTISM STATE SENATE TASK FORCE PARTICIPATION - FIRST FIVE COMMISSION PARTICIPATION - SONOMA HEALTH ALLIANCE PARTICIPATION - WORKFORCE DEVELOPMENT (F8) - GALILEO HEALTH ACADEMY - CITY WITHIN SPEAKER SERIES - HIRING PARTNER WITH WORKLINK - IMMACULATE CONCEPTION ACADEMY WORK STUDY PROGRAM - JVS FOSTER YOUTH HEALTHCARE CAREER EXPLORATION PROGRAM - LIFE LEARNING ACADEMY - PACIFIC EPILEPSY PROGRAM - ST. LUKE'S SUMMER YOUTH INTERNSHIPS PROGRAM - HEALTH OCCUPATIONS CLASS - CLEAR LAKE HIGH SCHOOL - HEALTHCARE WORKFORCE DEVELOPMENT ROUNDTABLE - SANTA ROSA JUNIOR COLLEGE PHARMACY TECH PROGRAM ADVISORY COMMITTEE PARTICIPATION
PART III, QUESTION 4   THE ORGANIZATION MAKES EVERY EFFORT TO QUALIFY THOSE ELIGIBLE FOR CHARITY CARE. IF A PATIENT HAS APPLIED FOR CHARITY CARE, HAS BEEN APPROVED TO RECEIVE CHARITY CARE, OR IS COOPERATING WITH THE HOSPITAL'S EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE HOSPITAL WILL NOT PURSUE COLLECTIONS. 1. AUDIT FOOTNOTE THE ORGANIZATION IS AN AFFILIATE OF SUTTER HEALTH WHICH UNDERWENT A SYSTEM-WIDE AUDIT. THE AUDIT REPORT DOES NOT INCLUDE A BAD DEBT EXPENSE FOOTNOTE. PROVISION FOR BAD DEBTS IS LISTED ON A SEPARATE LINE ITEM IN THE FINANCIAL STATEMENTS. THE AUDIT DOES INCLUDE FOOTNOTES FOR PATIENT ACCOUNTS RECEIVABLE AND PATIENT SERVICE REVENUES LISTED BELOW. PATIENT ACCOUNTS RECEIVABLE AUDIT FOOTNOTE: SUTTER'S PRIMARY CONCENTRATION OF CREDIT RISK IS PATIENT ACCOUNTS RECEIVABLE, WHICH CONSIST OF AMOUNTS OWED BY VARIOUS GOVERNMENTAL AGENCIES, INSURANCE COMPANIES AND PRIVATE PATIENTS. SUTTER MANAGES THE RECEIVABLES BY REGULARLY REVIEWING ITS PATIENT ACCOUNTS AND CONTRACTS AND BY PROVIDING APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE AMOUNTS. SIGNIFICANT CONCENTRATIONS OF GROSS PATIENT ACCOUNTS RECEIVABLE ARE AS FOLLOWS: MEDICARE 28% AS OF 12/31/10 27% AS OF 12/31/09 MEDI-CAL 20% AS OF 12/31/10 20% AS OF 12/31/09 DURING 2010 AND 2009, CERTAIN AFFILIATES COLLECTED ON ACCOUNTS THAT WERE PREVIOUSLY DEEMED UNCOLLECTIBLE AND RESERVED. SUCH RECOVERIES ARE RECOGNIZED IN THE PERIOD THAT CASH IS RECEIVED AND WERE NOT MATERIAL. DUE TO THE INHERENT VARIABILITY IN THIS AREA OF PATIENT RECEIVABLE COLLECTIONS, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM. PATIENT SERVICE REVENUES FOOTNOTE: PATIENT SERVICE REVENUES ARE REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT PROGRAMS WITH THIRD-PARTY PAYORS. ESTIMATED SETTLEMENTS UNDER THIRD-PARTY REIMBURSEMENT PROGRAMS ARE ACCRUED IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, PRIMARILY AS A RESULT OF FINAL COST REPORT SETTLEMENTS WITH GOVERNMENTAL AGENCIES. 2. METHODOLOGY FOR CALCULATING BAD DEBT (AT COST) THE RATIO OF PATIENT CARE COST TO CHARGES IS APPLIED TO THE BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS TO CALCULATE THE ESTIMATED COST OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS THAT IS REPORTED ON LINE 2. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE. 3. METHODOLOGY FOR DETERMINING THE AMOUNT OF BAD DEBT LIKELY ATTRIBUTABLE TO CHARITY CARE AMOUNTS MAY BE INCLUDED IN BAD DEBT PENDING A CHARITY CARE DETERMINATION. UPON ELIGIBILITY THESE AMOUNTS WOULD BE RECLASSIFIED AS CHARITY CARE.
PART III, QUESTION 7   MEDICARE COST REPORTS THAT THE ORGANIZATION FILES DO NOT INCLUDE ALL OF THE COSTS REQUIRED TO TREAT MEDICARE PATIENTS. THEREFORE THE AMOUNT REFLECTED ON THE COST REPORT WILL LIKELY DIFFER FROM ACTUAL COSTS WHICH MAY BE REFLECTED IN THE COMMUNITY BENEFIT REPORT AND ON THIS FORM.
PART III, QUESTION 8   COSTING METHODOLOGY MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST TO CHARGE RATIO. COMMUNITY BENEFIT MEDICARE SHORTFALL THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. CARING FOR MEDICARE PATIENTS FULFILLS A COMMUNITY NEED AND RELIEVES A GOVERNMENT BURDEN AS THESE PATIENTS TYPICALLY HAVE LOW AND/OR FIXED INCOMES. MEDICARE DOES NOT PROVIDE SUFFICIENT REIMBURSEMENT TO COVER THE COST OF PROVIDING CARE FOR THESE PATIENTS FORCING THE HOSPITAL TO USE OTHER FUNDS TO COVER THE DEFICIT OF $62,622,660.
PART III, QUESTION 9B   COLLECTION PRACTICES ARE CONSISTENT FOR ALL PATIENTS AND COMPLY WITH APPLICABLE PROVISIONS OF CALIFORNIA LAW. DURING PREADMISSION OR REGISTRATION, THE HOSPITAL PROVIDES ALL PATIENTS WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE. AN UNINSURED PATIENT WHO INDICATES THE FINANCIAL INABILITY TO PAY A BILL IS EVALUATED FOR FINANCIAL ASSISTANCE. PATIENTS WILL BE GIVEN AN APPLICATION WHICH WILL DOCUMENT THE PATIENT'S OVERALL FINANCIAL SITUATION. IF AN UNINSURED PATIENT DOES NOT COMPLETE THE APPLICATION FORM WITHIN 30 DAYS OF DELIVERY, THE HOSPITAL WILL NOTIFY THE PATIENT THAT THE APPLICATION HAS NOT BEEN RECEIVED AND WILL PROVIDE THE PATIENT AN ADDITIONAL 30 DAYS TO COMPLETE THE APPLICATION. IF A PATIENT HAS APPLIED FOR CHARITY CARE, HAS BEEN APPROVED TO RECEIVE CHARITY CARE, OR IS COOPERATING WITH THE HOSPITAL'S EFFORTS TO SETTLE AN OUTSTANDING BILL WITHIN A REASONABLE TIME PERIOD, THE HOSPITAL WILL NOT PURSUE COLLECTIONS.
NEEDS ASSESSMENT:   SUTTER WEST BAY HOSPITALS PARTICIPATE IN COLLABORATIVE NEEDS ASSESSMENT PROCESSES EVERY THREE YEARS, WHICH INCLUDES QUANTITATIVE AND QUALITATIVE DATA. AVAILABLE DATA FROM STATE AND COUNTY HEALTH OFFICES IS UTILIZED AS WELL AS COMMUNITY MEMBER INPUT THROUGH VARIOUS ADVISORY BOARDS. THE NEEDS ASSESSMENTS HELP TO FOCUS COMMUNITY BENEFIT EFFORTS TOWARD THE GREATEST HEALTH RELATED NEEDS.
PATIENT EDUCATION FOR ELIGIBILITY FOR ASSISTANCE:   SUTTER WEST BAY HOSPITALS FOLLOWS A SUTTER HEALTH SYSTEMWIDE CHARITY CARE POLICY, WHICH INCLUDES THE FOLLOWING DETAILS OF HOW PATIENT EDUCATION FOR ELIGIBILITY ASSISTANCE. COMMUNICATION OF FINANCIAL ASSISTANCE AVAILABILITY A. INFORMATION PROVIDED TO PATIENTS: 1. PREADMISSION OR REGISTRATION: DURING PREADMISSION OR REGISTRATION (OR AS SOON THEREAFTER AS PRACTICABLE) HOSPITAL AFFILIATES SHALL PROVIDE: A. ALL PATIENTS WITH INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES (IMPORTANT BILLING INFORMATION FOR UNINSURED PATIENTS) B. PATIENTS WHO THE HOSPITAL IDENTIFIES MAY BE UNINSURED WITH A FINANCIAL ASSISTANCE APPLICATION SUBSTANTIALLY SIMILAR TO THE SUTTER HEALTH STANDARDIZED FINANCIAL ASSISTANCE APPLICATION, "STATEMENT OF FINANCIAL CONDITION" 2. EMERGENCY SERVICES. IN THE CASE OF EMERGENCY SERVICES, HOSPITAL AFFILIATES SHALL PROVIDE THE ABOVE INFORMATION AS SOON AS PRACTICABLE AFTER STABILIZATION OF THE PATIENT'S EMERGENCY MEDICAL CONDITION OR UPON DISCHARGE. 3. ALL OTHER TIMES: UPON REQUEST, HOSPITAL AFFILIATES SHALL PROVIDE PATIENTS WITH INFORMATION ABOUT THEIR RIGHT TO REQUEST AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR SERVICES, THE SUTTER HEALTH STANDARDIZED FINANCIAL ASSISTANCE APPLICATION FORM, "STATEMENT OF FINANCIAL CONDITION" B. POSTINGS AND OTHER NOTICES: INFORMATION ABOUT FINANCIAL ASSISTANCE SHALL ALSO BE PROVIDED AS FOLLOWS: 1. BY POSTING NOTICES IN A VISIBLE MANNER IN LOCATIONS WHERE THERE IS A HIGH VOLUME OF INPATIENT OR OUTPATIENT ADMITTING/REGISTRATION, INCLUDING BUT NOT LIMITED TO THE EMERGENCY DEPARTMENT, BILLING OFFICES, ADMITTING OFFICE, AND OTHER HOSPITAL OUTPATIENT SERVICE SETTINGS. 2. BY POSTING INFORMATION ABOUT FINANCIAL ASSISTANCE ON THE SUTTER HEALTH WEBSITE AND EACH HOSPITAL AFFILIATE WEBSITE, IF ANY. 3. BY INCLUDING INFORMATION ABOUT FINANCIAL ASSISTANCE IN BILLS THAT ARE SENT TO UNINSURED PATIENTS. 4. BY INCLUDING LANGUAGE ON BILLS SENT TO UNINSURED PATIENTS AS SPECIFICALLY SET FORTH IN THE MANAGEMENT OF PATIENT ACCOUNTS RECEIVABLE, COLLECTION PRACTICES, HOSPITAL AFFILIATE THIRD-PARTY LIENS, AND AFFILIATE DISPUTE INITIATION POLICY (FINANCE POLICY 14-227). C. APPLICATIONS PROVIDED AT DISCHARGE: IF NOT PREVIOUSLY PROVIDED, HOSPITAL AFFILIATES SHALL PROVIDE UNINSURED PATIENTS WITH APPLICATIONS FOR MEDI-CAL, HEALTHY FAMILIES, CALIFORNIA CHILDREN'S SERVICES, OR ANY OTHER POTENTIALLY APPLICABLE GOVERNMENT PROGRAM AT THE TIME OF DISCHARGE. D. LANGUAGES: ALL NOTICES/COMMUNICATIONS PROVIDED IN THIS SECTION SHALL BE AVAILABLE IN THE PRIMARY LANGUAGE(S) OF THE AFFILIATE'S SERVICE AREA AND IN A MANNER CONSISTENT WITH ALL APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS. E. NOTIFICATION TO UNINSURED PATIENTS OF ESTIMATED FINANCIAL RESPONSIBILITY: BY LAW, UNINSURED PATIENTS ARE ENTITLED TO RECEIVE AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES. EXCEPT IN THE CASE OF EMERGENCY SERVICES, HOSPITAL AFFILIATES SHALL NOTIFY PATIENTS WHO THE HOSPITAL IDENTIFIES MAY BE UNINSURED PATIENTS THAT THEY MAY OBTAIN AN ESTIMATE OF THEIR FINANCIAL RESPONSIBILITY FOR HOSPITAL SERVICES, AND PROVIDE ESTIMATES TO THOSE PATIENTS UPON REQUEST. ESTIMATES SHALL BE WRITTEN, AND BE PROVIDED DURING NORMAL BUSINESS HOURS. ESTIMATES SHALL PROVIDE THE PATIENT WITH AN ESTIMATE OF THE AMOUNT THE HOSPITAL AFFILIATE WILL REQUIRE THE PATIENT TO PAY FOR THE HEALTH CARE SERVICES, PROCEDURES, AND SUPPLIES THAT ARE REASONABLY EXPECTED TO BE PROVIDED TO THE PATIENT BY THE HOSPITAL, BASED UPON THE AVERAGE LENGTH OF STAY AND SERVICES PROVIDED FOR THE PATIENT'S DIAGNOSIS.
COMMUNITY INFORMATION:   SUTTER WEST BAY HOSPITALS SERVES A DIVERSE GEOGRAPHICAL AREA SERVING BOTH URBAN AND RURAL AREAS. THE SERVICE AREA INCLUDES SAN FRANCISCO, THE EIGHTH DENSEST CITY IN THE UNITED STATES AND ALSO ONE OF THE MOST ETHNICALLY DIVERSE IN THE WORLD. IT ALSO INCLUDES LAKE COUNTY, A RURAL AREA WITH POCKETS OF IMPOVERISHED COMMUNITY MEMBERS, WHICH MAKES IT ONE OF THE 25 MOST IMPOVERISHED COUNTIES IN THE STATE. SUTTER WEST BAY HOSPITALS ALSO PROVIDES HEALTH CARE TO SONOMA AND MARIN COUNTIES, A MIX OF RURAL AND URBAN COMMUNITIES INCLUDING AREAS WHERE RESIDENTS FACE PARTICULAR CHALLENGES IN ACCESSING HEALTH CARE, BOTH GEOGRAPHICALLY AND SOCIOECONOMICALLY.
PROMOTION OF COMMUNITY HEALTH:   SUTTER HEALTH'S MISSION READS: WE ENHANCE THE WELL-BEING OF THE PEOPLE IN THE COMMUNITIES WE SERVE, THROUGH A NOT-FOR-PROFIT COMMITMENT TO COMPASSION AND EXCELLENCE IN HEALTH CARE SERVICES. SUTTER HEALTH'S MISSION REACHES BEYOND THE WALLS OF OUR CARE FACILITIES. OUR AFFILIATES FURTHER THEIR TAX EXEMPT PURPOSE BY: - BUILDING RELATIONSHIPS OF TRUST THROUGH WORKING COLLABORATIVELY WITH COMMUNITY GROUPS, SCHOOLS AND GOVERNMENT ORGANIZATIONS TO EFFECTIVELY LEVERAGE RESOURCES AND ADDRESS IDENTIFIED COMMUNITY NEEDS - SUPPORTING NONPROFIT ORGANIZATIONS THAT ARE COMMITTED TO COMMUNITY HEALTH IMPROVEMENT THROUGH FINANCIAL INVESTMENTS, IN-KIND SERVICES AND EMPLOYEE VOLUNTEERISM - PROVIDING GENEROUS CHARITY CARE POLICIES FOR OUR MOST VULNERABLE COMMUNITY MEMBERS EXAMPLES OF SUTTER WEST BAY HOSPITALS' SPECIFIC ACTIVITIES INCLUDE: - SAN FRANCISCO COUNTY: - PARTICIPATION IN HEALTHY SAN FRANCISCO, A HEALTH ACCESS PROGRAM FOR THE UNINSURED IN SAN FRANCISCO COUNTY - ST. LUKE'S HEALTH CARE CENTER AND HEALTH FIRST, CENTER AND PROGRAM FOCUSED ON REDUCING HEALTH DISPARITIES IN ADULT DIABETES AND PEDIATRIC ASTHMA - AFRICAN AMERICAN BREAST HEALTH AND SISTER-TO-SISTER BREAST HEALTH PROGRAMS AIMED AT REDUCING BREAST HEALTH DISPARITIES IN UNDERSERVED COMMUNITIES - KALMANOVITZ CHILD DEVELOPMENT CENTER, OFFERING MULTIDISCIPLINARY ASSESSMENT AND TREATMENT PROGRAMS TO HELP CHILDREN WITH SPECIAL NEEDS MEET THEIR POTENTIAL, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES - TRAINING PROGRAMS FOR PHYSICIANS, NURSES AND OTHER HEALTH PROFESSIONALS - COLLABORATION AND PARTNERSHIP WITH COMMUNITY-BASED PROGRAMS SUCH AS THE LIONS EYE FOUNDATION, SAN FRANCISCO PROJECT HOMELESS CONNECT, OPERATION ACCESS, AND THE HEP B FREE CAMPAIGN - LAKE COUNTY - MEDICAL CARE THROUGH A MOBILE HEALTH SERVICES UNIT SERVING THE UNDERSERVED IN REMOTE AREAS OF LAKE COUNTY - FREE MAMMOGRAMS FOR UNDERSERVED PATIENTS THROUGH THE MEDICAL IMAGING DEPARTMENT - CLINICAL TRAINING PROGRAMS FOR NURSES AND OTHER HEALTH PROFESSIONALS - MARIN COUNTY - HEALTH EXPRESS TRANSPORTATION TO MEDICAL APPOINTMENTS FOR SENIORS - ROTACARE CLINIC FOR THE UNINSURED - COMMUNITY DIABETES PROJECT FOCUSED ON PREVENTING TYPE 2 DIABETES IN AT-RISK YOUTHS - PARTICIPATION IN TEENS AND LEADERS CONNECT, A PROGRAM CONNECTING YOUTH AND COMMUNITY LEADERS THROUGH MENTORING RELATIONSHIPS - NOVATO YOUTH PARTNERSHIP, PROVIDING EPISODIC CARE FOR UNINSURED CHILDREN IN THE NOVATO UNIFIED SCHOOL DISTRICT - KALMANOVITZ CHILD DEVELOPMENT CENTER, MARIN COUNTY SATELLITE - SONOMA COUNTY - TRANSPORTATION TO MEDICAL APPOINTMENTS FOR INDIGENT PATIENTS AND THEIR FAMILIES - PARTICIPATION IN THE HEALTHY KIDS OF SONOMA PROGRAM - HEALTHCARE WORKFORCE DEVELOPMENT ROUNDTABLE/SUMMER CAREER INSTITUTE TO PROVIDE EXPOSURE TO AND PROMOTE CAREERS IN HEALTH CARE FOR UNDERSERVED YOUTH - FAMILY MEDICINE RESIDENCY PROGRAM AND PROFESSIONAL TRAINING/PRECEPTORSHIPS FOR OTHER HEALTH PROFESSIONALS - PARTICIPATION IN THE SONOMA COUNTY FLU CONSORTIUM TO PROVIDE FREE FLU VACCINES TO COMMUNITY - FREE CAFETERIA MEALS FOR INDIGENT PATIENTS AND FAMILIES, LOW-INCOME BREAST-FEEDING MOTHERS OF PEDIATRIC PATIENTS, ETC. - FREE PRESCRIPTION MEDICATIONS FOR INDIGENT PATIENTS - PARTICIPATION IN ANNUAL LATINO HEALTH FORUM - PARTICIPATION BY HOSPITAL LEADERS IN LOCAL NON-PROFIT BOARDS AND COMMITTEES (E.G., AMERICAN HEART ASSOCIATION, AMERICA RED CROSS, CENTER FOR WELL BEING, SANTA ROSA JUNIOR COLLEGE TECH PROGRAM) - DONATIONS OF MEDICATIONS TO THIRD WORLD COUNTRIES - ALL WEST BAY REGION COUNTIES - PARTICIPATION IN LOCAL COMMUNITY HEALTH COLLABORATIVE TO DETERMINE COMMUNITY HEALTH NEEDS - CASH SPONSORSHIPS FOR COMMUNITY ORGANIZATIONS AND THEIR EVENTS - HEALTH EDUCATION MATERIALS AND CLASSES FOR THE COMMUNITY - DONATION OF MEETING SPACE TO COMMUNITY ORGANIZATIONS
AFFILIATED HEALTH CARE SYSTEM:   SUTTER WEST BAY HOSPITALS IS PART OF SUTTER HEALTH, A NOT-FOR-PROFIT SYSTEM OF PHYSICIANS, HOSPITALS AND OTHER HEALTH CARE PROVIDERS. SERVING PATIENTS AND THEIR FAMILIES IN MORE THAN 100 NORTHERN CALIFORNIA CITIES AND TOWNS, SUTTER HEALTH AFFILIATES JOIN RESOURCES AND SHARE EXPERTISE TO ADVANCE HEALTH CARE QUALITY AND ACCESS. SUTTER-AFFILIATED HOSPITALS ARE REGIONAL LEADERS IN CARDIAC CARE, WOMEN'S AND CHILDREN'S SERVICES, CANCER CARE, ORTHOPEDICS, AND ADVANCED PATIENT SAFETY TECHNOLOGY. SUTTER HEALTH HOSPITALS PLAN AND DELIVER COMMUNITY BENEFIT SERVICES LOCALLY WITH A FOCUS ON COLLABORATING WITHIN THEIR COMMUNITY TO MEET IDENTIFIED NEEDS. IN 2010, SUTTER HEALTH AFFILIATES PROVIDED $751 MILLION IN SERVICES TO THE POOR* AND BROADER COMMUNITY**. SUTTER HEALTH FOLLOWS THE NATIONAL STANDARDS FOR COMMUNITY BENEFIT REPORTING AS OUTLINED IN CHA'S A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT 2008. * SERVICES FOR THE POOR AND UNDERSERVED INCLUDE SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR ARE UNINSURED OR UNDERINSURED, AS WELL AS THE COSTS OF PUBLIC PROGRAMS TREATING MEDI-CAL AND INDIGENT BENEFICIARIES. COSTS ARE COMPUTED BASED ON A RELATIONSHIP OF COSTS TO CHARGES. SERVICES FOR THE POOR AND UNDERSERVED ALSO INCLUDE THE COST OF OTHER SERVICES FOR INDIGENT POPULATIONS, AND CASH DONATIONS ON BEHALF OF THE POOR AND NEEDY. ** BENEFITS FOR THE BROADER COMMUNITY INCLUDE COSTS OF PROVIDING THE FOLLOWING SERVICES: HEALTH SCREENINGS AND OTHER HEALTH-RELATED SERVICES, TRAINING HEALTH PROFESSIONALS, EDUCATING THE COMMUNITY WITH VARIOUS SEMINARS AND CLASSES, THE COST OF PERFORMING MEDICAL RESEARCH AND THE COSTS ASSOCIATED WITH PROVIDING FREE CLINICS AND COMMUNITY SERVICES. BENEFITS FOR THE BROADER COMMUNITY ALSO INCLUDE CONTRIBUTIONS SUTTER HEALTH MAKES TO COMMUNITY AGENCIES TO FUND CHARITABLE ACTIVITIES.
STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI CA,
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number
94-0562680
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) AMERICAN HEART ASSOCIATION100 MONTGOMERY ST
SAN FRANCISCO,CA94104 		13-5613797 501(C)(3) 20,000       GENERAL DONATION
(2) APA FAMILY SERVICES657 JACKSON ST
SAN FRANCISCO,CA94133 		94-3164091 501(C)(3) 25,750       GENERAL DONATION
(3) ASIAN & PACIFIC ISLANDER WELLNESS CENTER730 POLK ST
SAN FRANCISCO,CA94109 		94-2897258 501(C)(3) 27,500       GENERAL DONATION
(4) ASIAN WEEK FOUNDATION564 MARKET ST 320
SAN FRANCISCO,CA94104 		20-1719535 501(C)(3) 40,000       GENERAL DONATION
(5) BAYVIEW HUNTER'S POINT MULTIPURPOSE SR SVCS1706 YOSEMITE
SAN FRANCISCO,CA94124 		94-8264774 501(C)(3) 43,000       GENERAL DONATION
(6) CHINESE AMERICAN VOTERS838 GRANT ST
SAN FRANCISCO,CA94108 		94-2502267 501(C)(3) 14,000       GENERAL DONATION
(7) CLINIC BY THE BAY4877 MISSION ST
SAN FRANCISCO,CA94112 		26-2593712 501(C)(3) 25,000       GENERAL DONATION
(8) COMMUNITY CENTER PROJECT OF SAN FRANCISCO1800 MARKET ST
SAN FRANCISCO,CA94102 		94-3236718 501(C)(3) 15,000       GENERAL DONATION
(9) COMMUNITY CHAPLAINCY INCPO BOX 38631
SACRAMENTO,CA95838 		20-0241444 501(C)(3) 10,000       GENERAL DONATION
(10) COMMUNITY INITIATIVES354 PINE ST
SAN FRANCISCO,CA94104 		94-3255070 501(C)(3) 8,000       GENERAL DONATION
(11) CURRY SENIOR CENTER333 TURK ST
SAN FRANCISCO,CA94102 		23-7362588 501(C)(3) 20,000       GENERAL DONATION
(12) EPISCOPAL CHARITIES1055 TAYLOR ST
SAN FRANCISCO,CA94108 		94-3345498 501(C)(3) 25,000       GENERAL DONATION
(13) GLIDE330 ELLIS ST
SAN FRANCISCO,CA94112 		36-2167731 501(C)(3) 10,000       GENERAL DONATION
(14) HOSPITAL COUNCIL OF CENTRAL AND NORTHERN CA1625 E SHAW AVE
FRESNO,CA93710 		86-1174825 501(C)(3) 59,000       GENERAL DONATION
(15) INSTITUTO LABORAL DE LA RAZA2947 16TH ST
SAN FRANCISCO,CA94103 		94-2890401 501(C)(3) 12,000       GENERAL DONATION
(16) KIMOCHI1715 BUCHANAN ST
SAN FRANCISCO,CA94115 		23-7117402 501(C)(3) 25,000       GENERAL DONATION
(17) LAGUNA HONDA HOSPITAL731 B LIGGETT AVE
SAN FRANCISCO,CA94129 		94-6065339 501(C)(3) 27,500       GENERAL DONATION
(18) LATINA BREAST CANCER AGENCY6 MONTEREY BLVD
SAN FRANCISCO,CA94131 		01-0628124 501(C)(3) 35,000       GENERAL DONATION
(19) LIONS EYE FOUNDATONPO BOX 7999
SAN FRANCISCO,CA94120 		94-1676055 501(C)(3) 15,400       GENERAL DONATION
(20) LIVABLE CITY995 MARKET ST 1550
SAN FRANCISCO,CA94103 		94-3350190 501(C)(3) 10,000       GENERAL DONATION
(21) MARCH OF DIMES1050 SANSOME ST
SAN FRANCISCO,CA94111 		13-1846366 501(C)(3) 27,000       GENERAL DONATION
(22) MISSION NEIGHBORHOOD CENTER240 SHOTWELL ST
SAN FRANCISCO,CA94131 		94-1408150 501(C)(3) 10,000       GENERAL DONATION
(23) NAACP1290 FILLMORE ST
SAN FRANCISCO,CA94115 		23-7177411 501(C)(3) 20,000       GENERAL DONATION
(24) PATIENT ASSISTANCE FOUNDATION2100 WEBSTER ST
SAN FRANCISCO,CA94115 		94-3096109 501(C)(3) 500,000       GENERAL DONATION
(25) SAN FRANCISCO CLINIC CONSORTIUM1550 BRYANT ST
SAN FRANCISCO,CA94103 		94-2897258 501(C)(3) 14,000       GENERAL DONATION
(26) SAN FRANCISCO CLINIC CONSORTIUM1550 BRYANT ST
SAN FRANCISCO,CA94103 		13-4317995 501(C)(3) 9,000       GENERAL DONATION
(27) SAN FRANCISCO FOOD BANK900 PENNSYLVANIA
SAN FRANCISCO,CA94107 		94-3041517 501(C)(3) 17,500       GENERAL DONATION
(28) SAN FRANCISCO INTERFAITH COUNCILPO BOX 29055
SAN FRANCISCO,CA94129 		94-3152098 501(C)(3) 10,000       GENERAL DONATION
(29) SAN FRANCISCO SENIOR CENTER890 BEACH ST
SAN FRANCISCO,CA94109 		94-1212136 501(C)(3) 60,000       GENERAL DONATION
(30) SELF HELP FOR THE ELDERLY407 SANSOME ST
SAN FRANCISCO,CA94118 		94-1750717 501(C)(3) 10,000       GENERAL DONATION
(31) SF CHAMBER OF COMMERCE235 MONTGOMERY ST
SAN FRANCISCO,CA94104 		94-0834950 501(C)(6) 10,000       GENERAL DONATION
(32) SF PROJECT HOMELESS CONNECT25 VAN NESS 340
SAN FRANCISCO,CA94102 		20-4331462 501(C)(3) 10,000       GENERAL DONATION
(33) SOUTH OF MARKET HEALTH CENTER551 MINNA ST
SAN FRANCISCO,CA94103 		23-7304921 501(C)(3) 31,906       GENERAL DONATION
(34) SPUR654 MISSION ST
SAN FRANCISCO,CA94105 		94-2502267 501(C)(3) 10,000       GENERAL DONATION
(35) ST ANTHONY'S FOUNDATION150 GOLDEN GATE AVE
SAN FRANCISCO,CA94102 		94-1513140 501(C)(3) 90,000       GENERAL DONATION
(36) TENDERLOIN NEIGHBORHOOD DEVELOPMENT CORP201 EDDY ST
SAN FRANCISCO,CA94102 		94-2761808 501(C)(3) 10,000       GENERAL DONATION
(37) UC BERKELEY SCHOOL OF PUBLIC HEALTH417 UNIVERSITY HALL
BERKELEY,CA94720 		94-6090626 501(C)(3) 50,000       GENERAL DONATION
(38) UNITED WAY1208 MASON ST
SAN FRANCISCO,CA94108 		94-1312348 501(C)(3) 8,000       GENERAL DONATION
(39) WOMEN'S COMMUNITY CLINIC2166 HAYES ST 104
SAN FRANCISCO,CA94117 		94-3213100 501(C)(3) 65,000       GENERAL DONATION
(40) HEALTHY MARIN PARTNERSHIP99 MONTECILLO RD
SAN RAFAEL,CA94903 		94-1312348 501(C)(3) 25,000       GENERAL DONATION
(41) HOMEWARD BOUND OF MARIN1385 HAMILTON PKY
NOVATO,CA94949 		68-0011405 501(C)(3) 7,167       GENERAL DONATION
(42) ROTACARE CLINIC OF SAN RAFAELPO BOX 6316
SAN RAFAEL,CA94903 		77-0328723 501(C)(3) 10,000       GENERAL DONATION
(43) AMERICAN HEART ASSOCIATION1400 N DUTTON AVE
SANTA ROSA,CA95401 		13-5613797 501(C)(3) 12,500       GENERAL DONATION
(44) NORTHERN CALIFORNIA CENTER FOR WELL-BEING365 TESCONI CIRCLE
SANTA ROSA,CA95401 		93-1144835 501(C)(3) 50,000       GENERAL DONATION
(45) SONOMA COUNTY DEPT OF HEALTH3313 CHANATE RD
SANTA ROSA,CA95404 		94-6000539 501(C)(3) 50,000       GENERAL DONATION
(46) SANTA ROSA MEMORIAL HOSPITAL1164 MONTGOMERY DR
SANTA ROSA,CA95402 		94-1231005 501(C)(3) 18,750       GENERAL DONATION
(47) SOUTHWEST COMMUNITY HEALTH CENTERS3569 ROUND BARN CIRCLE
SANTA ROSA,CA95403 		68-0365296 501(C)(3) 6,400       GENERAL DONATION
(48) MENDOCINO LAKE COMMUNITY COLLEGE1000 HENSLEY CREEK RD
UKIAH,CA95482 		94-6002711 501(C)(3) 20,000       GENERAL DONATION
2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
48
3
Enter total number of other organizations ................................ . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS PART I, QUESTION 2 COMMUNITY HEALTH PROGRAM GRANTEES SIGN A CONTRACT WITH CALIFORNIA PACIFIC MEDICAL CENTER OUTLINING TERMS AND CONDITIONS OF RECEIVING GRANT FUNDS SPECIFYING OBJECTIVES AND OUTCOMES. EACH AGENCY RECEIVING THE COMMUNITY HEALTH GRANTS ARE REQUIRED TO PREPARE AND SUBMIT OUTCOME-BASED REPORTS AT SIX-MONTHS AND TWELVE-MONTHS. AGENCIES RECEIVING SPONSORSHIP FUNDS GO THROUGH A DIFFERENT PROCESS; THEY ARE REQUESTED TO PROVIDE THE PURPOSE OF THE EVENT PRIOR TO SPONSORSHIP AS WELL AS A BRIEF SUMMARY OF THE OUTCOMES OF EVENT SOON AFTER THE EVENT. THE SUTTER HEALTH SYSTEM HAS AN OVERLAP IN LEADERSHIP WHICH MONITORS THE USE OF GRANTS BETWEEN AFFILIATES.
Schedule I (Form 990) 2010


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) JACK BAILEY (i)
(ii)		 111,540
0 		148,582
0 		637,762
0 		0
0 		20,662
0 		918,546
0 		0
0
(2) TONI BRAYER MD (i)
(ii)		 0
423,512 		0
151,767 		0
1,565 		0
157,508 		0
16,674 		0
751,026 		0
152,905
(3) MARTIN BROTMAN MD (i)
(ii)		 0
1,517,694 		0
1,006,400 		0
11,830 		0
1,734,000 		0
17,747 		0
4,287,671 		0
667,161
(4) WARREN BROWNER MD (i)
(ii)		 0
531,947 		0
228,195 		0
10,150 		0
427,558 		0
15,304 		0
1,213,154 		0
161,566
(5) GRANT DAVIES (i)
(ii)		 0
453,400 		0
164,984 		0
6,008 		0
168,636 		0
16,773 		0
809,801 		0
130,427
(6) MICHAEL DUNCHEON (i)
(ii)		 0
220,105 		0
41,911 		0
3,418 		0
75,667 		0
11,040 		0
352,141 		0
0
(7) PAT FRY (i)
(ii)		 0
1,450,576 		0
1,233,950 		0
15,110 		0
2,058,620 		0
30,292 		0
4,788,548 		0
973,771
(8) JOHN GATES (i)
(ii)		 0
507,458 		0
172,170 		0
48,530 		0
386,982 		0
12,955 		0
1,128,095 		0
0
(9) LINDA ISAACS (i)
(ii)		 0
287,151 		0
110,600 		0
5,181 		0
112,702 		0
6,414 		0
522,048 		0
81,148
(10) ALLAN PONT MD (i)
(ii)		 0
428,484 		0
83,236 		0
7,026 		0
93,041 		0
5,825 		0
617,612 		0
0
(11) CHRISTOPHER WILLRICH (i)
(ii)		 0
310,405 		0
112,420 		0
461 		0
113,858 		0
16,527 		0
553,671 		0
82,623
(12) SEAN TOWNSEND (i)
(ii)		 253,847
0 		424,850
0 		73,244
0 		428
0 		16,561
0 		768,930
0 		0
0
(13) STEVEN CUMMINGS (i)
(ii)		 452,077
0 		37,899
0 		2,376
0 		428
0 		26,493
0 		519,273
0 		0
0



Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
RELEVANT INFORMATION REGARDING COMPENSATION ITEMS PART I, QUESTION 1A DISCRETIONARY SPENDING ACCOUNT: EXECUTIVES AND KEY EMPLOYEES PAID BY SUTTER WEST BAY HOSPITALS (FKA CPMC) RECEIVE UP TO $12,000 PER YEAR IN NON-ACCOUNTABLE DOLLARS THAT ARE ADDED TO THEIR COMPENSATION AS TAXABLE WAGES. HOUSING ALLOWANCE: NEW EMPLOYEES RELOCATING FROM OUT OF THE AREA MAY RECEIVE TEMPORARY HOUSING BENEFITS WHICH ARE ADDED TO THEIR COMPENSATION AS TAXABLE WAGES. FIRST-CLASS TRAVEL: OFFICERS PAID BY SUTTER HEALTH MAY UPGRADE TO FIRST-CLASS TRAVEL FOR FLIGHTS GREATER THAN FOUR HOURS IN DURATION. TRAVEL FOR COMPANIONS: OFFICERS AND KEY EMPLOYEES PAID BY SUTTER HEALTH ARE ELIGIBLE TO BRING A COMPANION ON ONE BUSINESS TRIP PER CALENDAR YEAR AND HAVE THE COST OF THE AIRFARE AND MEALS PAID FOR BY SUTTER HEALTH. THE COST IS ADDED TO EMPLOYEE'S WAGES. TAX INDEMNIFICATION: STANDARD POLICY FOR ALL SUTTER HEALTH EMPLOYEES IS THAT NON-CASH GIFTS AND AWARDS ARE GROSSED-UP FOR TAX PURPOSES. THE AMOUNT OF THE GROSS-UP IS ADDED TO THE EMPLOYEE'S WAGES.
SUPPLEMENTAL COMPENSATION INFORMATION PART I, QUESTION 3 THE CEO OF THE ORGANIZATION IS AN EMPLOYEE OF SUTTER HEALTH. THE COMPENSATION COMMITTEE OF THE SUTTER HEALTH BOARD OF DIRECTORS RETAINS ULTIMATE DISCRETIONARY AUTHORITY OVER ALL ELEMENTS OF COMPENSATION TO ASSURE THAT ORGANIZATIONAL PURPOSES ARE APPROPRIATELY BEING SERVED. THE COMPENSATION COMMITTEE USES CREDIBLE DATA SOURCES AND MAINTAINS AN OBJECTIVE "ARMS LENGTH" DECISION-MAKING PROCESS, ENSURING THE INTEGRITY OF SUTTER'S EXECUTIVE PROGRAMS AND CONSISTENCY WITH THE ORGANIZATION'S OVERALL MISSION.
SEVERANCE PAYMENTS PART I, QUESTION 4A NAME: JACK BAILEY PAYMENT: $577,240
NONQUALIFIED RETIREMENT PLAN PART I, QUESTION 4B THE PURPOSE OF THE NONQUALIFIED RETIREMENT PLAN IS TO PROVIDE ADDITIONAL DEFERRED COMPENSATION BENEFITS TO THE PARTICIPANTS, WHO ARE MEMBERS OF A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES, BY PROVIDING FOR THE PAYMENT OF DEFERRED COMPENSATION AFTER THE COMPLETION OF THE SPECIFIED NUMBER OF YEARS OF SERVICE. ANNUALLY, SUTTER HEALTH MAKES A CONTRIBUTION TO EACH PARTICIPANT'S ACCOUNT BASED ON 4% OF BASE PAY. THERE IS AN ADDITIONAL CONTRIBUTION FOR EXECUTIVES WHOSE PENSION ELIGIBLE EARNINGS WERE GREATER THAN THE PENSION PAY CAP IN THE PREVIOUS YEAR. THE CALCULATION IS AS FOLLOWS: * PENSION ELIGIBLE EARNINGS * LESS PENSION PAYCAP AMOUNT * TIMES A SPECIFIC % BASED ON YEARS OF SERVICE THE PENSION RESTORATION PLAN IS DESIGNED TO HELP MAXIMIZE EACH PARTICIPANT'S RETIREMENT POTENTIAL BY PROVIDING A TARGETED BENEFIT THAT, ALONG WITH EACH PARTICIPANT'S OTHER RETIREMENT INCOME, PROVIDES: * 65% OF FINAL 4-YEAR AVERAGE SALARY IF PARTICIPANT RETIRES AT AGE 65 WITH 22.5 YEARS OF SERVICE. * 50% OF FINAL 4-YEAR AVERAGE SALARY IF PARTICIPANT RETIRES AT AGE 65 WITH 15 YEARS OF SERVICE. SINCE IT IS A TARGETED BENEFIT, ANNUAL CONTRIBUTION AMOUNTS VARY BASED ON ASSUMPTIONS MADE TAKING INTO ACCOUNT EACH PARTICIPANTS' AGE, YEARS OF SERVICE, AND OTHER RETIREMENT ACCOUNT BALANCES. NAME AND AMOUNT FOR 2010: MARTIN BROTMAN MD $1,370,936 WARREN BROWNER MD $231,800 JOHN GATES $267,700 PAT FRY $1,127,856 GRANT DAVIES $29,500 TONI BRAYER $26,900 LINDA ISAACS $19,200 CHRISTOPHER WILLRICH $19,600
NON-FIXED PAYMENTS PART I, QUESTION 7 SPOT AWARDS ARE INFREQUENTLY USED TO REWARD EMPLOYEES. THERE ARE NO SPECIFIC GUIDELINES FOR THE AMOUNT OF THE SPOT AWARD BUT THE AMOUNT TENDS TO NOT EXCEED 5% OF GROSS PAY. ANNUAL INCENTIVE PLAN (AIP) THE PURPOSE OF THE PLAN IS TO FOCUS EXECUTIVES ON SPECIFIC, SHORTER-TERM GOALS THAT ARE CRITICAL TO THE ACHIEVEMENT OF AFFILIATE, REGION, AND SYSTEM-WIDE OBJECTIVES THAT DRIVE OVERALL ORGANIZATION PERFORMANCE. A PORTION OF THE PLAN AWARD IS DISCRETIONARY IN THAT THE SUPERVISOR MAY ADD +/- 5% TO THE AWARD PROVIDED THE TOTAL AWARD (FORMULA PORTION PLUS DISCRETIONARY) DOES NOT EXCEED THE MAXIMUM ESTABLISHED FOR ANY GIVEN EXECUTIVE. LONG TERM PERFORMANCE PLAN (LTPP) Sutter Health also employs long term performance plans which are designed to focus on longer term strategic objectives of the organization. Sutters long term performance plan approach is a combination of both longer term measures of organization success and key organization strategies which require the combined effort of all leadership to achieve success. Sutter uses a common fate approach in that all plan participants are measured against the same, organization wide criteria vs. individual efforts. This fosters a common purpose across leadership and a shared sense of accountability for the overall success of Sutter Health. To ensure that extraordinary efforts by individuals can be recognized and that actions of leadership are consistent with supporting Sutter Healths overall Mission, Vision, and Values, Sutters long term incentive plan approach also incorporates a CEO discretionary component. This unique feature allows the President & CEO the ability to modify individual awards within limits that have been pre-approved by the Sutter Health Compensation Committee. This includes both the reduction and increase of award amounts. Such modifications generally do not exceed +/- 20% and are employed judiciously and are reviewed by the Compensation Committee.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number
94-0562680
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A CHFFA 2007A
  		52-1643828 13033FQ37 05-01-2007 153,078,860 CONSTRUCT & EQUIP FACILITY   X   X   X
B CHFFA 2008A
  		52-1643828 13033F2L3 05-14-2008 55,943,275 REFUNDING - 5/1/07   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . . 10,342,803 10,342,803    
2 Amount of bonds defeased . . . .        
3 Total proceeds of issue . . . . 165,813,667 55,943,275    
4 Gross proceeds in reserve funds . .        
5 Capitalized interest from proceeds. 12,950,607      
6 Proceeds in refunding escrow. . . . .        
7 Issuance costs from proceeds . . .        
8 Credit enhancement from proceeds.        
9 Working capital expenditures from proceeds . .        
10 Capital expenditures from proceeds . . 126,970,348      
11 Other spent proceeds . .        
12 Other unspent proceeds. . .        
13 Year of substantial completion . . . 2011
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue?   X X          
15 Were the bonds issued as part of an advance refunding issue?   X   X        
16 Has the final allocation of proceeds been made? . . X   X          
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X   X          
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . X              
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use? X              
b Are there any research agreements that may result in private business use of bond-financed property? . .   X            
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? . X              
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet 3.940 % 0.370 %    
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet 0 % 0 %    
6 Total of lines 4 and 5 . . .. . . . . . 3.940 % 0.370 %    
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? X   X          
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X        
2 Is the bond issue a variable rate issue?   X   X        
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   X   X        
b Name of provider .  
  		 
  		 
  		 
 
c Term of hedge . .        
d Was the hedge superintegrated? .                
e Was a hedge terminated? .                
4a Were gross proceeds invested in a GIC? .   X   X        
b Name of provider .  
  		 
  		 
  		 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? . X     X        
6 Did the bond issue qualify for an exception to rebate? . . .   X   X        
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
SEE SCHEDULE O    
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) DAMIAN AUGUSTYN MD DIRECTOR 155,412 SEE PART V   No
(2) DAMIAN AUGUSTYN MD DIRECTOR 435,445 SEE PART V   No
(3) MARTIN BROTMAN MD DIRECTOR 155,412 SEE PART V   No
(4) MARTIN BROTMAN MD DIRECTOR 435,445 SEE PART V   No
(5) MARTIN BROTMAN MD DIRECTOR 45,967 SEE PART V   No
(6) JORDAN HOROWITZ MD DIRECTOR 148,503 SEE PART V   No
(7) TERRI SLAGLE DIRECTOR 1,778,986 SEE PART V   No
(8) ROY EISENHARDT DIRECTOR 6,310,855 SEE PART V   No
(9) JAMES PALLESCHI MD DIRECTOR 237,420 SEE PART V   No
(10) STEVEN LEVENBERG DO DIRECTOR 237,420 SEE PART V   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
DESCRIPTION OF BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV DAMIAN AUGUSTYN, MD, DIRECTOR & CHIEF OF STAFF OF SUTTER WEST BAY HOSPITALS (SWBH), WAS ALSO A SHAREHOLDER OF PACIFIC INTERNAL MEDICINE ASSOCIATES (PIMA). DURING THE YEAR, PIMA PROVIDED SERVICES TO SWBH VIA AN ARMS-LENGTH AGREEMENT. DAMIAN AUGUSTYN, MD, DIRECTOR & CHIEF OF STAFF OF SUTTER WEST BAY HOSPITALS (SWBH), WAS ALSO A GENERAL PARTNER AND BOARD MEMBER OF PANMED PROPERTIES, LLP. DURING THE YEAR, SWBH OWNED 5.48% IN PANMED WHO PROVIDED RENTAL SERVICES TO SWBH. MARTIN BROTMAN, MD, DIRECTOR & PRESIDENT/CEO OF SUTTER WEST BAY HOSPITALS (SWBH), WAS ALSO A SHAREHOLDER OF PACIFIC INTERNAL MEDICINE ASSOCIATES (PIMA). DURING THE YEAR, PIMA PROVIDED SERVICES TO SWBH VIA AN ARMS-LENGTH AGREEMENT. MARTIN BROTMAN, MD, DIRECTOR & PRESIDENT/CEO OF SUTTER WEST BAY HOSPITALS (SWBH), WAS ALSO A GENERAL PARTNER AND BOARD MEMBER OF PANMED PROPERTIES, LLP. DURING THE YEAR, SWBH OWNED 5.48% IN PANMED WHO PROVIDED RENTAL SERVICES TO SWBH. MARTIN BROTMAN, MD, DIRECTOR & PRESIDENT/CEO OF SUTTER WEST BAY HOSPITALS (SWBH), HAS A SON WHO WORKED AS A LICENSED STAFF CHILDCARE WORKER IN SWBH'S CHILD DEVELOPMENT CENTER. JORDAN HOROWITZ, MD, DIRECTOR OF SUTTER WEST BAY HOSPITALS (SWBH) WAS ALSO A SHAREHOLDER PHYSICIAN IN CALIFORNIA PACIFIC MEDICAL GROUP (CPMG). DURING THE YEAR, CPMG PROVIDED SERVICES TO SWBH VIA AN ARMS-LENGTH AGREEMENT. TERRI SLAGLE, DIRECTOR OF SUTTER WEST BAY HOSPITALS (SWBH) WAS ALSO A SHAREHOLDER PHYSICIAN OF PEDIATRIX MEDICAL GROUP. DURING THE YEAR, PEDIATRIX MEDICAL GROUP PROVIDED SERVICES TO SWBH VIA AN ARMS-LENGTH AGREEMENT. ROY EISENHARDT, DIRECTOR OF SUTTER WEST BAY HOSPITALS (SWBH) IS A PARTIAL OWNER OF PROPERTY THAT IS RENTED TO SWBH. JAMES PALLESCHI, MD, DIRECTOR OF SUTTER WEST BAY HOSPITALS (SWBH) WAS ALSO A SHAREHOLDER PHYSICIAN IN SUTTER MEDICAL GROUP OF THE REDWOODS (SMGR). DURING THE YEAR, SMGR PROVIDED SERVICES ENTERED INTO VIA AN ARMS-LENGTH AGREEMENT. STEVEN LEVENBERG DO, DIRECTOR OF SUTTER WEST BAY HOSPITALS (SWBH) WAS ALSO PRESIDENT AND SHAREHOLDER PHYSICIAN IN SUTTER MEDICAL GROUP OF THE REDWOODS. DURING THE YEAR, SMGR PROVIDED SERVICES TO SWBH VIA AN ARMS-LENGTH AGREEMENT.
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
Identifier Return Reference Explanation
MISSION STATEMENT FORM 990, PART I, LINE 1 AND PART III, LINE 1 WE ENHANCE THE WELL BEING OF PEOPLE IN THE COMMUNITIES WE SERVE THROUGH OUR COMMITMENT TO COMPASSION, EXCELLENCE, INNOVATION AND A FULL CONTINUM OF HEALTH CARE SERVICES.
EXEMPT PURPOSE ACHIEVEMENTS FORM 990, PART III, LINE 4A GENERAL DESCRIPTION SUTTER WEST BAY HOSPITALS WAS FORMED IN JANUARY 1, 2010. IT CONSISTS OF FOUR HOSPITALS-CALIFORNIA PACIFIC MEDICAL CENTER, NOVATO COMMUNITY HOSPITAL, SUTTER MEDICAL CENTER SANTA ROSA, AND LAKESIDE HOSPITAL. CALIFORNIA PACIFIC MEDICAL CENTER (CPMC) IS ONE OF THE LARGEST PRIVATE, COMMUNITY BASED, NOT-FOR-PROFIT, TEACHING MEDICAL CENTERS IN CALIFORNIA. CPMC IS A TERTIARY REFERRAL CENTER PROVIDING ACCESS TO LEADING EDGE MEDICINE WHILE DELIVERING THE BEST POSSIBLE PERSONALIZED CARE. IT PROVIDES A WIDE VARIETY OF SERVICES, INCLUDING ACUTE, POST-ACUTE AND OUTPATIENT HOSPITAL CARE; HOSPICE SERVICES; PREVENTIVE AND COMPLEMENTARY CARE; AND HEALTH EDUCATION. CPMC IS COMPRISED OF THE FOUR OLDEST HOSPITALS IN SAN FRANCISCO. THE DAVIES CAMPUS, FORMERLY DAVIES MEDICAL CENTER, WAS FOUNDED IN 1854 TO HELP SAN FRANCISCO'S GERMAN-SPEAKING IMMIGRANTS FIND WORK, SHELTER, FOOD, CLOTHING AND HEALTH CARE. THE PACIFIC CAMPUS WAS FOUNDED IN 1857 AND WAS THE FIRST MEDICAL SCHOOL IN THE AMERICAN WEST. THE CALIFORNIA CAMPUS WAS FOUNDED IN 1875 AS THE PACIFIC DISPENSARY FOR WOMEN AND CHILDREN, A HOSPITAL RUN BY WOMEN, FOR WOMEN. FINALLY, THE ST. LUKE'S CAMPUS HAS BEEN PROVIDING QUALITY HEALTH SERVICES TO ALL SAN FRANCISCANS FOR OVER 130 YEARS. TOGETHER THE DAVIES, CALIFORNIA, PACIFIC AND ST. LUKE'S CAMPUSES COMPRISE THE MEDICAL CENTER'S 1,258 LICENSED ACUTE CARE BEDS AND 25 RESIDENTIAL BEDS. NOVATO COMMUNITY HOSPITAL (NOVATO) HAS SERVED THE NORTHERN MARIN AND SOUTHERN SONOMA COMMUNITIES SINCE 1961. IN 1985, THE HOSPITAL BECAME AN AFFILIATE OF SUTTER HEALTH, A NOT-FOR-PROFIT NETWORK OF DOCTORS, HOSPITALS, AND OTHER HEALTHCARE SERVICE PROVIDERS. NOVATO FACILITY IS LOCATED AT 180 ROWLAND WAY AND IS A 47-BED ACUTE CARE HOSPITAL NOTED FOR ITS TECHNOLOGY AND PERSONALIZED CARE IN A BEAUTIFUL SETTING, WHICH IS CONDUCIVE TO HEALING. SUTTER MEDICAL CENTER OF SANTA ROSA (SMCSR) HAS A LONG HISTORY IN SONOMA COUNTY DATING BACK TO 1866 WHEN THE FIRST HOSPITAL OPENED. IN 1996, SMCSR BECAME AN AFFILIATE OF SUTTER HEALTH. SMCSR IS LICENSED TO OPERATE 135 BEDS. SUTTER LAKESIDE HOSPITAL (LAKESIDE) WAS FOUNDED IN 1945 AS A 30-BED PRIVATE FACILITY CALLED LAKESIDE COMMUNITY HOSPITAL. THE HOSPITAL WAS DONATED TO THE COMMUNITY IN 1966 AND A NON-PROFIT CORPORATION WAS FORMED. IN 1992, THE HOSPITAL AFFILIATED WITH SUTTER HEALTH AND CHANGED ITS NAME TO SUTTER LAKESIDE HOSPITAL. LAKESIDE IS A 25-BED CRITICAL ACCESS HOSPITAL. IT IS LOCATED IN RURAL LAKEPORT, CALIFORNIA AND IS ONE OF ONLY TWO HOSPITALS THAT SERVE THE 64,000 RESIDENTS OF LAKE COUNTY. IT PROVIDES A WIDE VARIETY OF SERVICES, INCLUDING ACUTE, POST-ACUTE AND OUTPATIENT HOSPITAL CARE; SURGICAL SERVICES; PREVENTIVE CARE; AND HEALTH EDUCATION. 2010 PATIENT ACTIVITY TOTAL ACUTE CARE DISCHARGES (INC. PSYCH, REHAB) 39,048 ER VISITS: IP (ADMITTED) 18,482 OP (DISCHARGED FROM ER) 120,878 TOTAL ER VISITS 139,360 DELIVERIES 8,404 TRANSPLANTS 298 SNF DISCHARGES 2,008 ALZHEIMER'S DISCHARGES 12 SUBACUTE DISCHARGES 101 SUTTER WEST BAY HOSPITALS MISSION STATEMENT WE ENHANCE THE WELL BEING OF PEOPLE IN THE COMMUNITIES WE SERVE THROUGH OUR COMMITMENT TO COMPASSION, EXCELLENCE, INNOVATION AND A FULL CONTINUUM OF HEALTH CARE SERVICES. CLINICAL PROGRAMS INCLUDE: - ASTHMA EDUCATION PROGRAM - BREAST FEEDING CENTERS - BREAST HEALTH CENTERS - CALIFORNIA PACIFIC MEDICAL CENTER RESEARCH INSTITUTE - CANCER RECOVERY PROGRAMS - COMING HOME HOSPICE - COMMUNITY BENEFITS PROGRAMS (DETAILED BELOW) - COMMUNITY HEALTH RESOURCE CENTER - COMPREHENSIVE STROKE CENTER - DIABETES EDUCATION PROGRAM - END-STAGE ORGAN FAILURE/TRANSPLANTATION PROGRAMS (HEART, KIDNEY, LIVER, LIVER/PANCREAS) - FORBES NORRIS MDA/ALDS CENTER - HAND CLINIC - HOSPITALIST PROGRAM - INSTITUTE FOR HEALTH AND HEALING - IRENE SWINDELLS ALZHEIMER'S RESIDENTIAL CARE CENTER - LION'S EYE CLINIC - MUSCULAR DYSTROPHY ASSOCIATION NEUROMUSCULAR CLINIC - PACIFIC VISION FOUNDATION - PALLIATIVE CARE PROGRAM - PEDIATRIC SPECIALTY SERVICES - REHABILITATION SERVICES (ACUTE AND OUTPATIENT) - SIBLING CENTER - SMITH KETTLEWELL EYE RESEARCH INSTITUTE (THEY ARE INDEPENDENT OF CPMC.) - SUB-ACUTE CARE PROGRAM - TELEMEDICINE SERVICE (STROKE) - VISITING NURSES AND HOSPICE OF SAN FRANCISCO - WHITNEY NEWBORN ICU FOLLOW-UP CLINIC - WOMEN'S HEALTH RESOURCE CENTER - WOMEN'S SERVICES CLINICAL SERVICE OFFERINGS INCLUDE: - AIDS & HIV SERVICES - ALZHEIMER'S - ARTHRITIS - BARIATRIC SURGERY SERVICES - CANCER SERVICES - CARDIOVASCULAR SERVICES - CLINICAL LABORATORY - COMPLEMENTARY MEDICINE - COMPREHENSIVE STROKE SERVICES - CRITICAL CARE SERVICES - DIABETES SERVICES (ADULT & PEDIATRIC) - DIAGNOSTIC SERVICES/LABORATORIES - DIALYSIS SERVICES - EMERGENCY SERVICES - EPILEPSY - GASTROENTEROLOGY DISEASE SERVICES - HOME HEALTH & HOSPICE - INTERVENTIONAL ENDOSCOPY SERVICES - KALMONOVITZ CHILD DEVELOPMENT CENTERS - MEDICAL TRANSPORT SERVICES - MICROSURGERY AND LIMB SALVAGE SERVICES - NEONATAL INTENSIVE CARE - NEUROLOGY - NEURO-ONCOLOGY SURGERY - NUCLEAR MEDICINE - NUTRITION AND WEIGHT MANAGEMENT - OBSTETRICS & GYNECOLOGY - OCCUPATIONAL HEALTH - OPHTHALMOLOGY - ORGAN TRANSPLANTATION - ORTHOPEDICS - OTOLARYNGOLOGY - OUTPATIENT CLINICS & SERVICES - PATHOLOGY - PEDIATRIC EMERGENCY DEPARTMENT - PEDIATRIC SERVICES/PROGRAMS - PERIOPERATIVE SERVICES (OR AND POST-ANESTHESIA RECOVERY UNIT) - PHARMACY - PHYSICAL MEDICINE & REHABILITATION SERVICES - PSYCHIATRY - RADIOLOGY & DIAGNOSTIC IMAGING - RESPIRATORY CARE - RESIDENCY TRAINING AND FELLOWSHIP PROGRAMS - SURGICAL SERVICES/AMBULATORY SURGERY - URGENT CARE CENTER - VENTRICULAR ASSIST DEVICE (VAD) PROGRAM - WOMEN'S HEALTH PROGRAMS - WOUND CARE NON-CLINICAL SERVICES INCLUDE: - ADMINISTRATIVE SERVICES - CHAPLAINCY SERVICES - CHARITY CARE PROGRAM - COMMUNITY HEALTH RESOURCE CENTER - CONTINUING MEDICAL EDUCATION - INTERPRETER SERVICES - PATIENT SERVICES - RESEARCH INSTITUTE - SURGICAL TRAINING CENTER - VOLUNTEER SERVICES - WEB NURSERY - CALIFORNIA PACIFIC MEDICAL CENTER FOUNDATION - NOVATO COMMUNITY HOSPITAL DEVELOPMENT OFFICE - SUTTER LAKESIDE FOUNDATION
EXEMPT PURPOSE ACHIEVEMENTS FORM 990, PART III, LINE 4A COMMUNITY BENEFITS THE FOUR MEDICAL CENTERS IN SUTTER WEST BAY HOSPITALS PLAY INTEGRAL ROLES IN PROVIDING DIRECT HEALTH CARE SERVICES AS WELL AS MONETARY GRANTS OR SPONSORSHIPS TO NON-PROFIT ORGANIZATIONS TO ADDRESS THE COMMUNITY HEALTH NEEDS OF VULNERABLE, UNDERINSURED, AND UNINSURED POPULATIONS IN THEIR COMMUNITIES. THE HOSPITALS' COMMUNITY BENEFIT REPRESENTATIVES WORK COLLABORATIVELY AND IN PARTNERSHIPS WITH A BROAD AND DIVERSE NETWORK OF COMMUNITY-BASED NON-PROFITS, CITY AND COUNTY AGENCIES, PHYSICIANS, AND NEIGHBORHOOD GROUPS TO IDENTIFY LOCAL NEEDS, FORMULATE COMMUNITY BENEFIT PLANS, AND TAKE APPROPRIATE FUNDING ACTIONS. WHILE SUTTER WEST BAY REGIONAL MANAGEMENT SETS OVERALL GOALS FOR COMMUNITY BENEFITS, EACH OF THE AFFILIATES MEDICAL CENTER ADMINISTRATORS ARE RESPONSIBLE FOR IDENTIFYING HOW LOCAL NEEDS ARE TO BE ADDRESSED. CALIFORNIA PACIFIC MEDICAL CENTER (CPMC) IN 2010, CPMC PROVIDED A TOTAL OF $161.2 MILLION IN COMMUNITY BENEFITS: $100.4 MILLION IN THE COSTS OF SERVICES AND CASH TO THE POOR AND UNDERSERVED IN SAN FRANCISCO; AND, $60.8 MILLION FOR THE COSTS OF SERVICES AND CASH TO THE BROADER COMMUNITY. CPMC IS A MEMBER OF THE SAN FRANCISCO CHARITY CARE PARTNERSHIP AND BETTER HEALTHY SAN FRANCISCO CONSORTIUMS LED BY THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH. THE CONSORTIUM CONSISTS OF REPRESENTATIVES FROM ALL OF THE CITY'S HOSPITALS AND OTHER HEALTHCARE-RELATED NON-PROFIT STAKEHOLDERS. CONSORTIUM MEMBERS CONDUCT A TRI-ANNUAL COMMUNITY NEEDS ASSESSMENT, AS REQUIRED BY THE STATE, AND COORDINATE EFFORTS TO ADDRESS THE CITY'S HEALTH DISPARITIES IN SPECIFIC AT-RISK NEIGHBORHOODS OR VULNERABLE POPULATIONS. YEAR 2010 IS THE LAST YEAR OF THE TRI-ANNUAL COMMUNITY NEEDS ASSESSMENT FOR THE 2008-2010 PERIOD. THE CONSORTIUM IDENTIFIED THREE PRIORITIES OF COMMUNITY HEALTH NEEDS; THESE PRIORITIES GUIDED CPMC'S COMMUNITY BENEFITS STRATEGY: 1. ACCESS CPMC MANAGES OR FUNDS MANY PROGRAMS FOCUSED ON IMPROVING ACCESS TO CARE, INCLUDING THE FOLLOWING: - AFRICAN AMERICAN BREAST HEALTH PROGRAM (CANCER SCREENING & PREVENTION) - BAYVIEW CHILD HEALTH CENTER (PRIMARY CARE FOR LOW-INCOME CHILDREN) - LIONS EYE CLINIC (OUTPATIENT COMPLEX EYE SERVICES FOR LOW-INCOME INDIVIDUALS) 2. CHRONIC DISEASES CPMC FUNDS CHRONIC DISEASE AND HEALTHY LIVING PROGRAMS FOR LOW INCOME POPULATIONS, INCLUDING THE FOLLOWING: - HEALTH CHAMPIONS AT DEMARILLAC ACADEMY (HEALTHY LIFESTYLES) - HEALTH FIRST: A CENTER FOR PREVENTION AND EDUCATION (CHRONIC DISEASE MANAGEMENT) COMMUNICABLE DISEASES CPMC ADMINISTERS OR FUNDS PROGRAMS FOCUSED ON SCREENING AND TREATING COMMUNICABLE DISEASES, INCLUDING THE FOLLOWING: - HEPATITIS B FREE PROGRAM (NO-COST SCREENING & TREATMENT) - VARIOUS HEALTH FAIRS (NO-COST FLU SHOTS) 3. VIOLENCE AND INJURY PREVENTION CPMC'S PEDIATRICS CLINIC AT THE BAYVIEW CHILD HEALTH CENTER IN THE BAYVIEW DISTRICT OF SAN FRANCISCO OFFERS VIOLENCE & CHILDHOOD TRAUMA SERVICES TO AT-RISK CHILDREN SUTTER MEDICAL CENTER OF SANTA ROSA (SMCSR) SMCSR SERVES SONOMA COUNTY, AS WELL AS OTHER COUNTIES IN THE NORTH BAY. IN 2010, SMCSR PROVIDED A TOTAL OF $19.5 MILLION IN QUANTIFIABLE COMMUNITY BENEFITS: $11.1 MILLION IN THE COSTS OF SERVICES AND CASH TO THE POOR AND UNDERSERVED IN SONOMA COUNTY AND $8.4 MILLION IN COSTS OF SERVICES AND CASH TO THE BROADER COMMUNITY. SMCSR CONDUCTS A TRI-ANNUAL NEEDS ASSESSMENT IN COLLABORATION WITH KEY STAKEHOLDERS IN THE LOCAL COMMUNITY. COMMUNITY BENEFIT PROGRAMS INVOLVE COLLABORATION WITH A NETWORK OF COMMUNITY ORGANIZATIONS, COUNTY AGENCIES SUCH AS THE SONOMA DEPARTMENT OF HEALTH SERVICES, AND OTHER HOSPITALS IN THE AREA. THE NEEDS ASSESSMENT IDENTIFIED FOUR PRIORITIES IN COMMUNITY HEALTH NEEDS. 1. MEDICAL EDUCATION SMCSR OPERATES THE FAMILY MEDICINE RESIDENCY PROGRAM WHICH TRAINS PRIMARY CARE PHYSICIANS. OVER 35% OF LOCAL FAMILY PHYSICIANS ARE GRADUATES OF THIS RESIDENCY PROGRAM, INCLUDING PHYSICIANS WHO STAFF COMMUNITY HEALTH CENTERS CARING FOR LOW-INCOME AND UNDERSERVED FAMILIES. 2. CHILDREN'S HEALTH SMCSR PROVIDES FINANCIAL SUPPORT TO THE HEALTHY KIDS OF SONOMA COUNTY, WHICH IS A COLLABORATIVE THAT PROVIDES 2,300 LOW-INCOME CHILDREN WITH COMPREHENSIVE HEALTH INSURANCE. 3. WORKFORCE DEVELOPMENT SMCSR'S HEALTHCARE WORKFORCE DEVELOPMENT PROGRAM IS DESIGNED TO ENHANCE FUTURE WORKFORCE DIVERSITY BY PROVIDING INTERNSHIP OPPORTUNITIES FOR HIGH SCHOOL STUDENTS THROUGH A COLLABORATION WITH LOCAL HEALTHCARE AND EDUCATION PARTNERS. THE SUMMER HEALTH CAREER INSTITUTE IS LOCATED AT SANTA ROSA COMMUNITY COLLEGE. 4. WOMEN'S HEALTH ONE OF THE PRIORITIES IS WOMEN'S HEALTH; THESE COMMUNITY BENEFIT ACTIVITIES ARE REPORTED BY SUTTER PACIFIC MEDICAL FOUNDATION, ANOTHER SUTTER WEST BAY HOSPITALS AFFILIATE, IN A DIFFERENT FORM 990. NOVATO COMMUNITY HOSPITAL (NOVATO) NOVATO COMMUNITY HOSPITAL SERVES MARIN COUNTY, AS WELL AS PORTIONS OF SOUTHERN SONOMA COUNTY. IN 2010, NOVATO PROVIDED A TOTAL OF $6.7 MILLION IN QUANTIFIABLE COMMUNITY BENEFITS: $6.6 MILLION IN HEALTHCARE COSTS OF SERVICES AND CASH TO THE POOR AND UNDERSERVED IN SONOMA COUNTY AND $101,000 IN COSTS OF SERVICES AND CASH TO THE BROADER COMMUNITY. NOVATO IS A MEMBER OF THE HEALTHY MARIN PARTNERSHIP, A NETWORK OF HOSPITALS AND PUBLIC AND PRIVATE ORGANIZATIONS THAT WORKS COLLABORATIVELY TO CONDUCT A TRI-ANNUAL COMMUNITY NEEDS ASSESSMENT AND COORDINATE TARGETED PROGRAMS TO ADDRESS PRIORITY COMMUNITY NEEDS. OTHER NETWORK MEMBERS INCLUDE THE CITY OF NOVATO, COUNTY OF MARIN, NOVATO UNIFIED SCHOOL DISTRICT, MARIN COMMUNITY CLINIC, MARIN GENERAL HOSPITAL, AND OPERATION ACCESS. THREE AREAS OF NEEDS WERE SELECTED BY THE HOSPITAL FOR YEAR 2010: 1. IMPROVING ACCESS TO CARE FOR THE UNDERSERVED, DISABLED, UNINSURED, AND UNDERINSURED. 2. INTERVENING IN CHILDHOOD OBESITY WITH DIABETES PREVENTION AMONG YOUTH AGED 10 TO 14. 3. PROVIDING EXPERTISE AND LEADERSHIP IN PLANNING COMMUNITY DISASTER RESPONSE. SUTTER LAKESIDE HOSPITAL (LAKESIDE) IN 2010, LAKESIDE PROVIDED A TOTAL OF $8.1 MILLION IN QUANTIFIABLE COMMUNITY BENEFITS: $7.8 MILLION IN HEALTHCARE SERVICES AND CASH FOR THE POOR AND UNDERSERVED AND $275,000 IN THE COSTS OF SERVICES AND CASH FOR PROGRAMS SERVING THE BROADER COMMUNITY. THE POPULATION SERVED INCLUDES A HIGH PERCENTAGE OF FAMILIES WHOSE LOW INCOME AFFECTS THEIR ACCESS TO HEALTHCARE. SUTTER LAKESIDE'S COMMUNITY BENEFITS STRATEGY INCLUDES SPONSORING AND FUNDING PROGRAMS THAT PROVIDE FREE PREVENTIVE CARE SCREENINGS AND TESTS, SUCH AS MAMMOGRAMS, SEASONAL AND H1N1 FLU VACCINATIONS.
EXEMPT PURPOSE ACHIEVEMENTS FORM 990, PART III, LINE 4A CPMC RESEARCH INSTITUTE THE CALIFORNIA PACIFIC MEDICAL CENTER AND ITS RESEARCH INSTITUTE (CPMCRI) HAVE MADE A MAJOR COMMITMENT OF SPACE AND FUNDING TO ENHANCE ITS RESEARCH PROGRAMS. CPMC NOW RANKS IN THE TOP 25 OF ALL INDEPENDENT MEDICAL CENTERS IN THE US IN NATIONAL INSITUTE OF HEALTH (NIH) FUNDING. IN ADDITION TO BUILDING PROGRAMS IN CLINICAL RESEARCH, EPIDEMIOLOGY, BEHAVIORAL MEDICINE, AND PHARMACOKINETICS, CPMCRI HAS GREATLY STRENGTHENED ITS LABORATORY-BASED RESEARCH PROGRAMS. APPROXIMATELY 60 PRINCIPAL INVESTIGATORS, BOTH LABORATORY AND CLINICAL RESEARCHERS, INCLUDING MOLECULAR BIOLOGISTS, IMMUNOLOGISTS, PHARMACOLOGISTS, BIOCHEMISTS, PHYSICISTS, EPIDEMIOLOGISTS, BEHAVIORAL SCIENTISTS, BIOSTATISTICIANS, AND COMPUTER SCIENTISTS WORK WITHIN THE RESEARCH INSTITUTE AND THE MEDICAL CENTER. BIOMEDICAL RESEARCH IS CONDUCTED IN SUCH DIVERSE AREAS AS AGING, ARTHRITIS, EPILEPSY, DIABETES, NEUROBIOLOGY OF PAIN, CARDIOVASCULAR DISEASE, OSTEOPOROSIS, ORGAN TRANSPLANTATION, MECHANISMS OF DRUG ADDICTION, NEURODEGENERATIVE DISEASES (E.G. AMYOTROPHIC LATERAL SCLEROSIS), CANCER, AIDS, HEPATITIS AND OTHER INFECTIOUS DISEASES. SOME OF THESE SCIENTISTS ARE ENGAGED IN RESEARCH THAT WILL HELP US UNDERSTAND THE FUNCTION OF CERTAIN HUMAN CELLS, GENES, PROTEINS AND OTHER FUNDAMENTAL STRUCTURES WITHIN OUR BODIES. TWO YEARS AGO CPMCRI DEVELOPED A 42,000 SQUARE FOOT LAB FACILITY IN THE CHINA BASIN AREA OF SAN FRANCISCO, AND RECENTLY ADDED AN ADDITIONAL 19,000 S.F. AT THAT FACILITY TO PROVIDE SPACE TO RECRUIT ADDITIONAL SCIENTISTS AND TO HOLD ADVANCED TRAINING IN SURGERY. OVER 200 CLINICAL TRIALS, PRIMARILY FUNDED BY PHARMACEUTICAL AND BIOTECHNOLOGY COMPANIES, ARE CURRENTLY CONDUCTED AT THE MEDICAL CENTER THROUGH THE CPMCRI OFFICE OF CLINICAL RESEARCH. MIND-BODY MEDICINE RESEARCHERS IN THE BEHAVIORAL SCIENCES AT CALIFORNIA PACIFIC HAVE BEEN MAKING GREAT STRIDES IN UNDERSTANDING SOME OF THE BASICS OF THE MIND-BODY CONNECTION. THEIR STUDIES HAVE DEMONSTRATED THE EFFECTIVENESS OF BEHAVIORAL INTERVENTIONS INCLUDING COUNSELING, GUIDED IMAGERY, YOGA AND MEDITATION, AND GROUP THERAPY IN THE TREATMENT OF BREAST CANCER. UNDERSTANDING THE IMPACT OF ILLNESS ON HUMANS, PATIENTS AND THEIR FAMILIES, AS WELL AS HOW PERSONAL ATTITUDES AND PSYCHOSOCIAL ATTRIBUTES INFLUENCE THE COURSE OF DISEASE ARE IMPORTANT OUTCOMES OF THESE RESEARCHERS. CLOSE TIES WITH THE INSTITUTE FOR HEALTH AND HEALING AND THE HEALTH AND HEALING CLINIC AT CALIFORNIA PACIFIC MEDICAL CENTER PROVIDE SCIENTISTS WITH THE OPPORTUNITY TO CONDUCT RIGOROUS TRIALS EVALUATING A VARIETY OF COMPLEMENTARY APPROACHES. AMONG THE PRACTICES STUDIED ARE REMOTE HEALING FOR PERSONS WITH AIDS, TIBETAN AND CHINESE HERBAL THERAPY FOR BREAST CANCER, AND THE USE OF JIN SHIN JYTSU AS AN ADJUVANT THERAPY FOR ICU PATIENTS. "CRCLE" THE CENTER FOR RESEARCH IN CLINICAL EXCELLENCE (CRCLE) IS A PROGRAM DEDICATED TO PERFORMING CLINICAL RESEARCH AND DATA COLLECTION TO MEASURE AND IMPROVE THE QUALITY OF HEALTH CARE AT CPMC. CRCLE IS MODELED AFTER SUCCESSFUL PROGRAMS AT PREMIER INSTITUTIONS NATIONWIDE, INCLUDING THE ROCHESTER EPIDEMIOLOGY PROJECT AT THE MAYO CLINIC. CRCLE GOES ONE STEP BEYOND THESE PROGRAMS, HOWEVER, BY UTILIZING COLLECTED DATA TO ENHANCE THE CLINICAL ACTIVITIES OF SELECT CLINICAL SERVICE LINES AT CPMC, SUCH AS BREAST HEALTH AND RENAL TRANSPLANT. THE ACRONYM CRCLE SUGGEST A SYSTEM WHOSE COMPONENTS ARE INTERRELATED AND INTERDEPENDENT. WITHIN THE CENTERS FOR RESEARCH IN CLINICAL EXCELLENCE (CRCLE) AT CALIFORNIA PACIFIC, THE ACRONYM STANDS FOR A PROGRAM IN WHICH RESEARCHERS AND CLINICIANS WORK TOGETHER TO SEARCH FOR CLUES IN PATIENTS' MEDICAL HISTORIES, DIAGNOSTIC STUDIES, AND RESPONSES TO TREATMENT THAT CAN BE USED TO IMPROVE CARE. PHYSICIAN-INVESTIGATORS CHOSEN FOR THE CRCLE PROGRAM APPLY RIGOROUS RESEARCH METHODS AND DATA COLLECTION TECHNIQUES TO THEIR STUDIES. EACH CRCLE PROJECT STUDIES A COHORT OF PATIENTS, WHO HAVE AGREED TO PARTICIPATE AND ARE CARED FOR AT THE MEDICAL CENTER. THEY RECEIVE INTENSIVE DIAGNOSTIC WORK-UPS, TREATMENT AND FOLLOW-UP CARE. PATIENT OUTCOMES SUCH AS HOSPITALIZATION, METASTASIS OF A TUMOR, COMPLICATIONS OF TREATMENT OR DEATH ARE ASSESSED AT PREDETERMINED INTERVALS. BIOLOGICAL SPECIMENS, SUCH AS BLOOD OR TISSUE, ARE COLLECTED AND STORED FOR POTENTIAL FUTURE ANALYSES. SINCE ITS INCEPTION, THE CRCLE PROGRAM HAS FUNDED SIX PROJECTS: BRACES (BARIATRIC RESEARCH AND COHORT EVALUATION STUDY), BHIVE (BIOBANK FOR HIV EVALUATIONS), THE BREAST HEALTH STUDY, DGE (DELAYED GASTRIC EMPTYING), RKIVE (BIO-ARCHIVE IN RECIPIENTS OF KIDNEY TRANSPLANTS), AND THE BRAIN TUMOR TISSUE BANK. IN ADDITION TO ASSISTANCE WITH FUNDING, CRCLE PROVIDES METHODOLOGICAL AND TECHNICAL EXPERTISE. BY PROVIDING SOME INITIAL MOMENTUM, CRCLE WILL BE ABLE TO ENSURE THAT NEW AND POTENTIALLY BREAKTHROUGH PROJECTS GET OFF TO THE BEST POSSIBLE START. AS PART OF THIS PROGRAM, CPMC OFFERS PERIODIC COURSES ON RESEARCH METHODS TO INTERESTED STAFF. THESE COURSES INCLUDE TRAINING IN QUALITY IMPROVEMENT METHODOLOGIES, WITH AN EMPHASIS ON RESEARCH DESIGN AND PRESENTATION EFFECTIVENESS. HEALTH EDUCATION AND TRAINING TWO OF THE FOUR SUTTER WEST BAY HOSPITALS HAVE FORMAL HEALTH EDUCATION AND TRAINING PROGRAMS. SUTTER MEDICAL CENTER AT SANTA ROSA ESTABLISHED ITS FAMILY MEDICINE TRAINING PROGRAM IN 1938. THE SANTA ROSA FAMILY MEDICINE RESIDENCY IS A CRITICAL STRATEGIC HEALTHCARE ASSET THAT ADDRESSES THE GROWING PHYSICIAN SHORTAGE IN SONOMA COUNTY. THE RESIDENCY HAS BEEN THE LARGEST SINGLE SOURCE OF FAMILY PHYSICIANS TO SONOMA COUNTY FOR OVER 70 YEARS; RESIDENCY GRADUATES COMPRISE NEARLY HALF OF FAMILY PHYSICIANS IN SONOMA COUNTY. RESIDENCY GRADUATES FILL POSITIONS IN PRIVATE PRACTICES, COMMUNITY CLINICS, LARGE MEDICAL GROUPS SUCH AS SUTTER MEDICAL GROUP OF THE REDWOODS, PERMANENTE MEDICAL GROUP, LOCAL COMMUNITY HEALTH CENTERS, SONOMA COUNTY HEALTH SERVICES AND LEADERSHIP POSITIONS THROUGHOUT THE MEDICAL COMMUNITY. THE THREE-YEAR PROGRAM IS AFFILIATED WITH THE UCSF DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE. CALIFORNIA PACIFIC MEDICAL CENTER PROVIDES A MODEL OF SPECIALTY CARE BY BLENDING EXCELLENCE IN ACADEMICS AND RESEARCH WITH A FOCUS ON PATIENT-CENTERED CARE. CPMC IS A MAJOR TEACHING AFFILIATE OF DARTMOUTH MEDICAL SCHOOL, PROVIDING CLERKSHIPS IN MEDICINE, PSYCHIATRY, NEUROLOGY, PEDIATRICS AND OBSTETRICS-GYNECOLOGY. ADDITIONAL CLERKSHIPS (IN SURGERY AND OBSTETRICS-GYNECOLOGY) ARE PROVIDED FOR STUDENTS FROM UCSF. THE GRADUATE MEDICAL RESIDENCY TRAINING PROGRAMS OFFERED AT CALIFORNIA PACIFIC ARE OF THE HIGHEST CALIBER WITH CALIFORNIA PACIFIC MEDICAL CENTER'S PHYSICIANS EMBRACING THE ROLE OF EDUCATORS AS WELL AS CLINICIANS. CALIFORNIA PACIFIC MEDICAL CENTER HAS INDEPENDENT RESIDENCY AND FELLOWSHIP PROGRAMS IN INTERNAL MEDICINE, PSYCHIATRY, RADIATION ONCOLOGY, OPHTHALMOLOGY, CARDIOVASCULAR DISEASES, GASTROENTEROLOGY, PULMONARY/CRITICAL CARE MEDICINE, HEPATOLOGY/TRANSPLANT, KIDNEY TRANSPLANT, STOKE, GLAUCOMA, RETINA, SHOULDER AND HAND. CALIFORNIA PACIFIC ALSO OFFERS TRAINING IN PEDIATRICS, SURGERY, ORTHOPEDIC SURGERY, AND PLASTIC SURGERY TO UCSF RESIDENTS. IN ADDITION, CALIFORNIA PACIFIC MEDICAL CENTER IS A TRAINING SITE FOR OPERATING ROOM NURSING STUDENTS, OCCUPATIONAL THERAPISTS, PHYSICAL THERAPISTS AND SURGICAL TECHNOLOGISTS. CALIFORNIA PACIFIC MEDICAL CENTER OFFERS THE COLLECTIVE EXPERTISE OF THE MEDICAL CENTER PHYSICIANS AND STAFF TO PROVIDE CONSULTATION IN AREAS SUCH AS CARDIAC CARE, EMERGENCY ROOM OPERATIONS, GERIATRIC CARE, MANAGED CARE, NEW THERAPEUTIC APPROACHES TO OLD MEDICAL PROBLEMS, OBSTETRICS, SPECIALTY SERVICES, AND WORKER'S COMPENSATION. CALIFORNIA PACIFIC MEDICAL CENTER'S PHYSICIANS PRESENT CONTINUING MEDICAL EDUCATION LECTURES AT HOSPITALS THROUGHOUT NORTHERN CALIFORNIA.
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, QUESTIONS 6 & 7A THIS CORPORATION IS AN AFFILIATE OF SUTTER HEALTH, A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. SUTTER HEALTH IS THE SOLE MEMBER WITH THE RIGHT TO ELECT AT LEAST A MAJORITY OF THE MEMBERS OF THE BOARD OF DIRECTORS.
DESC CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS FORM 990, PART VI, QUESTION 7B SUTTER HEALTH AS THE SOLE MEMBER OF THE ORGANIZATION IS ENTITLED TO EXERCISE FULLY ALL RIGHTS AND PRIVILEGES OF MEMBERS OF NONPROFIT CORPORATIONS UNDER THE CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION LAW, AND ALL OTHER APPLICABLE LAWS. THE MEMBER HAS THE RIGHTS AND POWERS TO APPOINT (AND REMOVE) MEMBERS OF THE CORPORATION'S BOARD OF DIRECTORS, SUBJECT TO THE PROVISIONS OF THE BYLAWS, IN ADDITION, THE MEMBER HAS THE RIGHT TO APPROVE THE FOLLOWING ACTIONS OF THE CORPORATION'S BOARD OF DIRECTORS: A. MERGER, CONSOLIDATION, REORGANIZATION, OR DISSOLUTION OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; B. AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; C. ADOPTION OF OPERATING BUDGETS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY, INCLUDING CONSOLIDATED OR COMBINED BUDGETS OF THE CORPORATION AND ALL SUBSIDIARY ORGANIZATIONS OF THE CORPORATION; D. ADOPTION OF CAPITAL BUDGETS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; E. AGGREGATE OPERATING OR CAPITAL EXPENDITURES ON AN ANNUAL BASIS THAT EXCEED APPROVED OPERATING OR CAPITAL BUDGETS BY A SPECIFIED DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE GENERAL MEMBER; F. LONG-TERM OR MATERIAL AGREEMENTS INCLUDING, BUT NOT LIMITED TO, BORROWINGS, EQUITY FINANCINGS, CAPITALIZED LEASES AND INSTALLMENT CONTRACTS; AND PURCHASE, SALE, LEASE, DISPOSITION, HYPOTHECATION, EXCHANGE, GIFT, PLEDGE, OR ENCUMBRANCE OF ANY ASSET, REAL OR PERSONAL, WITH A FAIR MARKET VALUE IN EXCESS OF A DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE DIRECTORS OF THE GENERAL MEMBER, WHICH SHALL NOT BE LESS THAN 10% OF THE TOTAL ANNUAL CAPITAL BUDGET OF THE CORPORATION; G. APPOINTMENT OF AN INDEPENDENT AUDITOR AND HIRING OF INDEPENDENT COUNSEL EXCEPT IN CONFLICT SITUATIONS BETWEEN THE GENERAL MEMBER AND THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; H. THE CREATION OR ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE ENTITY; I. CONTRACTING WITH AN UNRELATED THIRD PARTY FOR ALL OR SUBSTANTIALLY ALL OF THE MANAGEMENT OF THE ASSETS OR OPERATIONS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; J. APPROVAL OF MAJOR NEW PROGRAMS AND CLINICAL SERVICES OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY. THE GENERAL MEMBER SHALL FROM TIME TO TIME DEFINE THE TERM "MAJOR" IN THIS CONTEXT; K. APPROVAL OF STRATEGIC PLANS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; L. ADOPTION OF QUALITY ASSURANCE POLICIES NOT IN CONFORMITY WITH POLICIES ESTABLISHED BY THE GENERAL MEMBER; M. ANY TRANSACTION BETWEEN THE CORPORATION, A SUBSIDIARY OR AFFILIATE AND A DIRECTOR OF THE CORPORATION OR AN AFFILIATE OF SUCH DIRECTOR. IN ADDITION, THE GENERAL MEMBER SHALL HAVE THE AUTHORITY (BY A VOTE OF NOT LESS THAN TWO-THIRDS (2/3) OF ITS BOARD), TO DECLARE A MAJOR ACTIVITY REQUIRING APPROVAL.
DESCRIBE THE PROCESS USED BY MGMT &/OR GOVERNING BODY TO REVIEW FORM 990 FORM 990, PART VI, QUESTION 11A SUTTER HEALTH HAS A CENTRALIZED TAX DEPARTMENT RESPONSIBLE FOR THE PREPARATION OF THE FORM 990. ANNUALLY THE TAX DEPARTMENT PROVIDES TRAINING AND EDUCATION TO AFFILIATE PERSONNEL WHO ASSIST THE TAX DEPARTMENT IN COLLECTING AND REVIEWING DATA TO BE REPORTED ON THE FORM 990. THE PREPARATION MATERIAL IS REVIEWED BY VARIOUS DEPARTMENTS INCLUDING TAX, FINANCE, OFFICE OF THE GENERAL COUNSEL, AND HUMAN RESOURCES. ADDITIONALLY, THE CHIEF FINANCIAL OFFICER SIGNS OFF ON THIS DATA BEFORE THE RETURN GOES TO THE PREPARATION STAGE. A NATIONAL ACCOUNTING FIRM PREPARES AND/OR REVIEWS THE RETURN. A COMPLETED RETURN IS THEN REVIEWED BY THE TAX DEPARTMENT AND THE AFFILIATE WITH THE CHIEF FINANCIAL OFFICER GIVING HIS/HER APPROVAL BEFORE THE RETURN IS FILED.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 12 EACH INDIVIDUAL BOARD MEMBER AND OFFICER HAS TO SIGN AN ACKNOWLEDGEMENT FORM THAT THEY HAVE READ THE POLICY. ANNUALLY A DISCLOSURE STATEMENT IS COMPLETED BY ALL OFFICERS AND BOARD MEMBERS. ON THIS STATEMENT THE INDIVIDUAL WILL LIST A WIDE RANGE OF INFORMATION WHICH INCLUDES BUSINESS RELATIONSHIPS, EMPLOYMENT RELATIONSHIPS, PROPERTY INTERESTS, AND THOSE OF RELATED PARTIES. THE CEO AND BOARD CHAIR WILL REVIEW THE STATEMENTS AND MONITOR SITUATIONS THAT MAY POSE A POTENTIAL CONFLICT OF INTEREST. THE CEO AND BOARD CHAIR MAY CONSULT WITH THE OFFICE OF THE GENERAL COUNSEL AS NECESSARY. IF THERE IS A POTENTIAL CONFLICT OF INTEREST RELATED TO A PARTICULAR TRANSACTION, THE INTERESTED TRUSTEE MUST DISCLOSE THE EXISTENCE AND NATURE OF THE RELATIONSHIP. THE BOARD CHAIR MAY APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE THE CONFLICT. UNTIL THE POTENTIAL CONFLICT IS RESOLVED, THE BOARD CHAIR MAY REQUEST THE TRUSTEE TO NOT PARTICIPATE DURING RELATED PRESENTATIONS AND DISCUSSIONS. IN ALL CIRCUMSTANCES INVOLVING AN ACTUAL CONFLICT, THE INTERESTED TRUSTEE SHALL REFRAIN FROM VOTING ON ANY MATTER RELATED TO THE TRANSACTION.
PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, QUESTION 15 THE COMPENSATION COMMITTEE OF THE SUTTER HEALTH BOARD OF DIRECTORS RETAINS ULTIMATE DISCRETIONARY AUTHORITY OVER ALL ELEMENTS OF COMPENSATION TO ASSURE THAT ORGANIZATIONAL PURPOSES ARE APPROPRIATELY BEING SERVED. THE COMPENSATION COMMITTEE USES CREDIBLE DATA SOURCES AND MAINTAINS AN OBJECTIVE "ARMS LENGTH" DECISION-MAKING PROCESS, ENSURING THE INTEGRITY OF SUTTER'S EXECUTIVE PROGRAMS AND CONSISTENCY WITH THE ORGANIZATION'S OVERALL MISSION. IN ORDER TO ENSURE EXTERNAL COMPETITIVENESS, NATIONAL, CALIFORNIA AND LOCAL MARKET AREA COMPENSATION DATA COMPARISONS ARE REVIEWED. COMPETITIVE ANALYSIS INCLUDES: (A) BASE SALARY, (B) TOTAL CASH (BASE SALARY + ANNUAL INCENTIVE) AND (C) TOTAL REMUNERATION (BASE SALARY + ANNUAL INCENTIVE + BENEFITS AND LONG TERM INCENTIVE). THIS ANALYSIS INCLUDES COMPARABLE ORGANIZATIONS AND GEOGRAPHIC CONSIDERATIONS. FOR THE MOST SENIOR EXECUTIVE POSITIONS, NATIONAL COMPARISONS FOR ORGANIZATIONS SIMILAR IN SIZE, SCOPE AND COMPLEXITY AS SUTTER HEALTH ARE MOST APPROPRIATE SINCE IT IS A NATIONAL MARKETPLACE IN WHICH SUTTER COMPETES FOR EXECUTIVE TALENT. ON THE OTHER HAND, BECAUSE CALIFORNIA'S UNDERLYING COMPENSATION STRUCTURE IS HIGHER THAN NATIONAL DATA (ESPECIALLY IN THE BAY AREA), REGIONAL PAY COMPARISONS AND ADJUSTMENTS ARE MADE. ALL OFFICERS OF THE ORGANIZATION (I.E., CEO, CFO, COO) UNDERGO A REVIEW AND COMPENSATION COMMITTEE APPROVAL ANNUALLY. KEY EMPLOYEES AND OTHER EXECUTIVES OF SUTTER HEALTH WHO ARE CONSIDERED DISQUALIFIED PERSONS FOR FORM 990 REPORTING PURPOSES ARE HANDLED IN THE SAME MANNER.
AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMT TO GEN PUBLIC FORM 990, PART VI, QUESTION 19 THE SUTTER HEALTH SYSTEM POSTS ITS CURRENT AND PAST AUDITED FINANCIAL STATEMENTS AT SUTTERHEALTH.ORG. OTHER DOCUMENTS ARE ALSO LOCATED AT THIS WEBSITE INCLUDING THE ANNUAL REPORT, MISSION STATEMENT, HISTORY, AND LINKS TO AFFILIATE WEBSITES.
HOURS PER WEEK DEVOTED TO RELATED ORGANIZATION FORM 990, PART VII THE FOLLOWING BOARD MEMBER/OFFICER OF THE ORGANIZATION IS A FULL-TIME (40 HOURS PER WEEK) EMPLOYEE OF SUTTER HEALTH AND THEIR SUTTER HEALTH SALARY IS REPORTED HEREIN. THIS INDIVIDUAL RECEIVED NO COMPENSATION FOR THEIR SERVICE AS BOARD MEMBER/OFFICER OF THIS ORGANIZATION. PAT FRY
OTHER CHANGES IN FUND BALANCE FORM 990, PART XI, LINE 5 CHANGE IN UNREALIZED GAIN/(LOSS) ON INVESTMENTS $ 8,759,521 EQUITY TRANSFERS (NET) (152,618,862) PARTNERSHIP INCOME BOOKED ON RETURN 11,166,811 K-1 ORDINARY INCOME (11,696,911) K-1 INTEREST INCOME (425,462) K-1 ORDINARY DIVIDENDS (980,165) K-1 SHORT-TERM CAPITAL GAIN 2,218,348 K-1 LONG-TERM CAPITAL GAIN 234,150 K-1 SECTION 1231 LOSS 690 K-1 RENTAL INCOME (112,153) CHANGE IN SPLIT INTEREST 33,750 OTHER CHANGES IN FUND BALANCE (2,514) PRIOR PERIOD ADJUSTMENT (36,777) ------------ $(143,459,574) ==============
COMPILATION, REVIEW AND AUDIT OF INDEPENDENT ACCOUNTANT FORM 990, PART XII, QUESTION 2 ANNUALLY THE SUTTER HEALTH SYSTEM HAS AN AUDIT OF COMBINED BALANCE SHEETS AND STATEMENTS OF OPERATIONS PERFORMED BY INDEPENDENT AUDITORS. AN AUDIT COMMITTEE SELECTS THE AUDITORS AND REVIEWS RESULTS.
SCHEDULE K SUPPLEMENTAL INFORMATION SCHEDULE K, PART V GLOBAL DISCLOSURE PART I, COLUMN (E): THE ORGANIZATION'S SOLE CORPORATE MEMBER IS A CONDUIT BORROWER OF TAX-EXEMPT BOND ISSUES THAT ALLOCATES PORTIONS OF EACH ISSUE TO SUBSIDIARY ORGANIZATIONS. THE ORGANIZATION IS ONLY REPORTING THE AMOUNT IT HAS BEEN ALLOCATED. PART II, LINE 7: ISSUANCE COSTS WERE FUNDED THROUGH AN EQUITY CONTRIBUTION. SWBH SPECIFIC PART I, LINE B, COLUMN (F): THE REFUNDING OCCURRED VIA THE REPAYMENT OF A DRAW ON A TAXABLE LINE OF CREDIT, DRAWN IN SEVERAL INSTALLMENTS BETWEEN APRIL 7 AND APRIL 11, 2008, USED TO REFUND THE 2007 ISSUE. THE REFUNDED BONDS WERE ISSUED IN 2007 TO REFUND BONDS ISSUED IN 1996, WHICH WERE USED TO REFUND BONDS ISSUED IN 1985, 1989, 1990 AND 1991 FOR CONSTRUCTION. PART IV, LINE 5, COLUMN (A): INVESTMENTS OF UNEXPENDED PROCEEDS CONTINUE TO BE MONITORED BY THE CORPORATE MEMBER OF THE ORGANIZATION AND ITS ARBITRAGE CONSULTANTS (THE BANK OF NEW YORK MELLON TRUST COMPANY, N.A. AND BLX GROUP) FOR COMPLIANCE WITH YIELD RESTRICTIONS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) ADOLESCENT TREATMENT CENTERS INC

390 40TH STREET

OAKLAND,CA94609
68-0088443 		HEALTHCARE CA 501(C)(3) 3 SUTTER EBH
 
 
 
(2) ALTA BATES SUMMIT FOUNDATION

3012 SUMMIT STREET 3RD FLOOR

OAKLAND,CA94609
51-0160184 		FUNDRAISING CA 501(C)(3) 11a - I SUTTER EBH
 
 
 
(3) CALIFORNIA PACIFIC MEDICAL CTR FOUND

2015 STEINER STREET 2ND FLOOR

SAN FRANCISCO,CA94115
94-2728423 		FUNDRAISING CA 501(C)(3) 11a - I SUTTER WBH
 
 
 
(4) DELTA MEMORIAL HOSPITAL FOUNDATION

3901 LONE TREE WAY

ANTIOCH,CA94509
94-2417022 		FUNDRAISING CA 501(C)(3) 11a - I SUTTER EBH
 
 
 
(5) EAST BAY PERINATAL CENTER

350 HAWTHORNE AVE

OAKLAND,CA94609
51-0172285 		HEALTHCARE CA 501(C)(3) 3 SUTTER EBH
 
 
 
(6) EDEN MEDICAL CENTER

20103 LAKE CHABOT ROAD

CASTRO VALLEY,CA94546
94-2948100 		HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
 
 
(7) MARIN COMMUNITY HEALTH

250 BON AIRE ROAD

GREENBRAE,CA94904
94-2994751 		SUPPORTING OR CA 501(C)(3) 11b - II SUTTER HLTH
 
 
 
(8) MILLS-PENINSULA HEALTH SERVICES

1501 TROUSDALE DRIVE

BURLINGAME,CA94010
94-1156265 		HOSPITAL CA 501(C)(3) 3 PAMF
 
 
 
(9) MILLS-PENINSULA HOSPITAL FOUNDATION

1501 TROUSDALE DRIVE

BURLINGAME,CA94010
23-7288765 		FUNDRAISING CA 501(C)(3) 11a - I MPHS
 
 
 
(10) PALO ALTO MEDICAL FOUNDATION

2350 EL CAMINO REAL

MOUNTAIN VIEW,CA94040
94-1156581 		HEALTHCARE CA 501(C)(3) 3 SUTTER HLTH
 
 
 
(11) SAMUEL MERRITT UNIVERSITY

450 30TH STREET 2840

OAKLAND,CA94609
94-2992642 		UNIVERSITY CA 501(C)(3) 2 SUTTER EBH
 
 
 
(12) SUTTER AUBURN FAITH HOSPITAL FOUNDATION

11815 EDUCATION ST

AUBURN,CA95602
94-2594966 		FUNDRAISING CA 501(C)(3) 7 SUTTER SSR
 
 
 
(13) SUTTER CENTRAL VALLEY HOSPITALS

1800 COFFEE ROAD SUITE 76

MODESTO,CA95355
94-1080917 		HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
 
 
(14) SUTTER COAST HOSPITAL

800 E WASHINGTON BLVD

CRESCENT CITY,CA95531
94-2988520 		HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
 
 
(15) SUTTER DAVIS HOSPITAL FOUNDATION

PO BOX 1617

DAVIS,CA95617
68-0217870 		FUNDRAISING CA 501(C)(3) 11a - I SUTTER SSR
 
 
 
(16) SUTTER EAST BAY HOSPITALS

3012 SUMMIT STREET 3RD FLOOR

OAKLAND,CA94609
94-1196176 		HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
 
 
(17) SUTTER EAST BAY MEDICAL FOUNDATION

3687 MT DIABLO BLVD 200

LAFAYETTE,CA94549
94-2690415 		HEALTHCARE CA 501(C)(3) 3 SUTTER HLTH
 
 
 
(18) SUTTER GOULD MEDICAL FOUNDATION

600 COFFEE ROAD

MODESTO,CA95355
94-1682256 		HEALTHCARE CA 501(C)(3) 3 SUTTER HLTH
 
 
 
(19) SUTTER HEALTH

2200 RIVER PLAZA DRIVE

SACRAMENTO,CA95833
94-2788907 		SUPPORTING OR CA 501(C)(3) 11c III-FI NA
 
 
 
(20) SUTTER HEALTH PACIFIC

91-2301 FT WEAVER RD

EWA BEACH,HI96706
99-0298651 		HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
 
 
(21) SUTTER HEALTH SACRAMENTO SIERRA REGION

PO BOX 160727

SACRAMENTO,CA95816
94-1156621 		HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
 
 
(22) SUTTER INSURANCE SERVICES CORPORATION

745 FORT STREET SUITE 800

HONOLULU,HI96813
99-0289310 		INSURANCE SER HI 501(C)(3) 11b - II SUTTER HLTH
 
 
 
(23) SUTTER MEDICAL CENTER FOUNDATION

PO BOX 160727

SACRAMENTO,CA95816
94-2788906 		FUNDRAISING CA 501(C)(3) 7 SUTTER SSR
 
 
 
(24) SUTTER MEDICAL CENTER CASTRO VALLEY

20130 LAKE CHABOT RD 103

CASTRO VALLEY,CA94546
77-0146047 		HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
 
 
(25) SUTTER MEDICAL FOUNDATION

2800 L STREET 7TH FLOOR

SACRAMENTO,CA95816
68-0273974 		HEALTH CARE CA 501(C)(3) 11b - II SUTTER HLTH
 
 
 
(26) SUTTER ROSEVILLE MEDICAL CTR FOUNDATION

ONE MEDICAL PLAZA

ROSEVILLE,CA95661
68-0040113 		FUNDRAISING CA 501(C)(3) 11a - I SUTTER SSR
 
 
 
(27) SUTTER SOLANO CHARITABLE FOUNDATION

300 HOSPITAL DRIVE

VALLEJO,CA94589
94-2668262 		FUNDRAISING CA 501(C)(3) 11a - I SUTTER SSR
 
 
 
(28) SUTTER VISITING NURSE ASSOC AND HOSPICE

1900 POWELL ST 300

EMERYVILLE,CA94608
94-6068843 		HEALTH CARE CA 501(C)(3) 9 SUTTER HLTH
 
 
 
(29) SUTTER WEST BAY HOSPITALS

2333 BUCHANAN STREET

SAN FRANCISCO,CA94115
94-0562680 		HOSPITAL CA 501(C)(3) 3 SUTTER HLTH
 
 
 
(30) SUTTER WEST BAY MEDICAL FOUNDATION

2015 STEINER STREET 1ST FLOOR

SAN FRANCISCO,CA94115
94-2948131 		HEALTHCARE CA 501(C)(3) 3 SUTTER HLTH
 
 
 
(31) TRACY HOSPITAL FOUNDATION

1420 N TRACY BLVD

TRACY,CA95376
68-0318845 		FUNDRAISING CA 501(C)(3) 11a - I SUTTER CVH
 
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) CALIFORNIA PACIFIC ADV IMAGING LLC

PO BOX 6102
NOVATO,CA94948
56-2311840 		MRI JOINT VENTURE CA  
RELATED 1,849,857 895,216   No 0 Yes   51.000 %
(2) SAN FRANCISCO ENDOSCOPY CENTER LLC

730 DISTEL
LOS ALTOS,CA94022
91-2160588 		ENDOSCOPY JV CA  
RELATED 3,923,369 4,207,618   No 0   No 51.000 %
(3) PRESIDIO SURGERY CENTER LLC

1635 DIVISADERO
SF,CA94115
32-0144060 		AMBULATORY SURG CA  
RELATED 5,927,435 3,682,016   No 0 Yes   51.000 %








Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership












Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
Yes
 
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
Yes
 
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
Yes
 
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) CALIFORNIA PACIFIC MEDICAL CENTER FOUNDATION

 C 12,104,776  
(2) CATHEDRAL HEIGHTS LLC

 L 154,330  
(3) CALIFORNIA PACIFIC ADVANCED IMAGING LLC

 R 1,728,900  
(4) SAN FRANCISCO ENDOSCOPY CENTER LLC

 R 3,955,381  
(5) PRESIDIO SURGERY CENTER LLC

 R 5,348,267  
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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Software Version: