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
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
MILLS-PENINSULA HEALTH SERVICES
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1501 TROUSDALE DRIVE
 
Room/suite
City or town, state or country, and ZIP + 4
BURLINGAME, CA94010
D Employer identification number

94-1156265
E Telephone number

G Gross receipts $ 577,408,717
F Name and address of principal officer:
ROBERT W MERWIN
1501 TROUSDALE DRIVE
BURLINGAME,CA94010
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: 1921
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 25
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 21
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 2,682
6 Total number of volunteers (estimate if necessary) .... 6 720
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
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) ......... 7,723,218 8,059,727
9 Program service revenue (Part VIII, line 2g) ......... 557,899,448 545,788,304
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 6,902,609 17,224,607
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 2,938,642 3,837,743
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 575,463,917 574,910,381
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 943,361 910,607
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) 273,070,407 273,262,306
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 226,412,026 247,161,714
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 500,425,794 521,334,627
19 Revenue less expenses. Subtract line 18 from line 12....... 75,038,123 53,575,754
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 932,579,964 893,446,200
21 Total liabilities (Part X, line 26)............. 574,755,522 569,917,701
22 Net assets or fund balances. Subtract line 21 from line 20..... 357,824,442 323,528,499
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 use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
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 organization’s program service accomplishments for each of its three largest program services, as measured 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 $ 482,855,533 including grants of $ 910,607 ) (Revenue $ 547,391,097 )
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$ 482,855,533
Form 990 (2011)
Form 990 (2011)
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
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which 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 temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
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, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? 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 I
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..........
18
 
No
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...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see list of attachments
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization 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
Yes
 
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
 
No
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......
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................
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.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
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 .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
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..
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
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, 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
35b
Yes
 
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 (2011)
Form 990 (2011)
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
373
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
2,682
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
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
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
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
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 (2011)
Form 990 (2011)
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
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
25
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
21
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
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
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
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete 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
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did 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 15a or 15b, 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
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
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 made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
NELSON YEE
1501 TROUSDALE DRIVE
BURLINGAME,CA94010
(650) 652-3803
Form 990 (2011)
Form 990 (2011)
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 (do not check more than one box, unless person is both an officer and a director/trustee) 		(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) ADRIAN BELLAMY
VICE CHAIR/DIRECTOR
 1.0 X   X       0 0 0
(2) AUGUST BENZ
DIRECTOR
 1.0 X           0 0 0
(3) JORDAN BLOOM
DIRECTOR
 1.0 X           0 0 0
(4) LAURA BROWN
DIRECTOR
 1.0 X           0 0 0
(5) SHEILA BURNS
CHAIR/DIRECTOR
 1.0 X   X       0 0 0
(6) CEIL CIRILLO
DIRECTOR
 1.0 X           0 0 0
(7) KEITH DUNCAN MD
MEDICAL OFFICER/DIRECTOR
 1.0 X           0 0 0
(8) RICHARD ELWOOD
DIRECTOR
 1.0 X           0 0 0
(9) JAMES FERRARA MD
DIRECTOR
 1.0 X           0 0 0
(10) JEFF GERARD
REG. PRES, PENINSULA COASTAL
 1.0 X           0 1,098,963 576,027
(11) JOSEPH LACY MD
DIRECTOR
 1.0 X           0 0 0
(12) STEVEN MCLAUGHLIN
DIRECTOR
 1.0 X           0 0 0
(13) ROBERT MERWIN
CEO, MILLS PENINSULA HLTH SVCS
 40.0 X   X       0 847,603 507,285
(14) RICHARD MORGAN MD
SECRETARY/DIRECTOR
 1.0 X   X       0 0 0
(15) TAK POON MD
DIRECTOR
 1.0 X           0 0 0
(16) BRIAN ROACH MD
DIVISION PRESIDENT PAMF-MILLS
 1.0 X           0 516,826 206,955
(17) JOHN ROOT
DIRECTOR
 1.0 X           0 0 0
Form 990 (2011)
Form 990 (2011)
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 (do not check more than one box, unless person is both an officer and a director/trustee) 		(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) ANDREW ROSENBERG MD
DIRECTOR
 1.0 X           0 0 0
(19) JOHN RYAN
DIRECTOR
 1.0 X           0 0 0
(20) HOWARD SALVAY MD
DIRECTOR
 1.0 X           0 0 0
(21) SARKIS SARKISIAN
DIRECTOR
 1.0 X           0 0 0
(22) RICHARD SLAVIN
PRESIDENT & CEO, PAMF
 1.0 X           0 842,265 324,909
(23) MARGARET TAYLOR
DIRECTOR
 1.0 X           0 0 0
(24) LEE TING
CHAIR F&P/DIRECTOR
 1.0 X   X       0 0 0
(25) REV PAUL WATERMULDER
DIRECTOR
 1.0 X           0 0 0
(26) IFTIKHAR HUSSAIN
CFO, MILLS PENINSULA HLTH SVCS
 40.0     X       0 398,004 134,845
(27) DOLORES GOMEZ
VP ACUTE SERVICES, MPHS
 40.0       X     0 446,870 132,317
(28) ROBERT HORTOP
VP STRATEGIC DVLPMT, MPHS
 40.0       X     0 331,468 93,028
(29) FORREST MALAKOFF
ADMIN-MENLO PARK SENIOR FOCUS
 40.0       X     0 258,022 55,733
(30) RICHARD K NICHOLS
ADMIN, SM&SC SANTA CRUZ
 40.0       X     0 347,429 105,432
(31) CARRIE OWEN-PLIETZ
COO, MILLS PENINSULA HLTH SVCS
 40.0       X     0 573,046 199,644
(32) SHELBY SPEAS
VP AMBULATORY SVCS, MPHS
 40.0       X     0 176,391 11,912
(33) MICHAEL WOOD MD
CMO, MILLS PENINSULA HLTH SVCS
 40.0       X     0 479,930 123,996
(34) YONIS MUDEY
REGISTERED NURSE
 40.0         X   377,414 0 10,017
(35) VICKI L WHITE
CNE, MPHS
 40.0         X   0 364,498 101,753
(36) PATRICIA M RYAN
VP, AMBULATORY SRVCS, MILLS
 40.0         X   0 337,615 94,269
(37) DANIEL BECKER
MEDICAL DIRECTOR
 40.0         X   322,448 0 26,708
(38) GAIUS JURADO
STAFF NURSE II
 40.0         X   273,244 0 20,140
(39) GORDON HUNT
SVP & CMO, SUTTER HEALTH
 0.0           X 0 2,577,109 617,227
(40) SHEILA LITTRELL
DIRECTOR ONCOLOGY, MPHS
 0.0           X 243,452 0 26,453
(41) MARGIE O'CLAIR
VP MARKETING, MPHS
 0.0           X 221,878 0 25,608
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,438,436 9,596,039 3,394,258
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet688
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
Yes
 
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. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
MILLS PENINSULA MEDICAL GROUP
500 AIRPORT BLVD SUITE 100
BURLINGAME,CA94010 		ADMIN MEDICAL SVCS 3,033,453
BOGARD CONSTRUCTION INC
350 CORAL ST
SANTA CRUZ,CA95060 		CONSTRUCTION 2,582,390
CAREFUSION SOLUTIONS LLC
25082 NETWORK PL
CHICAGO,IL606731250 		MEDICAL SERVICES 2,349,118
CROSS COUNTRY TRAVELER CORP
PO BOX 50941
LOS ANGELES,CA900740941 		STAFFING SERVICES 2,171,710
PENINSULA PATHOLOGISTS MEDICAL
2620 SOUTHWICK BLVD
TOLEDO,OH43614 		MEDICAL SERVICES 1,382,234
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet104
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 6,432,436
e Government grants (contributions)1e 490,880
f All other contributions, gifts, grants, and
similar amounts not included above1f 		1,136,411
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 8,059,727
Program Service Revenue Business Code
2a PATIENT SERVICE REVENUE 622,110 544,281,398 544,281,398    
b RENTAL TO AFFILIATES 900,099 1,506,906 1,506,906    
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 545,788,304
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 4,132,960     4,132,960
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 4,537,741  
b Less: rental expenses 2,302,791  
c Rental income or (loss) 2,234,950  
d Net rental income or (loss).......MediumBullet 2,234,950     2,234,950
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   13,287,192
b Less: cost or other basis and sales expenses   195,545
c Gain or (loss)   13,091,647
d Net gain or (loss)..........MediumBullet 13,091,647     13,091,647
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
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 AUXILIARY ACTIVITY 900,099 632,932 632,932    
b FOOD SERVICES 722,310 968,521 968,521    
c PARKING REVENUE 812,930 1,340 1,340    
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 1,602,793
12 Total revenue. See Instructions....MediumBullet 574,910,381 547,391,097   19,459,557
Form 990 (2011)
Form 990 (2011)
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).
Check if Schedule O contains a response to any question in this Part IX. .........
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 United States. See Part IV, line 21 842,171 842,171
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 68,436 68,436
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 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      
7 Other salaries and wages 174,394,881 163,931,188 10,463,693 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 8,298,940 7,801,004 497,936 0
9 Other employee benefits ....... 77,054,752 72,431,467 4,623,285 0
10 Payroll taxes ........... 13,513,733 12,702,909 810,824 0
11 Fees for services (non-employees):        
a Management ...... 2,682,779 2,655,951 26,828 0
b Legal ......... 1,143,734 1,132,297 11,437 0
c Accounting ........... 26,469 26,204 265 0
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 166,042 0 166,042 0
g Other .......... 19,023,449 17,121,104 1,902,345 0
12 Advertising and promotion .... 600,693 204,236 396,457 0
13 Office expenses ....... 2,380,653 0 2,380,653 0
14 Information technology ...... 3,683,284 3,683,284 0 0
15 Royalties .. 0      
16 Occupancy ........... 10,599,837 10,285,857 313,980 0
17 Travel ............ 454,723 295,570 159,153 0
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 70,654 0 70,654 0
20 Interest ........... 16,662,896 16,662,896 0 0
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 51,816,950 45,598,916 6,218,034 0
23 Insurance .............. 3,951,628 3,556,465 395,163 0
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL SUPPLIES 48,201,311 44,586,213 3,615,098 0
b PURCHASED SERVICES 35,581,971 32,913,323 2,668,648 0
c REGIONAL ALLOCATION 14,751,841 13,645,453 1,106,388 0
d SYSTEM ALLOCATION 8,028,925 7,426,756 602,169 0
e
f All other expenses 27,333,875 25,283,833 2,050,042  
25 Total functional expenses. Add lines 1 through 24f 521,334,627 482,855,533 38,479,094 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 0 1 0
2 Savings and temporary cash investments ....... 12,284,258 2 24,738,716
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 60,925,588 4 64,424,530
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
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 .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 7,227,242 8 8,316,261
9 Prepaid expenses and deferred charges ............ 3,037,470 9 3,359,950
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,050,720,531
b Less: accumulated depreciation. ..... 10b 294,654,429 762,984,113 10c 756,066,102
11 Investments—publicly traded securities .......... 63,133,976 11 19,953,686
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 22,987,317 15 16,586,955
16 Total assets. Add lines 1 through 15 (must equal line 34)... 932,579,964 16 893,446,200
Liabilities 17 Accounts payable and accrued expenses . 51,870,969 17 60,609,764
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 511,413,963 20 502,527,821
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 11,470,590 25 6,780,116
26 Total liabilities. Add lines 17 through 25..... 574,755,522 26 569,917,701
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 ..... 357,450,473 27 323,120,597
28 Temporarily restricted net assets ..... 373,969 28 407,902
29 Permanently restricted net assets ..... 0 29 0
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 ..... 357,824,442 33 323,528,499
34 Total liabilities and net assets/fund balances ..... 932,579,964 34 893,446,200
Form 990 (2011)
Form 990 (2011)
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
574,910,381
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
521,334,627
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
53,575,754
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
357,824,442
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-87,871,697
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
323,528,499
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
 
No
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 (2011)
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
2011
Open to Public
Inspection
Name of the organization
MILLS-PENINSULA HEALTH SERVICES
 
Employer identification number

94-1156265
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011

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
2011
Name of organization
MILLS-PENINSULA HEALTH SERVICES
 
Employer identification number

94-1156265
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 on line H of its
Form 990-EZ or on Part I, 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) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
MILLS-PENINSULA HEALTH SERVICES
  		Employer identification number

94-1156265
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total 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)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
MILLS-PENINSULA HEALTH SERVICES
  		Employer identification number

94-1156265
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(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) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
MILLS-PENINSULA HEALTH SERVICES
  		Employer identification number

94-1156265
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total 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 $  
Use duplicate copies of Part III if additional space is needed
(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) (2011)

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, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
MILLS-PENINSULA HEALTH SERVICES
 
Employer identification number

94-1156265
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 can 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 through 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, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax 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 (ASC 958), 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 (ASC 958), 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 (ASC 958), 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) 2011

Schedule D (Form 990) 2011
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 .... 6,719,626 6,271,261 5,797,262 6,910,971
b Contributions ........        
c Net investment earnings, gains, and losses ... 32,296 544,479 544,040 -865,337
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		53,792 96,114 70,041 248,372
f Administrative expenses ....        
g End of year balance ...... 6,698,130 6,719,626 6,271,261 5,797,262
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet90.000 %
c
Temporarily restricted endowment SchDMd Bullet10.000 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
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)
 
No
(ii) related organizations ........................
3a(ii)
 
No
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
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   11,852,348 11,852,348
b Buildings ................   794,830,193 160,195,107 634,635,086
c Leasehold improvements ............   4,117,451 3,804,026 313,425
d Equipment ................   207,101,779 127,122,764 79,979,015
e Other .................   32,818,760 3,532,532 29,286,228
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 756,066,102
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
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) must 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) must 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) must 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) Book value
Federal Income Taxes 0
INSURANCE LIABILITIES 2,300,747
OTHER LIABILITIES 4,479,369







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 6,780,116
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) 2011

Schedule D (Form 990) 2011
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 through 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 must 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 must 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
INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS PART V, QUESTION 4 THE ENDOWMENTS ARE USED TO SUPPORT THE PROGRAMS OF MILLS-PENINSULA HEALTH SERVICES.
ASC 740 (FIN48) AUDIT FOOTNOTE 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: SUTTER HEALTH AND MOST AFFILIATES HAVE BEEN DETERMINED TO BE EXEMPT ORGANIZATIONS BY THE INTERNAL REVENUE SERVICE, (PURSUANT TO INTERNAL REVENUE CODE SECTION 501(C)(3)), AND THE CALIFORNIA FRANCHISE TAX BOARD (PURSUANT TO CALIFORNIA REVENUE AND TAXATION CODE 23701(D)) AND, GENERALLY, ARE NOT SUBJECT TO TAXES ON INCOME. CERTAIN ACTIVITIES OF SUTTER ARE SUBJECT TO INCOME TAXES; HOWEVER, SUCH ACTIVITIES ARE NOT SIGNIFICANT TO THE COMBINED FINANCIAL STATEMENTS. WITH RESPECT TO ITS FOR-PROFIT SUBSIDIARIES AND TAXABLE ACTIVITIES, SUTTER RECORDS INCOME TAXES USING THE LIABILITY METHOD UNDER WHICH DEFERRED TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON THE DIFFERENCES BETWEEN THE FINANCIAL ACCOUNTING AND TAX BASIS OF ASSETS AND LIABILITIES. DEFERRED TAX ASSETS OR LIABILITIES AT THE END OF EACH PERIOD ARE DETERMINED USING THE CURRENTLY ENACTED TAX RATE EXPECTED TO APPLY TO TAXABLE INCOME IN THE PERIODS THAT THE DEFERRED TAX ASSET OR LIABILITY IS EXPECTED TO BE REALIZED OR SETTLED. SUTTER RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. SUTTER RECOGNIZES INTEREST AND PENALTIES RELATED TO INCOME TAX MATTERS IN OPERATING EXPENSES. AT DECEMBER 31, 2011 AND 2010, THERE WERE NO SUCH UNCERTAIN TAX POSITIONS.
Schedule D (Form 990) 2011

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
2011
Open to Public Inspection
Name of the organization
MILLS-PENINSULA HEALTH SERVICES
 
Employer identification number

94-1156265
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did 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 used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance 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 discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did 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
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
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 Financial Assistance at cost
(from Worksheet 1) .. 		    10,624,853 0 10,624,853 2.040 %
b Medicaid (from Worksheet 3, column a) .....     43,344,081 21,290,967 22,053,114 4.230 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .     813,939 382,459 431,480 0.080 %
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    54,782,873 21,673,426 33,109,447 6.350 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		15 28,048 796,011 180 795,831 0.150 %
f Health professions education
(from Worksheet 5) .. 		1 86 332,448 0 332,448 0.060 %
g Subsidized health services
(from Worksheet 6) .. 		3 491 5,687,186 3,455,233 2,231,953 0.430 %
h Research (from Worksheet 7)            
i Cash and in-kind contributions for community benefit (from Worksheet 8) .... 17 2,658 1,124,414 0 1,124,414 0.220 %
jTotal Other Benefits ... 36 31,283 7,940,059 3,455,413 4,484,646 0.860 %
kTotal. Add lines 7d and 7j. .. 36 31,283 62,722,932 25,128,839 37,594,093 7.210 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(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            
4 Environmental improvements 1 0 566 0 566 0 %
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development 1 10 11,696 0 11,696 0 %
9 Other            
10 Total 2 10 12,262 0 12,262 0 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did 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........
2
3,248,394
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance 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
85,944,855
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
118,668,663
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-32,723,808
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
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(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) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?4
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 MILLS-PENINSULA MEDICAL CENTER
1501 TROUSDALE DRIVE
BURLINGAME,CA94010 		X X         X    
2 MILLS-PENINSULA SKILLED NURSING FACILITY
1609 TROUSDALE DRIVE
BURLINGAME,CA94010 		X                
3 SUTTER MATERNITY & SURG CTR SANTA CRUZ
2900 CHANTICLEER AVENUE
SANTA CRUZ,CA95065 		X X             OUTPATIENT SERVICES
4 MENLO PARK SURGICAL HOSPITAL
570 WILLOW ROAD
MENLO PARK,CA94025 		X X             OUTPATIENT SERVICES
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
MILLS-PENINSULA MEDICAL CENTER
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
MILLS-PENINSULA SKILLED NURSING FACILITY
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
SUTTER MATERNITY & SURG CTR SANTA CRUZ
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
MENLO PARK SURGICAL HOSPITAL
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?5
Name and address Type of Facility (describe)
1 MILLS-PENINSULA HEALTH CENTER
100 S SAN MATEO DRIVE
SAN MATEO,CA94401 		CHRONIC DIALYSIS RENAL DISEASE
2 BURLINGAME DIALYSIS CENTER
1720 EL CAMINO REAL
BURLINGAME,CA94010 		RENAL DISEASE
3 MILLS-PENINSULA HEALTH SERVICES
1600 TROUSDALE DRIVE
BURLINGAME,CA94010 		PSYCH. SERVICES
4 MILLS-PENINSULA SKILLED NURSING FACILITY
101 S SAN MATEO DRIVE
SAN MATEO,CA94401 		SKILLED NURSING FACILITY
5 MILLS-PENINSULA SKILLED NURSING FACILITY
1609 TROUSDALE DRIVE
BURLINGAME,CA94010 		SKILLED NURSING FACILITY
6
7
8
9
10
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions 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, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any 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 350% OF FPG. PARTIAL WRITE-OFF OF THE HOSPITAL'S UNDISCOUNTED CHARGES APPLIES TO UNINSURED PATIENTS WHOSE FAMILY INCOMES ARE BETWEEN 351% AND 500%. 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 INSURE HAS NOT PROVIDED A DISCOUNT. - UNINSURED PATIENT DISCOUNT: A WRITE-OFF OF A PORTION OF COVERED SERVICES NO GREATER THAT 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 MILLS-PENINSULA HEALTH SERVICES MILLS-PENINSULA HEALTH SERVICES (MPHS) DOES NOT HAVE ANY COMMUNITY BUILDING ACTIVITIES TO REPORT IN 2011. SUTTER MATERNITY & SURGERY CENTER OF SANTA CRUZ SUTTER MATERNITY & SURGERY CENTER OF SANTA CRUZ FUNDED THE FOLLOWING PROGRAMS THAT HELPED ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS AND IMPACT THE HEALTH AND WELL-BEING IN THE COMMUNITIES WE SERVE (ALSO KNOWN AS COMMUNITY-BUILDING ACTIVITIES). THESE PROGRAMS HELPED SUPPORT COMMUNITY ASSETS BY OFFERING THE EXPERTISE AND RESOURCES OF SUTTER HEALTH. A) ENVIRONMENTAL AWARENESS PROGRAM: THE ENVIRONMENTAL AWARENESS PROGRAM AT SUTTER MATERNITY & SURGERY CENTER FOCUSES ON REDUCTION OF COMMUNITY ENVIRONMENTAL HAZARDS. ALONG WITH THE SHARE IN HEALTH CARE FACILITY ENVIRONMENTAL RESPONSIBILITY WHICH INCLUDES WASTE REDUCTION, GREEN PURCHASING AND OTHER ECOLOGY INITIATIVES. B) MENTORING OF STUDENTS/INTERNSHIPS: SUTTER MATERNITY & SURGERY CENTER TEACHES AND MENTORS STUDENTS FROM ALTERNATIVE PROGRAMS, PROVIDING RETRAINING AND RE-ENTRANCE INTO THE JOB MARKET SPECIFICALLY TO FIND WORK IN THE MEDICAL FIELD. THESE STUDENTS COME FROM THE SHORELINE WORKFORCE DEVELOPMENT SERVICES PROGRAM, WHICH IS SUBSIDIZED BY THE STATE, AND STUDENTS FROM THE REGULAR SHORELINE PROGRAM (8-MONTH SCHOOL TRAINING PROGRAM). THESE STUDENTS WORK ALL OVER THE HOSPITAL IN DIFFERENT SETTINGS.
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. 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. THESE ALLOWANCES ARE ESTIMATED BASED UPON AN EVALUATION OF HISTORICAL PAYMENTS, NEGOTIATED CONTRACTS AND GOVERNMENTAL REIMBURSEMENTS. SUTTER'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 90% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2011 AND 2010. ADJUSTMENTS AND CHANGES IN ESTIMATES ARE RECORDED IN THE PERIOD IN WHICH THEY ARE DETERMINED. SIGNIFICANT CONCENTRATIONS OF GROSS PATIENT ACCOUNTS RECEIVABLE ARE AS FOLLOWS: MEDICARE 25% AS OF 12/31/11 28% AS OF 12/31/10 MEDI-CAL 21% AS OF 12/31/11 20% AS OF 12/31/10 DURING 2011 AND 2010, 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 PAYERS AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT PROGRAMS WITH THIRD-PARTY PAYERS. 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. SUTTER HAD NO CHANGES IN ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES IN 2011. 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. 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.
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 $32,723,808.
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.
PART V, SECTION B, QUESTION 11H BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS: ADDITIONAL FACTORS USED IN DETERMINING AMOUNTS CHARGED TO PATIENTS INCLUDES HOUSEHOLD SIZE, WHICH IS PART OF THE FEDERAL POVERTY GUIDELINES.
PART V, SECTION B, QUESTION 13G MEASURES USED TO PUBLICIZE THE FACILITY'S FINANCIAL ASSISTANCE POLICY: A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WAS POSTED ON THE HOSPITAL'S FACILITY'S WEBSITE, WAS ATTACHED TO BILLING INVOICES, WAS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY/WAITING ROOM, WAS POSTED IN THE HOSPITAL'S ADMISSIONS OFFICE, WAS PROVIDED IN WRITING ON ADMISSION TO THE HOSPITAL, AND WAS AVAILABLE ON REQUEST. PATIENTS ELIGIBLE FOR CHARITY CARE ARE TRACKED IN THE HOSPITAL'S LEGACY SYSTEM AND ARE REMINDED 30 DAYS AFTER CHARITY CARE PACKET IS RECEIVED IF PAPERWORK HAS NOT BEEN SUBMITTED. ORGANIZATION USES AN INCOME VALIDATION TOOL TO ALERT PATIENTS THAT THEY MAY BE ELIGIBLE FOR CHARITY CARE.
PART V, SECTION B, QUESTION 19 AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS: THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY PROVIDES FOR DIFFERENT LEVELS OF ASSISTANCE FOR PATIENTS BASED ON VARIOUS ELIGIBILITY REQUIREMENTS INCLUDING, BUT NOT LIMITED TO (1) FULL CHARITY CARE, (2) PARTIAL CHARITY CARE, (3) SPECIAL CIRCUMSTANCES CHARITY CARE, (4) CATASTROPHIC CHARITY CARE, (5) HIGH COST MEDICAL CHARITY CARE, (6) UNINSURED PATIENT DISCOUNT, AND (7) PROMPT PAYMENT DISCOUNT. THE MAXIMUM AMOUNT BILLED TO THE PATIENT IS CALCULATED DIFFERENTLY DEPENDING ON THE CATEGORY OF FINANCIAL ASSISTANCE FOR WHICH THEY ARE ELIGIBLE.
NEEDS ASSESSMENT PART VI, QUESTION 2 MILLS-PENINSULA HEALTH SERVICES MILLS-PENINSULA HEALTH SERVICES (MPHS) ASSESSES THE NEEDS OF ITS COMMUNITY BY PARTICIPATING IN A COLLABORATIVE NEEDS ASSESSMENT PROCESS IN BOTH SAN MATEO COUNTY AND SANTA CRUZ COUNTY. IN SAN MATEO COUNTY, THE ASSESSMENT OCCURS EVERY THREE YEARS. BOTH PROJECTS INCLUDE QUANTITATIVE AND QUALITATIVE DATA AND INCLUDES INFORMATION COLLECTED FROM STATE AND COUNTY HEALTH AGENCIES AND COMMUNITY INPUT THROUGH ADVISORY BOARDS. THE NEEDS ASSESSMENT PROCESS HELPS TO FOCUS COMMUNITY BENEFIT EFFORTS TOWARD THE GREATEST HEALTH-RELATED NEEDS FOR RESIDENTS IN SAN MATEO AND SANTA CRUZ COUNTY. SUTTER MATERNITY & SURGERY CENTER OF SANTA CRUZ SUTTER MATERNITY & SURGERY CENTER WORKS WITH THE UNITED WAY OF SANTA CRUZ COUNTY ON THEIR COMMUNITY ASSESSMENT PROJECT (CAP), A COLLABORATIVE PROJECT TO MEASURE THE QUALITY OF LIFE IN SANTA CRUZ. THE COLLABORATIVE IS MADE UP OF PUBLIC AND PRIVATE HEALTH, EDUCATION, HUMAN SERVICE AND CIVIC ORGANIZATIONS WHO LOOK AT A SERIES OF INDICATORS IN HEALTH, ECONOMY, EDUCATION, PUBLIC SAFETY, THE NATURAL ENVIRONMENT AND SOCIAL ENVIRONMENT OF SANTA CRUZ COUNTY. CAP IDENTIFIED THE FOLLOWING HEALTH-RELATED GOALS IN THEIR MOST RECENT REPORT (SANTA CRUZ COUNTY COMMUNITY ASSESSMENT PROJECT, YEAR 17, 2011; PAGE 68): - BY THE YEAR 2015, ACCESS TO PRIMARY CARE WILL IMPROVE AS MEASURED BY: - 95% OF SANTA CRUZ COUNTY RESIDENTS WILL REPORT HAVING A REGULAR SOURCE OF HEALTH CARE; - LESS THAN 10% WILL REPORT TO THE EMERGENCY DEPARTMENT AS ONE OF THEIR REGULAR SOURCES OF HEALTH CARE; AND - NO SIGNIFICANT DIFFERENCE BETWEEN THE PERCENT OF CAUCASIAN AND LATINO RESIDENTS REPORTING A REGULAR SOURCE OF HEALTH CARE. - BY THE YEAR 2015, 98% OF SANTA CRUZ COUNTY CHILDREN 0 - 17 WILL HAVE COMPREHENSIVE HEALTH CARE COVERAGE AS MEASURED BY THE CAP SURVEY. - BY THE YEAR 2015, THE PREVALENCE OF CHILDHOOD OBESITY IN SANTA CRUZ COUNTY WILL DECREASE AS MEASURED BY: - % OF CHILDREN UNDER 5 YEARS WHO ARE OVERWEIGHT OR OBESE WILL DECREASE FROM 15% TO 12%, AND - % OF CHILDREN 5 TO 19 YEARS WHO ARE OVERWEIGHT OR OBESE WILL DECREASE FROM 26% TO 21%. TO SEE MORE OF THE MOST RECENT CAP, PLEASE VISIT THE WEBSITE AT HTTP://WWW.SANTACRUZCOUNTYCAP.ORG/CAP-17.HTM
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, QUESTION 3 MILLS-PENINSULA HEALTH SERVICES AND SUTTER MATERNITY & SURGERY CENTER OF SANTA CRUZ FOLLOW A SUTTER HEALTH SYSTEM-WIDE CHARITY CARE POLICY, WHICH INCLUDES THE FOLLOWING DETAILS OF HOW THE ORGANIZATIONS INFORM AND EDUCATE PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE. FOR A MORE DETAILED LOOK AT OUR CHARITY CARE POLICIES BY REGION, PLEASE VISIT THE OFFICE OF STATEWIDE AND HEALTH PLANNING'S WEBSITE AT HTTP://SYFPHR.OSHPD.CA.GOV. COMMUNICATIONS 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. NOTIFICATIONS 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 PART VI, QUESTION 4 MILLS-PENINSULA HEALTH SERVICES - SAN MATEO COUNTY ACCORDING TO THE 2010 U.S. CENSUS BUREAU THE POPULATION OF SAN MATEO COUNTY WAS 718,451 AND CONSISTED OF 49.2% MEN AND 50.8% WOMEN WITH A MEDIAN AGE OF 36.8 YEARS. THE POPULATION DENSITY WAS 1,602.2 PEOPLE PER SQUARE MILE IN 2010 WHICH IS OVER SIX TIMES THE CALIFORNIA STATE DENSITY OF 239.1 PEOPLE PER SQUARE MILE. SAN MATEO'S POPULATION CONSISTS OF 53.4% WHITE RESIDENTS, 25.4% HISPANIC OR LATINO AND 24.8% ASIAN. OVER HALF (58.5%) OF RESIDENTS SPEAK ENGLISH AT HOME WHILE 18.1% SPEAK SPANISH, AND 15.5% SPEAK ASIAN OR PACIFIC ISLANDER AT HOME. THE MEDIAN HOUSEHOLD SIZE IS 2.72 PEOPLE WITH A 2010 AVERAGE INCOME OF $85,648 AND A MEDIAN HOUSE VALUE OF $784,800. A HIGH PERCENTAGE 88.5% OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A HIGH SCHOOL DEGREE OR HIGHER WHILE 44% OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A BACHELOR'S DEGREE OR HIGHER. IN SAN MATEO THE POVERTY LEVEL IN 2010 WAS AT 7% OF RESIDENTS, BELOW BOTH THE CALIFORNIA STATE LEVEL OF 13.7% AND THE FEDERAL POVERTY LEVEL OF 15.1%.THE UNEMPLOYMENT RATE WAS AT 17.6% IN APRIL 2010 WHICH WAS ABOVE BOTH THE CALIFORNIA LEVEL OF 12.4% AND THE FEDERAL LEVEL OF 9.9%. FOOD SUPPLIES CONSIST OF 171 GROCERY STORES, 114 CONVENIENCE STORES (WITH GAS) AND 703 FULL SERVICE RESTAURANTS. IN 2010, HEALTH ISSUES IN THIS COUNTY INCLUDED 14.4% OF ADULTS BEING OBESE, 4.2% OF ADULTS WITH DIABETES AND 21.6% OF ADULTS WITH HIGH BLOOD PRESSURE. IN 2007 THERE WERE 4,536 DEATHS IN SAN MATEO COUNTY AND OF THOSE THE THREE LEADING CAUSES WERE CANCER, HEART DISEASE AND STROKE. IN 2007 THERE WERE 9,914 BIRTHS AS WELL AS 43 INFANT DEATHS THAT SAME YEAR. IN 2008 THE LIFE EXPECTANCY AT BIRTH WAS 80.3 YEARS WHICH WAS EXACTLY AT THE CALIFORNIA LIFE EXPECTANCY. IN 2010, 14.3% OF RESIDENTS WERE WITHOUT ANY HEALTH INSURANCE WHICH WAS BELOW BOTH THE STATE LEVEL OF 18.5% AND THE FEDERAL LEVEL OF 15.5%. IN SAN MATEO COUNTY 66% OF RESIDENTS HAVE EMPLOYMENT-BASED HEALTH INSURANCE WHILE 6.1% OF RESIDENTS ARE COVERED BY PUBLIC PROGRAMS SUCH AS MEDICAID OR MEDICARE. SUTTER MATERNITY & SURGERY CENTER OF SANTA CRUZ - SANTA CRUZ COUNTY ACCORDING TO THE 2010 U.S. CENSUS BUREAU, SANTA CRUZ HAD A POPULATION OF 262,382 AND CONSISTED OF 49.9% MEN AND 50.1% WOMEN WITH A MEDIAN AGE OF 35 YEARS. THE POPULATION DENSITY WAS 589.4 PEOPLE PER SQUARE MILE IN 2010 WHICH IS TWICE THE CALIFORNIA STATE DENSITY OF 239.1 PEOPLE PER SQUARE MILE. SANTA CRUZ'S POPULATION CONSISTS OF 72.5% WHITE RESIDENTS, 32% HISPANIC OR LATINO AND 4.2% ASIAN. ALMOST THREE QUARTERS (72.2%) OF RESIDENTS SPEAK ENGLISH AT HOME WHILE 22.2% SPEAK SPANISH (17% OF WHICH DO NOT SPEAK ENGLISH AT ALL). THE MEDIAN HOUSEHOLD SIZE IS 2.63 PEOPLE WITH A 2010 AVERAGE INCOME OF $65,253 AND A MEDIAN HOUSE VALUE OF $648,700. A HIGH PERCENTAGE (84.1%) OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A HIGH SCHOOL DEGREE OR HIGHER WHILE 37.3% OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A BACHELOR'S DEGREE OR HIGHER. IN SANTA CRUZ THE POVERTY LEVEL IN 2010 WAS AT 12.7% OF RESIDENTS, BELOW BOTH THE CALIFORNIA STATE LEVEL OF 13.7% AND THE FEDERAL POVERTY LEVEL OF 15.1%.THE UNEMPLOYMENT RATE WAS AT 13.5% IN APRIL 2010 WHICH WAS ABOVE BOTH THE CALIFORNIA LEVEL OF 12.4% AND THE FEDERAL LEVEL OF 9.9%. FOOD SUPPLIES CONSIST OF 64 GROCERY STORES, 39 CONVENIENCE STORES (WITH GAS) AND 246 FULL SERVICE RESTAURANTS. IN 2010, HEALTH ISSUES IN THIS COUNTY INCLUDED 20% OF ADULTS BEING OBESE, 7% OF ADULTS WITH DIABETES AND 20.4% OF ADULTS WITH HIGH BLOOD PRESSURE. IN 2007 THERE WERE 1,598 DEATHS IN SANTA CRUZ COUNTY AND OF THOSE THE THREE LEADING CAUSES WERE CANCER, HEART DISEASE AND STROKE. IN 2007 THERE WERE 3,571 BIRTHS AS WELL AS 19 INFANT DEATHS THAT SAME YEAR. IN 2008 THE LIFE EXPECTANCY AT BIRTH WAS 77.1 YEARS WHICH WAS BELOW THE CALIFORNIA LIFE EXPECTANCY. IN 2010, 22.3% OF RESIDENTS WERE WITHOUT ANY HEALTH INSURANCE WHICH WAS ABOVE BOTH THE STATE LEVEL OF 18.5% AND THE FEDERAL LEVEL OF 15.5%. IN SANTA CRUZ COUNTY 44.7% OF RESIDENTS HAVE EMPLOYMENT-BASED HEALTH INSURANCE WHILE 14.6% OF RESIDENTS ARE COVERED BY PUBLIC PROGRAMS SUCH AS MEDICAID OR MEDICARE.
PROMOTION OF COMMUNITY HEALTH PART VI, QUESTION 5 SUTTER HEALTH'S MISSION IS TO "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 HOSPITALS AND FACILITIES. OUR AFFILIATES FURTHER THEIR TAX-EXEMPT PURPOSE BY: - BUILDING RELATIONSHIPS OF TRUST BY 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; AND - PROVIDING GENEROUS CHARITY CARE POLICIES FOR OUR MOST VULNERABLE COMMUNITY MEMBERS. THE HOSPITAL HAS AN OPEN MEDICAL STAFF AND IS RUN BY A COMMUNITY BOARD. A FEW HIGHLIGHTS OF MILLS-PENINSULA HEALTH SERVICES' (MPHS) COMMUNITY BENEFIT ACTIVITIES IN 2011: MILLS-PENINSULA HEALTH SERVICES CREATED SENIOR FOCUS IN 1985 TO HELP SENIORS PROTECT THEIR INDEPENDENCE, WITH EDUCATION ABOUT HOW TO STAY HEALTHY AND SERVICES TO ASSIST WHEN CHALLENGES APPEAR. MORE THAN 25 YEARS LATER, SENIOR FOCUS HAS MATURED INTO A TRUSTED RESOURCE FOR FAMILIES AND A HIGHLY REGARDED PARTNER AND ADVISOR FOR LOCAL AGENCIES AND ORGANIZATIONS. REPRESENTING THE BEST CURRENT THINKING ABOUT HEALTHFUL AGING, SENIOR FOCUS SERVES AS EDUCATOR, SERVICE PROVIDER AND ADVOCATE FOR ELDERS IN THE COMMUNITY, IN THE HOSPITAL AND AT HOME. FROM TIME TO TIME, IT IS NECESSARY FOR THE HOSPITAL TO CALL UPON MEDICAL SPECIALISTS TO ASSIST IN THE CARE AND TREATMENT OF PATIENTS IN THE EMERGENCY DEPARTMENT AND/OR LABOR AND DELIVERY. MPHS ASSISTS THOSE PATIENTS WITH FINANCIAL HARDSHIPS TO PAY FOR SERVICES RENDERED. THIS PROGRAM HELPED SUPPORT MORE THAN 475 PERSONS IN 2011. MPHS PARTICIPATES IN NUMEROUS HEALTH FAIRS AT LOCAL SCHOOLS, COMMUNITY COLLEGE AND CHURCHES IN THE COUNTY. SERVICES AT THESE EVENTS INCLUDE BLOOD PRESSURE READINGS, STEP TESTS, BODY COMPOSITIONS AND FLEXIBILITY, CHAIR MASSAGES AND SCHOLARSHIPS. THESE PROGRAMS SERVED MORE THAN 5,400 PERSONS IN 2011. THE HOSPITAL HAS AN OPEN MEDICAL STAFF AND IS RUN BY A COMMUNITY BOARD. A FEW HIGHLIGHTS OF SUTTER MATERNITY & SURGERY CENTER OF SANTA CRUZ'S (SM&SC) COMMUNITY BENEFIT ACTIVITIES IN 2011: SM&SC PROVIDES A VARIETY MENTORING, INTERNSHIPS AND PRECEPTORSHIPS FOR STUDENTS LOOKING TO FURTHER THEIR EDUCATION IN THE HEALTH CARE FIELD. SM&SC PARTICIPATES IN A SENIOR HEALTH FAIR, PROSTATE CANCER AWARENESS FAIR AND BREAST CANCER AWARENESS FAIR TO PROVIDE FREE HEALTH SCREENINGS, RESOURCES AND EDUCATION FOR THE COMMUNITY. SM&SC SUPPORTS A VARIETY OF NONPROFIT ORGANIZATIONS SUCH AS THE AMERICAN RED CROSS, THE COMMUNITY FOUNDATION OF SANTA CRUZ COUNTY, BILLY FOUNDATION AND LEADERSHIP SANTA CRUZ COUNTY WITH CASH DONATIONS TO SUPPORT HIGH-RISK YOUTH, SCHOLARSHIPS AND EMERGENCY FUNDING FOR DISASTER RELIEF. SM&SC PROVIDES SPACE AND RESOURCES FOR GROUPS LIKE NARCOTICS ANONYMOUS, OVER EATERS ANONYMOUS AND ALCOHOLICS ANONYMOUS. THESE CRITICAL SELF-HELP RECOVERY PROGRAMS SUPPORT COMMUNITY MEMBERS SUFFERING FROM ADDICTION.
AFFILIATED HEALTH CARE SYSTEM PART VI, QUESTION 6 MILLS-PENINSULA HEALTH SERVICES AND SUTTER MATERNITY & SURGERY CENTER OF SANTA CRUZ ARE AFFILIATED WITH SUTTER HEALTH, A NOT-FOR-PROFIT NETWORK OF 48,000 PHYSICIANS, EMPLOYEES, AND VOLUNTEERS WHO CARE FOR MORE THAN 100 NORTHERN CALIFORNIA TOWNS AND CITIES. TOGETHER, WE'RE CREATING FOR A MORE INTEGRATED, SEAMLESS AND AFFORDABLE APPROACH TO CARING FOR PATIENTS. IT'S BETTER FOR PATIENTS: WE BELIEVE THIS COMMUNITY-OWNED, NOT-FOR-PROFIT APPROACH TO HEALTH CARE BEST SERVES OUR PATIENTS AND OUR COMMUNITIES - FOR MULTIPLE REASONS. FIRST OF ALL, IT'S GOOD FOR PATIENTS. ACCORDING TO THE JOURNAL OF GENERAL INTERNAL MEDICINE (APRIL 2000), PATIENTS TREATED AT FOR-PROFIT OR GOVERNMENT-OWNED HOSPITALS WERE TWO-TO-FOUR TIMES MORE LIKELY TO SUFFER PREVENTABLE ADVERSE EVENTS THAN PATIENTS TREATED AT NOT-FOR-PROFIT INSTITUTIONS. OUR STOCKHOLDERS ARE OUR COMMUNITIES: INVESTOR-OWNED, FOR-PROFIT HEALTH SYSTEMS HAVE A FINANCIAL INCENTIVE TO AVOID CARING FOR UNINSURED AND UNDERINSURED PATIENTS. THEY ALSO HAVE A FINANCIAL INCENTIVE TO AVOID HARD-TO-SERVE POPULATIONS AND "UNDESIRABLE" GEOGRAPHIC AREAS SUCH AS RURAL AREAS. IN MANY OF NORTHERN CALIFORNIA'S UNDERSERVED RURAL LOCALES, SUTTER HEALTH IS THE ONLY PROVIDER OF HOSPITAL AND EMERGENCY MEDICAL SERVICES IN THE COMMUNITY. PROVIDING CHARITY CARE AND SPECIAL PROGRAMS TO COMMUNITIES: OUR COMMUNITIES' SUPPORT HELPS US EXPAND SERVICES, INTRODUCE NEW PROGRAMS AND IMPROVE MEDICAL TECHNOLOGY. ACROSS OUR NETWORK, EVERY SUTTER HOSPITAL, PHYSICIAN ORGANIZATION AND CLINIC HAS A SPECIAL STORY TO TELL ABOUT FULFILLING VITAL COMMUNITY NEEDS. OUR COMMITMENT TO COMMUNITY BENEFIT: MEETING THE HEALTH CARE NEEDS OF OUR COMMUNITIES IS THE CORNERSTONE OF SUTTER HEALTH'S NOT-FOR-PROFIT MISSION. THIS INCLUDES DIRECTLY SERVING THOSE WHO CANNOT AFFORD TO PAY FOR HEALTH CARE AND SUPPORTING PROGRAMS AND SERVICES THAT HELP THOSE IN FINANCIAL NEED. SUTTER HEALTH NOW PROVIDES $2.7 MILLION IN CHARITY CARE PER WEEK. IN 2011, OUR NETWORK OF PHYSICIAN ORGANIZATIONS, HOSPITALS AND OTHER HEALTH CARE PROVIDERS INVESTED A RECORD $756 MILLION IN BENEFITS TO THE POOR AND UNDERSERVED* AND THE BROADER COMMUNITY**. THIS INCLUDES: - THE COST OF PROVIDING CHARITY CARE - THE UNPAID COSTS OF PARTICIPATING IN MEDI-CAL - INVESTMENTS IN MEDICAL RESEARCH, HEALTH EDUCATION AND COMMUNITY-BASED PUBLIC BENEFIT PROGRAMS SUCH AS SCHOOL-BASED CLINICS AND PRENATAL CARE FOR PATIENTS. * 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 PART VI, QUESTION 7 CALIFORNIA
Schedule H (Form 990) 2011
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
2011
Open to Public
Inspection
Name of the organization
MILLS-PENINSULA HEALTH SERVICES
 
Employer identification number
94-1156265
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) SANTA CRUZ COUNTY COMMUNITY FOUNDATION2425 PORTER ST
SOQUEL,CA95073 		94-2808039 501(C)(3) 140,000       GENERAL SUPPORT
(2) COMMUNITY GATEPATH875 STANTON RD
BURLINGAME,CA94010 		94-1156502 501(C)(3) 115,000       GENERAL SUPPORT
(3) SAMARITAN HOUSE4031 PACIFIC BLVD
SAN MATEO,CA94403 		23-7416272 501(C)(3) 115,000       GENERAL SUPPORT
(4) HOSPITAL CONSORTIUM1600 TROUSDALE DR
BURLINGAME,CA94010 		94-2637032 501(C)(3) 56,000       GENERAL SUPPORT
(5) BURLINGAME CITY850 BURLINGAME AVE
BURLINGAME,CA94010 		94-6000304   29,000       GENERAL SUPPORT
(6) PAL CARE INC945 CALIFORNIA DR
BURLINGAME,CA94010 		94-3048383 501(C)(3) 25,000       GENERAL SUPPORT
(7) AMERICAN HEART ASSOCIATION100 MONTGOMERY ST
SAN FRANCISCO,CA94104 		13-5613797 501(C)(3) 20,950       GENERAL SUPPORT
(8) MID PENINSULA BOYS & GIRLS CLUB200 N QUEBEC ST
SAN MATEO,CA94401 		94-1431583 501(C)(3) 18,000       GENERAL SUPPORT
(9) HUMAN INVESTMENT PROJECT364 S RAILROAD AVE
SAN MATEO,CA94401 		94-2154614 501(C)(3) 16,000       GENERAL SUPPORT
(10) ROTACARE COASTSIDE CLINICPO BOX 18430
SAN JOSE,CA95158 		77-0328723 501(C)(3) 16,000       GENERAL SUPPORT
(11) CORA1633 BAYSHORE HWY
BURLINGAME,CA94010 		94-2481188 501(C)(3) 15,000       GENERAL SUPPORT
(12) PARCA800 AIRPORT BLVD
BURLINGAME,CA94010 		94-1650851 501(C)(3) 15,000       GENERAL SUPPORT
(13) PENINSULA FAMILY SVC AGENCY24 SECOND AVE
SAN MATEO,CA94401 		94-1186169 501(C)(3) 15,000       GENERAL SUPPORT
(14) PUENTE DELA COSTAPO BOX 554
PESCADERO,CA94060 		37-1484262 501(C)(3) 15,000       GENERAL SUPPORT
(15) SHELTER NETWORK1660 S AMPHLETT BLVD
SAN MATEO,CA94402 		77-0160469 501(C)(3) 15,000       GENERAL SUPPORT
(16) UNITED WAY SANTA CRUZPO BOX 1458
CAPITOLA,CA95010 		94-1422471 501(C)(3) 10,500       GENERAL SUPPORT
(17) HOME & HOPE1720 EL CAMINO REAL
BURLINGAME,CA94010 		94-3356735 501(C)(3) 10,000       GENERAL SUPPORT
(18) SAN MATEO CITY2645 ALAMEDA LAS PULGAS
SAN MATEO,CA94403 		94-6000422   13,000       GENERAL SUPPORT
(19) CABRILLO COLLEGE ACCRUAL6500 SOQUEL DR
APTOS,CA95003 		77-0385111 501(C)(3) 10,000       GENERAL SUPPORT
(20) STAR VISTA610 ELM ST
SAN CARLOS,CA94070 		94-3094966 501(C)(3) 9,500       GENERAL SUPPORT
(21) CASA OF SAN MATEO1700 EL CAMINO REAL
SAN MATEO,CA94402 		68-0484676 501(C)(3) 8,000       GENERAL SUPPORT
(22) COASTSIDE ADULT DAY HEALTH645 CORREAS ST
HALF MOON BAY,CA94019 		94-2435784 501(C)(3) 8,000       GENERAL SUPPORT
(23) EDGEWOOD CTR CHILDREN1801 VICENTE ST
SAN FRANCISCO,CA94116 		94-1186168 501(C)(3) 8,000       GENERAL SUPPORT
(24) FAMILY CONNECTIONSPO BOX 358
SAN CARLOS,CA94070 		94-3315163 501(C)(3) 8,000       GENERAL SUPPORT
(25) LEGAL AIDS OF SAN MATEO COUNTY521 E 5TH AVE
SAN MATEO,CA94402 		94-1451894 501(C)(3) 8,000       GENERAL SUPPORT
(26) NOTRE DAME DE NAMUR UNIVERSITY1500 RALSTON AVE
BELMONT,CA94002 		94-1156646 501(C)(3) 8,000       GENERAL SUPPORT
(27) OMBUDSMAN SVC SMC711 NEVADA ST
REDWOOD CITY,CA94061 		94-3397402 501(C)(3) 8,000       GENERAL SUPPORT
(28) PENINSULA JEWISH2440 CARLMONT DR
BELMONT,CA94002 		94-3227262 501(C)(3) 8,000       GENERAL SUPPORT
(29) PLANNED PARENTHOOD MAR MONTE1746 THE ALAMEDA
SAN JOSE,CA95126 		94-1583439 501(C)(3) 8,000       GENERAL SUPPORT
(30) SENIOR COASTSIDE535 KELLEY AVE
HALF MOON BAY,CA94019 		94-3119310 501(C)(3) 8,000       GENERAL SUPPORT
(31) SONRISAS210 SAN MATEO DR
HALF MOON BAY,CA94019 		94-3390196 501(C)(3) 8,000       GENERAL SUPPORT
(32) VISTA CTR FOR THE BLIND & VISUALLY IMPAIRED2470 EL CAMINO REAL
PALO ALTO,CA94306 		94-1196206 501(C)(3) 8,000       GENERAL SUPPORT
(33) FRIENDS FOR YOUTH1741 BROADWAY ST
REDWOOD CITY,CA94063 		94-2961034 501(C)(3) 7,500       GENERAL SUPPORT
(34) SAN MATEO COUNTY1720 EL CAMINO REAL
BURLINGAME,CA94010 		94-3356735 501(C)(3) 7,500       GENERAL SUPPORT
(35) WOMEN CARE2901 PARK AVE
SOQUEL,CA95073 		77-0410099 501(C)(3) 7,500       GENERAL SUPPORT
(36) BURLINGAME CHAMBER OF COMMERCE290 CALIFORNIA DR
BURLINGAME,CA94010 		94-1073698 501(C)(6) 5,500       GENERAL SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
33
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
3
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
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
(1) SCHOLARSHIPS 57 68,436      













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
Schedule I (Form 990) 2011


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
2011
Open to Public Inspection
Name of the organization
MILLS-PENINSULA HEALTH SERVICES
 
Employer identification number

94-1156265
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 or provision 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. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
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
 
No
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 Regulations 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) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(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 as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) JEFF GERARD (i)
(ii)		 0
658,710 		0
434,975 		0
5,278 		0
556,451 		0
19,576 		0
1,674,990 		0
456,135
(2) DOLORES GOMEZ (i)
(ii)		 0
346,419 		0
99,563 		0
888 		0
114,105 		0
18,212 		0
579,187 		0
110,278
(3) ROBERT HORTOP (i)
(ii)		 0
247,764 		0
78,808 		0
4,896 		0
85,942 		0
7,086 		0
424,496 		0
89,508
(4) GORDON HUNT (i)
(ii)		 0
1,988,650 		0
579,173 		0
9,286 		0
607,893 		0
9,334 		0
3,194,336 		0
682,355
(5) IFTIKHAR HUSSAIN (i)
(ii)		 0
303,701 		0
93,851 		0
452 		0
116,747 		0
18,098 		0
532,849 		0
93,851
(6) SHEILA LITTRELL (i)
(ii)		 204,152
0 		21,057
0 		18,243
0 		9,957
0 		16,496
0 		269,905
0 		0
0
(7) FORREST MALAKOFF (i)
(ii)		 0
194,021 		0
63,182 		0
819 		0
48,476 		0
7,257 		0
313,755 		0
63,182
(8) ROBERT MERWIN (i)
(ii)		 0
570,826 		0
271,164 		0
5,613 		0
486,829 		0
20,456 		0
1,354,888 		0
338,126
(9) RICHARD K NICHOLS (i)
(ii)		 0
250,906 		0
95,061 		0
1,462 		0
92,221 		0
13,211 		0
452,861 		0
105,938
(10) MARGIE O'CLAIR (i)
(ii)		 189,074
0 		25,622
0 		7,182
0 		9,075
0 		16,533
0 		247,486
0 		0
0
(11) CARRIE OWEN-PLIETZ (i)
(ii)		 0
387,788 		0
125,723 		0
59,535 		0
181,333 		0
18,311 		0
772,690 		0
125,723
(12) BRIAN ROACH MD (i)
(ii)		 0
371,616 		0
143,829 		0
1,381 		0
191,135 		0
15,820 		0
723,781 		0
143,829
(13) RICHARD SLAVIN (i)
(ii)		 0
786,819 		0
50,000 		0
5,446 		0
306,745 		0
18,164 		0
1,167,174 		0
50,000
(14) SHELBY SPEAS (i)
(ii)		 0
176,391 		0
0 		0
0 		0
11,912 		0
0 		0
188,303 		0
0
(15) MICHAEL WOOD MD (i)
(ii)		 0
365,064 		0
113,793 		0
1,073 		0
121,924 		0
2,072 		0
603,926 		0
126,951
(16) YONIS MUDEY (i)
(ii)		 377,414
0 		0
0 		0
0 		10,017
0 		0
0 		387,431
0 		0
0
(17) VICKI L WHITE (i)
(ii)		 0
256,395 		0
75,254 		0
32,849 		0
83,702 		0
18,051 		0
466,251 		0
73,254
(18) PATRICIA M RYAN (i)
(ii)		 0
249,952 		0
13,320 		0
74,343 		0
87,160 		0
7,109 		0
431,884 		0
13,320
(19) DANIEL BECKER (i)
(ii)		 301,164
0 		19,220
0 		2,064
0 		10,017
0 		16,691
0 		349,156
0 		0
0
(20) GAIUS JURADO (i)
(ii)		 272,894
0 		0
0 		350
0 		10,017
0 		10,123
0 		293,384
0 		0
0
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 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 FIRST-CLASS TRAVEL: CERTAIN OFFICERS AND KEY EMPLOYEES OF SUTTER HEALTH MAY UPGRADE TO FIRST-CLASS TRAVEL FOR FLIGHTS GREATER THAN FOUR HOURS IN DURATION. 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 AND TAXED ACCORDINGLY.
SUPPLEMENTAL COMPENSATION INFORMATION PART I, QUESTION 3 THE CEO OF THE ORGANIZATION IS AN EMPLOYEE OF SUTTER HEALTH, A RELATED TAX-EXEMPT ORGANIZATION. THE COMPENSATION COMMITTEE OF THE SUTTER HEALTH BOARD OF DIRECTORS RETAINS ULTIMATE DISCRETIONARY AUTHORITY OVER ALL ELEMENTS OF COMPENSATION TO ENSURE 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.
NONQUALIFIED RETIREMENT PLAN PART I, QUESTION 4B THE PURPOSE OF THE NONQUALIFIED RETIREMENT PLAN IS TO PROVIDE SUTTER HEALTH EXECUTIVES WITH A COMPETITIVE RETIREMENT BENEFIT CONSISTENT WITH SUTTER HEALTH'S OVERALL COMPENSATION PHILOSOPHY FOR ALL EMPLOYEES. CONTRIBUTIONS ARE DESIGNED TAKING INTO CONSIDERATION LOST RETIREMENT BENEFITS THAT WOULD OTHERWISE BE OBTAINED THROUGH THE QUALIFIED PENSION PLAN. SUTTER'S PLANS ARE DESIGNED CONSISTENT WITH COMPETITIVE INDUSTRY PRACTICES. THE RETIREMENT PLAN FOR SUTTER HEALTH EMPLOYEES IS A COMBINATION OF SOCIAL SECURITY, 403B EMPLOYER MATCH CONTRIBUTIONS AND QUALIFIED PLAN BENEFITS. SUTTER HEALTH EXECUTIVES ARE GENERALLY INELIGIBLE FOR EMPLOYER MATCH CONTRIBUTIONS. ADDITIONALLY, QUALIFIED PLAN BENEFITS CAPS HAVE THE EFFECT OF SUBSTANTIALLY REDUCING RETIREMENT BENEFITS THAT ARE OTHERWISE PROVIDED TO ALL EMPLOYEES. THE EFFECT IS THAT EXECUTIVES OFTEN DO NOT RECEIVE THE SAME LEVEL OF RETIREMENT BENEFIT ON AN INCOME REPLACEMENT BASIS AS OTHER EMPLOYEES. TO ENSURE A COMPETITIVE RETIREMENT BENEFIT AND TO ADDRESS THE SHORTFALLS DESCRIBED ABOVE, SUTTER HEALTH MAKES AN ANNUAL CONTRIBUTION TO A NON-QUALIFIED 457(F) PLAN FOR ITS EXECUTIVES. THE FORMULA HAS TWO PARTS: (1) 4% TO 7% OF BASE SALARY (COMMENSURATE WITH MANAGEMENT LEVEL), PLUS (2) A CONTRIBUTION STARTING AT 5% (BASED UPON TENURE) FOR EARNINGS BEYOND THE PENSION PAY CAP. THE LATTER OF WHICH IS DESIGNED TO HELP RESTORE LOST PENSION BENEFITS FORFEITED UNDER THE QUALIFIED PLAN FOR EARNINGS OVER THE PENSION PAY CAP LIMIT. CONTRIBUTIONS ARE ALSO MADE FOR A SMALL GROUP OF SENIOR LEVEL EXECUTIVES WHOSE ESTIMATED RETIREMENT BENEFIT (SOCIAL SECURITY PLUS QUALIFIED PLAN BENEFITS PLUS 457F) FALLS BELOW 50% - 65% OF FINAL 4-YEAR AVERAGE BASE SALARY WHEN RETIRING AT AGE 65. TARGET BENEFIT LEVELS VARY BY YEARS OF SERVICE. UNLIKE SUTTER HEALTH'S QUALIFIED PLAN WHERE EMPLOYEE BENEFITS ARE GUARANTEED (I.E., A DEFINED BENEFIT), SUTTER'S NON-QUALIFIED PLAN BENEFITS ARE NOT GUARANTEED BY SUTTER HEALTH. INVESTMENT RISK IS BORNE BY PARTICIPANTS AND BENEFITS ARE NOT PROTECTED SHOULD SUTTER HEALTH BECOME INSOLVENT.
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 PLANS SUTTER HEALTH ALSO EMPLOYS LONG TERM PERFORMANCE PLANS WHICH ARE DESIGNED TO FOCUS ON LONGER TERM STRATEGIC OBJECTIVES OF THE ORGANIZATION. SUTTER'S 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 HEALTH'S OVERALL MISSION, VISION, AND VALUES, SUTTER'S LONG TERM INCENTIVE PLAN APPROACH ALSO INCORPORATES A COMBINATION OF CEO AND SUTTER HEALTH COMPENSATION COMMITTEE DISCRETION. IN SOME CASES, THE SUTTER HEALTH COMPENSATION COMMITTEE HAS DELEGATED AUTHORITY TO THE PRESIDENT & CEO 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. IN ALL CASES, THE COMPENSATION COMMITTEE OF THE BOARD DETERMINES ACHIEVEMENT OF ORGANIZATION GOALS AND MAKES FINAL AWARD DETERMINATION WHICH MAY RESULT IN A REDUCTION OF AWARD IF APPROPRIATE. ALL SENIOR EXECUTIVE AWARDS ARE REVIEWED FOR COMPENSATION REASONABLENESS AND APPROVED PRIOR TO PAYMENT BY THE COMPENSATION COMMITTEE.
Schedule J (Form 990) 2011

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 Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
MILLS-PENINSULA HEALTH SERVICES
 
Employer identification number
94-1156265
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 CSCDA 2005A
  		68-0164610 130911U24 10-19-2005 276,217,522 REFUNDING - 7/18/1995   X   X   X
B CSCDA 2005BC
  		68-0164610 130795EG8 05-01-2007 49,994,066 REFUNDING - 10/19/2005   X   X   X
C CHFFA 2007A
  		52-1643828 13033FQ37 05-01-2007 790,998,316 CONSTRUCT & EQUIP FACILITY   X   X   X
D CHFFA 2008A
  		52-1643828 13033F2L3 05-14-2008 329,041,638 REFUNDING - 5/1/2007   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 0 0 0 66,210,000
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 284,787,106 52,179,709 857,735,124 329,041,638
4 Gross proceeds in reserve funds . . . . . . . . 21,070,840 3,461,872 0 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 55,398,317 0
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0 0
7 Issuance costs from proceeds . . . . . . . . . . . 0 0 0 0
8 Credit enhancement from proceeds . . . . . . . . . . 0 0 0 0
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 189,282,478 0 759,620,124 0
11 Other spent proceeds . . . . . . . . . . . 74,433,788 48,717,837 584,502 329,041,638
12 Other unspent proceeds . . . . . . . . . . . 0 0 42,132,181 0
13 Year of substantial completion . . . . . . . . . . . 2011 2011
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X   X     X X  
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   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       X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X       X      
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
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 of bond-financed property? . . . . . . . . . X       X      
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X       X      
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X       X      
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? . X       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 0% 0% 0% 0%
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 0.00000%   % 0.00000%   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0%   % 0%   %
7 Does the bond issue meet the private security or payment test? . . . X       X      
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
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   X   X
2 Is the bond issue a variable rate issue?   X   X   X   X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider . . . . . . . . 0
  		0
  		0
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X   X
b Name of provider . . . . . . 0
  		0
  		0
  		0
 
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   X   X
6 Did the bond issue qualify for an exception to rebate? .   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
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 0  
Schedule K (Form 990) 2011

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
2011
Open to Public
Inspection
Name of the organization
MILLS-PENINSULA HEALTH SERVICES
 
Employer identification number

94-1156265
Identifier Return Reference Explanation
MISSION STATEMENT FORM 990, PART I, LINE 1 AND PART III, LINE 1 "WE ENHANCE THE WELL-BEING OF THE PEOPLE IN OUR COMMUNITIES THROUGH COMPASSION, EXCELLENCE AND INNOVATION IN HEALTH CARE SERVICES, RESEARCH AND EDUCATION."
EXEMPT PURPOSE ACHIEVEMENTS FORM 990, PART III, LINE 4A MILLS-PENINSULA HEALTH SERVICES CONTINUES TO BE A COMMITTED PARTNER WITH THE COMMUNITIES WE SERVE. IN ADDITION TO A RECORD OF $35 MILLION IN CHARITY CARE IN 2011 AS WELL AS $5 MILLION IN OTHER COMMUNITY BENEFIT ACTIVITIES, THE HIGHLIGHT OF THE LAST DECADE HAS BEEN THE DEVELOPMENT AND OPENING OF A NEW $640 MILLION HOSPITAL. IN COMPLIANCE WITH CALIFORNIA SENATE BILL 1953, THE NEW FACILITY, OPENED IN MAY 2011, IS CONSTRUCTED TO WITHSTAND AN 8-POINT EARTHQUAKE AND REMAIN OPERATIONAL TO SERVE THE COMMUNITY. IN 2011, MILLS-PENINSULA SERVED 14,812 INPATIENTS, HAD 91,745 PATIENT DAYS, MANAGED 44,738 VISITS TO THE ER, 314,558 OUTPATIENT VISITS AND 10,532 SURGERIES OVERALL. NEARLY 2,000 BABIES WERE BORN AT MILLS-PENINSULA; 103 HEART SURGERIES PERFORMED AND 1,345 PEOPLE TREATED FOR CANCER. OTHER HIGHLIGHTS OF 2011 INCLUDE: MILLS-PENINSULA PARTICIPATES IN THE SAN MATEO COUNTY HOSPITAL CONSORTIUM'S HEALTHY COMMUNITY COLLABORATIVE. PART OF THE COLLABORATIVE'S WORK IS TO CONDUCT COMMUNITY HEALTH ASSESSMENTS EVERY THREE YEARS. OUR COMMUNITY BENEFIT PROGRAMS ARE DESIGNED TO MEET NEEDS IDENTIFIED IN THE ASSESSMENTS. THE PROGRAMS BELOW ARE EXAMPLES OF THE SIGNIFICANT CONTRIBUTION MILLS-PENINSULA PROVIDES IN OUR COMMUNITY. - ONGOING SUPPORT FOR SENIORS THROUGH MILLS-PENINSULA'S SENIOR FOCUS PROGRAM THAT PROVIDES ADULT DAY HEALTH CARE, ALZHEIMER'S DAY CARE RESOURCE CENTER AND EDUCATION - COOPERATIVE PROGRAM WITH SAN MATEO COUNTY AND THE PENINSULA HEALTH CARE DISTRICT TO PROVIDE PREGNANCY AND DELIVERY CARE FOR MEDICAL MOMS - EXPANSION OF MILLS-PENINSULA'S AFRICAN AMERICAN COMMUNITY HEALTH ADVISORY COMMITTEE EFFORTS TO PROVIDE SCREENING AND EDUCATION TO UNDERSERVED POPULATIONS - ONGOING SUPPORT FOR SAMARITAN HOUSE, A KEY NON-PROFIT SAFETY NET AGENCY THAT PROVIDES MEDICAL CARE, HOUSING, FOOD AND JOB TRAINING FOR THE UNDERSERVED - GRANTS PROGRAM FOR COMMUNITY NON-PROFITS THAT IN 2011 PROVIDED $377,000 IN FUNDING FOR SPECIAL PROJECTS SENIOR FOCUS: 2011 CONTRIBUTION $1,226,037 THE PROPORTION OF ADULTS AGED 60 AND OLDER IN SAN MATEO COUNTY IS EXPECTED TO ROUGHLY DOUBLE OVER THE NEXT FOUR DECADES. AS THE FASTEST-GROWING POPULATION SEGMENT, THE HEALTH AND SOCIAL NEEDS OF OLDER ADULTS REQUIRE INCREASING ATTENTION. SENIOR FOCUS SERVES OLDER ADULTS AND THEIR FAMILIES IN SAN MATEO COUNTY, PROVIDING SERVICES ACROSS THE SPECTRUM FROM PREVENTION EDUCATION TO MEDICAL DAY CARE. THOUSANDS OF PEOPLE ARE SERVED ANNUALLY. HEALTH EDUCATION CLASSES AND SCREENINGS PROMOTE A HEALTHY LIFESTYLE AND HELP SENIORS PREVENT OR MANAGE DISEASE WHEN IT OCCURS. VOLUNTEER PROGRAMS HELP SENIORS MAINTAIN AN ACTIVE LIFESTYLE AND CONTRIBUTE TO THE NON-PROFITS IN THE COMMUNITY. THE ADULT DAY HEALTH AND ALZHEIMER'S PROGRAMS - ONE OF ONLY TWO IN THE COUNTY - PROVIDE MULTIDISCIPLINARY HEALTH CARE SERVICES IN AN OUTPATIENT SETTING, ALLOWING FRAIL OR IMPAIRED SENIORS TO REMAIN LIVING AT HOME INSTEAD OF IN INSTITUTIONS. CAREGIVER SERVICES INCLUDE CLASSES, SUPPORT GROUPS, ONE TO ONE COUNSELING, REFERRAL TO COMMUNITY RESOURCES AND A CAREGIVER LIBRARY. THE PROGRAMS ALSO PROVIDE LEARNING OPPORTUNITIES TO HEALTH CARE AND SOCIAL SERVICES PROFESSIONALS IN THE COMMUNITY AND THOSE WHO ARE SEEKING CAREERS IN THE FIELD OF AGING. OUR ONGOING GOAL IS TO ENSURE STABILITY OF THE PROGRAMS IN LIGHT OF STATE BUDGET CONSTRAINTS THAT REDUCED STATE FUNDING. OUR EFFORTS ALSO INCLUDE WORKING WITH THE COUNTY AND APPROPRIATE ADVOCACY ORGANIZATIONS TO CREATE AND IMPLEMENT PROGRAM REVISIONS THAT WILL HELP MAKE THE SERVICES SUSTAINABLE. PREGNANCY AND BIRTHING CARE FOR MEDI-CAL MOMS IN SAN MATEO COUNTY: 2011 CONTRIBUTION: $55,000 PRIOR TO THE IMPLEMENTATION OF OUR PROGRAM, MOMS WITH MEDI-CAL COVERAGE WERE UNABLE TO ACCESS COMMUNITY OBSTETRICIANS AND HAD TO DELIVER WITH COUNTY-CONTRACTED DOCTORS AT PACKARD CHILDREN'S HOSPITAL FURTHER SOUTH AND OUTSIDE OUR COUNTY. WITH FINANCIAL SUPPORT FROM THE PENINSULA HEALTH CARE DISTRICT TO THE HEALTH PLAN OF SAN MATEO COUNTY, LOCAL COMMUNITY PHYSICIANS WERE CONTRACTED TO PARTICIPATE. MILLS-PENINSULA FUNDED A MEDICAL DIRECTOR POSITION FOR THE PROGRAM AND PROVIDED ADMINISTRATIVE SUPPORT. OUR GOAL HAS BEEN TO PROVIDE THE OPTION FOR COMMUNITY MOMS TO DELIVER THEIR BABIES AT THEIR LOCAL HOSPITAL RATHER THAN TRAVEL FURTHER SOUTH. WE ARE SUCCEEDING IN THAT GOAL BY COLLABORATING WITH THE SAN MATEO COUNTY HEALTH DEPARTMENT AND THE PENINSULA HEALTH CARE DISTRICT. HEALTH SCREENINGS AND EDUCATION FOR AFRICAN AMERICAN, HISPANIC AND PACIFIC ISLANDER POPULATIONS IN SAN MATEO COUNTY: 2011 CONTRIBUTION $140,000 MILLS-PENINSULA'S AFRICAN AMERICAN COMMUNITY HEALTH ADVISORY COMMITTEE (AACHAC) HAS SINCE 1995 PARTNERED PRIMARILY WITH COMMUNITY CHURCHES AND GRASS-ROOTS ORGANIZATIONS TO ADDRESS THE HIGHER INCIDENCE OF CANCER, HEART DISEASE, DIABETES, ASTHMA AND OTHER CHRONIC DISEASES IN THE AFRICAN AMERICAN COMMUNITY WITH EDUCATION AND SCREENINGS FOR EARLY DETECTION. THE COMMITTEE'S OUTREACH ALSO INCLUDES PROVIDING MAMMOGRAMS TO WOMEN WITH NO INSURANCE. IN 2011, THE MILLS-PENINSULA WOMEN'S CENTER PROVIDED $35,345 IN MAMMOGRAPHY SERVICES AS PART OF THIS PROGRAM. THE ASIAN, HISPANIC AND PACIFIC ISLANDER POPULATIONS ARE AMONG THE FASTEST GROWING IN SAN MATEO COUNTY AND AS EVIDENCED IN THE LAST TWO COMMUNITY NEEDS ASSESSMENTS, THESE POPULATIONS ARE MORE LIKELY TO HAVE LIMITED ACCESS TO SCREENINGS THAT CAN PROVIDE EARLY DETECTION AND EDUCATION FOR HEALTHIER LIFESTYLES. IN 2010 AND 2011, THE COMMITTEE SOUGHT TO INCREASE ITS OUTREACH TO EMBRACE THE ASIAN, HISPANIC AND PACIFIC ISLANDER COMMUNITIES. THE COMMITTEE'S SUCCESSFUL EXPERIENCE IN THE AFRICAN AMERICAN COMMUNITY WAS BASED LARGELY ON THE RELATIONSHIPS COMMITTEE LEADERS ENJOYED WITH THE COMMUNITY ITSELF. THAT SAME APPROACH HAS BEEN APPLIED TO OUTREACH IN THE ASIAN, HISPANIC AND PACIFIC ISLANDER COMMUNITIES. IN EACH DEMOGRAPHIC, LEADERS ARE BEING IDENTIFIED AND INVITED TO COLLABORATE TO ENSURE CULTURALLY COMPETENT OUTREACH. THE AACHAC HAS ENJOYED EXTRAORDINARY SUCCESS IN ITS WORK. MORE THAN 2,500 PEOPLE HAVE BEEN SCREENED FOR BREAST CANCER, HEART DISEASE, DIABETES AND OTHER HEALTH CONCERNS, AND ANOTHER 10,000 HAVE BEEN REACHED THROUGH ITS EDUCATIONAL PROGRAMS, SOCIAL MEDIA AND INDIVIDUAL CONTACT.
EXEMPT PURPOSE ACHIEVEMENTS (CONTINUED) FORM 990, PART III, LINE 4A SUPPORT FOR OUTPATIENT SERVICES FOR PEOPLE WHO HAVE NO INSURANCE: 2011 CONTRIBUTION: $1.3 MILLION AS PART OF CHARITY CARE, MILLS-PENINSULA PROVIDES ONGOING FINANCIAL AND IN-KIND SERVICES FOR SAMARITAN HOUSE, A PRIVATE NONPROFIT ORGANIZATION THAT SERVES MORE THAN 12,000 LOW-INCOME PEOPLE WITHIN SAN MATEO COUNTY WITH A FULL SPECTRUM OF SERVICES INCLUDING A MEDICAL CLINIC WHICH IS STAFFED BY VOLUNTEERS. MILLS-PENINSULA PHYSICIANS VOLUNTEER THEIR TIME AND SERVICES, AND MILLS-PENINSULA PROVIDES IN-KIND SERVICES INCLUDING RADIOLOGY. IN ADDITION TO THESE SERVICES THAT ARE PART OF CHARITY CARE, IN 2011 MILLS-PENINSULA PROVIDED AN ADDITIONAL $100,000 CASH GRANT TO SUPPORT INCREASED MEDICAL CARE NEEDS DURING THE CONTINUING RECESSION. CONTINUED SUPPORT FOR SAFETY NET CLINICS SUCH AS SAMARITAN HOUSE HELPS PROVIDE CARE AT THE APPROPRIATE LEVEL RATHER THAN LEAVING PEOPLE IN NEED WITH NO ALTERNATIVE BUT THE EMERGENCY ROOM. GOOD PRIMARY AND PRENATAL CARE HELPS PEOPLE MAINTAIN HEALTH AND AVOID DISEASE. THE ESSENTIAL WORK OF SAMARITAN HOUSE CONTINUES STRONG EVEN THROUGH FUNDING REDUCTIONS. THE PROGRAM PROVIDES AN ESSENTIAL LAYER OF INFRASTRUCTURE IN THE HEALTH CARE SYSTEM. COMMUNITY GRANTS PROGRAM: 2011 CONTRIBUTION: $377,000 MILLS-PENINSULA'S COMMUNITY GRANTS PROGRAM PROVIDES GRANTS OF $5,000 TO $15,000 EACH YEAR TO HELP WITH SPECIAL HEALTH-RELATED PROJECTS PROPOSED BY LOCAL NONPROFIT ORGANIZATIONS. THIS FUNDING IS PART OF OUR OVERALL GOAL TO HELP CREATE AND SUSTAIN A STRONG SUPPORT SYSTEM FOR THE UNDERSERVED IN OUR COMMUNITY. IN 2011, THE FOLLOWING ORGANIZATIONS RECEIVED FUNDING FOR THEIR PROJECTS: ALZHEIMER'S ASSOCIATION BAY AREA LEGAL AID BREAST CANCER CONNECTIONS CASA DE SAN MATEO COUNTY CHILDRENS' HEALTH COUNCIL CID (CENTER FOR THE INDEPENDENCE OF THE DISABLED) CLEO EULAU CENTER COASTSIDE ADULT DAY HEALTH CENTER COASTSIDE CHILDREN'S SERVICES COMMUNITY LEARNING CENTER CORA (COMMUNITY OVERCOMING RELATIONSHIP ABUSE) EDGEWOOD CENTER FOR CHILDREN & FAMILIES EL CENTRO LA LIBERTAD FAMILY CAREGIVER ALLIANCE FATHERHOOD COLLABORATIVE OF SAN MATEO COUNTY FREEDOM HOUSE, TWBD, INC. FRIENDS FOR YOUTH COMMUNITY GATEPATH HIP HOUSING HOME AND HOPE LEGAL AID SOCIETY MENTAL HEALTH ASSOCIATION OF SAN MATEO COUNTY MID PENINSULA BOY AND GIRLS CLUB MISSION HOSPICE AND HOME CARENAMI OF SAN MATEO COUNTY NORTH PENINSULA NEIGHBORHOOD SERVICES CENTER NOTRE DAME DE NAMUR UNIVERSITY OMBUDSMAN SERVICES OF SAN MATEO COUNTY PARCA (PENINSULA ASSOCIATION FOR RETARDED CHILDREN AND ADULTS) PENINSULA CLERGY NETWORK PENINSULA COMMUNITY SERVICES PENINSULA FAMILY SERVICES PENINSULA JEWISH COMMUNITY CENTER PUENTE DE LA COSTA SUR RAPE TRAUMA SERVICES REBUILDING TOGETHER PENINSULA SAN MATEO COUNTY DENTAL SOCIETY DHF SELF HELP FOR THE ELDERLY SHELTER NETWORK MISSION HOSPICE DOELGER SENIOR CENTER TEEN TALK SEXUALITY EDUCATION VISTA CENTER FOR THE BLIND WRA (WOMEN'S RECOVERY ASSOCIATION) AWARDS AND ACCOMPLISHMENTS - FOR THE SECOND YEAR IN A ROW, MILLS-PENINSULA WAS NAMED ONE OF THE TOP HOSPITALS IN THE NATION BY THE LEAPFROG GROUP. MILLS-PENINSULA WAS ONE OF ONLY 65 HOSPITALS IN THE NATION RECOGNIZED IN 2011, OUT OF A FIELD OF 1,200. THE ACHIEVEMENT IS BASED ON MEASUREMENTS OF PATIENT SAFETY AND QUALITY. SPECIFICALLY, MILLS-PENINSULA WAS HONORED FOR USE OF COMPUTER PHYSICIAN ORDER ENTRY (CPOE) TO PREVENT MEDICATION ERRORS, STANDARDS FOR HIGH-RISK PROCEDURES SUCH AS HEART SURGERY AND PROTOCOLS AND POLICIES TO REDUCE MEDICAL ERRORS. - MILLS-PENINSULA IS ONE OF THREE HOSPITALS AFFILIATED WITH THE SUTTER HEALTH NETWORK OF CARE TO EARN A JULY 2011 "CERTIFICATE OF EXCELLENCE" BY THE RENOWNED CALIFORNIA HOSPITAL ASSESSMENT AND REPORTING TASK FORCE (CHART). AWARDED FOR KEY QUALITY ACHIEVEMENTS IN 50 CATEGORIES, MILLS-PENINSULA ONE OF ONLY 29 HOSPITALS ACROSS CALIFORNIA RECOGNIZED FOR OUTSTANDING CLINICAL PERFORMANCE. - MILLS-PENINSULA EARNED A 2011 WASTE REDUCTION AWARD FROM THE CALIFORNIA DEPARTMENT OF RESOURCES RECYCLING AND RECOVERY. THE AWARD PROGRAM RECOGNIZES ORGANIZATIONS THAT HAVE SIGNIFICANTLY REDUCED THE AMOUNT OF WASTE SENT TO LANDFILLS AND SAVED MONEY IN THE PROCESS. MILLS-PENINSULA PREVENTED MORE THAN 400 TONS OF WASTE FROM BEING SENT TO LANDFILLS AND SAVED $135,000. - THE AMERICAN HEART ASSOCIATION AWARDED MILLS-PENINSULA A STROKE GOLD PLUS AWARD, THE HIGHEST AVAILABLE IN THE AHA'S GET WITH THE GUIDELINES STROKE PREVENTION PROGRAM. THE AWARD RECOGNIZES HOSPITALS THAT HAVE REACHED THE GOAL OF TREATING STROKE PATIENTS WITH 85 PERCENT OR HIGHER COMPLIANCE TO AMERICAN HEART ASSOCIATION/AMERICAN STROKE ASSOCIATION STANDARDS OF CARE FOR AT LEAST 24 CONSECUTIVE MONTHS. - THE AMERICAN DIABETES ASSOCIATION (ADA) AWARDED MILLS-PENINSULA'S OUTPATIENT DIABETES AND NUTRITION SERVICES WITH THE ADA EDUCATION RECOGNITION CERTIFICATE, RECOGNIZING QUALITY DIABETES SELF-MANAGEMENT. THIS IS THE NINTH CONSECUTIVE YEAR THAT THIS DEPARTMENT HAS RECEIVED THE HONOR. - THE BREAST PROGRAM AT THE MILLS-PENINSULA WOMEN'S CENTER RECEIVED A THREE-YEAR BREAST MRI PROGRAM ACCREDITATION FROM THE AMERICAN COLLEGE OF RADIOLOGY (ACR). MILLS-PENINSULA IS ONE OF ONLY 13 FACILITIES IN CALIFORNIA ACCREDITED BY ACR IN BREAST MRI. - U.S. NEWS & WORLD REPORT / MILLS-PENINSULA WAS ONE OF 14 HOSPITALS OUT OF 44 IN THE SAN FRANCISCO METROPOLITAN AREA RANKED IN U.S. NEWS & WORLD REPORT'S "BEST HOSPITALS METRO AREA RANKINGS."
EXEMPT PURPOSE ACHIEVEMENTS (CONTINUED) FORM 990, PART III, LINE 4A SUTTER MATERNITY & SURGERY CENTER MISSION STATEMENT WE ENHANCE THE WELL-BEING OF PEOPLE IN THE COMMUNITIES WE SERVE THROUGH A NOT-FOR-PROFIT COMMITMENT TO COMPASSION AND EXCELLENCE IN HEALTH CARE SERVICES. ORGANIZATION'S PROGRAM/SERVICE ACCOMPLISHMENTS COMMUNITY PROGRAMS SUTTER MATERNITY & SURGERY CENTER (SMSC) OFFERS STATE-OF-THE-ART PERINATAL AND MEDICAL/SURGICAL SERVICES, COMBINING PATIENT CENTER CARE AND FAMILY CONVENIENCE WITH THE SAFETY AND SECURITY OF A LICENSED AND ACCREDITED ACUTE CARE HOSPITAL. WITH 30 LICENSED BEDS, SMSC IS SMALL ENOUGH TO PROVIDE THE UTMOST PERSONAL ATTENTION TO EVERY PATIENT. THE FACILITY HAS SIX OPERATING ROOMS, TWELVE BIRTHING SUITES AND EIGHTEEN MEDICAL/SURGICAL PATIENT SUITES. A JOINT PROJECT OF SUTTER HEALTH AND SANTA CRUZ MEDICAL CLINIC (NOW THE PALO ALTO MEDICAL FOUNDATION), SMSC WAS COMPLETED AND OPENED TO PATIENTS IN MARCH OF 1996. THE HOSPITAL IS FULL ACCREDITED BY THE JOINT COMMISSION. SUTTER MATERNITY & SURGERY CENTER (SMSC) WORKS JOINTLY WITH THE PALO ALTO MEDICAL FOUNDATION SANTA CRUZ (PAMF SANTA CRUZ) TO SUPPORT THE HEALTH NEEDS OF THE MEDICALLY UNDERSERVED IN OUR COMMUNITY AND OUR COMMUNITY PARTNERS IN ADDITION TO PROVIDING HIGH QUALITY MEDICAL CARE TO OUR PATIENTS. SOME OF THESE ACTIVITIES INCLUDE: - SMSC AND PAMF SANTA CRUZ CONTINUE TO BE THE LARGEST PRIVATE SPONSORS OF THE SANTA CRUZ COUNTY HEALTHY KIDS AND HEALTHY FAMILIES PROGRAMS. THESE PROGRAMS IMPROVE THE HEALTH AND WELL-BEING OF LOW-INCOME CHILDREN BY PROVIDING THEM WITH HEALTH INSURANCE, THEREBY ENSURING ACCESS TO COMPREHENSIVE MEDICAL, DENTAL, VISION, AND MENTAL HEALTH SERVICES. SINCE THE PROGRAM'S INCEPTION IN 2004, WE HAVE DONATED OVER $1.4 MILLION TO HEALTHY KIDS AND HEALTHY FAMILIES. - WE ANNUALLY PROVIDE A SCHOLARSHIP TO UCSC HEALTH SCIENCES GRADUATES WHO HAVE BEEN ACCEPTED TO MEDICAL SCHOOL AND EXPRESS THE INTENTION TO RETURN TO THE AREA AND PROVIDE PRIMARY CARE SERVICES TO PATIENTS, INCLUDING MEDI-CAL, MEDICRUZ, AND MEDICARE PATIENTS. THE AWARD IS CO-SPONSORED BY THE CENTRAL CALIFORNIA ALLIANCE FOR HEALTH, SMSC, AND PAMF SANTA CRUZ. - WHILE WE WORK ON A CONTINUOUS BASIS PROVIDING HEALTH SERVICES SUPPORT TO LOCAL COMMUNITY CLINICS, IN 2010 IN CONJUNCTION WITH SUTTER HEALTH, PAMF SANTA CRUZ AND SMSC AWARDED GRANTS TO THE FOLLOWING LOCAL COMMUNITY CLINICS AND PROGRAMS: - SALUD PARA LA GENTE FOR A PROGRAM TO REDUCE PREGNANCY AMONG AT-RISK TEENS - DIENTES COMMUNITY DENTAL CARE TO FUND THE ACQUISITION OF A DIGITAL PANORAMIC X-RAY MACHINE TO BE INTEGRATED INTO THEIR ELECTRONIC HEALTH RECORD (EHR) AND DIGITAL RADIOGRAPHY SYSTEMS - SANTA CRUZ WOMEN'S HEALTH CENTER TO MAINTAIN THEIR CAPACITY TO PROVIDE A MEDICAL HOME FOR LOW-INCOME RESIDENTS WITH CHRONIC CONDITIONS - HOMELESS PERSONS HEALTH PROJECT TO SUPPORT PROJECT CONNECT, A PROGRAM THAT IDENTIFIES "FREQUENT FLYERS" IN EMERGENCY ROOMS AND FINDS THEM A MEDICAL HOME - SMSC AND PAMF SANTA CRUZ CONTINUE TO SUPPORT THE ALLIED HEALTH PROFESSIONAL AND NURSING PROGRAMS AT CABRILLO COLLEGE. THIS INCLUDES SUPPORT FOR THE NURSING, RADIOLOGY TECH, AND MEDICAL ASSISTANT PROGRAMS. - MEDICRUZ IS THE SANTA CRUZ COUNTY HEALTH SERVICES AGENCY INSURANCE PROGRAM FOR INDIGENT CARE, AND THEY UTILIZE PAMF AND SMSC'S DIAGNOSTIC FACILITIES AND BIRTHING PROGRAMS. SMSC PROVIDES THE MEDICRUZ PROGRAM AND IT'S REFERRED PATIENTS' FREE OR DISCOUNTED CARE AND DIAGNOSTIC SERVICES. SMSC CONTINUES TO ENSURE THE AVAILABILITY OF OB AND PEDIATRIC PHYSICIANS FOR COUNTY UNASSIGNED AND INCARCERATED PATIENTS. NEUROLOGY COVERAGE IS ALSO SUPPORTED BY SMSC. - SMSC, IN CONJUNCTION WITH PAMF, PROVIDES COMMUNITY HEALTH EDUCATION AND SCREENING EVENTS FREE TO THE COMMUNITY, INCLUDING THE ANNUAL SENIOR HEALTH FAIR AND PROSTATE CANCER AWARENESS DAY, WHICH ARE PROVIDED AT SMSC. IN THE 2011 SENIOR HEALTH FAIR, 385 SENIORS RECEIVED FREE SCREENINGS IN THE 2011 FAIR, MOST OF WHOM CANNOT AFFORD AN ANNUAL CHECK UP. AT THE 2011 PROSTATE CANCER AWARENESS DAY, 220 MEN RECEIVED PROSTATE CANCER SCREENINGS. WE SUPPORT OUR COMMUNITY HEALTH PARTNERS BY WORKING COLLABORATIVELY WITH THE SAFETY NET CLINICS, THE SANTA CRUZ COUNTY HEALTH SERVICES AGENCY, AND THE HEALTH IMPROVEMENT PARTNERSHIP OF SANTA CRUZ COUNTY (HIPSCC). BELOW ARE ADDITIONAL PROGRAMS THAT SMSC PROVIDES TO THE COMMUNITY. PROGRAM NAME/DETAIL SELF HELP PROGRAMS FOR COMMUNITY MEMBERS WITH A VARIETY OF PROBLEMS INCLUDING ADDICTION, DEPRESSION, ETC, SUCH AS NAR-ANON, WFS, AA, OVER EATERS ANONYMOUS, THE AUGUSTINE FELLOWSHIP, EDRC, DBSA, ART FOR HEALING, AND MINDFUL EATING. NURSING REPRESENTATION ON THE LOCAL COMMUNITY COLLEGE ADVISORY COMMITTEE. PROVIDE MEETING SPACE FOR THE CA ASSOCIATION FOR MARRIAGE AND FAMILY THERAPISTS AND AREA SOCIAL WORKERS. CASH DONATIONS TO DIFFERENT AGENCIES SUCH AS AMERICAN RED CROSS, COMMUNITY FOUNDATION OF SANTA CRUZ COUNTY, BILLY FOUNDATION, LEADERSHIP SANTA CRUZ COUNTY, AND SHC. PROVIDE MEETING SPACE FOR EARLY PREGNANCY NUTRITION (HEALTHY BEGINNINGS), CHILDBIRTH REFRESHER CLASSES, AND CHILDHOOD PREP CLASSES. PROVIDE FREE MEETING SPACE TO LOW INCOME WOMEN IN THE COMMUNITY, TEACHING INFANT CARE AND BREAST FEEDING, INCLUDING VISITS TO THE LACTATION CENTER AND FREE PHONE CONSULTATIONS. PROVIDE FREE MEETING SPACE TO AREA COALITION CONSULTANTS FOR BREASTFEEDING. COMMITTEE PARTICIPATION BY ADMINISTRATOR, DIRECTORS, AND STAFF FOR HEALTH IMPROVEMENT COUNCIL, INDIGENT CARE COMMITTEE, UNITED WAY JOINT STEERING COMMITTEE, COMMUNITY ADVISORY COUNCIL, ACCESS TO CARE, PAJARO VALLEY COMMUNITY HEALTH TRUST, AND UC EXTENSION. PROVIDE FREE MEETING SPACE FOR ORGANIZATION WHO PROVIDES SERVICES TO PEOPLE WITH HEALTH RELATED ISSUES: SANTA CRUZ COUNTY COUNSELING CENTER, SC COUNTY SPECIAL EDUCATION PARENT TEACHER ASSOCIATION, COUNTY YOUTH CONNECTION, HOSPICE, AND ART FOR HEALING. PROVIDE MEETING SPACE FOR CPR INSTRUCTION TO THE COMMUNITY, DAY CARE PROVIDERS, AND FOSTER PARENTS. DONATION OF GOOD USE LINEN, CLOTHING, AND MEDICAL SUPPLIES AND EQUIPMENT TO SHELTERS AND WORLDWIDE. CASH DONATIONS TO DIENTES COMMUNITY DENTAL CLINIC, DIABETES FORUM, SIENNA HOUSE, SECOND HARVEST FOOD BANK, AND WOMENCARE. ENVIRONMENTAL AWARENESS PROGRAM - TO HELP REDUCE COMMUNITY ENVIRONMENTAL HAZARDS, PARTICIPATE IN COMMUNITY WASTER REDUCTION AND SHARPS DISPOSAL PROGRAM, SHARE IN HEALTH CARE FACILITY ENVIRONMENTAL RESPONSIBILITY SUCH AS WASTE REDUCTION, GREEN PURCHASING, AND OTHER ECOLOGY INITIATIVES. MENTORING OF STUDENTS AND INTERNSHIPS - TEACH AND MENTOR STUDENT FROM ALTERNATIVE PROGRAMS RETRAINING AND REENTERING THE JOB MARKET TO FIND WORK IN THE MEDICAL FIELD. PROVIDE MENTORING, PRECEPTORSHIP, AND EDUCATION TO NURSING STUDENTS. PROVIDE SPACE FOR MIDWIVES AND DOULAS, FAMILY PRACTICE AND OBS, ENT AND PLASTIC SURGERY TO PRESENT OPTIONS TO THE LARGER COMMUNITY. STAFF TRAINING AND ATTENDANCE DURING WORK HOURS IN PROGRAMS SUCH AS WIC, BREASTFEEDING COMMUNITY EDUCATION, AHA, EDUCATION FOR CHILD CARE PROVIDERS, BREASTFEEDING EDUCATION (SIENNA HOUSE - HOME FOR UNWED MOTHERS). PROVIDE MEETING SPACE FOR NATIONAL ASSOCIATION FOR THE MENTALLY ILL AND THERAPISTS WHO IN TURN PROVIDE TREATMENT IN THE COMMUNITY AND AREA BOARD VII. PROVIDE SUPPORT AND EDUCATION TO NEW MOTHERS - POST PARTUM WELLNESS PROGRAM AND SECOND BABY AND MOM. OB PHYSICIANS ON-CALL COVERAGE FOR THE COUNTY HEALTH PROGRAM, AS WELL AS PHYSICIAN STIPENDS FOR INDIGENT PATIENTS. FREE SCREENINGS AND EDUCATION THROUGH THE SENIOR HEALTH FAIR, PROSTATE CANCER AWARENESS DAY, AND BREAST CANCER AWARENESS MONTH. PROVIDE MEETING SPACE FOR GROUPS WHO STUDY STRESS MANAGEMENT VIA MEDITATION. TOY DRIVE FOR WORD OF LIFE FOOD PANTRY (DURING CHRISTMAS SEASON). ACCOMPLISHMENTS SMSC CONTINUES TO BE ONE OF THE HIGHEST PERFORMING HOSPITALS IN THE SUTTER HEALTH NETWORK, WITH HIGH PATIENT AND STAFF EVALUATIONS. IN ADDITION TO THE OUTSTANDING SUTTER HEALTH NETWORK PERFORMANCE, SMSC HAS RECEIVED THE FOLLOWING HIGHLY VALUED ACKNOWLEDGEMENTS: - IN 2010, SMSC WAS ONE OF ONLY 450 HOSPITALS NATIONALLY TO RECEIVE JOINT COMMISSION RECOGNITION FOR "TOP PERFORMANCE IN QUALITY MEASURES". - IN 2011, AND FOR THE FOURTH YEAR IN A ROW, SMSC RECEIVED THE PRESS GANEY SUMMIT AWARD FOR SUSTAINING AN OVERALL RANK ABOVE THE 95TH PERCENTILE IN PATIENT SATISFACTION. - IN 2011, AND FOR THE THIRD YEAR IN A ROW, SMSC WAS SELECTED BY MODERN HEALTHCARE MAGAZINE AS ONE OF THE TOP 100 "BEST PLACES TO WORK IN HEALTHCARE." - IN 2011, SMSC RECEIVED THE SUTTER HEALTH PRESIDENT'S AWARD FOR OUTSTANDING PERFORMANCE. - IN 2011, PAMF SANTA CRUZ AND SMSC WERE AWARDED THE "CHILDREN'S CHAMPION AWARD" BY THE CALIFORNIA CHILDREN'S HEALTH INITIATIVES (CCHI) FOR THEIR SUPPORT OF CHILDREN'S HEALTH INSURANCE PROGRAMS. - IN 2011, SMSC RECEIVED THE SANTA CRUZ CHAMBER OF COMMERCE "ORGANIZATION OF THE YEAR" AWARD FOR THEIR CONTRIBUTION TO THE COMMUNITY.
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 THIS CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY, INCLUDING CONSOLIDATED OR COMBINED BUDGETS OF THIS CORPORATION AND ALL SUBSIDIARY ORGANIZATIONS OF THIS CORPORATION; PROVIDED, HOWEVER, THAT IN RESPONDING TO BUDGETS PROPOSED BY THIS CORPORATION, THE GENERAL MEMBER SHALL ACCOMMODATE THIS CORPORATION'S OBLIGATIONS UNDER ITS LEASE OF HOSPITAL PREMISES AS DESCRIBED IN SECTION 4 OF THIS ARTICLE; D. ADOPTION OF CAPITAL BUDGETS OF THIS CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; PROVIDED, HOWEVER, THAT IN RESPONDING TO BUDGETS PROPOSED BY THIS CORPORATION, THE GENERAL MEMBER SHALL ACCOMMODATE THIS CORPORATION'S OBLIGATIONS UNDER ITS LEASE OF HOSPITAL PREMISES AS DESCRIBED IN SECTION 4 OF THIS ARTICLE; 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 11B SUTTER HEALTH, A RELATED TAX-EXEMPT ORGANIZATION, 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, LEGAL, AND HUMAN RESOURCES. A NATIONAL ACCOUNTING FIRM PREPARES AND/OR REVIEWS THE RETURN. A COMPLETED RETURN IS THEN REVIEWED BY THE TAX DEPARTMENT, THE AFFILIATE, AND THE CFO BEFORE THE RETURN IS FILED.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, QUESTION 12 EMPLOYEES ARE EDUCATED ON THE CONFLICT OF INTEREST POLICY AND THE NEED TO MAKE DISCLOSURE AS PART OF ANNUAL COMPLIANCE EDUCATION. IN ADDITION, ANNUALLY A DISCLOSURE STATEMENT IS COMPLETED BY ALL DIRECTORS AND OFFICERS THAT INCLUDES AN ACKNOWLEDGEMENT THAT THEY HAVE READ THE CONFLICT OF INTEREST POLICY. 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 INDIVIDUAL 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 INDIVIDUAL TO NOT PARTICIPATE DURING RELATED PRESENTATIONS AND DISCUSSIONS. IN ALL CIRCUMSTANCES INVOLVING AN ACTUAL CONFLICT, THE INTERESTED INDIVIDUAL 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 ENSURE 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. OFFICERS AND KEY EMPLOYEES OF THIS ORGANIZATION WHO ARE SUTTER HEALTH EMPLOYEES UNDERGO A REVIEW AND COMPENSATION COMMITTEE APPROVAL, AND SUCH APPROVAL IS RECORDED IN THE MINUTES.
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. THE GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME.
HOURS PER WEEK DEVOTED TO RELATED ORGANIZATION FORM 990, PART VII THE FOLLOWING BOARD MEMBERS OF THE ORGANIZATION ARE FULL-TIME EMPLOYEES (40 HOURS PER WEEK) OF SUTTER HEALTH AND THEIR SUTTER HEALTH SALARIES ARE REPORTED HEREIN. THESE INDIVIDUALS RECEIVE NO COMPENSATION FOR THEIR SERVICE AS BOARD MEMBERS OF THIS ORGANIZATION. JEFF GERARD BRIAN ROACH RICHARD SLAVIN
OTHER CHANGES IN FUND BALANCE FORM 990, PART XI, LINE 5 CHANGE IN UNREALIZED GAIN/(LOSS) ON INVESTMENTS $ 14,103 EQUITY TRANSFERS (NET) (87,885,800) ------------- (87,871,697)
SCHEDULE K SUPPLEMENTAL INFORMATION SCHEDULE K, PART VI 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 CERTAIN SUBSIDIARY ORGANIZATIONS. THE OUTSTANDING BOND LIABILITY ALLOCATED TO THIS ORGANIZATION IS REPORTED ON FORM 990, PART X, BALANCE SHEET. WITH THE EXCEPTION OF PART I(F), THE SCHEDULE K FOR THIS ORGANIZATION IS REPORTING INFORMATION FOR THE ENTIRE BOND ISSUE. PART II, LINE 7: ISSUANCE COSTS WERE FUNDED THROUGH EQUITY CONTRIBUTIONS. MPHS SPECIFIC PART I, COLUMN (E): THE FILING ORGANIZATION RECEIVED BOND PROCEEDS IN THE AMOUNTS OF: $10,364,166 FROM THE 2005A ISSUE, $2,278,156 FROM THE 2005BC ISSUE, $536,525,653 FROM THE 2007A ISSUE AND $5,730,952 FROM THE 2008A ISSUE. PART I, LINE B, COLUMN (F): THE INITIAL BONDS ISSUED IN 2005 REFUNDED 1995 CERTIFICATES AND WERE RETIRED AND REISSUED ON MAY 1, 2007. ACCORDINGLY, WHERE APPROPRIATE, SCHEDULE K REFLECTS THE CURRENT REFUNDING BONDS THAT WERE TREATED AS REISSUED RATHER THAN REFLECTING THE ORIGINAL REFUNDING BONDS. PART I, LINE D, 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 ISSUED IN 2007 WERE USED TO REFUND BONDS ISSUED IN 1995.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

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
2011
Open to Public Inspection
Name of the organization
MILLS-PENINSULA HEALTH SERVICES
 
Employer identification number

94-1156265
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
 
Yes
 
(2) ALTA BATES SUMMIT FOUNDATION

3012 SUMMIT STREET 3RD FLOOR

OAKLAND,CA94609
51-0160184 		FUNDRAISING CA 501(C)(3) 11a - I SUTTER EBH
 
Yes
 
(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
 
Yes
 
(4) DELTA MEMORIAL HOSPITAL FOUNDATION

3901 LONE TREE WAY

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

350 HAWTHORNE AVE

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

20103 LAKE CHABOT ROAD

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

250 BON AIRE ROAD

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

1501 TROUSDALE DRIVE

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

2350 EL CAMINO REAL

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

450 30TH STREET 2840

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

11815 EDUCATION ST

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

1800 COFFEE ROAD SUITE 76

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

800 E WASHINGTON BLVD

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

PO BOX 1617

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

3012 SUMMIT STREET 3RD FLOOR

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

3687 MT DIABLO BLVD 200

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

600 COFFEE ROAD

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

2200 RIVER PLAZA DRIVE

SACRAMENTO,CA95833
94-2788907 		SUPPORTING OR CA 501(C)(3) 11c III-FI NA
 
 
No
(19) SUTTER HEALTH PACIFIC

91-2301 FT WEAVER RD

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

PO BOX 160727

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

745 FORT STREET SUITE 800

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

PO BOX 160727

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

20130 LAKE CHABOT RD 103

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

2800 L STREET 7TH FLOOR

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

ONE MEDICAL PLAZA

ROSEVILLE,CA95661
68-0040113 		FUNDRAISING CA 501(C)(3) 7 SUTTER SSR
 
Yes
 
(26) SUTTER SOLANO CHARITABLE FOUNDATION

300 HOSPITAL DRIVE

VALLEJO,CA94589
94-2668262 		FUNDRAISING CA 501(C)(3) 7 SUTTER SSR
 
Yes
 
(27) SUTTER VISITING NURSE ASSOC AND HOSPICE

1900 POWELL ST 300

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

2333 BUCHANAN STREET

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

2015 STEINER STREET 1ST FLOOR

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

1420 N TRACY BLVD

TRACY,CA95376
68-0318845 		FUNDRAISING CA 501(C)(3) 11a - I SUTTER CVH
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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) MAGNETIC IMAGING AF

175 LENNON
WLN CK,CA94598
94-2953833 		PATIENT CARE CA NA
  		N/A                
(2) SURG CTR OF ABSMC

3875 TELEGRAPH
OAKLAND,CA94609
47-0946086 		OUTPATIENT SURG CA NA
  		N/A                
(3) ALTA CT SERVICES LP

175 LENNON
WLN CK,CA94598
94-3083464 		PATIENT CARE CA NA
  		N/A                
(4) CALIFORNIA PACIFIC ADV IMAGING LLC

PO BOX 6102
NOVATO,CA94948
56-2311840 		MRI JOINT VENTURE CA NA
  		N/A                
(5) SAN FRANCISCO ENDOSCOPY CENTER LLC

3000 RIVERCHASE
BIRMINGHAM,AL35244
91-2160588 		ENDOSCOPY JV CA NA
  		N/A                
(6) PRESIDIO SURGERY CENTER LLC

1635 DIVISADERO
SF,CA94115
32-0144060 		AMBULATORY SURG CA NA
  		N/A                
(7) SUTTER FAIRFIELD SURGERY CTR

2700 LOW CT
FAIRFIELD,CA94533
30-0233892 		SURGERY CA NA
  		N/A                
(8) TWIN CITIES SURGICAL HOSPITAL LLC

250 S WACKER
CHICAGO,IL60606
35-2182617 		SURGERY CA NA
  		N/A                
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
(1) HEALTH VENTURES INC
350 HAWTHORNE ST
OAKLAND,CA94609
94-2918780 		HEALTH SERVICE CA NA
  		C CORP      












Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related 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) MILLS-PENINSULA HOSPITAL FOUNDATION

 B 2,435,808 FMV
(2) MILLS-PENINSULA HOSPITAL FOUNDATION

 C 6,069,168 FMV
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(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 Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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


Software ID:  
Software Version: