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
SUTTER WEST BAY HOSPITALS
 
Doing Business As
CALIFORNIA PACIFIC MEDICAL CENTER
 
Number and street (or P.O. box if mail is not delivered to street address)
PO BOX 7999
 
Room/suite
City or town, state or country, and ZIP + 4
SAN FRANCISCO, CA94120
D Employer identification number

94-0562680
E Telephone number

G Gross receipts $ 1,644,851,244
F Name and address of principal officer:
MARTIN BROTMAN MD
PO BOX 7999
SAN FRANCISCO,CA94120
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.SUTTERHEALTH.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1854
M State of legal domicile: CA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 32
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 25
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 8,792
6 Total number of volunteers (estimate if necessary) .... 6 1,305
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 2,301,677
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) ......... 33,710,172 34,573,903
9 Program service revenue (Part VIII, line 2g) ......... 1,542,831,482 1,534,702,744
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 9,541,135 14,775,202
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 6,728,834 3,480,969
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 1,592,811,623 1,587,532,818
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,836,582 1,671,113
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) 736,482,501 762,546,152
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet621,768    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 665,272,592 605,287,270
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,403,591,675 1,369,504,535
19 Revenue less expenses. Subtract line 18 from line 12....... 189,219,948 218,028,283
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,510,104,441 1,563,746,524
21 Total liabilities (Part X, line 26)............. 574,175,255 561,430,605
22 Net assets or fund balances. Subtract line 21 from line 20..... 935,929,186 1,002,315,919
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 $ 1,263,244,684 including grants of $ 1,671,113 ) (Revenue $ 1,534,702,744 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 1,263,244,684
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
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, 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 IClick to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II.......... Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
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
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
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...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or 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......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
 
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.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
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
Yes
 
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
945
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
8,792
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (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
32
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
25
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
Yes
 
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
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
CA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you 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
HENRY YU
PO BOX 7999
SAN FRANCISCO,CA94120
(415) 600-7310
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) RT REV MARC H ANDRUS
DIRECTOR
 1.0 X           0 0 0
(2) DAMIAN AUGUSTYN MD
DIRECTOR
 1.0 X           18,321 0 0
(3) MARTIN BROTMAN MD
REGIONAL PRESIDENT, WEST BAY
 40.0 X   X       0 1,374,850 713,389
(4) WILLIAM L BRUNETTI
DIRECTOR
 1.0 X           0 0 0
(5) WILLIAM CARROLL MD
DIRECTOR
 1.0 X           30,000 0 0
(6) THEODORE DEIKEL
DIRECTOR
 1.0 X           0 0 0
(7) THOMAS J DIETZ PHD
DIRECTOR
 1.0 X           0 0 0
(8) ROY EISENHARDT
DIRECTOR
 1.0 X           0 0 0
(9) PETER FULCHIRON
VICE CHAIR/DIRECTOR
 1.0 X   X       0 0 0
(10) PAT FRY
PRESIDENT & CEO, SUTTER HEALTH
 1.0 X           0 3,045,216 2,196,089
(11) JORDAN HOROWITZ MD
DIRECTOR
 1.0 X           35,400 0 0
(12) PETER JACOBI
DIRECTOR
 1.0 X           0 0 0
(13) JOAN C KAHR PHD
DIRECTOR
 1.0 X           0 0 0
(14) RONALD H KAUFMAN
DIRECTOR
 1.0 X           0 0 0
(15) STEVEN E LEVENBERG DO
DIRECTOR
 1.0 X           0 0 0
(16) THOMAS E LINCOLN
DIRECTOR
 1.0 X           0 0 0
(17) ALASTAIR A MACTAGGART
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) ANTHONY W MILES
DIRECTOR
 1.0 X           0 0 0
(19) SCOTT MINICK
DIRECTOR
 1.0 X           0 0 0
(20) TIMOTHY MURPHY MD
DIRECTOR
 1.0 X           0 0 0
(21) CYNTHIA NESTLE
DIRECTOR
 1.0 X           0 0 0
(22) DENNIS J O'CONNELL
DIRECTOR
 1.0 X           0 0 0
(23) STEVEN H OLIVER
DIRECTOR
 1.0 X           0 0 0
(24) ROBERT W OSORIO MD
DIRECTOR
 1.0 X           0 0 0
(25) ROBERT A ROSENFELD
DIRECTOR
 1.0 X           0 0 0
(26) TERRI SLAGLE MD
DIRECTOR
 1.0 X           11,025 0 0
(27) LEO C H SOONG
FINANCE CHAIR/DIRECTOR
 1.0 X   X       0 0 0
(28) ROSS E STROMBERG
DIRECTOR
 1.0 X           0 0 0
(29) ROBERT M TOMASELLO
CHAIR/DIRECTOR
 1.0 X   X       0 0 0
(30) MICHAEL N VALAN MD
DIRECTOR
 1.0 X           0 0 0
(31) ANTHONY G WAGNER
DIRECTOR
 1.0 X           0 0 0
(32) DEBORAH D WYATT MD
DIRECTOR
 1.0 X           0 0 0
(33) MICHAEL DUNCHEON
VP, REGIONAL COUNSEL WEST BAY
 40.0     X       0 405,094 152,376
(34) JOHN GATES
REGION VP FINANCE, WEST BAY
 40.0     X       0 735,733 275,268
(35) WARREN BROWNER MD
CEO, SAN FRANCISCO HOSP, SWBH
 40.0       X     0 815,134 452,253
(36) GRANT DAVIES
EXEC VP, CPMC & CAO, WB
 40.0       X     0 688,198 306,792
(37) ALLAN PONT MD
VP MEDICAL AFFAIRS
 40.0         X   0 722,474 146,025
(38) TONI BRAYER MD
REGIONAL VP & CMO, WEST BAY
 40.0         X   0 599,216 212,759
(39) MARK KIMBELL
CPMC FOUNDATION DIRECTOR
 40.0         X   0 472,157 151,094
(40) STEVEN R CUMMINGS
DIRECTOR, CRCLE
 40.0         X   436,460 0 27,945
(41) CRAIG VERCRUYSSE
REGIONAL CIO, WEST BAY
 40.0         X   0 409,900 117,713
(42) JACK BAILEY
EXEC VP/ADMINISTRATOR, CPMC
 0.0           X 618,590 0 21,713
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,149,796 9,267,972 4,773,416
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet1,853
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
ARAMARK
2500 WARRENVILLE ROAD
DOWNERS GROVE,IL60515 		MANAGEMENT SERVICES 17,100,378
PACIFIC INPATIENT MEDICAL GROUP INC
PO BOX 1230
SUISUN CITY,CA94585 		UTILIZATION SERVICES 6,792,853
ANESTHESIA AND ANALGESIA MEDICAL GR
837 5TH STREET 2ND FLOOR
SANTA ROSA,CA95404 		ANESTHESIA SERVICES 5,796,544
ANGELICA
DEPT 6777
LOS ANGELES,CA90084 		LAUNDRY SERVICES 3,367,348
AUXILIO
27401 LOS ALTOS STE 100
MISSION VIEJO,CA92691 		PRINTER SVC MGMT 3,012,287
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet142
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 45,914
d Related organizations...1d 11,371,805
e Government grants (contributions)1e 14,308,396
f All other contributions, gifts, grants, and
similar amounts not included above1f 		8,847,788
g Noncash contributions included in lines 1a-1f:$ 86,954
h Total. Add lines 1a-1f.......MediumBullet 34,573,903
Program Service Revenue Business Code
2a PATIENT SERVICE REVENUE 622,110 1,518,237,022 1,518,237,022    
b CA PACIFIC ADVANCED IMAGING 621,512 1,726,947 1,726,947    
c SAN FRAN ENDOSCOPY CENTER 621,498 5,037,640 5,037,640    
d PRESIDIO SURGERY CENTER LLC 621,493 6,038,377 6,038,377    
e RENTAL TO AFFILIATES 900,099 3,662,758 3,662,758    
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 1,534,702,744
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 10,689,412     10,689,412
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 11,573,430  
b Less: rental expenses 13,785,834  
c Rental income or (loss) -2,212,404  
d Net rental income or (loss).......MediumBullet -2,212,404     -2,212,404
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 47,261,406 311,307
b Less: cost or other basis and sales expenses 43,102,023 384,900
c Gain or (loss) 4,159,383 -73,593
d Net gain or (loss)..........MediumBullet 4,085,790     4,085,790
8a Gross income from fundraising events (not including
$ 45,914
of contributions reported on line 1c). See Part IV, line 18 ...
a 66,309
b Less: direct expenses ...b 43,169
c Net income or (loss) from fundraising events..MediumBullet 23,140   23,140
9a Gross income from gaming activities.
See Part IV, line 19 ...
a 4,925
b Less: direct expenses ...b 2,500
c Net income or (loss) from gaming activities...MediumBullet 2,425     2,425
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a UBI - LABORATORY 621,500 486,248   486,248  
b UBI - PARKING 812,930 1,815,429   1,815,429  
c CAFETERIA 900,099 3,292,653     3,292,653
d All other revenue .... 73,478     73,478
e Total. Add lines 11a–11d ......MediumBullet 5,667,808
12 Total revenue. See Instructions....MediumBullet 1,587,532,818 1,534,702,744 2,301,677 15,954,494
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 1,670,863 1,670,863
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 250 250
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 .... 94,746   94,746  
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 507,796,154 486,255,508 21,540,646  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 46,421,462 44,682,197 1,739,265  
9 Other employee benefits ....... 166,841,946 153,361,827 13,480,119  
10 Payroll taxes ........... 41,391,844 39,897,843 1,493,611 390
11 Fees for services (non-employees):        
a Management ...... 6,567,126 4,331,871 2,053,605 181,650
b Legal ......... 4,457,042 154,927 4,302,115 0
c Accounting ........... 94,125 21,492 72,633 0
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 661,555 0 661,555 0
g Other .......... 20,409,760 19,387,627 1,022,133 0
12 Advertising and promotion .... 3,487,656 3,484,795 2,230 631
13 Office expenses ....... 176,803,725 176,154,285 643,902 5,538
14 Information technology ...... 16,192,706 0 16,192,706 0
15 Royalties .. 0      
16 Occupancy ........... 15,370,503 15,118,400 252,103 0
17 Travel ............ 1,293,557 958,119 332,354 3,084
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 657,792 556,479 101,313 0
20 Interest ........... 11,170,444 11,170,444 0 0
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 76,152,979 76,121,225 31,754 0
23 Insurance .............. 11,519,736 11,513,676 6,060 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 PURCHASED SERVICES 104,837,091 92,663,996 12,154,286 18,809
b PROFESSIONAL FEES-PHYSICIANS 68,333,931 64,740,180 3,593,751 0
c REPAIRS & MAINTENANCE 23,038,036 21,532,530 1,503,806 1,700
d SYSTEM ALLOCATION FEES 19,702,731 -220,122 19,569,289 353,564
e
f All other expenses 44,536,775 39,686,272 4,794,101 56,402
25 Total functional expenses. Add lines 1 through 24f 1,369,504,535 1,263,244,684 105,638,083 621,768
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 ....... 82,045,309 2 70,103,047
3 Pledges and grants receivable, net ......... 399,739 3 2,333,524
4 Accounts receivable, net ......... 197,248,328 4 196,199,741
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 .............. 14,589,638 8 14,314,230
9 Prepaid expenses and deferred charges ............ 4,035,606 9 4,406,229
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,833,729,439
b Less: accumulated depreciation. ..... 10b 806,823,517 951,078,166 10c 1,026,905,922
11 Investments—publicly traded securities .......... 183,970,682 11 177,768,432
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 5,320,918 13 6,745,744
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 71,416,055 15 64,969,655
16 Total assets. Add lines 1 through 15 (must equal line 34)... 1,510,104,441 16 1,563,746,524
Liabilities 17 Accounts payable and accrued expenses . 189,729,837 17 190,124,956
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 334,770,632 20 340,300,560
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..... 49,674,786 25 31,005,089
26 Total liabilities. Add lines 17 through 25..... 574,175,255 26 561,430,605
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 ..... 913,463,129 27 979,818,227
28 Temporarily restricted net assets ..... 22,466,057 28 22,497,692
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 ..... 935,929,186 33 1,002,315,919
34 Total liabilities and net assets/fund balances ..... 1,510,104,441 34 1,563,746,524
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
1,587,532,818
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
1,369,504,535
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
218,028,283
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
935,929,186
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-151,641,550
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
1,002,315,919
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
Yes
 
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
Yes
 
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
SUTTER WEST BAY HOSPITALS
 
Employer identification number

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

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 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
SUTTER WEST BAY HOSPITALS
 
Employer identification number

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





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box 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
SUTTER WEST BAY HOSPITALS
  		Employer identification number

94-0562680
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
SUTTER WEST BAY HOSPITALS
  		Employer identification number

94-0562680
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
SUTTER WEST BAY HOSPITALS
  		Employer identification number

94-0562680
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
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
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds 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 ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
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)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
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 .................   169,781,890 169,781,890
b Buildings ................   749,848,183 432,550,558 317,297,625
c Leasehold improvements ............   45,079,983 28,960,024 16,119,959
d Equipment ................   445,532,337 342,088,770 103,443,567
e Other .................   423,487,046 3,224,165 420,262,881
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 1,026,905,922
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 5,271,542
3RD PARTY SETTLEMENTS 4,922,594
OTHER LIABILITIES 20,810,953






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 31,005,089
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
ASC 740 (FIN48) FOOTNOTE FROM AUDIT PART X, LINE 2 THIS ORGANIZATION WAS PART OF A CONSOLIDATED FINANCIAL SYSTEM AUDIT. THE ASC 740 AUDIT FOOTNOTE DISCLOSURE FOR THE SUTTER SYSTEM IS AS FOLLOWS: 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 G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,or if the organization entered more than $15,000 on Form 990-EZ, line 6a.right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

ANNIVERSARY
(event type) 		(b) Event #2

GOLF TOURNY
(event type) 		(c) Other Events

1
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 66,787 39,441 5,995 112,223
2 Less: Charitable
contributions . . . 		35,834 10,080 0 45,914
3 Gross income (line 1
minus line 2) . . . 		30,953 29,361 5,995 66,309
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . .        
6 Rent/facility costs . .   8,832   8,832
7 Food and beverages . . 13,311 7,299   20,610
8 Entertainment . . . 750     750
9 Other direct expenses . 8,564 3,611 802 12,977
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 43,169
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow 23,140
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 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
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
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
 
 
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) .. 		    24,624,802 0 24,624,802 1.800 %
b Medicaid (from Worksheet 3, column a) .....     205,368,207 138,373,293 66,994,914 4.900 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .     11,127,041 6,633,395 4,493,646 0.330 %
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    241,120,050 145,006,688 96,113,362 7.030 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		66 104,440 3,463,924 60,684 3,403,240 0.250 %
f Health professions education
(from Worksheet 5) .. 		25 1,110 40,311,004 5,026,128 35,284,876 2.580 %
g Subsidized health services
(from Worksheet 6) .. 		16 80,997 34,399,348 28,443,660 5,955,688 0.440 %
h Research (from Worksheet 7) 1 1,989 21,848,548 0 21,848,548 1.600 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) .... 36 900 3,690,918 0 3,690,918 0.270 %
jTotal Other Benefits ... 144 189,436 103,713,742 33,530,472 70,183,270 5.140 %
kTotal. Add lines 7d and 7j. .. 144 189,436 344,833,792 178,537,160 166,296,632 12.170 %
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 0 5,184 0 5,184 0 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building 6 25,138 87,691 0 87,691 0.010 %
7 Community health improvement advocacy 3 100 20,084 0 20,084 0 %
8 Workforce development 7 105 497,306 0 497,306 0.040 %
9 Other            
10 Total 20 25,343 610,265 0 610,265 0.050 %
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
11,887,778
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
299,955,308
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
359,868,436
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-59,913,128
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?5
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 CALIFORNIA PACIFIC MEDICAL CENTER
45 CASTRO STREET
SAN FRANCISCO,CA94114 		X X         X    
2 CPMC-ST LUKE'S CAMPUS
3555 CESAR CHAVEZ STREET
SAN FRANCISCO,CA94110 		X X         X    
3 NOVATO COMMUNITY HOSPITAL
180 ROWLAND WAY
NOVATO,CA94945 		X X         X    
4 SUTTER LAKESIDE HOSPITAL
5176 HILL ROAD
LAKEPORT,CA95463 		X X     X   X    
5 SUTTER MEDICAL CENTER SANTA ROSA
3325 CHANATE ROAD
SANTA ROSA,CA95404 		X X         X    
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)
CALIFORNIA PACIFIC 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: 400.%
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   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
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)
CPMC-ST LUKE'S CAMPUS
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: 400.%
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   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
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)
NOVATO COMMUNITY HOSPITAL
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: 400.%
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   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
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 LAKESIDE 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: 400.%
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   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
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 MEDICAL CENTER SANTA ROSA
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):5

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 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: 400.%
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   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
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?23
Name and address Type of Facility (describe)
1 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 100
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-MRI
2 CALIFORNIA PACIFIC MEDICAL CENTER
2323 SACRAMENTO STREET
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-PSYCHIATRY
3 CALIFORNIA PACIFIC MEDICAL CENTER
1625 VAN NESS AVENUE
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES - CHILD DEVELOPMENT
4 CALIFORNIA PACIFIC MEDICAL CENTER
1580 VALENCIA STREET SUITE 440
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES - CHILD DEVELOPMENT
5 CALIFORNIA PACIFIC MEDICAL CENTER
3838 CALIFORNIA STREET SUITE 106
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES - LABORATORY/IMAGING
6 CALIFORNIA PACIFIC MEDICAL CENTER
101 NORTH EL CAMINO SUITE 1
SAN MATEO,CA94402 		OUTPATIENT SERVICES - HAND THERAPY
7 SUTTER MED CTR SANTA ROSA-PERINATAL CTR
3327 CHANATE ROAD
SANTA ROSA,CA95404 		OUTPATIENT SERVICES
8 SMC SANTA ROSA-SPORTS & ORTHOPEDIC REHAB
4729 HORN AVENUE SUITE A
SANTA ROSA,CA95405 		OUTPATIENT SERVICES
9 TERRA LINDA HEALTH PLAZA
4000 CIVIC CENTER DRIVE
SAN RAFAEL,CA94903 		OUTPATIENT SERVICES
10 PHYSICAL THERAPY & SPORT FITNESS
180 ROWLAND WAY 310
NOVATO,CA94945 		OUTPATIENT SERVICES
11 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET 4TH FLOOR
SAN FRANCISCO,CA94115 		CHRONIC DIALYSIS
12 CALIFORNIA PACIFIC MEDICAL CENTER
2323 SACRAMENTO STREET
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES
13 CALIFORNIA PACIFIC MEDICAL CENTER
2340 CLAY STREET SUITE 114A
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES - HEART TRANSPLANT CLINIC
14 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 600
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-IES
15 CALIFORNIA PACIFIC MEDICAL CENTER
2340 CLAY STREET 4TH FLOOR
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES - LIVER, PANCREAS & KIDNEY TRANSPLANT CLINIC
16 CALIFORNIA PACIFIC MEDICAL CENTER
2340 CLAY STREET 5TH FLOOR
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES - OPHTHAMOLOGY CLINIC
17 CALIFORNIA PACIFIC MEDICAL CENTER
2360 CLAY STREET
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES - PT, OT & CARDIAC REHAB
18 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 502
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES - PULMONARY
19 CALIFORNIA PACIFIC MEDICAL CENTER
2100 WEBSTER STREET SUITE 103
SAN FRANCISCO,CA94115 		RAD/LAB/ULTRASOUND SERVICES
20 CALIFORNIA PACIFIC MEDICAL CENTER
2351 CLAY STREET SUITE 150
SAN FRANCISCO,CA94115 		OUTPATIENT SERVICES-ALS
21 SUTTER LAKESIDE FAMILY MEDICAL CLINIC
5176 HILL ROAD EAST
LAKEPORT,CA95453 		RURAL HEALTH CLINIC
22 SUTTER LAKESIDE OUTPATIENT DRAW STATION
5132 HILL ROAD EAST
LAKEPORT,CA95453 		OUTPATIENT SERVICES
23 SUTTER LAKESIDE UPPER LAKE COMM CLINIC
750 OLD LUCERNE ROAD
UPPER LAKE,CA95485 		RURAL HEALTH CLINIC
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 400% OF FPG. IN ADDITION, THE FOLLOWING DISCOUNTS APPLY TO UNINSURED PATIENTS: - SPECIAL CIRCUMSTANCES CHARITY CARE: FOR UNINSURED PATIENTS WHO DO NOT MEET THE FINANCIAL ASSISTANCE CRITERIA SET FORTH BY THE ORGANIZATION, A COMPLETE OR PARTIAL WRITE-OFF IN CIRCUMSTANCES INCLUDING BUT NOT LIMITED TO BANKRUPTCY, HOMELESSNESS, DECEASED, ELIGIBLE FOR MEDICARE/MEDI-CAL, OR IF A COLLECTION AGENCY IDENTIFIES A PATIENT MEETING THE ORGANIZATION'S CHARITY CARE ELIGIBILITY CRITERIA. - CATASTROPHIC CHARITY CARE: PARTIAL WRITE-OFF WHEN THE FINANCIAL RESPONSIBILITY EXCEEDS 30% OF THE PATIENT'S FAMILY INCOME. PATIENTS THAT MEET THE CRITERIA WILL RECEIVE A FULL WRITE-OFF OF UNDISCOUNTED CHARGES THAT EXCEED 30% OF THEIR FAMILY INCOME. - HIGH MEDICAL COST CHARITY CARE (FOR INSURED PATIENTS): PARTIAL WRITE-OFF OF THE HOSPITAL'S UNDISCOUNTED CHARGES FOR PATIENTS WHOSE FAMILY INCOME IS LESS THAN 350% OF FPG, MEDICAL EXPENSES EXCEED 10% OF THE PATIENT'S FAMILY INCOME, AND THE PATIENT'S 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 I, QUESTION 7G   THE AMOUNT OF COSTS ASSOCIATED WITH PHYSICIAN CLINICS IS $25,440.
PART II COMMUNITY BUILDING ACTIVITIES CALIFORNIA PACIFIC MEDICAL CENTER CALIFORNIA PACIFIC MEDICAL CENTER (CPMC) 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) PROJECT HOME CONNECT: PROJECT HOMELESS CONNECT IS SAN FRANCISCO'S SIGNATURE PROGRAM TO PROVIDE SERVICES TO ITS HOMELESS POPULATION. THE MISSION OF PROJECT HOMELESS CONNECT IS TO PROVIDE A SINGLE LOCATION WHERE NONPROFIT MEDICAL AND SOCIAL SERVICE PROVIDERS COLLABORATE TO SERVE THE HOMELESS OF SAN FRANCISCO WITH COMPREHENSIVE, HOLISTIC SERVICES. CPMC HAD 72 VOLUNTEERS SERVE A TOTAL OF 576 HOURS OF SERVICE FOR THIS EVENT. B) FIRST FIVE COMMISSION - CHILD DEVELOPMENT CENTER (CDC): CPMC'S CDC IS PART OF THE FIRST 5 CALIFORNIA COALITIONS. FIRST 5 CALIFORNIA REPRESENTS AN IMPORTANT PART OF OUR STATE'S EFFORT TO NURTURE AND PROTECT OUR MOST PRECIOUS RESOURCE - OUR CHILDREN. FIRST 5 CALIFORNIA'S SERVICES AND SUPPORT ARE DESIGNED TO ENSURE THAT MORE CHILDREN ARE BORN HEALTHY AND REACH THEIR FULL POTENTIAL. C) GALILEO HEALTH ACADEMY - CITY WITHIN SPEAKER SERIES: THE GALILEO HEALTH ACADEMY OFFERS A 12-WEEK SPEAKER SERIES CALLED "THE CITY WITHIN." TWICE A WEEK, EMPLOYEES OF CPMC PROVIDE LECTURES, DEMONSTRATIONS, TOURS AND ACTIVITIES TO ENHANCE STUDENTS' UNDERSTANDING OF THE COMPLEXITIES AND EMPLOYMENT OPPORTUNITIES IN AN ACUTE CARE MEDICAL CENTER. IN 2011, 80 STUDENTS PARTICIPATED IN THIS PROGRAM. D) IMMACULATE CONCEPTION ACADEMY WORK STUDY PROGRAM: THE IMMACULATE CONCEPTION ACADEMY WORK STUDY PROGRAM PROVIDES STUDENTS WITH CRUCIAL HANDS-ON WORK EXPERIENCE, WHILE EMPOWERING THEM TO TAKE AN ACTIVE PART IN FINANCING THEIR OWN EDUCATION. STUDENTS ACQUIRE DESIRABLE JOB EXPERIENCE AND MARKETABLE SKILLS; DEVELOP A NETWORK OF BUSINESS CONTACTS AND EXPOSURE TO A VARIETY OF CAREER OPPORTUNITIES. E) PACIFIC EPILEPSY PROGRAM: THE PACIFIC EPILEPSY PROGRAM (PEP) PROVIDES PATIENTS WITH AN ALL-INCLUSIVE EPILEPSY TREATMENT PROGRAM AND PLACEMENT OF PEP PATIENTS IN VOLUNTEER POSITIONS WITHIN CPMC. THIS ALLOWS PEP STAFF TO EVALUATE THE PATIENTS' ABILITY TO WORK AND TO MODIFY TREATMENT ACCORDINGLY. F) YEAR UP INTERNS: ALTHOUGH CPMC HAS BEEN PARTICIPATING IN THE YEAR UP PROGRAM FOR THE PAST THREE YEARS, 2011 WAS ITS FIRST REPORTING YEAR. YEAR UP INTERNS ARE ASSIGNED TO CPMC'S IT DEPARTMENT AT THE FOLSOM CAMPUS. EACH INTERN SHADOWS AN EXISTING IT EMPLOYEE TO RECEIVE INSTRUCTION IN INSTALLATION OF COMPUTER EQUIPMENT, PROPER COMPUTER INTERFACE AND ONCE PROFICIENT, TROUBLESHOOT PROBLEMS. G) ENABLING PATIENTS TO VOTE: THIS SERVICE PROVIDES PATIENTS WITH THE OPPORTUNITY TO VOTE IN SAN FRANCISCO ELECTIONS. A VOLUNTEER VISITS CITY HALL TO OBTAIN THE BALLOT AND ASSISTS PATIENTS IN COMPLETING BALLOTS, IF NEEDED. THE VOLUNTEER THEN COLLECTS THE BALLOTS AND RETURNS THEM TO CITY HALL IN A TIMELY MANNER FOR TABULATION. NOVATO COMMUNITY HOSPITAL NOVATO COMMUNITY HOSPITAL (NCH) 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) COUNTY OF MARIN EMERGENCY SERVICES: NOVATO COMMUNITY HOSPITAL PARTICIPATES IN THE MEDICAL DISASTER PREPAREDNESS SECTION OF THE MARIN COUNTY DISASTER & CORPS COUNCIL, PER COUNTY REGULATIONS. B) HEALTHY MARIN PARTNERSHIP: IN 1995, THE HEALTHY MARIN PARTNERSHIP WAS FORMED IN RESPONSE TO CALIFORNIA SENATE BILL 697, A LEGISLATIVE MANDATE REQUIRING NOT-FOR-PROFIT HOSPITALS TO COMPLETE A COMMUNITY NEEDS ASSESSMENT EVERY THREE YEARS. NCH PARTICIPATES IN THIS PARTNERSHIP, ALONG WITH OTHER KEY STAKEHOLDERS, TO PRODUCE THE COMMUNITY NEED HEALTH ASSESSMENT. C) MARIN COUNTY HOSPITAL PREPAREDNESS COMMITTEE: THE MARIN COUNTY HOSPITAL PREPAREDNESS COMMITTEE FOLLOWS THE GUIDELINES OF THE NATIONAL HOSPITAL PREPAREDNESS PROGRAM (HPP) PROVIDING LEADERSHIP AND FUNDING THROUGH GRANTS AND COOPERATIVE AGREEMENTS TO STATES, TERRITORIES AND ELIGIBLE MUNICIPALITIES TO IMPROVE SURGE CAPACITY AND ENHANCE COMMUNITY AND HOSPITAL PREPAREDNESS FOR PUBLIC HEALTH EMERGENCIES. THE MARIN ORGANIZATION IS COMPOSED OF NCH AND OTHER COUNTY HOSPITALS AND MEETS REGULARLY TO PLAN HOSPITAL RESPONSE TO NATURAL DISASTERS. THE GROUP PARTICIPATES IN ALL COUNTY AND STATE DRILLS AND OVERSEES A CACHE OF MEDICAL SUPPLIES IN MARIN COUNTY. SUTTER LAKESIDE HOSPITAL SUTTER LAKESIDE HOSPITAL (SLH) FUNDED THE FOLLOWING PROGRAM 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). THIS PROGRAM HELPED SUPPORT COMMUNITY ASSETS BY OFFERING THE EXPERTISE AND RESOURCES OF SUTTER HEALTH. A) COMMUNITY SERVICE ORGANIZATION ACTIVITY: SUTTER LAKESIDE HOSPITAL ENCOURAGES STAFF TO PROVIDE ASSISTANCE TO OTHER NON-PROFIT ORGANIZATIONS THAT PROVIDE UNIQUE SERVICES TO THE COMMUNITY THAT WERE NOT PROVIDED BY THE HOSPITAL. PAID STAFF TIME WAS DONATED TO THE LAKE FAMILY RESOURCE CENTER AND ROTARY INTERNATIONAL. IN ADDITION, TWO (2) EMPLOYEE WERE FEMA ICS-300 CERTIFIED (16 HOURS EACH). THIS CERTIFICATION IS ABOVE AND BEYOND ACCREDITATION REQUIREMENTS. THIS DISASTER PREPAREDNESS TRAINING GREATLY BENEFITS THE ENTIRE COMMUNITY IN THE EVENT OF A DISASTER. SUTTER MEDICAL CENTER OF SANTA ROSA SUTTER MEDICAL CENTER OF SANTA ROSA (SMCSR) 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) COMMUNITY COLLABORATIVES: MEMBERS OF SMCSR'S SOCIAL WORK DEPARTMENT PARTICIPATE IN A SPECTRUM OF WORKGROUPS THAT ADDRESS ISSUES IMPACTING INTEGRATE HEALTH CARE DELIVERY TO SPECIFIC UNDERSERVED POPULATIONS (HOMELESS, SUBSTANCE ABUSERS, ELDERLY). B) HEALTHY KIDS: HEALTHY KIDS WAS ESTABLISHED WITH TWO MAJOR GOALS: TO PROVIDE EXPANDED ENROLLMENT ASSISTANCE AND CASE MANAGEMENT TO UNFUNDED AND UNDERFUNDED CHILDREN AND FAMILIES AND TO FUND AND MANAGE AN INSURANCE PROGRAM FOR CHILDREN WHO DO NOT QUALIFY FOR EXISTING PUBLIC HEALTH COVERAGE. HEALTHY KIDS IS A COLLABORATION OF LOCAL HEALTH CARE PROVIDERS, SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES, SONOMA COUNTY OFFICE OF EDUCATION AND KID'S NET. OVER THE PAST FEW YEARS, THE STEERING COMMITTEE OF THIS DYNAMIC COLLABORATIVE WAS CHARGED WITH MITIGATING THE DEVASTATING IMPACT OF STATE BUDGET CUTS AND ENSURING THAT CHILDREN DID NOT LOSE HEALTH COVERAGE OR ACCESS TO MEDICAL HOMES. C) SONOMA HEALTH ALLIANCE: THIS COLLABORATIVE OF LOCAL HEALTH LEADERS COME TOGETHER TO SET LOCAL HEALTH INITIATIVES AND DISCUSS OPPORTUNITIES TO LEVERAGE COLLABORATION TO IMPACT LOCAL HEALTH OUTCOMES. THE SHA HAS SPONSORED MANY PROJECTS OVER THE YEARS, INCLUDING COUNTY-WIDE FLU IMMUNIZATION EFFORTS, SENIOR FALL PREVENTION PROGRAMS, LOCAL CHILDREN'S DENTAL HEALTH SURVEY (2008), ORAL HEALTH TASKFORCE (2011), HEALTHYSONOMA.ORG, AND THE TRIENNIAL COMMUNITY HEALTH NEEDS ASSESSMENT. D) HEALTHCARE WORKFORCE DEVELOPMENT ROUNDTABLE: THIS GROUP WAS FORMED TO PROMOTE INTEREST IN HEALTH PROFESSIONS AND CREATE OPPORTUNITIES TO PURSUE HEALTH CAREERS FOR DIVERSE POPULATIONS IN SONOMA COUNTY. THIS PROGRAM IS A PARTNERSHIP WITH SANTA ROSA JUNIOR COLLEGE AND HAS BEEN AWARDED MULTIPLE GRANTS OVER THE YEARS TO CONTINUE ITS IMPORTANT OUTREACH, RECRUITMENT AND SUPPORT EFFORTS. SMCSR CONTINUES TO PROVIDE LEADERS TO THIS EFFORT, BOTH IN STRATEGIC PLANNING AND PROVIDING OPPORTUNITIES FOR STUDENTS TO SHADOW STAFF IN A VARIETY OF HEALTH PROFESSIONS WITH THE HOSPITAL SETTING. TODAY, THIS PARTNERSHIP HAS GROWN INTO A ROBUST CONTINUUM OF PROGRAMS AND SERVICES TARGETING HIGH SCHOOL AND COLLEGE STUDENTS OF COLOR. E) NORTH BAY HOSPITALS AND COLLEGES COUNCIL NURSING ADMIN: THIS IS A LOCAL CONSORTIUM ORGANIZED BY THE CALIFORNIA HOSPITALS ASSOCIATION THAT IS WORKING TO ESTABLISH A SUSTAINABLE HEALTHCARE WORKFORCE PIPELINE FOR SONOMA COUNTY. F) SANTA ROSA JUNIOR COLLEGE PHARMACY TECH PROGRAM ADVISORY COMMITTEE: PHARMACY TECHNICIAN IS ONE OF THE MOST HIGH-DEMAND JOBS. SMCSR'S PARTICIPATION IN THIS PROGRAM HELPS TO ENSURE A PIPELINE OF SKILLED PHARMACY TECHS TO MEET THE NEEDS OF OUR COMMUNITY PRESENTLY AND IN THE FUTURE. THE COMMITTEE ADVISES FACULTY IN THE DEVELOPMENT OF CURRICULUM AND IN THE RESOLUTION OF ISSUES IMPACTING THE PHARMACY TECHNICIAN PROGRAM AT SRJC. STUDENTS ALSO ROTATE THROUGH SMCSR'S PHARMACY FOR A PORTION OF THEIR HOSPITAL EXPERIENCE TRAINING.
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 $59,913,128.
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 CALIFORNIA PACIFIC MEDICAL CENTER (CPMC) CPMC IS A FOUNDING MEMBER OF BUILDING A HEALTHIER SAN FRANCISCO (BHSF), A CITY-WIDE COLLABORATIVE OF SAN FRANCISCO NON-PROFIT HOSPITALS, THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH, HEALTH PLANS, AND COMMUNITY-BASED HEALTH ORGANIZATIONS. BHSF CONDUCTS A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS TO DETERMINE WHERE THE MEMBERS OF THE COLLABORATIVE SHOULD FOCUS EFFORTS TO IMPROVE THE HEALTH OF SAN FRANCISCO RESIDENTS. BASED ON THE 2010 COMMUNITY NEEDS ASSESSMENT, BHSF DEFINED THE FOLLOWING FOUR HEALTH IMPROVEMENT GOALS: 1. IMPROVE ACCESS TO CARE 2. PREVENT CHRONIC DISEASE AND INCREASE WELLNESS 3. REDUCE THE INCIDENCE OF COMMUNICABLE DISEASE 4. ENGAGE IN VIOLENCE PREVENTION AS A MEMBER OF THE BHSF COLLABORATIVE, CPMC IS COMMITTED TO FORWARDING THESE GOALS THROUGH ITS COMMUNITY BENEFIT PROGRAM. FOR MORE INFORMATION ABOUT THE 2010 COMMUNITY NEEDS ASSESSMENT, INCLUDING QUANTITATIVE AND QUALITATIVE DATA, PLEASE VISIT OUR WEBSITE AT WWW.HEALTHMATTERSINSF.ORG. NOVATO COMMUNITY HOSPITAL (NCH) DURING 2011, NOVATO COMMUNITY HOSPITAL REVIEWED ITS COMMUNITY BENEFIT PROGRAMS TO ALIGN ACTIVITIES WITH HEALTH CARE NEEDS IDENTIFIED IN THE 2011 COMMUNITY HEALTH NEEDS ASSESSMENT. SINCE 1995 NOVATO COMMUNITY HOSPITAL HAS PARTICIPATED IN A COALITION CALLED HEALTHY MARIN PARTNERSHIP THAT INCLUDES THE THREE HOSPITALS IN MARIN COUNTY AND OTHER COMMUNITY LEADERS TO CONDUCT THE TRI-ANNUAL NEEDS ASSESSMENT REQUIRED BY SB697. THE COALITION ALSO IDENTIFIES PRIORITY HEALTH NEEDS AND A PLAN FOR MEETING THEM. NCH PARTICIPATES FULLY IN THE PROCESS AND USES THIS DATA TO DEVELOP ITS COMMUNITY BENEFIT APPROACH. AS A RESULT, NCH IS FOCUSING ON THE FOLLOWING COMMUNITY BENEFIT PRIORITIES: - HEALTH CARE SERVICES FOR UNDER-INSURED AND UNINSURED MEMBERS OF OUR COMMUNITY. - UPSTREAM STRATEGIES TO PREVENT ILLNESSES THAT ARE THE LEADING CONTRIBUTORS TO ILLNESS AND DEATH IN MARIN COUNTY - HEART DISEASE, STROKE, AND OTHER CHRONIC CONDITIONS SUCH AS DIABETES: - OBESITY - TOBACCO USE - ALCOHOL USE/BINGE DRINKING - INTERVENTION INTO THE LIVES OF YOUTH AT RISK OF DEVELOPING CHILDHOOD DIABETES. - INFLUENCE POLICIES AND PRACTICES THAT SUPPORT CHANGES AT LOCAL, STATE, AND FEDERAL LEVELS TO FOSTER HEALTHY COMMUNITIES - ECONOMIC, HOUSING, LAND USE, RETAIL, AND HEALTH PLANNING ACTIVITIES THAT SUPPORT CONDITIONS CONDUCIVE TO GOOD HEALTH. A COPY OF THIS REPORT IS AVAILABLE FOR DOWNLOAD AT WWW.HEALTHYMARINPARTNERSHIP.ORG. SUTTER LAKESIDE HOSPITAL (SLH) IN 2009-2010, SUTTER LAKESIDE HOSPITAL, ST. HELENA CLEARLAKE, LAKE COUNTY PUBLIC HEALTH AND OTHER ORGANIZATIONS FORMED A COLLABORATIVE TO PLAN FOR A COMMUNITY NEEDS HEALTH ASSESSMENT (CHNA). THE CHNA ASSISTS THESE ORGANIZATIONS IN DEVELOPING THEIR COMMUNITY BENEFIT PLANS THAT HELP IMPROVE COMMUNITY HEALTH. TWO PRIMARY DATA SOURCES WERE USED IN THE CHNA PROCESS, INCLUDING DEMOGRAPHIC, SOCIOECONOMIC AND HEALTH INDICATORS (QUANTITATIVE) AND DATA FROM A COMMUNITY INPUT PROCESS (QUALITATIVE). THE HEALTHY LAKE COUNTY SURVEY WAS DISTRIBUTED ONLINE AND IN VARIOUS LOCATIONS THROUGHOUT LAKE COUNTY IN AN ATTEMPT TO GAIN A BETTER UNDERSTANDING OF THE HEALTH NEEDS OF THOSE WHO LIVE IN COMMUNITY. THESE LOCATIONS INCLUDED PUBLIC LIBRARY BRANCHES, YUBA COLLEGE COFFEE SHOP, SENIOR CENTERS IN MIDDLETOWN AND CLEARLAKE OAKS, LAKEPORT MOVIE THEATERS, CASINOS AND A RESTAURANT. ADDITIONALLY, SURVEYS WERE DISTRIBUTED AT SERVICE SITES FOR HEALTH, MENTAL HEALTH, AND ALCOHOL AND DRUG CLIENTS. OVERALL 869 SURVEYS WERE COMPLETED, 37% ONLINE AND 63% ON PAPER. COMMUNITY FOCUS GROUPS WERE HELD AT THREE LOCATIONS: CLEARLAKE, LAKEPORT AND KELSEYVILLE. THESE LOCATIONS WERE CHOSEN STRATEGICALLY TO ENSURE GEOGRAPHIC REPRESENTATION. KEY COMMUNITY-BASED ORGANIZATIONS WERE IDENTIFIED BY THE COLLABORATIVE AND ASKED TO HOST A FOCUS GROUP. FOCUS GROUPS WERE CO-SCHEDULED AT THE SITES AMONG PARTICIPANTS WHO WERE ALREADY MEETING FOR OTHER PURPOSES (FOR EXAMPLE, YOUNG MOTHERS AT PARENTING CLASS). THIS HELPED TO IMPROVE ACCESS AND ENSURE MAXIMUM ATTENDANCE. ALTHOUGH THE PARTICIPANTS CONSTITUTED A CONVENIENCE SAMPLE, THERE WAS THE EXPECTATION THAT IN THE AGGREGATE THE GROUPS WOULD BE DIVERSE AND INCLUDE POPULATIONS OF HIGHEST INTEREST. THE FOUR PRIORITY AREAS IDENTIFIED BY THE COLLABORATIVE IN THE CHNA ARE SENIOR SUPPORT SERVICES, SUBSTANCE ABUSE, PREVENTATIVE HEALTH AND MENTAL AND EMOTIONAL HEALTH. FOR MORE DETAILS ABOUT THE CHNA, PLEASE VISIT: HTTP://HEALTH.LAKECOUNTYCA.GOV/ASSETS/HEALTH/PUBLIC+HEALTH+DIVISION/HEALTH +NEEDS+ASSESSMENT+DEC+2010.PDF SUTTER MEDICAL CENTER OF SANTA ROSA (SMCSR) SUTTER MEDICAL CENTER OF SANTA ROSA IS COMMITTED TO COLLABORATING WITH PARTNERS TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. EVERY THREE YEARS, SMCSR PARTNERS WITH OTHER LOCAL HEALTH CARE ORGANIZATIONS TO CONDUCT A COMPREHENSIVE HEALTH NEEDS ASSESSMENT FROM WHICH COMMUNITY NEEDS AND PRIORITIES ARE IDENTIFIED. THESE PRIORITIES DRIVE THE COMMUNITY BENEFIT PLANNING SO THAT PREVIOUS HEALTH CARE RESOURCES AND DOLLARS ARE ALLOCATED IN WAYS THAT WILL BE MOST MEANINGFUL TO THE PEOPLE WE SERVE. THIS REPORT CONTINUES TO DRAW ATTENTION TO CHILDREN'S HEALTH ISSUES, ESPECIALLY DENTAL HEALTH, WHICH HAS BEEN IDENTIFIED AS A COMMUNITY HEALTH PRIORITY. TO ACCESS THE COMMUNITY HEALTH NEEDS ASSESSMENT, VISIT WWW.HEALTHYSONOMA.ORG.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI, QUESTION 3 CALIFORNIA PACIFIC MEDICAL CENTER, NOVATO COMMUNITY HOSPITAL, SUTTER LAKESIDE HOSPITAL AND SUTTER MEDICAL CENTER OF SANTA ROSA 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 CALIFORNIA PACIFIC MEDICAL CENTER - SAN FRANCISCO COUNTY ACCORDING TO THE 2010 U.S. CENSUS BUREAU THE POPULATION OF SAN FRANCISCO WAS 805,235 AND CONSISTED OF 50.7% MEN AND 49.3% WOMEN WITH A MEDIAN AGE OF 36.5 YEARS. THE POPULATION DENSITY WAS 17,179.1 PEOPLE PER SQUARE MILE IN 2010 WHICH IS OVER SEVENTY-ONE TIMES THE CALIFORNIA STATE DENSITY OF 239.1 PEOPLE PER SQUARE MILE. SAN FRANCISCO'S POPULATION CONSISTS OF 48.5% WHITE RESIDENTS, 33.3% ASIAN AND 15.1% HISPANIC OR LATINO. HALF OF THE RESIDENTS (54.3%) SPEAK ENGLISH AT HOME WHILE 12% SPEAK SPANISH. THE MEDIAN HOUSEHOLD SIZE IS 2.31 PEOPLE WITH A 2010 AVERAGE INCOME OF $71,304 AND A MEDIAN HOUSE VALUE OF $785,200. A HIGH PERCENTAGE (85.7%) OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A HIGH SCHOOL DEGREE OR HIGHER WHILE OVER HALF (51.2%) OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A BACHELOR'S DEGREE OR HIGHER. IN SAN FRANCISCO THE POVERTY LEVEL IN 2010 WAS AT 11.9% OF RESIDENTS, RIGHT BELOW BOTH THE CALIFORNIA STATE LEVEL OF 13.7% AND THE FEDERAL POVERTY LEVEL OF 15.1%.THE UNEMPLOYMENT RATE WAS AT 10.6% IN APRIL 2010 WHICH WAS BELOW THE CALIFORNIA LEVEL OF 12.4% YET ABOVE THE FEDERAL LEVEL OF 9.9%. FOOD SUPPLIES CONSIST OF 311 GROCERY STORES, 65 CONVENIENCE STORES (WITH GAS) AND 1,580 FULL SERVICE RESTAURANTS. IN 2010, HEALTH ISSUES IN THIS COUNTY INCLUDED 10.5% OF ADULTS BEING OBESE, 3.7% OF ADULTS WITH DIABETES AND 20.8% OF ADULTS WITH HIGH BLOOD PRESSURE. IN 2007 THERE WERE 5,808 DEATHS IN SAN FRANCISCO COUNTY AND OF THOSE THE THREE LEADING CAUSES WERE CANCER, HEART DISEASE AND STROKE. IN 2007 THERE WERE 9,129 BIRTHS AS WELL AS 38 INFANT DEATHS THAT SAME YEAR. IN 2008 THE LIFE EXPECTANCY AT BIRTH WAS 85 YEARS WHICH WAS ABOVE THE CALIFORNIA LIFE EXPECTANCY. IN 2010 17.2% OF RESIDENTS WERE WITHOUT ANY HEALTH INSURANCE WHICH WAS BELOW THE STATE LEVEL OF 18.5% YET ABOVE THE FEDERAL LEVEL OF 15.5%. IN SAN FRANCISCO COUNTY 62.9% OF RESIDENTS HAVE EMPLOYMENT-BASED HEALTH INSURANCE WHILE 10.1% OF RESIDENTS ARE COVERED BY PUBLIC PROGRAMS SUCH AS MEDICAID OR MEDICARE. NOVATO COMMUNITY HOSPITAL - MARIN COUNTY ACCORDING TO THE 2010 U.S. CENSUS BUREAU, MARIN COUNTY HAS A POPULATION OF 252,409 CONSISTING OF 49.2% MEN AND 50.8% WOMEN WITH A MEDIAN AGE OF 41.3 YEARS. THE POPULATION DENSITY WAS 485.1 PEOPLE PER SQUARE MILE IN 2010 WHICH IS TWICE THE CALIFORNIA STATE DENSITY OF 239.1 PEOPLE PER SQUARE MILE. MARIN'S POPULATION IS PRIMARILY WHITE (80%) WITH 15.5% HISPANIC OR LATINO AND 5.5% ASIAN. A LARGE PORTION OF RESIDENTS (80.5%) SPEAK ENGLISH AT HOME WHILE 9.5% SPEAK SPANISH AT HOME (11% OF WHICH DO NOT SPEAK ENGLISH AT ALL). THE MEDIAN HOUSEHOLD SIZE IS 2.33 PEOPLE WITH A 2010 AVERAGE INCOME OF $89,268 AND A MEDIAN HOUSE VALUE OF $868,000. NEARLY ALL (91.8%) OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A HIGH SCHOOL DEGREE OR HIGHER WHILE OVER HALF (54.1%) OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A BACHELOR'S DEGREE OR HIGHER. IN MARIN 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 8.2% IN APRIL 2010 WHICH WAS BELOW BOTH THE CALIFORNIA LEVEL OF 12.4% AND THE FEDERAL LEVEL OF 9.9%. FOOD SUPPLIES CONSIST OF 64 GROCERY STORES, 32 CONVENIENCE STORES (WITH GAS) AND 295 FULL SERVICE RESTAURANTS. IN 2010, HEALTH ISSUES IN THIS COUNTY INCLUDED 9.9% OF ADULTS BEING OBESE, 2.8% OF ADULTS WITH DIABETES AND 23% OF ADULTS WITH HIGH BLOOD PRESSURE. IN 2007 THERE WERE 1,803 DEATHS IN MARIN COUNTY AND OF THOSE THE THREE LEADING CAUSES WERE CANCER, HEART DISEASE AND STROKE. IN 2007 THERE WERE 2,820 BIRTHS AS WELL AS 8 INFANT DEATHS THAT SAME YEAR. IN 2008 THE LIFE EXPECTANCY AT BIRTH WAS 81.1 YEARS WHICH IS NEARLY THE SAME AS THE CALIFORNIA LIFE EXPECTANCY. IN 2010 16.3% OF RESIDENTS WERE WITHOUT ANY HEALTH INSURANCE WHICH WAS BELOW THE STATE LEVEL OF 18.5% YET RIGHT ABOUT THE FEDERAL LEVEL OF 15.5%. IN MARIN COUNTY 56.9% OF RESIDENTS HAVE EMPLOYMENT-BASED HEALTH INSURANCE WHILE 8.6% OF RESIDENTS ARE COVERED BY PUBLIC PROGRAMS SUCH AS MEDICAID OR MEDICARE. SUTTER LAKESIDE HOSPITAL - LAKE COUNTY ACCORDING TO THE 2010 U.S. CENSUS BUREAU LAKE COUNTY HAD A POPULATION OF 64,665 AND CONSISTED OF 50.2% MEN AND 49.8% WOMEN WITH A MEDIAN AGE OF 42.7 YEARS. THE POPULATION DENSITY WAS 51.5 PEOPLE PER SQUARE MILE IN 2010 WHICH IS FAR BELOW THAT OF THE CALIFORNIA STATE DENSITY OF 239.1. LAKE COUNTY'S POPULATION CONSISTS OF 80.5% WHITE RESIDENTS, 17.1% HISPANIC OR LATINO AND 3.2% AMERICAN INDIAN. A LARGE PORTION OF RESIDENTS (89.8%) SPEAK ENGLISH AT HOME WHILE 7.7% SPEAK SPANISH AT HOME (10% OF WHICH DO NOT SPEAK ENGLISH AT ALL). THE MEDIAN HOUSEHOLD SIZE IS 2.53 PEOPLE WITH A 2010 AVERAGE INCOME OF $39,491 AND A MEDIAN HOUSE VALUE OF $265,400. THE GREATER PART (86.3%) OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A HIGH SCHOOL DEGREE OR HIGHER WHILE 16.4% OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A BACHELOR'S DEGREE OR HIGHER. IN LAKE COUNTY THE POVERTY LEVEL IN 2010 WAS AT 19.1% OF RESIDENTS, ABOVE BOTH THE CALIFORNIA STATE LEVEL OF 13.7% AND THE FEDERAL POVERTY LEVEL OF 15.1%.THE UNEMPLOYMENT RATE WAS AT 18.4% IN APRIL 2010 WHICH WAS ABOVE BOTH THE CALIFORNIA LEVEL OF 12.4% AND THE FEDERAL LEVEL OF 9.9%. FOOD SUPPLIES CONSIST OF 24 GROCERY STORES, 21 CONVENIENCE STORES (WITH GAS) AND 40 FULL SERVICE RESTAURANTS. IN 2007, HEALTH ISSUES IN THIS COUNTY INCLUDED 23.7% OF ADULTS BEING OBESE AND 8.3% OF ADULTS WITH DIABETES. IN 2007 THERE WERE 813 DEATHS AND OF THOSE THE THREE LEADING CAUSES WERE HEART DISEASE, DEMENTIA (INCLUDING ALZHEIMER) AND STROKE. IN 2007 THERE WERE 742 BIRTHS WITH ONLY 2 INFANT DEATHS OCCURRING THAT YEAR. THE LIFE EXPECTANCY AT BIRTH IS 79.3 YEARS WHICH IS NEARLY THE SAME AS THE CALIFORNIA LIFE EXPECTANCY. IN 2009 26.7% 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 LAKE COUNTY 39.1% OF RESIDENTS HAVE EMPLOYMENT-BASED HEALTH INSURANCE WHILE 23.8% OF RESIDENTS ARE COVERED BY PUBLIC PROGRAMS SUCH AS MEDICAID OR MEDICARE. SUTTER MEDICAL CENTER OF SANTA ROSA - SONOMA COUNTY ACCORDING TO THE 2010 U.S. CENSUS BUREAU, SONOMA COUNTY HAS A POPULATION OF 483,878 CONSISTING OF 49.2% MEN AND 50.8% WOMEN WITH A MEDIAN AGE OF 37.5 YEARS. THE POPULATION DENSITY WAS 307.1 PEOPLE PER SQUARE MILE IN 2010 WHICH IS OVER THE CALIFORNIA STATE DENSITY OF 239.1 PEOPLE PER SQUARE MILE. SONOMA'S POPULATION CONSISTS OF 76.8% WHITE RESIDENTS, 24.9% HISPANIC OR LATINO, AND 3.8% ASIAN. A LARGE MAJORITY OF RESIDENTS (80.2%) SPEAK ENGLISH AT HOME WHILE 13.8% SPEAK SPANISH. THE MEDIAN HOUSEHOLD SIZE IS 2.52 PEOPLE WITH A 2010 AVERAGE INCOME OF $63,274 AND A MEDIAN HOUSE VALUE OF $524,400. A HIGH PERCENTAGE (86.2%) OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A HIGH SCHOOL DEGREE OR HIGHER WHILE 31.5% OF RESIDENTS 25 YEARS OF AGE OR OLDER HAVE A BACHELOR'S DEGREE OR HIGHER. IN SONOMA THE POVERTY LEVEL IN 2010 WAS AT 10.3% OF RESIDENTS, BELOW BOTH THE CALIFORNIA STATE LEVEL OF 13.7% AND THE FEDERAL POVERTY LEVEL OF 15.1%. THE UNEMPLOYMENT RATE WAS AT 10.5% IN APRIL 2010 WHICH WAS BELOW THE CALIFORNIA LEVEL OF 12.4% YET ABOVE THE FEDERAL LEVEL OF 9.9%. FOOD SUPPLIES CONSIST OF 130 GROCERY STORES, 92 CONVENIENCE STORES (WITH GAS) AND 468 FULL SERVICE RESTAURANTS. IN 2010, HEALTH ISSUES IN THIS COUNTY INCLUDED 20.7% OF ADULTS BEING OBESE, 6.3% OF ADULTS WITH DIABETES AND 17.1% OF ADULTS WITH HIGH BLOOD PRESSURE. IN 2007 THERE WERE 3,781 DEATHS IN SONOMA COUNTY AND OF THOSE THE THREE LEADING CAUSES WERE CANCER, HEART DISEASE AND STROKE. IN 2007 THERE WERE 5,742 BIRTHS AS WELL AS 28 INFANT DEATHS THAT SAME YEAR. IN 2008 THE LIFE EXPECTANCY AT BIRTH WAS 80 YEARS WHICH WAS RIGHT AT THE CALIFORNIA LIFE EXPECTANCY. IN 2010 18.2% OF RESIDENTS WERE WITHOUT ANY HEALTH INSURANCE WHICH WAS JUST BELOW BOTH THE STATE LEVEL OF 18.5% AND THE FEDERAL LEVEL OF 15.5%. IN SONOMA COUNTY 55.2% OF RESIDENTS HAVE EMPLOYMENT-BASED HEALTH INSURANCE WHILE 11.1% 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 CALIFORNIA PACIFIC MEDICAL CENTER'S (CPMC) COMMUNITY BENEFIT ACTIVITIES IN 2011: CPMC UTILIZES COMMUNITY CLINICS, HEALTH PLANS, AND NON-PROFIT PROVIDERS AS WELL AS ADVOCACY GROUPS TO IMPROVE THE HEALTH STATUS OF SAN FRANCISCO RESIDENTS. CPMC PARTNERS WITH COMMUNITY ORGANIZATIONS ON A NUMBER OF PROGRAMS FOCUSED ON PREVENTATIVE HEALTH STRATEGIES. OUR STRATEGY IS TO PARTICIPATE IN HEALTH FAIRS AND EVENTS FOCUSED ON WELLNESS AND PREVENTION, OFFER HEALTH SCREENINGS AND EDUCATION TO OUR COMMUNITIES. CLINICAL PREVENTATIVE CARE, PRIMARY CARE, EMERGENCY SERVICES, AND LONG-TERM AND REHABILITATIVE CARE ARE ALL AVAILABLE THROUGH CPMC'S FOUR CAMPUSES AND PARTNERS. CPMC ALSO PARTNERS WITH ORGANIZATIONS TO PROVIDE GRANTS OR SPONSORSHIPS TO PROVIDE CARE WITHIN SAN FRANCISCO COMMUNITIES. AS A RESULT, IN 2011 CPMC PROVIDED OVER $19 MILLION DOLLARS OF CHARITY CARE TO PROVIDE ACCESS AT THEIR FOUR CAMPUSES. THE BAYVIEW CHILD HEALTH CENTER IS A COMPREHENSIVE, COMMUNITY-BASED CHILD AND ADOLESCENT HEALTH CARE CENTER PROVIDING HIGH-QUALITY PRIMARY CARE AND SERVES AS A HUB FOR ACCESS TO COMMUNITY RESOURCES. THE COMMUNITY HEALTH GRANTS PROGRAM REPRESENTS AN ANNUAL INVESTMENT OF MORE THAN $750,000 IN HEALTH PROMOTIONS. THE AWARDED GRANTS FOCUS ON IMPROVING THE HEALTH OF VULNERABLE POPULATIONS, PARTICULARLY TARGETING THE UNINSURED, CHILDREN AND YOUTH, SENIORS AND UNDERSERVED COMMUNITIES. CPMC'S MEDICAL EDUCATION PROGRAMS PROVIDE HEALTH CARE PROFESSIONALS WITH THE OPPORTUNITY TO RECEIVE WORLD-CLASS TRAINING IN MEDICINE, NURSING AND OTHER ALLIED HEALTH PROFESSIONS. IN ADDITION, CPMC'S RESEARCH INSTITUTE (CPMCRI) BRINGS CLINICIANS AND RESEARCHERS TOGETHER TO DISCOVER EFFECTIVE TREATMENTS AND DIAGNOSTIC TECHNOLOGIES. BIOMEDICAL RESEARCH IS CONDUCTED IN SUCH DIVERSE AREAS AS ARTHRITIS, NEUROBIOLOGY OF PAIN, CARDIOVASCULAR DISEASE, ORGAN TRANSPLANTATION, NEURODEGENERATIVE DISEASES, CANCER, AIDS AND OTHER INFECTIOUS DISEASES. OVER 100 CLINICAL TRAILS ARE CURRENTLY ACTIVE AT CPMC. CPMC ALSO HAS ONE OF THE FEW MEDICAL CENTER-BASED PROGRAMS IN THE UNITED STATES IN WHICH COMPLEMENTARY MEDICINE APPROACHES TO TREATMENT FOR SPECIFIC HEALTH PROBLEMS ARE STUDIED. CPMC PARTNERS WITH 15 LOCAL AGENCIES AND PROGRAM PARTNERS TO BUILD THE SAN FRANCISCO WORKFORCE BY CREATING OPPORTUNITIES FOR YOUTH. CPMC PROVIDES TRAINING OPPORTUNITIES AND EXPOSURE TO HEALTHCARE OPPORTUNITIES TO THE YOUTH THROUGH SPEAKER SERIES, HANDS-ON EXPERIENCE IN THEIR SIMSURG CENTER AND PROVIDING STUDENTS WITH INTERNSHIPS TO GAIN EXPERIENCE IN HEALTH CARE OPERATIONS. EACH YEAR, ALMOST 200 NEW STUDENTS ARE INTRODUCED TO OPPORTUNITIES IN HEALTHCARE. HEALTHFIRST, AN AMBULATORY HEALTH RESOURCE CENTER AT ST. LUKE'S CAMPUS PRESENTS AN UNPRECEDENTED OPPORTUNITY TO ESTABLISH A SPECIALIZED MULTICULTURAL HEALTH CARE FACILITY OFFERING AN ARRAY OF CULTURALLY TAILORED HEALTH EDUCATION, NUTRITION, SOCIAL SERVICES, AND PATIENT NAVIGATION SERVICES IN CONJUNCTION WITH MEDICAL PROVIDERS, AND OTHER HEALTH AND SOCIAL SERVICE ORGANIZATIONS IN THE SOUTH OF MARKET AREA. THE CENTER SERVES AS A HUB OF PREVENTION, EDUCATION, AND CARE COORDINATION ACTIVITIES IN THE NEIGHBORHOODS SURROUNDING ST. LUKE'S HOSPITAL. BREAST CANCER IS THE MOST COMMON CANCER AMONG AFRICAN AMERICAN WOMEN AND A LEADING CAUSE IN THEIR CANCER DEATHS. CPMC IS COMMITTED TO REDUCING BREAST CANCER AND ITS DEVASTATION BY GETTING WOMEN IN EARLIER FOR FIRST-TIME SCREENINGS AND ANNUAL MAMMOGRAMS, AND RAISING AWARENESS THROUGH OUTREACH EDUCATION. CPMC ALSO PARTNERS WITH ORGANIZATIONS SUCH AS AFRICAN-AMERICAN BREAST HEALTH AND SISTER-TO-SISTER. THROUGH CPMC'S HIV/AIDS CASE MANAGEMENT PROGRAM, CPMC IS ACTIVELY WORKING ON REDUCING THE INCIDENCES OF THIS COMMUNICABLE DISEASE. CPMC'S HIV/AIDS CASE MANAGEMENT PROGRAM WAS ESTABLISHED IN 1980 IN RESPONSE TO THE ONSITE OF THE HIV/AIDS EPIDEMIC. CPMC OFFERS SERVICES SUCH AS ENROLLMENT OF PATIENTS IN THE AIDS DRUG ASSISTANCE PROGRAM (ADAP) AND COORDINATION OF CARE TO INCREASE QUALITY OF LIFE. THE OBJECTIVE OF THE PROGRAM IS TO PROMOTE INDEPENDENCE AND MAXIMIZE FUNCTION IN THE HOME ENVIRONMENT, PROVIDING NEEDED SERVICES, AVOIDING CRISES AND LIVING A NORMAL LIFE WITH THE DISEASE. THE PROGRAM INCLUDES A CPMC REGISTER NURSE CASE MANAGER AND A LICENSED CLINICAL SOCIAL WORKER, BOTH SERVE AS RESOURCES FOR MEDICAL, FINANCIAL AND EMOTIONAL ISSUES. HIV/AIDS CASE MANAGEMENT CONTINUES TO BE AVAILABLE TO CPMC PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY FOR THESE SERVICES. CPMC ALSO PARTNERS WITH THE SAN FRANCISCO HEPB FREE CAMPAIGN WHOSE GOAL IS TO SCREEN, VACCINATE AND PROTECT THOSE AT SIGNIFICANT RISK FOR INFECTION WITHIN THE SAN FRANCISCO COMMUNITY. THE CPMC TEAM DEVELOPED A MOBILE PROGRAM THAT BRINGS COMMUNITY EDUCATION AND FREE, CONFIDENTIAL TESTING TO CITY LOCATIONS. THE SAN FRANCISCO HEPB FREE PROGRAM HAS SCREENED ALMOST 4,000 PATIENTS SINCE ITS INCEPTION IN 2008. THE HOSPITAL HAS AN OPEN MEDICAL STAFF AND IS RUN BY A COMMUNITY BOARD. A FEW HIGHLIGHTS OF NOVATO COMMUNITY HOSPITAL'S (NCH) COMMUNITY BENEFIT ACTIVITIES IN 2011: WHILE MARIN COUNTY IS AMONG THE WEALTHIEST IN THE UNITED STATE, APPROXIMATELY 28% OF RESIDENTS LIVE AT OR BELOW 300% OF THE FEDERAL POVERTY LEVEL AND LACK ACCESS TO BASIC SERVICES, INCLUDING HEALTH CARE. TO ADDRESS THIS NEED, NOVATO COMMUNITY HOSPITAL DONATES CASH AND IN-KIND SERVICES TO COMMUNITY HEALTH CLINICS THAT PROVIDE PRIMARY AND SPECIALTY CARE TO THE UNDERINSURED AND UNINSURED. IN 2011, NCH WORKED TO ACCOMPLISH THIS THROUGH TWO GOALS: PROVIDE GRANTS TO CLINICS FOR DIRECT PATIENT CARE AND FORM PARTNERSHIP AGREEMENTS WITH CLINICS TO PROVIDE IN-KIND INPATIENT AND OUTPATIENT DIAGNOSTIC SERVICES. EXAMPLES OF ORGANIZATIONS THAT RECEIVED FUNDING WERE: - A $31,600 GRANT TO HOMEWARD BOUND OF MARIN FOR THE PROVISION OF RESPITE BEDS FOR HOMELESS PATIENTS RECOVERING FROM INPATIENT HOSPITAL STAYS - A $14,064 GRANT TO NOVATO UNIFIED SCHOOL DISTRICT TO PROVIDE COMPENSATION FOR OUTPATIENT PHYSICIAN VISITS FOR UNINSURED K-12 STUDENTS - A $119,958 IN-KIND AGREEMENT WITH ROTOCARE CLINIC TO PROVIDE (CHARITY CARE) LABORATORY SERVICES FOR UNINSURED CLIENTS APPROXIMATELY 1 IN 5 MARIN YOUTH CONSISTENTLY REPORT BEING OVERWEIGHT OR OBESE, A PRIMARY CONTRIBUTOR TO TYPE 2 CHILDHOOD DIABETES. DIFFERENCES IN WEIGHT AMONG SCHOOL-AGE CHILDREN EXIST BETWEEN RACIAL AND ETHNIC GROUPS, WITH A GREATER PERCENTAGE OF MARIN'S ASIAN AND CAUCASIAN CHILDREN BEING AT A HEALTHY WEIGHT COMPARED TO LATINO AND AFRICAN-AMERICAN CHILDREN. TO ADDRESS THIS NEED, NCH FACILITATES A COLLABORATIVE WITH NOVATO UNIFIED SCHOOL DISTRICT, MARIN COMMUNITY CLINIC, MARIN COUNTY HEALTH AND HUMAN SERVICES' NUTRITION WELLNESS PROGRAM AND KAISER PERMANENTE. THE GOAL OF THE COLLABORATIVE IS TO INCREASE COMMUNITY AWARENESS OF YOUTH RISK FOR TYPE 2 DIABETES (WITH A FOCUS ON LATINO AND AFRICAN-AMERICAN YOUTH), EDUCATE YOUNG PEOPLE AT HIGH-RISK FOR TYPE 2 DIABETES, TEACH SELF MANAGEMENT SKILLS AND PROVIDE TECHNICAL EDUCATION IN HEALTH SCIENCES TO STUDENT INTERNS. HIGH SCHOOL SOPHOMORES AND JUNIORS WHO ARE INTERESTED IN HEALTH CAREERS ARE RECRUITED AS INTERNS. THESE INTERNS COMMIT TO MULTI-YEAR TRAINING WITH NCH AND ITS PARTNER AGENCIES. POST-FIRST SEMESTER INTERNS BECOME PEER NUTRITION EDUCATORS AND TEACH YOUNGER AT-RISK CHILDREN AND HIGH SCHOOL PEERS ABOUT TYPE 2 DIABETES. IN 2011, 8 HIGH SCHOOL SOPHOMORES AND JUNIORS WERE TRAINED AS INTERNS. APPROXIMATELY 40 YOUTH AT HIGH RISK FOR TYPE 2 DIABETES ALSO PARTICIPATED IN TWO 2-DAY PREVENTION NOW DAY CAMPS HOSTED AT NCH. THROUGH THIS PROGRAM'S OUTREACH EFFORTS, MORE THAN 100 YOUTH WERE ENGAGED AND EDUCATED ABOUT THE DISEASE.
PROMOTION OF COMMUNITY HEALTH (CONTINUED) PART VI, QUESTION 5 THE HOSPITAL HAS AN OPEN MEDICAL STAFF AND IS RUN BY A COMMUNITY BOARD. A FEW HIGHLIGHTS OF SUTTER LAKESIDE HOSPITAL (SLH) COMMUNITY BENEFIT ACTIVITIES IN 2011: THE SUTTER LAKESIDE MOBILE HEALTH SERVICES UNIT (MHSU) PROVIDES MEDICAL CARE TO UNDERSERVED POPULATIONS EXPERIENCING DIFFICULTY ACCESSING HEALTHCARE SERVICES. THIS INCLUDES A VARIETY OF SERVICES SUCH AS HEALTH SCREENINGS (BASIC VISION, HEARING, BLOOD PRESSURE, DIABETES, SCOLIOSIS, JUST TO NAME A FEW) AND IMMUNIZATIONS. THE MHSU ALSO PROVIDES EDUCATION AND SUPPORT FOR DIABETES, OBESITY, ASTHMA, FAMILY PLANNING AND PREGNANCY. FURTHER, THE MHSU SUPPLIES A VARIETY OF SOCIAL SERVICES REFERRALS INCLUDING MEDI-CAL APPLICATIONS, WELFARE APPLICATION, FOOD PROGRAMS, MENTAL HEALTH, COUNSELING AND WIC. THIS PROGRAM SERVED ALMOST 2,000 PERSONS IN 2011. THE EMERGENCY DEPARTMENT (ED) AT SUTTER LAKESIDE HOSPITAL IS A LEVEL IV TRAUMA CENTER AND IS EDAP-CERTIFIED. AN ONSITE HELIPORT PROVIDES AIR TRANSPORTATION TO AND FROM HARD-TO-REACH MOUNTAIN LOCATIONS AND TRANSPORTS CRITICAL PATIENTS WHO REQUIRE SPECIALIZED CARE TO TRAUMA CENTERS IN NEARBY CITIES. THE ED SERVED OVER 17,900 PERSONS IN 2011. THE FAMILY MEDICINE CLINIC IS A PRIMARY AND PREVENTATIVE CARE CLINIC SERVING ALL POPULATIONS. SUTTER LAKESIDE HOSPITAL OFFERS THE ONLY CLINIC IN THE AREA THAT PROVIDES SERVICES TO MEDI-CAL, WORKERS COMP AND MEDICARE PATIENTS. THIS PROGRAM SERVED OVER 16,000 PATIENTS IN 2011. THE HOSPITAL HAS AN OPEN MEDICAL STAFF AND IS RUN BY A COMMUNITY BOARD. A FEW HIGHLIGHTS FROM SUTTER MEDICAL CENTER OF SANTA ROSA (SMCSR) COMMUNITY BENEFIT ACTIVITIES IN 2011: OVER 3,300 PATIENTS WERE SERVED THROUGH A FINANCIAL COUNSELING PROGRAM FOR UNFUNDED PATIENTS TO HELP RELIEVE OR REDUCE THE FINANCIAL BURDEN OF HEALTH CARE COSTS. HEALTHY KIDS IS A LOCALLY DEVELOPED PROGRAM THAT PROVIDES COMPREHENSIVE HEALTH INSURANCE FOR CHILDREN OF LOW INCOME FAMILIES. COUNTYWIDE OUTREACH EFFORTS CONNECT FAMILIES TO HEALTHY KIDS SERVICES THROUGH A CENTRALIZED REFERRAL LINE. CERTIFIED APPLICATION ASSISTORS HELP FAMILIES ENROLL THEIR CHILDREN INTO AN AFFORDABLE HEALTH INSURANCE PROGRAM. SMCSR SUPPORTS THE HEALTHY KIDS SONOMA COUNTY PROGRAM THROUGH A COMMUNITY BENEFIT LEAD HOLDING A SEAT ON THE STEERING COMMITTEE AS WELL AS EITHER SMCSR OR SPMF CONTRIBUTING $25,000 ANNUALLY TO THE PROGRAM. IN 2011 OVER 12,500 APPLICATIONS/RENEWALS FOR INSURANCE COVERAGE WERE PROCESSED, A 24% INCREASE OVER 2010 APPLICATIONS/RENEWALS. HEALTHY KIDS ALSO COMPLETED THE WORK PLAN FOR ORAL HEALTH TASK FORCE, A PROGRAM TO IDENTIFY GAPS AND STRATEGIES TO INCREASE ACCESS TO ORAL HEALTH. OVERALL, SINCE 2003 THE NUMBER OF COMPLETELY UNFUNDED CHILDREN HAS DECREASED SIGNIFICANTLY AS A RESULT OF THESE EFFORTS BUT FOCUS IS STILL NEEDED ON OUTREACH AND RETENTION. SMCSR DONATED OPERATING ROOM TIME AND SUPPLIES FOR ELECTIVE, BUT LIFE-ENHANCING SURGERIES FOR UNINSURED PATIENTS THROUGH OPERATION ACCESS, A NONPROFIT THAT PROVIDES THESE SERVICES TO SEVEN COUNTIES IN THE BAY AREA. SINCE 1993, OPERATION ACCESS HAS SERVED MORE THAN 7,500 LOW INCOME PEOPLE, UNINSURED WORKERS, AND SELF-EMPLOYED PERSONS IN SIX NORTHERN CALIFORNIA COUNTIES. THE STAFF AT OPERATION ACCESS RECRUITS THE MEDICAL PROVIDERS AND HOSPITALS, SCREENS PATIENTS AND CASE MANAGES FROM REFERRAL THROUGH POST-OPERATIVE RECOVERY. IN 2011, THERE WERE 300 PEOPLE REFERRED TO OPERATION ACCESS THAT NEEDED SURGICAL OR SPECIALTY MEDICAL CARE THAT THEY COULD NOT OTHERWISE ACCESS DUE TO LACK OF ANY OR ADEQUATE HEALTH INSURANCE. SMCSR PROVIDED $175,142 IN WAIVED HOSPITAL CHARGES FOR 12 SURGICAL PROCEDURES AND 1 RADIOLOGY PROCEDURE IN 2011. ADDITIONALLY, FOUR OF THEIR SURGEONS DONATED THEIR TIME. AS A RESULT, OPERATION ACCESS SAW A 10% INCREASE IN SERVICES PROVIDED OVER THE PREVIOUS YEAR. SMCSR IS ONE OF THE FOUNDING PARTNERS OF THE HEALTHCARE WORKFORCE DEVELOPMENT (HWDP) PROGRAM. FORMED IN 2001, HWDP IS A CONSORTIUM OF OVER 30 HEALTHCARE PROVIDERS, WHICH ALSO INCLUDES KAISER PERMANENTE AND ST. JOSEPH HEALTH SYSTEMS, THE SONOMA COUNTY OFFICE OF EDUCATION, POST-SECONDARY EDUCATION INSTITUTIONS, LOCAL GOVERNMENT AND COMMUNITY BASED ORGANIZATIONS. FOR THE LAST ELEVEN YEARS, THE ROUNDTABLE HAS BEEN WORKING TO PROMOTE HEALTHCARE CAREERS IN THE COMMUNITY WITH A FOCUS ON INCREASING DIVERSITY IN THE HEALTH PROFESSIONS IN ORDER TO CREATE A MORE CULTURALLY COMPETENT HEALTHCARE WORKFORCE. HWDP HAS BEEN SERVING THE UNDERREPRESENTED, ECONOMICALLY/EDUCATIONALLY DISADVANTAGED POPULATIONS OF SONOMA COUNTY FOR THE LAST SEVEN YEARS BY INTRODUCING LOW SOCIOECONOMIC AND DISADVANTAGED STUDENTS TO THE POSSIBILITIES OF HEALTH PROFESSIONS, REACHING OUT TO BILINGUAL AND BICULTURAL STUDENTS THAT REPRESENT THEIR COMMUNITY'S DEMOGRAPHICS AND SUPPORTING FIRST GENERATION COLLEGE AND COLLEGE BOUND STUDENTS. AS A RESULT, FROM 2010 TO 2011 HWDP SAW A 50% INCREASE OF THE NUMBER OF STUDENTS SERVED BY THE COLLEGE ACADEMIC PREPARATORY PROGRAM AS WELL AS 21 OF 22 STUDENTS GRADUATED FROM THE SUMMER PROGRAM. SMCSR HAS SPONSORED THE SANTA ROSA FAMILY MEDICINE RESIDENCY PROGRAM FOR MORE THAN 40 YEARS. IN A REGION WHERE THE COST OF LIVING OUTPACES THE COMPENSATION FOR PRIMARY CARE PROVIDERS, RECRUITING FAMILY PHYSICIANS FROM OUTSIDE THE AREA IS EXTREMELY CHALLENGING. EACH YEAR, SMCSR GRADUATES 12 FAMILY PHYSICIANS, MANY OF WHOM STAY AND PRACTICE IN SONOMA COUNTY IN COMMUNITY HEALTH CLINICS THAT PRIMARILY SERVE THE POOR AND UNINSURED. EACH YEAR, APPLICATIONS ARE RECEIVED, INTERVIEWS ARE CONDUCTED AND MATCHES ARE MADE TO SELECT THE UPCOMING CLASS OF 12 INTERNS. THE SELECTION CRITERIA INCLUDES AN EMPHASIS ON CULTURAL COMPETENCE AND A PRIMARY INTEREST IN SERVING UNDERSERVED POPULATIONS. THE PROGRAM ALSO PARTNERS WITH UCSF TO PROVIDE FACULTY INSTRUCTORS. THE TOTAL COST (LESS GME REIMBURSEMENT) TO ADMINISTER THE PROGRAM IN 2011 WAS $9,892,483. AS A RESULT, ABOUT 50% OF THE PRACTICING FAMILY MEDICINE PHYSICIANS IN SONOMA COUNTY ARE GRADUATES OF THIS PROGRAM AND ABOUT 75% OF THE DOCTORS WHO STAFF THE FQHC CLINICS ARE ALSO GRADUATES. THIS PROGRAM IS A CRUCIAL ELEMENT IN BUILDING CAPACITY TO MEET THE INCREASING DEMAND FOR PRIMARY CARE DOCTORS. SMCSR FINANCIALLY SUPPORTS THE CENTER FOR WELL BEING, A WELLNESS ORGANIZATION THAT PROVIDES HEALTH EDUCATION, CARDIAC REHABILITATION AND A VARIETY OF SUPPORT SERVICES FOR LOW OR NO COST TO PATIENTS.
AFFILIATED HEALTH CARE SYSTEM PART VI, QUESTION 6 CALIFORNIA PACIFIC MEDICAL CENTER, NOVATO COMMUNITY HOSPITAL, SUTTER LAKESIDE HOSPITAL AND SUTTER MEDICAL CENTER OF SANTA ROSA 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
SUTTER WEST BAY HOSPITALS
 
Employer identification number
94-0562680
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) PATIENT ASSISTANCE FOUNDATION2100 WEBSTER ST
SAN FRANCISCO,CA94115 		94-2944137 501(C)(3) 500,000       GENERAL SUPPORT
(2) HOSPITAL COUNCIL OF CENTRAL AND NORTHERN CA1625 E SHAW AVE
FRESNO,CA93710 		86-1174825 501(C)(3) 54,804       GENERAL SUPPORT
(3) NORTHERN CALIFORNIA CENTER FOR WELL-BEING365 TESCONI CIRCLE
SANTA ROSA,CA95401 		93-1144835 501(C)(3) 50,000       GENERAL SUPPORT
(4) SAN FRANCISCO SENIOR CENTER890 BEACH ST
SAN FRANCISCO,CA94109 		94-1212136 501(C)(3) 50,000       GENERAL SUPPORT
(5) SAN FRANCISCO CHAMBER OF COMMERCE235 MONTGOMERY ST
SAN FRANCISCO,CA94104 		94-0834950 501(C)(6) 36,000       GENERAL SUPPORT
(6) CHINESE HOSPITAL845 JACKSON ST
SAN FRANCISCO,CA94133 		94-0382780 501(C)(3) 35,000       GENERAL SUPPORT
(7) MISSION NEIGHBORHOOD CENTER362 CAPP ST
SAN FRANCISCO,CA94110 		94-1408150 501(C)(3) 35,000       GENERAL SUPPORT
(8) ASIAN & PACIFIC ISLANDER WELLNESS CENTER730 POLK ST
SAN FRANCISCO,CA94109 		94-3096109 501(C)(3) 35,000       GENERAL SUPPORT
(9) OPERATION ACCESS115 SANSOME
SAN FRANCISCO,CA94107 		94-3180356 501(C)(3) 35,000       GENERAL SUPPORT
(10) HOMEWARD BOUND OF MARIN1385 HAMILTON PKY
NOVATO,CA94949 		68-0011405 501(C)(3) 31,600       GENERAL SUPPORT
(11) ASIAN WEEK FDN564 MARKET ST
SAN FRANCISCO,CA94104 		20-1719535 501(C)(3) 30,500       GENERAL SUPPORT
(12) MAITRI401 DUBOCE AVE
SAN FRANCISCO,CA94117 		94-3189198 501(C)(3) 30,300       GENERAL SUPPORT
(13) CATHOLIC CHARITIES465 A STREET
SANTA ROSA,CA95402 		94-2479393 501(C)(3) 30,000       GENERAL SUPPORT
(14) MARCH OF DIMES1050 SANSOME ST
SAN FRANCISCO,CA94111 		13-1846366 501(C)(3) 29,100       GENERAL SUPPORT
(15) APA FAMILY SERVICES657 JACKSON ST
SAN FRANCISCO,CA94133 		94-3164091 501(C)(3) 26,700       GENERAL SUPPORT
(16) EPISCOPAL CHARITIES1055 TAYLOR ST
SAN FRANCISCO,CA94108 		94-3345498 501(C)(3) 26,000       GENERAL SUPPORT
(17) BAY AREA COUNCIL201 CALIFORNIA ST
SAN FRANCISCO,CA94111 		23-7325853 501(C)(3) 25,000       GENERAL SUPPORT
(18) HEALTHY MARIN PARTNERSHIP99 MONTECILLO RD
SAN RAFAEL,CA94903 		94-1312348 501(C)(3) 25,000       GENERAL SUPPORT
(19) EPISCOPAL COMMUNITY SERVICES165 8TH ST
SAN FRANCISCO,CA94103 		94-3096716 501(C)(3) 25,000       GENERAL SUPPORT
(20) SAN FRANCISO LBGT COMMUNITY CENTER1800 MARKET ST
SAN FRANCISCO,CA94102 		94-3236718 501(C)(3) 25,000       GENERAL SUPPORT
(21) AMERICAN HEART ASSOCIATION1400 N DUTTON AVE
SANTA ROSA,CA95401 		13-5613797 501(C)(3) 21,000       GENERAL SUPPORT
(22) KIMOCHI1715 BUCHANAN ST
SAN FRANCISCO,CA94115 		23-7117402 501(C)(3) 20,000       GENERAL SUPPORT
(23) NAACP1290 FILLMORE ST
SAN FRANCISCO,CA94115 		23-7177411 501(C)(3) 20,000       GENERAL SUPPORT
(24) NEW VISION SANTA ROSA FOUNDATION637 FIRST ST
SANTA ROSA,CA95404 		68-0074807 501(C)(3) 20,000       GENERAL SUPPORT
(25) LAKEPORT FIRE PROTECTION DISTRICT445 NO MAIN ST
LAKEPORT,CA95453 		68-0454069 501(C)(3) 20,000       GENERAL SUPPORT
(26) SPUR654 MISSION ST
SAN FRANCISCO,CA94105 		94-1498232 501(C)(3) 20,000       GENERAL SUPPORT
(27) MENDOCINO LAKE COMMUNITY COLLEGE1000 HENSLEY CREEK RD
UKIAH,CA95482 		94-6002711 501(C)(3) 20,000       GENERAL SUPPORT
(28) SELF HELP FOR THE ELDERLY407 SANSOME ST
SAN FRANCISCO,CA94105 		94-1750717 501(C)(3) 15,000       GENERAL SUPPORT
(29) ON LOK DAY SERVICES1333 BUSH ST
SAN FRANCISCO,CA94109 		94-2162549 501(C)(3) 15,000       GENERAL SUPPORT
(30) THE ALS ASSOCIATIONONE EMBARCADERO
SAN FRANCISCO,CA94111 		95-4163338 501(C)(3) 15,000       GENERAL SUPPORT
(31) NOVATO HEALTH PARTNERSHIP PROGRAM1015 SEVENTH ST
NOVATO,CA94945 		68-0112169 501(C)(3) 14,064       GENERAL SUPPORT
(32) NEIGHBORHOOD PARKS CO451 HAYES ST
SAN FRANCISCO,CA94102 		26-4715914 501(C)(3) 12,500       GENERAL SUPPORT
(33) CHILD PASSENGER SAFETY EVENT455 EIGHTH ST
SAN FRANCISCO,CA94103 		94-2257827 501(C)(3) 11,044       GENERAL SUPPORT
(34) SF CRISIS CAREPO BOX 38631
SACRAMENTO,CA95838 		20-0241444 501(C)(3) 10,000       GENERAL SUPPORT
(35) PROJECT HOMELESS CONNECTP O BOX 420404
SAN FRANCISCO,CA94142 		20-4331462 501(C)(3) 10,000       GENERAL SUPPORT
(36) SAN FRANCISCO ALLIANCE FOR JOBS3217 18TH ST
SAN FRANCISCO,CA94110 		45-2300645 501(C)(3) 10,000       GENERAL SUPPORT
(37) BOARD OF TRUSTEES FOR THE GLIDE FOUNDATION330 ELLIS ST
SAN FRANCISCO,CA94112 		94-1156481 501(C)(3) 10,000       GENERAL SUPPORT
(38) SANTA ROSA MEMORIAL HOSPITAL1165 MONTGOMERY DR
SANTA ROSA,CA95404 		94-1231005 501(C)(3) 10,000       GENERAL SUPPORT
(39) CONARD HOUSE1385 MISSION ST
SAN FRANCISCO,CA94120 		94-1489356 501(C)(3) 10,000       GENERAL SUPPORT
(40) MISSION LANGUAGE AND VOCATIONAL SCHOOL2929 19TH ST
SAN FRANCISCO,CA94110 		94-2174237 501(C)(3) 10,000       GENERAL SUPPORT
(41) MARIN COMMUNITY CLINICSP O BOX 1868
NOVATO,CA94948 		94-2237120 501(C)(3) 10,000       GENERAL SUPPORT
(42) AMERICAN RED CROSS85 SECOND ST
SAN FRANCISCO,CA94105 		94-3045430 501(C)(3) 10,000       GENERAL SUPPORT
(43) TRANSFORMATION FOR A LIVABLE CITY995 MARKET ST
SAN FRANCISCO,CA94103 		94-3350190 501(C)(3) 10,000       GENERAL SUPPORT
(44) UNIVERSITY OF CA SCHOOL OF PUBLIC HEALTH417 UNIVERSITY HALL
BERKELEY,CA94720 		94-6002123 501(C)(3) 10,000       GENERAL SUPPORT
(45) COMMUNITY WORKS WEST731 B LIGGETT AVE
SAN FRANCISCO,CA94129 		94-6065339 501(C)(3) 10,000       GENERAL SUPPORT
(46) SAN FRANCISCO CLINIC CONSORTIUM1550 BRYANT ST
SAN FRANCISCO,CA94103 		13-4317995 501(C)(3) 9,000       GENERAL SUPPORT
(47) AFRICAN AMERICAN ART & CULTURE COMPLEX762 FULTON ST
SAN FRANCISCO,CA94102 		20-0118582 501(C)(3) 8,400       GENERAL SUPPORT
(48) SAN FRANCISCO BUSINESS TIMES275 BATTERY ST
SAN FRANCISCO,CA94111 		59-3089188 501(C)(3) 8,250       GENERAL SUPPORT
(49) HEATH EXPRESSWHISTLESTOP930 TAMALPIAS AVE
SAN RAFAEL,CA94901 		94-1422463 501(C)(3) 7,751       GENERAL SUPPORT
(50) ASIAN WOMEN'S RESOURCE CENTER940 WASHINGTON ST
SAN FRANCISCO,CA94108 		94-1156357 501(C)(3) 7,500       GENERAL SUPPORT
(51) LAKE FAMILY RESOURCE CENTER896 LAKEPORT BLVD
LAKEPORT,CA95453 		68-0353914 501(C)(3) 7,000       GENERAL SUPPORT
(52) COMMUNITY INITIATIVES384 PINE ST
SAN FRANCISCO,CA94104 		94-3255070 501(C)(3) 5,500       GENERAL SUPPORT
(53) SAN FRANCISCO BUILDING AND CONSTRUCTION1188 FRANKLIN ST
SAN FRANCISCO,CA94109 		94-0348191 501(C)(3) 5,400       GENERAL SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
52
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
1
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













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

94-0562680
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement 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
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in 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) JACK BAILEY (i)
(ii)		 0
0 		0
0 		618,590
0 		0
0 		21,713
0 		640,303
0 		0
0
(2) MARTIN BROTMAN MD (i)
(ii)		 0
956,111 		0
407,007 		0
11,732 		0
694,351 		0
19,038 		0
2,088,239 		0
407,007
(3) WARREN BROWNER MD (i)
(ii)		 0
573,306 		0
231,141 		0
10,687 		0
433,326 		0
18,927 		0
1,267,387 		0
284,481
(4) GRANT DAVIES (i)
(ii)		 0
532,318 		0
147,058 		0
8,822 		0
286,798 		0
19,994 		0
994,990 		0
147,058
(5) MICHAEL DUNCHEON (i)
(ii)		 0
341,507 		0
56,950 		0
6,637 		0
134,182 		0
18,194 		0
557,470 		0
56,950
(6) PAT FRY (i)
(ii)		 0
1,556,049 		0
1,472,283 		0
16,884 		0
2,163,921 		0
32,168 		0
5,241,305 		0
1,637,694
(7) JOHN GATES (i)
(ii)		 0
523,371 		0
177,579 		0
34,783 		0
258,736 		0
16,532 		0
1,011,001 		0
151,681
(8) ALLAN PONT MD (i)
(ii)		 0
443,913 		0
115,572 		0
162,989 		0
138,895 		0
7,130 		0
868,499 		0
131,772
(9) TONI BRAYER MD (i)
(ii)		 0
439,358 		0
158,102 		0
1,756 		0
194,426 		0
18,333 		0
811,975 		0
185,605
(10) MARK KIMBELL (i)
(ii)		 0
345,534 		0
82,813 		0
43,810 		0
132,872 		0
18,222 		0
623,251 		0
82,813
(11) STEVEN R CUMMINGS (i)
(ii)		 404,256
0 		29,828
0 		2,376
0 		5,145
0 		22,800
0 		464,405
0 		0
0
(12) CRAIG VERCRUYSSE (i)
(ii)		 0
266,764 		0
138,452 		0
4,684 		0
104,581 		0
13,132 		0
527,613 		0
96,187




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. HOUSING ALLOWANCE: NEW EMPLOYEES RELOCATING FROM OUT OF THE AREA MAY RECEIVE TEMPORARY HOUSING BENEFITS WHICH ARE ADDED TO THEIR COMPENSATION AS TAXABLE WAGES. TAX INDEMNIFICATION: STANDARD POLICY FOR ALL SUTTER HEALTH EMPLOYEES IS THAT NON-CASH GIFTS AND AWARDS ARE GROSSED-UP FOR TAX PURPOSES. THE AMOUNT OF THE GROSS-UP IS ADDED TO THE EMPLOYEE'S WAGES 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.
SEVERANCE PAYMENTS PART I, QUESTION 4A NAME: JACK BAILEY PAYMENT: $600,330
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
SUTTER WEST BAY HOSPITALS
 
Employer identification number
94-0562680
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A CHFFA 2007A
  		52-1643828 13033FQ37 05-01-2007 790,998,316 CONSTRUCT & EQUIP FACILITY   X   X   X
B CHFFA 2008A
  		52-1643828 13033F2L3 05-14-2008 329,041,638 REFUNDING - 5/1/07   X   X   X
C CHFFA 2011D
  		52-1643828 13033LVW4 12-22-2011 331,759,643 REFUNDING 1998 AND 1999 ISSUES   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 0 66,210,000 0  
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0  
3 Total proceeds of issue . . . . . . . . . . . . . 857,735,124 329,041,638 331,942,116  
4 Gross proceeds in reserve funds . . . . . . . . 0 0 0  
5 Capitalized interest from proceeds . . . . . . . . . . 55,398 0 65,070,000  
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0  
7 Issuance costs from proceeds . . . . . . . . . . . 0 0 0  
8 Credit enhancement from proceeds . . . . . . . . . . 0 0 0  
9 Working capital expenditures from proceeds . . . . . . . 0 0 0  
10 Capital expenditures from proceeds . . . . . . . . . . 759,620,124 0 0  
11 Other spent proceeds . . . . . . . . . . . 584,502 329,041,638 124,025,000  
12 Other unspent proceeds . . . . . . . . . . . 42,132,181 0 142,847,116  
13 Year of substantial completion . . . . . . . . . . . 2011
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . .   X X   X      
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X    
16 Has the final allocation of proceeds been made? . . . . . . X   X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . 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            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X              
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 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              
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              
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . 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              
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%   %
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%   %   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0%   %   %   %
7 Does the bond issue meet the private security or payment test? . . . 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              
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    
2 Is the bond issue a variable rate issue?   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    
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    
b Name of provider . . . . . . 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    
6 Did the bond issue qualify for an exception to rebate? .   X   X   X    
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   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 L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number

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





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

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) PANMED PROPERTIES LLP SEE PART V 487,810 SEE PART V   No
(2) BROWN TOLLAND MEDICAL GROUP SEE PART V 281,701 SEE PART V   No
(3) NORTHERN CALIFORNIA MEDICAL ASSOCIA SEE PART V 927,647 SEE PART V   No
(4) SWIG GROUP LLC SEE PART V 6,462,318 SEE PART V   No
(5) PEDIATRIX MEDICAL GROUP SEE PART V 2,335,062 SEE PART V   No
(6) SITE OF CARE SYSTEMS SEE PART V 25,000 SEE PART V   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
DESCRIPTION OF BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L, PART IV DAMIAN AUGUSTYN, MD AND MARTIN BROTMAN, MD, DIRECTORS OF SUTTER WEST BAY HOSPITALS (SWBH), ARE ALSO GENERAL PARTNERS AND BOARD MEMBERS OF PANMED PROPERTIES, LLP. DURING THE YEAR, SWBH OWNED 5.48% IN PANMED WHO PROVIDED RENTAL SERVICES TO SWBH. DAMIAN AUGUSTYN, MD, MARTIN BROTMAN, MD, TERRI SLAGLE MD AND JORDAN HOROWITZ, MD, DIRECTORS OF SUTTER WEST BAY HOSPITALS (SWBH), ARE ALSO MEMBERS OF BROWN & TOLLAND MEDICAL GROUP (BTMG). DURING THE YEAR, BTMG PROVIDED SERVICES TO SWBH VIA AN ARMS-LENGTH AGREEMENT. WILLIAM CARROLL, MD, DIRECTOR OF SUTTER WEST BAY HOSPITALS (SWBH) IS ALSO A MEMBER OF NORTHERN CALIFORNIA MEDICAL ASSOCIATES (NCMA). DURING THE YEAR, NCMA PROVIDED MEDICAL SERVICES TO SWBH VIA AN ARMS-LENGTH AGREEMENT. ROY EISENHARDT, DIRECTOR OF SUTTER WEST BAY HOSPITALS (SWBH) IS A PARTIAL OWNER OF PROPERTY THAT IS RENTED TO SWBH VIA SWIG GROUP LLC AS COLLECTION AGENT. TERRI SLAGLE, MD, DIRECTOR OF SUTTER WEST BAY HOSPITALS (SWBH) IS ALSO A SHAREHOLDER PHYSICIAN OF PEDIATRIX MEDICAL GROUP. DURING THE YEAR, PEDIATRIX MEDICAL GROUP PROVIDED SERVICES TO SWBH VIA AN ARMS-LENGTH AGREEMENT. TERRI SLAGLE, MD, DIRECTOR OF SUTTER WEST BAY HOSPITALS (SWBH) IS ALSO A BOARD MEMBER AND SHAREHOLDER OF SITE OF CARE SYSTEMS (SCS). DURING THE YEAR, SWBH PURCHASED SOFTWARE FROM SCS VIA AN ARMS-LENGTH AGREEMENT.
Schedule L (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded . X 1 75,610 FMV
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( SPA ) X 1 5,500 FMV
26 Other Right pointing arrow large image ( CASES OF WINE ) X 1 5,844 FMV
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
0
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ............................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2011
Schedule M (Form 990) 2011
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33 and whether the organization is reporting in Part I, column (b) the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
PART I, COLUMN (B)   COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED.
Schedule M (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
SUTTER WEST BAY HOSPITALS
 
Employer identification number

94-0562680
Identifier Return Reference Explanation
MISSION STATEMENT FORM 990, PART I, LINE 1 AND PART III, LINE 1 WE ENHANCE THE WELL BEING OF PEOPLE IN THE COMMUNITIES WE SERVE THROUGH OUR COMMITMENT TO COMPASSION, EXCELLENCE, INNOVATION AND A FULL CONTINUM OF HEALTH CARE SERVICES.
EXEMPT PURPOSE ACHIEVEMENTS FORM 990, PART III, LINE 4A GENERAL DESCRIPTION SUTTER WEST BAY HOSPITALS WAS FORMED IN JANUARY 1, 2010. IT CONSISTS OF FOUR HOSPITALS: CALIFORNIA PACIFIC MEDICAL CENTER, NOVATO COMMUNITY HOSPITAL, SUTTER MEDICAL CENTER SANTA ROSA, AND LAKESIDE HOSPITAL. CALIFORNIA PACIFIC MEDICAL CENTER (CPMC) IS ONE OF THE LARGEST PRIVATE, COMMUNITY BASED, NOT-FOR-PROFIT, TEACHING MEDICAL CENTERS IN CALIFORNIA. CPMC IS A TERTIARY REFERRAL CENTER PROVIDING ACCESS TO LEADING EDGE MEDICINE WHILE DELIVERING THE BEST POSSIBLE PERSONALIZED CARE. IT PROVIDES A WIDE VARIETY OF SERVICES, INCLUDING ACUTE, POST-ACUTE AND OUTPATIENT HOSPITAL CARE; HOSPICE SERVICES; PREVENTIVE AND COMPLEMENTARY CARE; AND HEALTH EDUCATION. CPMC IS COMPRISED OF THE FOUR OLDEST HOSPITALS IN SAN FRANCISCO. THE DAVIES CAMPUS, FORMERLY DAVIES MEDICAL CENTER, WAS FOUNDED IN 1854 TO HELP SAN FRANCISCO'S GERMAN-SPEAKING IMMIGRANTS FIND WORK, SHELTER, FOOD, CLOTHING AND HEALTH CARE. THE PACIFIC CAMPUS WAS FOUNDED IN 1857 AND WAS THE FIRST MEDICAL SCHOOL IN THE AMERICAN WEST. THE CALIFORNIA CAMPUS WAS FOUNDED IN 1875 AS THE PACIFIC DISPENSARY FOR WOMEN AND CHILDREN, A HOSPITAL RUN BY WOMEN, FOR WOMEN. FINALLY, THE ST. LUKE'S CAMPUS HAS BEEN PROVIDING QUALITY HEALTH SERVICES TO ALL SAN FRANCISCANS FOR OVER 130 YEARS. TOGETHER THE DAVIES, CALIFORNIA, PACIFIC AND ST. LUKE'S CAMPUSES COMPRISE CPMC'S 1,258 LICENSED ACUTE CARE BEDS AND 25 RESIDENTIAL BEDS. NOVATO COMMUNITY HOSPITAL (NOVATO) HAS SERVED THE NORTHERN MARIN AND SOUTHERN SONOMA COMMUNITIES SINCE 1961. IN 1985, THE HOSPITAL BECAME AN AFFILIATE OF SUTTER. THE NOVATO FACILITY IS LOCATED AT 180 ROWLAND WAY AND IS A 47-BED ACUTE CARE HOSPITAL NOTED FOR ITS ORTHOPEDIC SURGERY PROGRAM. SUTTER MEDICAL CENTER OF SANTA ROSA (SMCSR) HAS A LONG HISTORY IN SONOMA COUNTY DATING BACK TO 1866 WHEN THE FIRST HOSPITAL OPENED. IN 1996, SMCSR BECAME AN AFFILIATE OF SUTTER HEALTH. SMCSR IS LICENSED TO OPERATE 135 BEDS. SUTTER LAKESIDE HOSPITAL (LAKESIDE) IS A 25-BED CRITICAL ACCESS HOSPITAL AND IS ONE OF ONLY TWO HOSPITALS THAT SERVE THE 64,000 RESIDENTS OF LAKE COUNTY. IN 1992, THE HOSPITAL AFFILIATED WITH SUTTER HEALTH. LAKESIDE PROVIDES A WIDE VARIETY OF SERVICES, INCLUDING ACUTE, POST-ACUTE AND OUTPATIENT HOSPITAL CARE; SURGICAL SERVICES; PREVENTIVE CARE; AND HEALTH EDUCATION. 2011 PATIENT ACTIVITY TOTAL EMERGENCY ROOM IP (ADMITTED) 18,754 EMERGENCY ROOM OP (NOT ADMITTED) 121,991 TOTAL ER VISITS 140,745 ACUTE DISCHARGES (INCL. PSYCH, REHAB) 37,613 SNF DISCHARGES 1,842 ALZHEIMER DISCHARGES 5 SUB ACUTE DISCHARGES 85 TOTAL DISCHARGES 39,545 DELIVERIES 8,114 TRANSPLANTS 317 SUTTER WEST BAY HOSPITALS MISSION STATEMENT WE ENHANCE THE WELL BEING OF PEOPLE IN THE COMMUNITIES WE SERVE THROUGH OUR COMMITMENT TO COMPASSION, EXCELLENCE, INNOVATION AND A FULL CONTINUUM OF HEALTH CARE SERVICES. CLINICAL PROGRAMS INCLUDE: - ASTHMA EDUCATION PROGRAM - BREAST FEEDING CENTERS - BREAST HEALTH CENTERS - CALIFORNIA PACIFIC MEDICAL CENTER RESEARCH INSTITUTE - CANCER RECOVERY PROGRAMS - COMING HOME HOSPICE - COMMUNITY BENEFITS PROGRAMS (DETAILED BELOW) - COMMUNITY HEALTH RESOURCE CENTER - COMPREHENSIVE STROKE CENTER - DIABETES EDUCATION PROGRAM - END-STAGE ORGAN FAILURE/TRANSPLANTATION PROGRAMS (HEART, KIDNEY, LIVER, PANCREAS) - FORBES NORRIS MDA/ALDS CENTER - HAND CLINIC - HOSPITALIST PROGRAM - INSTITUTE FOR HEALTH AND HEALING - IRENE SWINDELLS ALZHEIMER'S RESIDENTIAL CARE CENTER - LION'S EYE CLINIC - MUSCULAR DYSTROPHY ASSOCIATION NEUROMUSCULAR CLINIC - PACIFIC VISION FOUNDATION - PALLIATIVE CARE PROGRAM - PEDIATRIC SPECIALTY SERVICES - REHABILITATION SERVICES (ACUTE AND OUTPATIENT) - SIBLING CENTER - SMITH KETTLEWELL EYE RESEARCH INSTITUTE (THEY ARE INDEPENDENT OF CPMC.) - SUB-ACUTE CARE PROGRAM - TELEMEDICINE SERVICE (STROKE) - VISITING NURSES AND HOSPICE OF SAN FRANCISCO - WHITNEY NEWBORN ICU FOLLOW-UP CLINIC - WOMEN'S HEALTH RESOURCE CENTER - WOMEN'S SERVICES CLINICAL SERVICE OFFERINGS INCLUDE: - AIDS & HIV SERVICES - ALZHEIMER'S - ARTHRITIS - BARIATRIC SURGERY SERVICES - CANCER SERVICES - CARDIOVASCULAR SERVICES - CLINICAL LABORATORY - COMPLEMENTARY MEDICINE - COMPREHENSIVE STROKE SERVICES - CRITICAL CARE SERVICES - DIABETES SERVICES (ADULT & PEDIATRIC) - DIAGNOSTIC SERVICES/LABORATORIES - DIALYSIS SERVICES - EMERGENCY SERVICES - EPILEPSY - GASTROENTEROLOGY DISEASE SERVICES - HOME HEALTH & HOSPICE - INTERVENTIONAL ENDOSCOPY SERVICES - KALMONOVITZ CHILD DEVELOPMENT CENTERS - MEDICAL TRANSPORT SERVICES - MICROSURGERY AND LIMB SALVAGE SERVICES - NEONATAL INTENSIVE CARE - NEUROLOGY - NEURO-ONCOLOGY SURGERY - NUCLEAR MEDICINE - NUTRITION AND WEIGHT MANAGEMENT - OBSTETRICS & GYNECOLOGY - OCCUPATIONAL HEALTH - OPHTHALMOLOGY - ORGAN TRANSPLANTATION - ORTHOPEDICS - OTOLARYNGOLOGY - OUTPATIENT CLINICS & SERVICES - PATHOLOGY - PEDIATRIC EMERGENCY DEPARTMENT - PEDIATRIC SERVICES/PROGRAMS - PERIOPERATIVE SERVICES (OR AND POST-ANESTHESIA RECOVERY UNIT) - PHARMACY - PHYSICAL MEDICINE & REHABILITATION SERVICES - PSYCHIATRY - RADIOLOGY & DIAGNOSTIC IMAGING - RESPIRATORY CARE - RESIDENCY TRAINING AND FELLOWSHIP PROGRAMS - SURGICAL SERVICES/AMBULATORY SURGERY - URGENT CARE CENTER - VENTRICULAR ASSIST DEVICE (VAD) PROGRAM - WOMEN'S HEALTH PROGRAMS - WOUND CARE NON-CLINICAL SERVICES INCLUDE: - ADMINISTRATIVE SERVICES - CHAPLAINCY SERVICES - CHARITY CARE PROGRAM - COMMUNITY HEALTH RESOURCE CENTER - CONTINUING MEDICAL EDUCATION - INTERPRETER SERVICES - PATIENT SERVICES - RESEARCH INSTITUTE - SURGICAL TRAINING CENTER - VOLUNTEER SERVICES - WEB NURSERY - CALIFORNIA PACIFIC MEDICAL CENTER FOUNDATION - NOVATO COMMUNITY HOSPITAL DEVELOPMENT OFFICE - SUTTER LAKESIDE FOUNDATION
EXEMPT PURPOSE ACHIEVEMENTS FORM 990, PART III, LINE 4A COMMUNITY BENEFITS THE FOUR MEDICAL CENTERS IN SUTTER WEST BAY HOSPITALS (SWBH) PLAY INTEGRAL ROLES IN PROVIDING DIRECT HEALTH CARE SERVICES AS WELL AS MONETARY GRANTS OR SPONSORSHIPS TO NON-PROFIT ORGANIZATIONS TO ADDRESS THE COMMUNITY HEALTH NEEDS OF VULNERABLE, UNDERINSURED, AND UNINSURED POPULATIONS IN THEIR COMMUNITIES. THE HOSPITALS' COMMUNITY BENEFIT REPRESENTATIVES WORK COLLABORATIVELY AND IN PARTNERSHIPS WITH A BROAD AND DIVERSE NETWORK OF COMMUNITY-BASED NON-PROFITS, CITY AND COUNTY AGENCIES, PHYSICIANS, AND NEIGHBORHOOD GROUPS TO IDENTIFY LOCAL NEEDS, FORMULATE COMMUNITY BENEFIT PLANS, AND TAKE APPROPRIATE FUNDING ACTIONS. WHILE SUTTER WEST BAY REGIONAL MANAGEMENT SETS OVERALL GOALS FOR COMMUNITY BENEFITS, EACH OF THE AFFILIATES MEDICAL CENTER ADMINISTRATORS ARE RESPONSIBLE FOR IDENTIFYING HOW LOCAL NEEDS ARE TO BE ADDRESSED. IN FISCAL YEAR 2011, SUTTER WEST BAY HOSPITALS PROVIDED A REGIONAL TOTAL OF $96.0 MILLION IN COST OF SERVICES AND CASH TO THE POOR AND UNDERSERVED: $24.6 MILLION IN TRADITIONAL CHARITY CARE, $66.9 MILLION IN THE UNPAID COSTS OF MEDICAID, AND $4.5 MILLION IN COSTS FOR OTHER MEANS-TESTED PROGRAMS. IN ADDITION, THE FOLLOWING ARE HIGHLIGHTS BY HOSPITAL OF QUANTIFIABLE COMMUNITY BENEFITS IN SERVICES AND CASH FOR THE BROADER COMMUNITY. CALIFORNIA PACIFIC MEDICAL CENTER (CPMC) IN 2011, CPMC PROVIDED $59.7 MILLION IN QUANTIFIABLE COMMUNITY BENEFITS AND CASH TO THE BROADER COMMUNITY. CPMC SUSTAINS ROBUST MEDICAL, NURSING, AND ALLIED HEALTH PROFESSIONS RESIDENCY PROGRAMS AS WELL AS A RESEARCH INSTITUTE THAT PROVIDE SIGNIFICANT COMMUNITY BENEFIT. CPMC IS A MEMBER OF THE SAN FRANCISCO CHARITY CARE PARTNERSHIP AND BETTER HEALTHY SAN FRANCISCO CONSORTIUMS LED BY THE SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH. THE CONSORTIUM CONSISTS OF REPRESENTATIVES FROM ALL OF THE CITY'S HOSPITALS AND OTHER HEALTHCARE-RELATED NON-PROFIT STAKEHOLDERS. CONSORTIUM MEMBERS CONDUCT A TRI-ANNUAL COMMUNITY NEEDS ASSESSMENT, AS REQUIRED BY THE STATE, AND COORDINATE EFFORTS TO ADDRESS THE CITY'S HEALTH DISPARITIES IN SPECIFIC AT-RISK NEIGHBORHOODS OR VULNERABLE POPULATIONS. THE CONSORTIUM IDENTIFIED FOUR PRIORITIES OF COMMUNITY HEALTH NEEDS; THESE PRIORITIES GUIDED CPMC'S COMMUNITY BENEFITS STRATEGY: 1. ACCESS CPMC MANAGES OR FUNDS MANY PROGRAMS FOCUSED ON IMPROVING ACCESS TO CARE, INCLUDING THE FOLLOWING: - AFRICAN AMERICAN BREAST HEALTH PROGRAM (CANCER SCREENING & PREVENTION) - BAYVIEW CHILD HEALTH CENTER (PRIMARY CARE FOR LOW-INCOME CHILDREN) - LIONS EYE CLINIC (OUTPATIENT COMPLEX EYE SERVICES FOR LOW-INCOME INDIVIDUALS) 2. CHRONIC DISEASES CPMC FUNDS CHRONIC DISEASE AND HEALTHY LIVING PROGRAMS FOR LOW INCOME POPULATIONS, INCLUDING THE FOLLOWING: - HEALTH CHAMPIONS AT DEMARILLAC ACADEMY (HEALTHY LIFESTYLES) - HEALTHFIRST: A CENTER FOR PREVENTION AND EDUCATION (CHRONIC DISEASE MANAGEMENT) 3. COMMUNICABLE DISEASES CPMC ADMINISTERS OR FUNDS PROGRAMS FOCUSED ON SCREENING AND TREATING COMMUNICABLE DISEASES, INCLUDING THE FOLLOWING: - HEPATITIS B FREE PROGRAM (NO-COST SCREENING & TREATMENT) - VARIOUS HEALTH FAIRS (NO-COST FLU SHOTS) 4. VIOLENCE AND INJURY PREVENTION CPMC'S PEDIATRICS CLINIC AT THE BAYVIEW CHILD HEALTH CENTER IN THE BAYVIEW DISTRICT OF SAN FRANCISCO OFFERS VIOLENCE & CHILDHOOD TRAUMA SERVICES FOR AT-RISK CHILDREN. SUTTER MEDICAL CENTER OF SANTA ROSA (SMCSR) SMCSR SERVES SONOMA COUNTY, AS WELL AS OTHER COUNTIES IN THE NORTH BAY. IN 2011, SMCSR PROVIDED A TOTAL OF $10.7 MILLION IN QUANTIFIABLE COMMUNITY BENEFITS AND CASH TO THE BROADER COMMUNITY. SMCSR CONDUCTS A TRI-ANNUAL NEEDS ASSESSMENT IN COLLABORATION WITH KEY STAKEHOLDERS IN THE LOCAL COMMUNITY. COMMUNITY BENEFIT PROGRAMS INVOLVE COLLABORATION WITH A NETWORK OF COMMUNITY ORGANIZATIONS, COUNTY AGENCIES SUCH AS THE SONOMA DEPARTMENT OF HEALTH SERVICES, AND OTHER HOSPITALS IN THE AREA. THE NEEDS ASSESSMENT IDENTIFIED FOUR PRIORITIES IN COMMUNITY HEALTH NEEDS. 1. MEDICAL EDUCATION SMCSR OPERATES THE FAMILY MEDICINE RESIDENCY PROGRAM WHICH TRAINS PRIMARY CARE PHYSICIANS. NEARLY 50% OF LOCAL FAMILY PHYSICIANS ARE GRADUATES OF THIS RESIDENCY PROGRAM, INCLUDING PHYSICIANS WHO STAFF COMMUNITY HEALTH CENTERS CARING FOR LOW-INCOME AND UNDERSERVED FAMILIES. 2. CHILDREN'S HEALTH SMCSR PROVIDES FINANCIAL SUPPORT TO THE HEALTHY KIDS OF SONOMA COUNTY, WHICH IS A COLLABORATIVE THAT PROVIDES 2,300 LOW-INCOME CHILDREN WITH COMPREHENSIVE HEALTH INSURANCE. 3. WORKFORCE DEVELOPMENT THE HEALTHCARE WORKFORCE DEVELOPMENT PROGRAM IS DESIGNED TO ENHANCE FUTURE WORKFORCE DIVERSITY BY PROVIDING INTERNSHIP OPPORTUNITIES FOR HIGH SCHOOL AND COLLEGE STUDENTS THROUGH COLLABORATION WITH LOCAL HEALTHCARE AND EDUCATION PARTNERS. THE SUMMER HEALTH CAREER INSTITUTE IS LOCATED AT SANTA ROSA JUNIOR COLLEGE. 4. WOMEN'S HEALTH ONE OF THE PRIORITIES IS WOMEN'S HEALTH; THESE COMMUNITY BENEFIT ACTIVITIES ARE REPORTED BY SUTTER PACIFIC MEDICAL FOUNDATION, ANOTHER SUTTER WEST BAY HOSPITALS AFFILIATE, IN A DIFFERENT FORM 990. NOVATO COMMUNITY HOSPITAL (NOVATO) NOVATO COMMUNITY HOSPITAL SERVES MARIN COUNTY, AS WELL AS PORTIONS OF SOUTHERN SONOMA COUNTY. IN 2011, NOVATO PROVIDED A TOTAL OF $189 THOUSAND IN QUANTIFIABLE COMMUNITY BENEFITS AND CASH TO THE BROADER COMMUNITY AND 3.9 MILLION IN HEALTHCARE COSTS OF SERVICES AND CASH TO THE POOR. NOVATO IS A MEMBER OF THE HEALTHY MARIN PARTNERSHIP, A NETWORK OF HOSPITALS AND PUBLIC AND PRIVATE ORGANIZATIONS THAT WORKS COLLABORATIVELY TO CONDUCT A TRI-ANNUAL COMMUNITY NEEDS ASSESSMENT AND COORDINATE TARGETED PROGRAMS TO ADDRESS PRIORITY COMMUNITY NEEDS. OTHER NETWORK MEMBERS INCLUDE THE CITY OF NOVATO, COUNTY OF MARIN, NOVATO UNIFIED SCHOOL DISTRICT, MARIN COMMUNITY CLINIC, MARIN GENERAL HOSPITAL, AND OPERATION ACCESS. THREE AREAS OF NEEDS WERE SELECTED BY THE HOSPITAL FOR YEAR 2011: 1. IMPROVING ACCESS TO CARE FOR THE UNDERSERVED, DISABLED, UNINSURED, AND UNDERINSURED. 2. DIABETES PREVENTION AMONG AT-RISK YOUTH AGES 10 TO 14. 3. WORKING WITH THE COMMUNITY TO INFLUENCE POLICY THAT PROMOTES A HEALTHY LIVING. SUTTER LAKESIDE HOSPITAL (LAKESIDE) IN 2011, LAKESIDE PROVIDED A TOTAL OF OVER $3.9 MILLION IN QUANTIFIABLE COMMUNITY BENEFITS AND CASH TO THE BROADER COMMUNITY. THE POPULATION SERVED INCLUDES A HIGH PERCENTAGE OF FAMILIES WHOSE LOW INCOME AFFECTS THEIR ACCESS TO HEALTHCARE. SUTTER LAKESIDE'S COMMUNITY BENEFITS STRATEGY INCLUDES PREVENTIVE CARE, CLINICAL EDUCATION, AND SUBSIDIZING HEALTH SERVICES. LAKESIDE PREVENTIVE CARE INCLUDES THE SPONSORING AND FUNDING PROGRAMS THAT PROVIDE FREE OR LOW-COST PREVENTIVE CARE SCREENINGS AND TESTS, SUCH AS MAMMOGRAMS, SEASONAL AND H1N1 FLU VACCINATIONS. LAKESIDE'S ROLE IN CLINICAL EDUCATION IS TO PROVIDE OPPORTUNITIES FOR STUDENTS FROM MULTIPLE CLINICAL PROGRAMS TO APPLY THEIR LEARNING UNDER THE GUIDANCE AND SUPERVISION OF LAKESIDE'S STAFF. FINALLY, LAKESIDE SUBSIDIZES THE OPERATING COSTS OF HEALTH SERVICES THAT ARE CRUCIAL TO THE HEALTH AND WELLBEING OF THE COMMUNITY, INCLUDING; EMERGENCY DEPARTMENT, RURAL HEALTH CLINICS, PAIN CLINIC AND BIRTH CENTER.
EXEMPT PURPOSE ACHIEVEMENTS FORM 990, PART III, LINE 4A CPMC RESEARCH INSTITUTE THE CALIFORNIA PACIFIC MEDICAL CENTER AND ITS RESEARCH INSTITUTE (CPMCRI) HAVE MADE A MAJOR COMMITMENT OF SPACE AND FUNDING TO ENHANCE ITS RESEARCH PROGRAMS. CPMC NOW RANKS IN THE TOP 25 PERCENT OF ALL INDEPENDENT MEDICAL CENTERS IN THE U.S. IN NATIONAL INSTITUTE OF HEALTH FUNDING. IN ADDITION TO BUILDING PROGRAMS IN CLINICAL RESEARCH, EPIDEMIOLOGY, BEHAVIORAL MEDICINE, AND PHARMACOKINETICS, CPMCRI HAS GREATLY STRENGTHENED ITS LABORATORY-BASED RESEARCH PROGRAMS. APPROXIMATELY 60 PRINCIPAL INVESTIGATORS, BOTH LABORATORY AND CLINICAL RESEARCHERS, INCLUDING MOLECULAR BIOLOGISTS, IMMUNOLOGISTS, PHARMACOLOGISTS, BIOCHEMISTS, PHYSICISTS, EPIDEMIOLOGISTS, BEHAVIORAL SCIENTISTS, BIOSTATISTICIANS, AND COMPUTER SCIENTISTS WORK WITHIN THE RESEARCH INSTITUTE AND THE MEDICAL CENTER. BIOMEDICAL RESEARCH IS CONDUCTED IN SUCH DIVERSE AREAS AS AGING, ARTHRITIS, EPILEPSY, DIABETES, NEUROBIOLOGY OF PAIN, CARDIOVASCULAR DISEASE, OSTEOPOROSIS, ORGAN TRANSPLANTATION, MECHANISMS OF DRUG ADDICTION, NEURODEGENERATIVE DISEASES (E.G. AMYOTROPHIC LATERAL SCLEROSIS), CANCER, AIDS, HEPATITIS AND OTHER INFECTIOUS DISEASES. SOME OF THESE SCIENTISTS ARE ENGAGED IN RESEARCH THAT WILL HELP US UNDERSTAND THE FUNCTION OF CERTAIN HUMAN CELLS, GENES, PROTEINS AND OTHER FUNDAMENTAL STRUCTURES WITHIN OUR BODIES. OVER 200 CLINICAL TRIALS, PRIMARILY FUNDED BY PHARMACEUTICAL AND BIOTECHNOLOGY COMPANIES, ARE CURRENTLY CONDUCTED AT THE MEDICAL CENTER THROUGH THE CPMCRI OFFICE OF CLINICAL RESEARCH. IN 2005 CPMCRI MOVED INTO A 42,000 SQUARE FOOT LAB FACILITY IN THE CHINA BASIN AREA OF SAN FRANCISCO, AND IN 2009 ADDED AN ADDITIONAL 19,000 SQUARE FEET AT THAT FACILITY TO PROVIDE SPACE TO RECRUIT ADDITIONAL SCIENTISTS AND TO HOLD ADVANCED MEDICAL AND SURGICAL SIMULATION AT THE SIMSURG TRAINING FACILITY. CPMCRI CREATES AN ACTIVE PARTNERSHIP BETWEEN CLINICIANS AND RESEARCHERS, MERGING RESEARCH INSTITUTE INTERESTS WITH THE NEEDS OF THE MEDICAL CENTER AND THE COMMUNITY OF PATIENTS THAT WE SERVE. THIS COMBINED EFFORT IMPROVES HEALTH CARE DELIVERY AND PATIENTS BENEFIT DIRECTLY BY INCREASED ACCESS TO CUTTING EDGE THERAPIES THROUGH AN EXTENSIVE CLINICAL TRIAL PROGRAM. WHEN ASSOCIATED WITH A RESEARCH PROGRAM, PHYSICIANS HAVE KNOWLEDGE AND ACCESS TO MORE EFFECTIVE TREATMENTS AND DIAGNOSTIC TECHNOLOGIES. HEALTH EDUCATION AND TRAINING TWO OF THE FOUR SUTTER WEST BAY HOSPITALS HAVE FORMAL HEALTH EDUCATION AND TRAINING PROGRAMS. SUTTER MEDICAL CENTER AT SANTA ROSA ESTABLISHED ITS FAMILY MEDICINE TRAINING PROGRAM IN 1938. THE SANTA ROSA FAMILY MEDICINE RESIDENCY IS A CRITICAL STRATEGIC HEALTHCARE ASSET THAT ADDRESSES THE GROWING PHYSICIAN SHORTAGE IN SONOMA COUNTY. THE RESIDENCY HAS BEEN THE LARGEST SINGLE SOURCE OF FAMILY PHYSICIANS TO SONOMA COUNTY FOR OVER 70 YEARS; RESIDENCY GRADUATES COMPRISE NEARLY HALF OF FAMILY PHYSICIANS IN SONOMA COUNTY. RESIDENCY GRADUATES FILL POSITIONS IN PRIVATE PRACTICES, COMMUNITY CLINICS, LARGE MEDICAL GROUPS SUCH AS SUTTER MEDICAL GROUP OF THE REDWOODS, THE PERMANENTE MEDICAL GROUP, LOCAL COMMUNITY HEALTH CENTERS, SONOMA COUNTY HEALTH SERVICES AND LEADERSHIP POSITIONS THROUGHOUT THE MEDICAL COMMUNITY. THE THREE-YEAR PROGRAM IS AFFILIATED WITH THE UCSF DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE. CALIFORNIA PACIFIC MEDICAL CENTER PROVIDES A MODEL OF SPECIALTY CARE BY BLENDING EXCELLENCE IN ACADEMICS AND RESEARCH WITH A FOCUS ON PATIENT-CENTERED CARE. CPMC IS A MAJOR TEACHING AFFILIATE OF DARTMOUTH MEDICAL SCHOOL, PROVIDING CLERKSHIPS IN MEDICINE, PSYCHIATRY, NEUROLOGY, PEDIATRICS AND OBSTETRICS-GYNECOLOGY. ADDITIONAL CLERKSHIPS (IN SURGERY AND OBSTETRICS-GYNECOLOGY) ARE PROVIDED FOR STUDENTS FROM UCSF. THE GRADUATE MEDICAL RESIDENCY TRAINING PROGRAMS OFFERED AT CPMC ARE OF THE HIGHEST CALIBER WITH CPMC'S PHYSICIANS EMBRACING THE ROLE OF EDUCATORS AS WELL AS CLINICIANS. CPMC HAS INDEPENDENT RESIDENCY AND FELLOWSHIP PROGRAMS IN INTERNAL MEDICINE, PSYCHIATRY, RADIATION ONCOLOGY, OPHTHALMOLOGY, CARDIOVASCULAR DISEASES, GASTROENTEROLOGY, PULMONARY/CRITICAL CARE MEDICINE, HEPATOLOGY/TRANSPLANT, KIDNEY TRANSPLANT, STOKE, GLAUCOMA, RETINA, SHOULDER AND HAND. CPMC ALSO OFFERS TRAINING IN PEDIATRICS, SURGERY, ORTHOPEDIC SURGERY, AND PLASTIC SURGERY TO UCSF RESIDENTS. IN ADDITION, CPMC IS A TRAINING SITE FOR OPERATING ROOM NURSING STUDENTS, OCCUPATIONAL THERAPISTS, PHYSICAL THERAPISTS AND SURGICAL TECHNOLOGISTS. CPMC OFFERS THE COLLECTIVE EXPERTISE OF THE MEDICAL CENTER PHYSICIANS AND STAFF TO PROVIDE CONSULTATION IN AREAS SUCH AS CARDIAC CARE, EMERGENCY ROOM OPERATIONS, GERIATRIC CARE, MANAGED CARE, NEW THERAPEUTIC APPROACHES TO OLD MEDICAL PROBLEMS, OBSTETRICS, SPECIALTY SERVICES, AND WORKER'S COMPENSATION. CPMC'S PHYSICIANS PRESENT CONTINUING MEDICAL EDUCATION LECTURES AT HOSPITALS THROUGHOUT NORTHERN CALIFORNIA.
DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, QUESTIONS 6 & 7A THIS CORPORATION IS AN AFFILIATE OF SUTTER HEALTH, A CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION. SUTTER HEALTH IS THE SOLE MEMBER WITH THE RIGHT TO ELECT AT LEAST A MAJORITY OF THE MEMBERS OF THE BOARD OF DIRECTORS.
DESC CLASSES OF PERSONS, DECISIONS REQUIRING APPR & TYPE OF VOTING RIGHTS FORM 990, PART VI, QUESTION 7B SUTTER HEALTH AS THE SOLE MEMBER OF THE ORGANIZATION IS ENTITLED TO EXERCISE FULLY ALL RIGHTS AND PRIVILEGES OF MEMBERS OF NONPROFIT CORPORATIONS UNDER THE CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION LAW, AND ALL OTHER APPLICABLE LAWS. THE MEMBER HAS THE RIGHTS AND POWERS TO APPOINT (AND REMOVE) MEMBERS OF THE CORPORATION'S BOARD OF DIRECTORS, SUBJECT TO THE PROVISIONS OF THE BYLAWS. IN ADDITION, THE MEMBER HAS THE RIGHT TO APPROVE THE FOLLOWING ACTIONS OF THE CORPORATION'S BOARD OF DIRECTORS: A. MERGER, CONSOLIDATION, REORGANIZATION, OR DISSOLUTION OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; B. AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; C. ADOPTION OF OPERATING BUDGETS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY, INCLUDING CONSOLIDATED OR COMBINED BUDGETS OF THE CORPORATION AND ALL SUBSIDIARY ORGANIZATIONS OF THE CORPORATION; D. ADOPTION OF CAPITAL BUDGETS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; E. AGGREGATE OPERATING OR CAPITAL EXPENDITURES ON AN ANNUAL BASIS THAT EXCEED APPROVED OPERATING OR CAPITAL BUDGETS BY A SPECIFIED DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE GENERAL MEMBER; F. LONG-TERM OR MATERIAL AGREEMENTS INCLUDING, BUT NOT LIMITED TO, BORROWINGS, EQUITY FINANCINGS, CAPITALIZED LEASES AND INSTALLMENT CONTRACTS; AND PURCHASE, SALE, LEASE, DISPOSITION, HYPOTHECATION, EXCHANGE, GIFT, PLEDGE, OR ENCUMBRANCE OF ANY ASSET, REAL OR PERSONAL, WITH A FAIR MARKET VALUE IN EXCESS OF A DOLLAR AMOUNT TO BE DETERMINED FROM TIME TO TIME BY THE DIRECTORS OF THE GENERAL MEMBER, WHICH SHALL NOT BE LESS THAN 10% OF THE TOTAL ANNUAL CAPITAL BUDGET OF THE CORPORATION; G. APPOINTMENT OF AN INDEPENDENT AUDITOR AND HIRING OF INDEPENDENT COUNSEL EXCEPT IN CONFLICT SITUATIONS BETWEEN THE GENERAL MEMBER AND THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; H. THE CREATION OR ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE ENTITY; I. CONTRACTING WITH AN UNRELATED THIRD PARTY FOR ALL OR SUBSTANTIALLY ALL OF THE MANAGEMENT OF THE ASSETS OR OPERATIONS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; J. APPROVAL OF MAJOR NEW PROGRAMS AND CLINICAL SERVICES OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY. THE GENERAL MEMBER SHALL FROM TIME TO TIME DEFINE THE TERM "MAJOR" IN THIS CONTEXT; K. APPROVAL OF STRATEGIC PLANS OF THE CORPORATION OR ANY SUBSIDIARY OR AFFILIATE ENTITY; L. ADOPTION OF QUALITY ASSURANCE POLICIES NOT IN CONFORMITY WITH POLICIES ESTABLISHED BY THE GENERAL MEMBER; M. ANY TRANSACTION BETWEEN THE CORPORATION, A SUBSIDIARY OR AFFILIATE AND A DIRECTOR OF THE CORPORATION OR AN AFFILIATE OF SUCH DIRECTOR. IN ADDITION, THE GENERAL MEMBER SHALL HAVE THE AUTHORITY (BY A VOTE OF NOT LESS THAN TWO-THIRDS (2/3) OF ITS BOARD), TO DECLARE A MAJOR ACTIVITY REQUIRING APPROVAL.
DESCRIBE THE PROCESS USED BY MGMT &/OR GOVERNING BODY TO REVIEW FORM 990 FORM 990, PART VI, QUESTION 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 MEMBER OF THE ORGANIZATION IS A FULL-TIME EMPLOYEE (40 HOURS PER WEEK) OF SUTTER HEALTH AND THEIR SUTTER HEALTH SALARY IS REPORTED HEREIN. THIS INDIVIDUAL RECEIVES NO COMPENSATION FOR THEIR SERVICE AS BOARD MEMBER OF THIS ORGANIZATION. PAT FRY
OTHER CHANGES IN FUND BALANCE FORM 990, PART XI, LINE 5 CHANGE IN UNREALIZED GAIN/(LOSS) ON INVESTMENTS $ (11,267,000) EQUITY TRANSFERS (NET) (135,033,959) PARTNERSHIP INCOME BOOKED ON RETURN 12,894,883 K-1 ORDINARY INCOME (12,802,964) K-1 INTEREST INCOME (178,211) K-1 ORDINARY DIVIDENDS (1,295,738) K-1 SHORT-TERM CAPITAL GAIN 297,046 K-1 LONG-TERM CAPITAL GAIN (4,079,383) K-1 RENTAL INCOME (124,314) K-1 OTHER INCOME (73,478) CHANGE IN SPLIT INTEREST 26,366 OTHER CHANGES IN FUND BALANCE 2,516 PRIOR PERIOD ADJUSTMENT (7,314) ------------- TOTAL $(151,641,550) =============
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. SWBH SPECIFIC PART I, COLUMN (E): THE FILING ORGANIZATION RECEIVED BOND PROCEEDS IN THE AMOUNTS OF: $165,813,667 FROM THE 2007A ISSUE, $55,943,275 FROM THE 2008A ISSUE AND $47,567,042 FROM THE 2011D ISSUE. PART I, LINE B, COLUMN (F): THE REFUNDING OCCURRED VIA THE REPAYMENT OF A DRAW ON A TAXABLE LINE OF CREDIT, DRAWN IN SEVERAL INSTALLMENTS BETWEEN APRIL 7 AND APRIL 11, 2008, USED TO REFUND THE 2007 ISSUE. THE REFUNDED BONDS ISSUED IN 2007 WERE USED TO REFUND BONDS ISSUED IN 1996 THAT WERE USED TO REFUND BONDS ISSUED IN 1985, 1989, 1990 AND 1991.
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:  
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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
SUTTER WEST BAY HOSPITALS
 
Employer identification number

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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

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


 		(f)
Direct controlling
entity







(1) CATHEDRAL HEIGHTS LLC
PO BOX 7999
SAN FRANCISCO,CA94120
20-0511266 		RENTAL PROP. CA 90,986 23,783 SWBH
 










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 HEALTH SERVICES

1501 TROUSDALE DRIVE

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

1501 TROUSDALE DRIVE

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

2350 EL CAMINO REAL

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

450 30TH STREET 2840

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

11815 EDUCATION ST

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

1800 COFFEE ROAD SUITE 76

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

800 E WASHINGTON BLVD

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

PO BOX 1617

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

3012 SUMMIT STREET 3RD FLOOR

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

3687 MT DIABLO BLVD 200

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

600 COFFEE ROAD

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

2200 RIVER PLAZA DRIVE

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

91-2301 FT WEAVER RD

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

PO BOX 160727

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

745 FORT STREET SUITE 800

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

PO BOX 160727

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

20130 LAKE CHABOT RD 103

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

2800 L STREET 7TH FLOOR

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

ONE MEDICAL PLAZA

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

300 HOSPITAL DRIVE

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

1900 POWELL ST 300

EMERYVILLE,CA94608
94-6068843 		HEALTH CARE CA 501(C)(3) 9 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) CALIFORNIA PACIFIC ADV IMAGING LLC

PO BOX 6102
NOVATO,CA94948
56-2311840 		MRI JOINT VENTURE CA NA
  		RELATED 1,727,632 765,818   No 0 Yes   51.000 %
(2) SAN FRANCISCO ENDOSCOPY CENTER LLC

3000 RIVERCHASE
BIRMINGHAM,AL35244
91-2160588 		ENDOSCOPY JV CA NA
  		RELATED 5,039,217 2,141,472   No 0   No 51.000 %
(3) PRESIDIO SURGERY CENTER LLC

1635 DIVISADERO
SF,CA94115
32-0144060 		AMBULATORY SURG CA NA
  		RELATED 6,040,176 4,109,061   No 0 Yes   51.000 %
(4) MAGNETIC IMAGING AF

175 LENNON
WLN CK,CA94598
94-2953833 		PATIENT CARE CA NA
  		N/A 0 0           0 %
(5) SURG CTR OF ABSMC

3875 TELEGRAPH
OAKLAND,CA94609
47-0946086 		OUTPATIENT SURG CA NA
  		N/A 0 0           0 %
(6) ALTA CT SERVICES LP

175 LENNON
WLN CK,CA94598
94-3083464 		PATIENT CARE CA NA
  		N/A 0 0           0 %
(7) SUTTER FAIRFIELD SURGERY CTR

2700 LOW CT
FAIRFIELD,CA94533
30-0233892 		SURGERY CA NA
  		N/A 0 0           0 %
(8) TWIN CITIES SURGICAL HOSPITAL LLC

250 S WACKER
CHICAGO,IL60606
35-2182617 		SURGERY CA NA
  		N/A 0 0           0 %
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
 
No
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
Yes
 
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
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
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
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
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) CALIFORNIA PACIFIC MEDICAL CENTER FOUNDATION

 K 6,728,916 FMV
(2) CALIFORNIA PACIFIC MEDICAL CENTER FOUNDATION

 K 135,067 FMV
(3) CALIFORNIA PACIFIC MEDICAL CENTER FOUNDATION

 K 120,979 FMV
(4) CALIFORNIA PACIFIC MEDICAL CENTER FOUNDATION

 K 97,518 FMV
(5) CALIFORNIA PACIFIC MEDICAL CENTER FOUNDATION

 C 10,822,317 FMV
(6) CATHEDRAL HEIGHTS LLC

 L 30,000 FMV
(7) CALIFORNIA PACIFIC ADVANCED IMAGING LLC

 R 1,856,400 FMV
(8) SAN FRANCISCO ENDOSCOPY CENTER LLC

 R 4,720,050 FMV
(9) PRESIDIO SURGERY CENTER LLC

 R 5,154,876 FMV
(10) EDEN MEDICAL CENTER

 P 1,525,401 FMV
(11) MILLS-PENINSULA HEALTH SERVICES

 P 636,650 FMV
(12) PALO ALTO MEDICAL FOUNDATION

 O 2,247,342 FMV
(13) SUTTER EAST BAY HOSPITALS

 P 2,117,821 FMV
(14) SUTTER EAST BAY HOSPITALS

 L 100,551 FMV
(15) SUTTER VISITING NURSE ASSOC AND HOSPICE

 O 91,667 FMV
(16) SUTTER VISITING NURSE ASSOC AND HOSPICE

 I 708,685 FMV
(17) SUTTER WEST BAY MEDICAL FOUNDATION

 P 519,615 FMV
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


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Software Version: